Evolution from microscopic transoral to endoscopic endonasal odontoidectomy.

OBJECT: The goal of this study was to compare the indications, benefits, and complications between the endoscopic endonasal approach (EEA) and the microscopic transoral approach to perform an odontoidectomy. Transoral approaches have been standard for odontoidectomy procedures; however, the potential benefits of the EEA might be demonstrated to be a more innocuous technique. The authors present their experience with 12 consecutive cases that required odontoidectomy and posterior instrumentation. METHODS: Twelve consecutive cases of craniovertebral junction instability with or without basilar invagination were diagnosed at the National Institute of Neurology and Neurosurgery in Mexico City, Mexico, between January 2009 and January 2013. The EEA was used for 5 cases in which the odontoid process was above the nasopalatine line, and was compared with 7 cases in which the odontoid process was beneath the nasopalatine line; these were treated using the transoral microscopic approach (TMA). Odontoidectomy was performed after occipital-cervical or cervical posterior augmentation with lateral mass and translaminar screws. One case was previously fused (Oc-C4 fusion). The senior author performed all surgeries. American Spinal Injury Association scores were documented before surgical treatment and after at least 6 months of follow-up. RESULTS: Neurological improvement after odontoidectomy was similar for both groups. From the transoral group, 2 patients had postoperative dysphonia, 1 patient presented with dysphagia, and 1 patient had intraoperative CSF leakage. The endoscopic procedure required longer surgical time, less time to extubation and oral feeding, a shorter hospital stay, and no complications in this series. CONCLUSIONS: Endoscopic endonasal odontoidectomy is a feasible, safe, and well-tolerated procedure. In this small series there was no difference in the outcome between the EEA and the TMA; however, fewer complications were documented with the endonasal technique.

Altered dynamics of a lipid raft associated protein in a kidney model of Fabry disease.

Accumulation of globotriaosylceramide (Gb3) and other neutral glycosphingolipids with galactosyl residues is the hallmark of Fabry disease, a lysosomal storage disorder caused by deficiency of the enzyme alpha-galactosidase A (α-gal A). These lipids are incorporated into the plasma membrane and intracellular membranes, with a preference for lipid rafts. Disruption of raft mediated cell processes is implicated in the pathogenesis of several human diseases, but little is known about the effects of the accumulation of glycosphingolipids on raft dynamics in the context of Fabry disease. Using siRNA technology, we have generated a polarized renal epithelial cell model of Fabry disease in Madin-Darby canine kidney cells. These cells present increased levels of Gb3 and enlarged lysosomes, and progressively accumulate zebra bodies. The polarized delivery of both raft-associated and raft-independent proteins was unaffected by α-gal A knockdown, suggesting that accumulation of Gb3 does not disrupt biosynthetic trafficking pathways. To assess the effect of α-gal A silencing on lipid raft dynamics, we employed number and brightness (N&B) analysis to measure the oligomeric status and mobility of the model glycosylphosphatidylinositol (GPI)-anchored protein GFP-GPI. We observed a significant increase in the oligomeric size of antibody-induced clusters of GFP-GPI at the plasma membrane of α-gal A silenced cells compared with control cells. Our results suggest that the interaction of GFP-GPI with lipid rafts may be altered in the presence of accumulated Gb3. The implications of our results with respect to the pathogenesis of Fabry disease are discussed.

Padrões de organização do sistema de comunicação mãe-bebê nas interações face a face: estudo de cinco díades / Patterns of organization of the mother-infant communication in face-to-face interactions: the study of five dyads

Apresentamos os que emergem do processo de desenvolvimento da comunicação mãe-bebê nas interações do tipo face a face. Este processo é concebido como compondo um sistema dinâmico em constante transformação e construção. Os padrões de organização descrevem as fases de maior estabilidade desse sistema, propostas pelo modelo EEA como constituindo três padrões que se sucedem: um estabelecimento inicial, seguido de um período de extensão e, finalmente, um período de abreviação das trocas comunicativas. Analisamos os dados longitudinais das trocas comunicativas do tipo face a face de cinco díades mãe-bebê, descrevendo o processo através do qual esses padrões se organizam. Identificamos uma tendência geral de manutenção da mesma sequência de aparecimento e dominância desses três padrões nas cinco díades, tal como proposto pelo modelo EEA. Todavia, cada díade difere na idade de aparecimento, de dominância e na duração de cada um dos padrões referidos.

We present the patterns of organization that emerge from the developmental process of mother-infant communication in face-to-face exchanges. This process is conceived as creating a dynamic system in constant transformation and construction. The patterns of organization describe the periods of stability of this system, proposed by the EEA model as corresponding to three successive patterns, starting by an initial establishment, followed by a period of extension, and finally by an abbreviation of the dyadic exchanges. We analyzed the longitudinal mother-infant face-to-face exchanges from five dyads, describing the process of organization of these patterns. We identified a general tendency toward maintenance of the sequence of emergence and dominance of these three patterns in all five dyads, according to the proposals of the EEA model. However, each dyad differs in terms of age of appearance, dominance and duration of each of these patterns.

Padrões de organização do sistema de comunicação mãe-bebê nas interações face a face: estudo de cinco díades / Patterns of organization of the mother-infant communication in face-to-face interactions: the study of five dyads

Apresentamos os que emergem do processo de desenvolvimento da comunicação mãe-bebê nas interações do tipo face a face. Este processo é concebido como compondo um sistema dinâmico em constante transformação e construção. Os padrões de organização descrevem as fases de maior estabilidade desse sistema, propostas pelo modelo EEA como constituindo três padrões que se sucedem: um estabelecimento inicial, seguido de um período de extensão e, finalmente, um período de abreviação das trocas comunicativas. Analisamos os dados longitudinais das trocas comunicativas do tipo face a face de cinco díades mãe-bebê, descrevendo o processo através do qual esses padrões se organizam. Identificamos uma tendência geral de manutenção da mesma sequência de aparecimento e dominância desses três padrões nas cinco díades, tal como proposto pelo modelo EEA. Todavia, cada díade difere na idade de aparecimento, de dominância e na duração de cada um dos padrões referidos.(AU)

We present the patterns of organization that emerge from the developmental process of mother-infant communication in face-to-face exchanges. This process is conceived as creating a dynamic system in constant transformation and construction. The patterns of organization describe the periods of stability of this system, proposed by the EEA model as corresponding to three successive patterns, starting by an initial establishment, followed by a period of extension, and finally by an abbreviation of the dyadic exchanges. We analyzed the longitudinal mother-infant face-to-face exchanges from five dyads, describing the process of organization of these patterns. We identified a general tendency toward maintenance of the sequence of emergence and dominance of these three patterns in all five dyads, according to the proposals of the EEA model. However, each dyad differs in terms of age of appearance, dominance and duration of each of these patterns.(AU)

A concepção das mães sobre o desenvolvimento da comunicação mãe-bebê / Mother's conceptualization of the mother-infant communication development

Comparamos duas abordagens teórico-metodológicas distintas e investigamos a concepção que mães apresentam acerca do processo de desenvolvimento da comunicação mãe-bebê. Lyra e colaboradores propõem o modelo EEA, que integra uma seqüência de três padrões de organização do desenvolvimento da comunicação, denominados estabelecimento, extensão e abreviação (EEA). Esse modelo está baseado na observação longitudinal e na análise microgenética de estudos de caso a partir da perspectiva dos sistemas dinâmicos. Utilizando o procedimento de classificação múltipla, investigamos como esses três períodos do desenvolvimento da comunicação (EEA) são conceituados pelas mães. Foram pesquisadas 48 mães pertencentes a dois níveis sócio-econômicos. Os resultados encontrados fortalecem o modelo EEA, confirmando: a distinção entre as trocas face-a-face e aquelas mediadas pelo objeto (MOB); a diferenciação dos três períodos do desenvolvimento da comunicação (EEA) em ambas as trocas; e a distribuição ordenada (axial) desses três períodos, exceto, nesse último caso, para as trocas MOB, quando analisadas separadamente.

Two theoretical-methodological distinct perspectives are compared in order to study mother's conceptualization of the process of mother-infant development of communication. Based on dynamic systems perspective and relying on longitudinal microanalysis of case studies observations, Lyra and collaborators propose the EEA model for studying this process of development. This model integrates a sequence of three periods of development of this process, conceived as developmental patterns of organization: establishment, extension and abbreviation (EEA). Using a 'multiple sorting procedure', we investigated mothers' conceptualization of these three periods of development. We examined 48 mothers, from two socioeconomic levels. The results support the EEA model confirming: the distinction between face-to-face and the exchanges mediated by the object (MOB); the differentiation among the three periods of communication development (EEA) in both type of exchanges; and, an order distribution (axial) of these three periods, except for the specific analysis of the MOB type of exchanges.