Navigated Anterior Full-Endoscopic Transcervical Approach Odontoidectomy for Traumatic Posterior Atlantoaxial Dislocation Without Odontoid Fracture.

BACKGROUND AND IMPORTANCE: Complete posterior atlantoaxial dislocation (PAAD) with an unfractured odontoid process is a rare condition where a dislocated but intact odontoid process is positioned ventrally to the anterior arch of C1. This lesion is related to transverse and alar ligament rupture secondary to hyperextension and rotatory traumatic injury and is often associated with neurological deficit. The treatment strategy remains controversial, and in many cases, odontoidectomy is required. Traditional approaches for odontoidectomy (transnasal and transoral) are technically demanding and are related to several complications. This article describes a 360° reduction and stabilization technique through a navigated anterior full-endoscopic transcervical approach (nAFETA) as a novel technique for odontoidectomy and C1-C2 anterior transarticular fixation supplemented with posterior fusion. CLINICAL PRESENTATION: A 21-year-old man presented to the emergency room by ambulance after a motorcycle accident. On evaluation, incomplete ASIA B spinal cord injury was documented. Imaging revealed a complete PAAD. We performed a two-staged procedure, a nAFETA odontoidectomy plus C1-C2 anterior transarticular fixation followed by posterior C1-C2 wired fusion. At a 2-year follow-up, the patient had a 10-point Oswestry Disability Index score and neurological improvement to ASIA E. CONCLUSION: PAAD can be successfully treated through minimally invasive nAFETA. Noteworthy, the risks of the transoral and endonasal routes were avoided through this approach. In addition, nAFETA allows anterior transarticular fixation during the same procedure providing spinal stability. Further studies are required to expand the use of nAFETA in this field.

Predicting plant-pollinator interactions: concepts, methods, and challenges.

Plant-pollinator interactions are ecologically and economically important, and, as a result, their prediction is a crucial theoretical and applied goal for ecologists. Although various analytical methods are available, we still have a limited ability to predict plant-pollinator interactions. The predictive ability of different plant-pollinator interaction models depends on the specific definitions used to conceptualize and quantify species attributes (e.g., morphological traits), sampling effects (e.g., detection probabilities), and data resolution and availability. Progress in the study of plant-pollinator interactions requires conceptual and methodological advances concerning the mechanisms and species attributes governing interactions as well as improved modeling approaches to predict interactions. Current methods to predict plant-pollinator interactions present ample opportunities for improvement and spark new horizons for basic and applied research.

Collet-Sicard syndrome: a scoping review.

Collet-Sicard syndrome (CSS) is the unilateral palsy of the cranial nerves (CN) IX, X, XI, and XII. To our knowledge, no review describes the characteristics of patients diagnosed with CSS. Therefore, this review aims to collect and describe all cases in the literature labeled as CSS. We performed a scoping review of the literature and conducted a database search in Embase and PubMed. We included articles and abstracts with case reports or case series of patients with CSS diagnosis. We classified the cases into two groups: "CSS", referring to patients presenting exclusively with IX-XII nerve involvement, and "CSS-plus", which corresponds to cases with CSS and other neurological impairments. We included 135 patients from 126 articles, of which 84 (67.7%) were male. The most common clinical manifestations reported were dysphagia and dysphonia. The most common etiology was tumoral in 53 cases (39.6%) and vascular in 37 cases (27.6%). The majority of patients showed partial or total improvement, with just over half receiving conservative treatment. The most frequent anatomic space was the jugular foramen (44.4%) and the parapharyngeal retrostyloid space (28.9%). Approximately 21% of the patients had other CN impairments, with the seventh and eighth CN most frequently compromised. We conclude that although there is a need for greater rigor in CSS reporting, the syndrome has a clear utility in identifying the localization of jugular foramen and parapharyngeal retrostyloid space pathology.

Sphenoidal meningoencephalocele associated with CSF fistula and arteriovenous malformation Spetzler-Martin V: A case report.

Cerebral Arteriovenous malformations (AVMs) are presumed congenital anomalies of the blood vessels, which can increase intracranial pressure by uncertain mechanisms. We report the rare case of a 55-year-old male patient who complained about CSF rhinorrhea. Persisting CSF leakage prompted CT, which evidenced a bone defect in the right middle cranial fossa with protruding brain tissue. The diagnosis of a sphenoidal meningoencephalocele was made. Neuroimaging evidenced an AVM Spetzler Martin V. The lesion was targeted via an endonasal approach with resection of the herniated brain tissue and closure of the bony and dural defects. The postoperative course was uneventful without recurrence of the CSF fistula. Documentation of these cases is essential to come up with standardized therapeutical protocols and follow-up. Nevertheless, conservative management of the AVM and surgical repair of the bone defects is an appropriate approach in the first instance, depending on the morphology and characterization of the AVM.

Microsurgical technique for reconstruction of Hemi-uterus with non-communicating rudimentary uterine horns.

Case description: Three cases of patients diagnosed with Hemi-uterus with non-communicating functional rudimentary cavity are reported. Clinical findings: Adolescent patients with the presence of disabling pelvic pain during menstrual periods, in addition to depressive states and functional disability secondary to pain. Treatment and outcome: Reconstruction of Hemi-uterus with non-communicating functional rudimentary cavity using a microsurgical technique, without the need for non-communicating horn resection. The patients were assessed at the 1st, third, and sixth months, showing a marked improvement in their dysmenorrhea. In addition, there was an improvement in the depressive state; there was no change in the volume of her menstrual bleeding, and one of these patients achieved pregnancy with normal prenatal control and cesarean delivery, obtaining a full-term newborn without complications. Clinical Relevance: Description of a novel microsurgical technique for the management of the hemi-uterus with a non-communicating functional rudimentary cavity, which could benefit not only the reduction of associated symptoms but could also become an alternative to improve fertility in these patients.

Descripción del caso: Se reportan tres casos de pacientes con diagnóstico de Hemiútero con cavidad rudimentaria funcional no comunicante. Hallazgos clínicos: Pacientes adolescentes con presencia de dolor pélvico incapacitante durante los períodos menstruales, además de estados depresivos e incapacidad funcional secundaria al dolor. Tratamiento y resultado: Reconstrucción de Hemiútero con cavidad rudimentaria funcional no comunicante mediante técnica microquirúrgica, sin necesidad de resección de cuerno no comunicante. Las pacientes fueron evaluadas al 1, 3 y 6 mes, mostrando una marcada mejoría en su dismenorrea. Además, hubo mejoría en el estado depresivo; no hubo cambio en el volumen de su sangrado menstrual, y una de estas pacientes logró el embarazo con control prenatal normal y parto por cesárea, obteniendo un recién nacido a término sin complicaciones. Relevancia clínica: Descripción de una novedosa técnica microquirúrgica para el manejo del Hemiútero con cavidad rudimentaria funcional no comunicante, que podría beneficiar no solo la reducción de los síntomas asociados, sino que podría convertirse en una alternativa para mejorar la fertilidad en estas pacientes.

Cerebrospinal fluid leak following penetrating trauma to the spine without neurological deficit: A case report.

Background: Posttraumatic spinal cerebrospinal fluid leak (CSFL) without neurological deficit is a rare entity. Historically, the first-line treatment is a nonsurgical approach, which includes Trendelenburg positioning, carbonic anhydrase inhibitor (acetazolamide), and subarachnoid catheter, with a high successful rate of leak correction. However, in some cases, this first-line treatment could fail, being necessary the surgical approach. Case Description: A 23-year-old male with a recent stab wound to his lumbar region, complained of positional headache and fluid outflow through his wound. On physical examination, an active CSFL was detected without evidence of neurologic deficit. Imaging studies showed a CSF collection extending from the right L4 lamina to the subcutaneous tissue. CSF studies revealed bacterial meningitis. The treatment with carbonic anhydrase inhibitors, Trendelenburg position, lumbar subarachnoid catheter, and antibiotics was initiated. Failure of conservative measures prompted a surgical treatment to resolve the CSFL. Intraoperatively, a dura mater defect was identified, and an autologous paravertebral muscle flap was used for water-tight closure of the defect. The patient recovered without further complications and with CSFL resolution. Conclusion: Even though the nonsurgical approach is the first-line of treatment of traumatic CSFL cases, failures can occur. The evidence of a CSF trajectory in imaging studies could be a predictor of treatment failure of the nonsurgical treatment. The surgical treatment as second-line treatment has outstanding results regarding CSFL correction and should be considered when the prediction rate to nonsurgical approach failure is high.

Microsurgical technique for reconstruction of Hemi-uterus with non-communicating rudimentary uterine horns / Técnica microquirúrgica para reconstrucción de Hemi-útero con cuernos uterinos rudimentarios no comunicantes

Abstract Case description: Three cases of patients diagnosed with Hemi-uterus with non-communicating functional rudimentary cavity are reported. Clinical findings: Adolescent patients with the presence of disabling pelvic pain during menstrual periods, in addition to depressive states and functional disability secondary to pain. Treatment and outcome: Reconstruction of Hemi-uterus with non-communicating functional rudimentary cavity using a microsurgical technique, without the need for non-communicating horn resection. The patients were assessed at the 1st, third, and sixth months, showing a marked improvement in their dysmenorrhea. In addition, there was an improvement in the depressive state; there was no change in the volume of her menstrual bleeding, and one of these patients achieved pregnancy with normal prenatal control and cesarean delivery, obtaining a full-term newborn without complications. Clinical Relevance: Description of a novel microsurgical technique for the management of the hemi-uterus with a non-communicating functional rudimentary cavity, which could benefit not only the reduction of associated symptoms but could also become an alternative to improve fertility in these patients.

Resumen Descripción del caso: Se reportan tres casos de pacientes con diagnóstico de Hemiútero con cavidad rudimentaria funcional no comunicante. Hallazgos clínicos: Pacientes adolescentes con presencia de dolor pélvico incapacitante durante los períodos menstruales, además de estados depresivos e incapacidad funcional secundaria al dolor. Tratamiento y resultado: Reconstrucción de Hemiútero con cavidad rudimentaria funcional no comunicante mediante técnica microquirúrgica, sin necesidad de resección de cuerno no comunicante. Las pacientes fueron evaluadas al 1, 3 y 6 mes, mostrando una marcada mejoría en su dismenorrea. Además, hubo mejoría en el estado depresivo; no hubo cambio en el volumen de su sangrado menstrual, y una de estas pacientes logró el embarazo con control prenatal normal y parto por cesárea, obteniendo un recién nacido a término sin complicaciones. Relevancia clínica: Descripción de una novedosa técnica microquirúrgica para el manejo del Hemiútero con cavidad rudimentaria funcional no comunicante, que podría beneficiar no solo la reducción de los síntomas asociados, sino que podría convertirse en una alternativa para mejorar la fertilidad en estas pacientes

Developing a Web-Based Congress: The 2020 International Web-Based Neurosurgery Congress Method.

BACKGROUND: Continuing medical education and continuing professional development have been affected by the ongoing 2019 novel coronavirus disease (COVID-19) pandemic. Therefore, we developed the 2020 International Web-Based Neurosurgery Congress (2020 IWBNC), which became the first successful virtual neurosurgical congress. The aim of this article was to describe the experience designing and organizing a web congress by the 2020 IWBNC method. METHODS: The 2020 IWBNC was organized by the Center for Research and Training in Neurosurgery (Centro de Investigación y Entrenamiento en Neurocirugía [CIEN]) in a record time of 4 weeks. Eight committees were created and assigned a specific task. The event followed a strict protocol based on the double-room method, which consisted of 2 virtual rooms (A and B) hosted from 4 different physical locations to avoid lecture overlapping and connection drops. Quality and impact were measured by a videoconferencing platform and social media parameters as well as an audience perception survey. RESULTS: High quality was achieved in academic standards, worldwide assistance, schedule adherence, and security. The 2020 IWBNC hosted 25 internationally renowned speakers and offered 30 top-of-the-line multidisciplinary conferences. There were 3096 participants from 125 countries, and 22,266 live-stream views were registered. No technical or cybersecurity-related issues occurred. CONCLUSIONS: Web-based academic meetings will continue to be a helpful educational tool for continuing medical education and continuing professional development. The 2020 IWBNC double-room method represents an alternative design that may be replicated by the academic community planning web congresses and similar events.

Abordaje clínico y diagnóstico de la glomerulonefritis membranoproliferativa. Reporte de caso / Clinical approach and diagnosis of membranoproliferative glomerulonephritis, case report

Resumen La glomerulonefritis membranoproliferativa es una lesión poco frecuente que abarca un grupo de patologías que comparten un patrón histológico en común y pueden originarse a partir de diversos mecanismos patogénicos. Mediante biopsias renales se ha establecido que en estas lesiones el daño renal inicial ocurre por el depósito de inmunoglobulinas que generan depósitos subendoteliales, subepiteliales y/o en la membrana basal glomerular, con lo cual el glomérulo adopta frecuentemente un aspecto lobulado. Se presenta el caso de un hombre de 48 años, quien ingresó al servicio de urgencias del Hospital de San José de Bogotá, Colombia, sin antecedentes relevantes y presentó proteinuria en rango nefrótico severo (62 gramos en 24 horas), elevación de nitrogenados y reporte de biopsia con glomerulonefritis membranoproliferativa. Se describe el enfoque clínico y diagnóstico de esta entidad.

Abstract The membranophroliferative glomerulonephritis is a rare lesion that covers a group of pathologies that share a histologic pattern, and can generate from diverse pathogenic mechanisms. Based on the findings of the kidney biopsy, starts a process to search the etiology of the lesion. The initial kidney damage occurs due to the deposit of immunoglobulins, complement elements or both in the mesangium and in the capillary endothelium, generating sub endothelial, sub epithelial, and/or glomerular basal membrane deposits, frequently adopting glomerulus a lobed aspect. We present a case of a man 48 years old admitted in the emergency of the San Jose Hospital in Bogotá, without relevant pathological background that debuts with proteinuria in severe nephrotic range (62 grams in 24 hours), nitrogenous elevation and biopsy report with membranophroliferative glomerulonephritis, we describe de clinical and diagnostic approach of this entity.

Granulomatosis Con Poliangeítis Y Compromiso En Fosa Posterior. Reporte De Un Caso / Granulomatosis With Polyangeitis In Posterior Fosa. Report of a Case

Resumen La Granulomatosis con Poliangeitis, también conocida como granulomatosis de Wegner presenta una incidencia de 5-10 casos por millón de habitantes y solo el 2-11% de los casos presentan manifestaciones en el sistema nervioso central. No existen unos criterios diagnósticos estandarizados, sin embargo, la sospecha clínica, la serología positiva para ANCA, la evidencia histológica de vasculitis necrotizante, la glomerulonefritis necrotizante o la inflamación granulomatosa de órganos como piel, pulmón o riñón, pueden hacer pensar en dicha patología. La neurocirugía es una opción tanto diagnostica como terapéutica y debería realizarse en aquellos casos en que las lesiones se encuentren en zonas accesibles y tengan bajo riesgo de generar comorbilidades. Presentamos el caso de una paciente femenina de 39 años con cuadro de Granulomatosis con Poliangeítis con compromiso en fosa posterior a quién se le realiza un abordaje occipitocervical derecho. Posterior al manejo quirúrgico presenta infección meningea. Adicionalmente, realizamos una revisión de la literatura sobre dicha patología.

Granulomatosis with Poliangeitis or Wegner's granulomatosis has an incidence of 5-10 cases per million of habitants and only 2-11% of cases present manifestations in the central nervous system. There are no standardized diagnostic criteria, however, clinical suspicion, positive serology for ANCA 'S, histological evidence of necrotizing vasculitis, necrotizing glomerulonephritis or granulomatous inflammation of organs such as skin, lung or kidney, may suggest this pathology. Neurosurgery is a diagnostic and therapeutic option and could be a possibility in those cases in which the lesions are in accessible areas and have low risk of generating comorbidities. We present the case of a 39-year-old female patient with granulomatosis and polyangiitis with involvement in the posterior fossa. After surgical management, it presents meningeal infection. Additionally, we conducted a review of the pathology.

Right aortic arch with situs solitus frequently heralds a vascular ring.

OBJECTIVE: We hypothesized that a right aortic arch in situs solitus, with or without an associated cardiovascular malformation, is often associated with a vascular ring. METHODS: From those born in Southern Nevada between March 2012 and March 2017, we identified 50 (3.6 per 10,000 live births) with a right aortic arch and situs solitus. From the 50 patients, 6 did not meet inclusion criteria for further analysis. RESULTS: Of the 44 remaining, 33 (75%) had a vascular ring. Of the 33 with a vascular ring, 26 (79%) occurred with an isolated right aortic arch, and 7 (21%) had an associated cardiovascular malformation. Of the total 44 patients with a right aortic arch in situs solitus, 34 (79%) were diagnosed prenatally. CONCLUSIONS: In conclusion, we found a right aortic arch in situs solitus was often associated with a vascular ring. Further, to the best of our knowledge, no previous general population study has demonstrated an equal or higher right aortic arch, prenatal detection rate of 79%.

Vascular Ring Diagnosis and Management: Notable Trends Over 25 Years.

BACKGROUND: Vascular rings (VRs) are recognized as uncommon but not rare cardiovascular malformations. METHODS: We analyzed data from all patients born in Southern Nevada, who underwent diagnosis and management of VR from 1990 to 2015, RESULTS: From 1990 to 2015, a total of 92 patients were diagnosed prenatally and postnatally. Of the 92 patients, 73 (79%) had right aortic arch and aberrant left subclavian artery (RAA-ALS) with a left ductus arteriosus or ligamentum, 17 (19%) had a double aortic arch (DAA), and 2 (2%) had a pulmonary artery sling. Of the 92 patients, 75 had an isolated VR and 17 VR had significant additional congenital heart disease (CHD). Of the 75 patients with an isolated VR, 52 underwent surgical repair, and the most common surgical diagnosis was DAA in 6 (66%) of 9 for the period 1990 to 2005 versus less common in 9 (21%) of 43 during the period 2006 to 2015, P < .05. The isolated VR repair age significantly negatively correlated with increasing time from 1990 to 2015, R = -0.7 (P < .0001). Of the 75 isolated VR, 23 remain asymptomatic. The 17 VR with CHD were treated during infant palliation or intracardiac repair. Of the total 92 VR, 60 were born after a 2004 community introduction of the three-vessel fetal echocardiography view, from then the prenatal-detection rate has significantly increased-2004 to 2006, 0 (0%) of 9; 2007 to 2009, 1 (9%) of 11; 2010 to 2012, 11 (55%) of 20; and 2013 to 1015, 14 (70%) of 20 (P < .0001). CONCLUSION: Over 25 years in Southern Nevada, VR prenatal diagnosis has increased, isolated VR age at surgery has decreased, and the percentage of those with RAA-ALS has increased.

Hybrid Palliation for Ductal-Dependent Systemic Circulation.

We reviewed our hybrid palliation experience for 91 neonates, with ductal-dependent systemic circulation, born between August 2007 and October 2015. For analysis, we stratified the 91 patients by a risk factor (RF) score and divided them into three groups: (1) high-risk two-functional ventricles (2V) median RF score of 3 (N = 20); (2) low-risk one-functional ventricle (1V) RF score 0-1 (N = 32); and (3) high-risk 1V RF score ≥2 (N = 39). Midterm survival (median 4 years) by group was: (1) 95 %, (2) 91 %, and (3) 15 %, (p = 0.001). In conclusion, hybrid palliation was associated with excellent midterm results for high-risk 2V and low-risk 1V patients with ductal-dependent systemic circulation. In contrast, high-risk 1V patients had significantly worse outcomes.

Moving towards universal prenatal detection of critical congenital heart disease in southern Nevada: a community-wide program.

This study compares the current, prenatal detection rate for critical congenital heart disease in Southern Nevada with the previously reported rate, after developing and expanding a comprehensive, community-wide fetal cardiology program. For the current-period analysis, we inquired our database and electronic health records for patients born in Clark County, Nevada, with critical congenital heart disease between May 2012 and April 2014, and we compared the results with the previous period between May 2003 and April 2006. The major components of the community-wide program include fetal congenital heart disease screening via general obstetric ultrasound studies performed in obstetrician's offices, radiology imaging centers, or maternal-fetal medicine specialty practices; subsequent referral for comprehensive fetal echocardiography performed in maternal-fetal medicine offices under the on-site supervision by fetal cardiologists; and recurring community educational programs teaching the 5-axial plane, fetal echocardiographic screening protocol to general obstetric sonographers and instructing perinatal sonographers in advanced imaging topics. For the current period, the prenatal detection rate for critical congenital heart disease in Southern Nevada was 71 versus 36% for the previous period (p < 0.001). The temporal improvement in prenatal detection of critical congenital heart disease may be related to our expanded decentralized, community-wide fetal cardiology program, and our experiences may be applicable to other metropolitan areas.

An increased incidence of total anomalous pulmonary venous connection among Hispanics in southern Nevada.

OBJECTIVE: Ethnicity may influence the occurrence of specific cardiac malformations. DESIGN: We retrospectively analyzed the occurrence of isolated total anomalous pulmonary venous connection in the Hispanic and non-Hispanic populations of Southern Nevada over a 10-year period from 2003 to 2013. RESULTS: The mean cases per 100,000 live births among Hispanics was 19.8 (99% confidence interval 5.9-33.7) and among non-Hispanics was 2.5 (99% confidence interval 0.4-4.6), P = 0.007. CONCLUSIONS: We found a significantly higher incidence of isolated total anomalous pulmonary venous connection in Hispanics vs. non-Hispanics.

Fluorescent protein barrel fluctuations and oxygen diffusion pathways in mCherry.

Fluorescent proteins (FPs) are valuable tools as biochemical markers for studying cellular processes. Red fluorescent proteins (RFPs) are highly desirable for in vivo applications because they absorb and emit light in the red region of the spectrum where cellular autofluorescence is low. The naturally occurring fluorescent proteins with emission peaks in this region of the spectrum occur in dimeric or tetrameric forms. The development of mutant monomeric variants of RFPs has resulted in several novel FPs known as mFruits. Though oxygen is required for maturation of the chromophore, it is known that photobleaching of FPs is oxygen sensitive, and oxygen-free conditions result in improved photostabilities. Therefore, understanding oxygen diffusion pathways in FPs is important for both photostabilites and maturation of the chromophores. In this paper, we use molecular dynamics calculations to investigate the protein barrel fluctuations in mCherry, which is one of the most useful monomeric mFruit variant. We employ implicit ligand sampling to determine oxygen pathways from the bulk solvent into the mCherry chromophore in the interior of the protein. We also show that these pathways can be blocked or altered and barrel fluctuations can be reduced by strategic amino acid substitutions.

The changing occurrences of tetralogy of Fallot and simple transposition of the great arteries in Southern Nevada.

We analysed the occurrence of tetralogy of Fallot and simple transposition in the Hispanic and non-Hispanic populations of Clark County, Nevada, in the United States of America over a 30-year period from 1980 to 2009. We found a downward trend in the incidence of simple transposition of the great arteries in the non-Hispanic population but an upward trend in the incidence in the Hispanic population. For tetralogy of Fallot, we found an upward trend in the incidence in both populations; the trend, however, was more dramatic in the Hispanic population. We also noted differences in the male to female ratios in the different groups. Even though we make no definitive conclusions regarding the causes of these incidence curves or the differences in occurrence between males or females, the data suggest an interplay of genetics and the environment.

Stenosis of alternative umbilical venous pathways in absence of the ductus venosus.

OBJECTIVE: We evaluated fetuses with absence of the ductus venosus (ADV) and restricted alternative umbilical venous pathways. METHODS: We identified 3 cases that fit our objective. The angles of insonation for spectral Doppler ultrasound interrogation were less than 20 degrees in all cases. We used commercially available ultrasound systems with a curved array transducer. RESULTS: In all 3 cases, we noted mild cardiac volume overload without fetal hydrops. CONCLUSIONS: We speculate that the fetus with ADV and a restrictive alternative umbilical venous pathway may have a more benign clinical course than fetuses previously reported with unrestricted alternative pathways.