Deep Brain Stimulation with Double Targeting of the VIM and PSA for the Treatment of Rare Tremor Syndromes.

INTRODUCTION: In tremor syndromes, pharmacological therapy is the primary treatment, but deep brain stimulation (DBS) is used when it is insufficient. We explore the use of DBS, focusing on the globus pallidus internus for dystonia and the ventral intermediate nucleus (VIM) for tremor conditions. We introduce the posterior subthalamic area (PSA) as a potential target, suggesting its efficacy in tremor reduction, particularly in rare tremor syndromes. We aim to evaluate the efficacy and safety of double targeting the VIM and PSA in rare tremor conditions, highlighting the limited existing data on this. METHODS: Between 2019 and 2023, 22 patients with rare tremor syndromes were treated with bilateral DBS of the VIM and PSA. This case series consisted of 7 isolated head tremor, 1 hepatic encephalopathic tremor due to Abernethy syndrome, 2 voice tremor, 4 dystonic tremor, and 8 Holmes tremor (2 multiple sclerosis, 2 cerebellar insult, and 4 posttraumatic) patients. Patients' preoperative and 12-month postoperative tremor scores were compared, and the optimum VIM and PSA stimulation areas were investigated. RESULTS: There was a significant reduction in the mean TRS score from 3.70 (±0.57) to 0.45 (±0.68) after 12 months of surgery. Specific outcomes for different indications were observed: for head tremor, 6 of 7 patients showed a reduction in TRS scores to 0 points; the vocal tremor patients demonstrated improvement; this change was not statistically significant, which is likely to be due to the low number of patients in this subgroup; the dystonic tremor patients showed either complete tremor abolition or a reduction in TRS scores; the Holmes tremor patients showed an 80% reduction in TRS scores; and the hepatic encephalopathy tremor and Abernethy syndrome patients showed a 75% improvement in TRS scores. The stimulation parameters converged on the VIM and dorsal PSA. Complications included the need for electrode repositioning, infections requiring electrode removal and re-implantation, dysarthria, and stimulation-induced ataxia, which was resolved by adjusting the stimulation parameters. DISCUSSION: The literature on DBS for rare tremors is limited. Double targeting of the VIM and PSA appears to produce promising improvements on the outcomes reported in the existing literature on VIM-only DBS. The proximity of the VIM and PSA allows for flexible electrode placement, contributing to the potential success of the dual-target approach. We also discuss the theoretical advantages of targeting the PSA based on the distribution of tremor circuits, emphasizing the need for further research and electrophysiological studies.

Does subthalamic nucleus deep brain stimulation affect the static balance at different frequencies? / ¿La estimulación cerebral profunda del núcleo subtalámico afecta el equilibrio estático en diferentes frecuencias?

Purpose To investigate the effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) with different stimulation frequencies on static balance. Materials and methods Twenty patients (15 males and 5 females), aged between 43 and 81 (mean: 60.05±7.4) years, who had been diagnosed with idiopathic Parkinson's disease (PD) and undergone STN-DBS surgery were included in the study. Static balance was assessed with TecnoBody Rehabilitation System at four different frequencies: 230, 130, 90 and 60Hz and off-stimulation. Static balance tests were ‘stabilometric test, stabilometric compared bipedal closed/opened eye, stabilometric compared mono pedal (right/left foot)’. These tests reported the centre of pressure data ‘ellipse area, perimeter, front/back and mediolateral standard deviations’. Results There were no statically differences between the static balance test results at any frequency (p>0.05), but results were found better at 90Hz. Stabilometric compared bipedal opened eye forward–backward standard deviation result was significant between off-stimulation and 130Hz (p=0.04). Different frequency stimulation affected the static balance categories percentage with no statistical significance between off-stimulation and others (all p>0.05). Conclusion This study showed that STN-DBS did not affect the static balance negatively. Low-frequency (LF) stimulation improved the static equilibrium. Posturography systems will give more precise and quantitative results in similar studies with wide frequency ranges (AU)

Propósito Investigar los efectos de la estimulación cerebral profunda del núcleo subtalámico bilateral (STN-DBS) con diferentes frecuencias de estimulación sobre el equilibrio estático. Materiales y métodos Se incluyó en el estudio a 20 pacientes (15 varones y 5 mujeres), con edades comprendidas entre 43 y 81 años (media: 60,05±7,4), que habían sido diagnosticados de enfermedad de Parkinson idiopática e intervenidos mediante cirugía STN-DBS. El equilibrio estático se evaluó con el sistema de rehabilitación TecnoBody en 4 frecuencias diferentes: 230, 130, 90 y 60Hz y sin estimulación. Las pruebas de equilibrio estático fueron: prueba estabilométrica, ojo cerrado/abierto bípedo comparado con estabilométrico, monopedal comparado con estabilométrico (pie derecho/izquierdo). Estas pruebas informaron el centro de datos de presión: área de elipse, perímetro, desviaciones estándar mediolateral y frontal/posterior. Resultados No hubo diferencias estadísticamente significativas entre los resultados de la prueba de equilibrio estático en cualquier frecuencia (p>0,05), pero los resultados fueron mejores con 90Hz. El resultado de la desviación estándar hacia adelante-atrás del ojo abierto bípedo comparado con el estabilométrico fue significativo entre la estimulación inactiva y 130Hz (p=0,04). La estimulación de diferente frecuencia afectó al porcentaje de categorías de equilibrio estático, sin significación estadística entre la estimulación inactiva y otras (todas p>0,05). Conclusión Este estudio mostró que STN-DBS no afectó negativamente al equilibrio estático. La estimulación de baja frecuencia mejoró el equilibrio estático. Los sistemas de posturografía darán resultados más precisos y cuantitativos en estudios similares con amplios rangos de frecuencia (AU)

Does subthalamic nucleus deep brain stimulation affect the static balance at different frequencies?

PURPOSE: To investigate the effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) with different stimulation frequencies on static balance. MATERIALS AND METHODS: Twenty patients (15 males and 5 females), aged between 43 and 81 (mean: 60.05±7.4) years, who had been diagnosed with idiopathic Parkinson's disease (PD) and undergone STN-DBS surgery were included in the study. Static balance was assessed with TecnoBody Rehabilitation System at four different frequencies: 230, 130, 90 and 60Hz and off-stimulation. Static balance tests were 'stabilometric test, stabilometric compared bipedal closed/opened eye, stabilometric compared mono pedal (right/left foot)'. These tests reported the centre of pressure data 'ellipse area, perimeter, front/back and mediolateral standard deviations'. RESULTS: There were no statically differences between the static balance test results at any frequency (p>0.05), but results were found better at 90Hz. Stabilometric compared bipedal opened eye forward-backward standard deviation result was significant between off-stimulation and 130Hz (p=0.04). Different frequency stimulation affected the static balance categories percentage with no statistical significance between off-stimulation and others (all p>0.05). CONCLUSION: This study showed that STN-DBS did not affect the static balance negatively. Low-frequency (LF) stimulation improved the static equilibrium. Posturography systems will give more precise and quantitative results in similar studies with wide frequency ranges.

Deep brain stimulation for the abernethy malformation related tremor.

Deep brain stimulation (DBS) is introduced for the surgical treatment of movement disorders such as Parkinson's disease, tremor, dystonia, and tics. Electrostimulation of the ventral thalamus or subthalamic area has been found effective in different types of tremors that have different etiologies. Abernethy malformation is a rare congenital abnormality characterized by the presence of a congenital extrahepatic portosystemic shunt between the portal vein and systemic circulation. In this report, we present as a case of Abernethy malformation that caused hyperammonemia congenitally and presented as action and resting tremor in the hands and, treated with DBS.

Adjacent Segment Disease (ASD) in Incidental Segmental Fused Vertebra and Comparison With the Effect of Stabilization Systems on ASD.

Objective Adjacent segment disease is a controversial process after spine stabilization. The two important factors discussed are natural aging and hypermobility in incidental segmental fusion anomalies; patients have two or more fused vertebrae from birth, which are the results of spinal movement restriction due to the fusion of some spinal units. This article's main purpose is to determine the degree of relationship of hypermobility and the aging process in the deterioration of the disks adjacent to fusion. Methods In this study, the degenerative process developed by hypermobility in the adjacent segment due to incidental segmental fusion was evaluated. The MRI images of 52 adjacent and nonadjacent disks of 45 patients in total were analyzed according to the Pfirrmann grading systems. The average Pfirrmann rating of the disks just above and below the fused segment and the distant first, second, and third non-neighboring levels were evaluated and calculated, respectively. Results The highest rate of incidental fusion is determined on the cervical area with 51.9%, followed by the thoracal area with 32.7%, and the lumbar area with 15.4%. Damage to the adjacent segment disks in cases with incidental fusion can still be seen at any age, with fusion, indicating that the hypermobility effect plays a more prominent role. The evidence of hypermobility without aging is that the segments adjacent to fusion undergo more degeneration than the distant disks. Conclusion Adjacent segment disease is under the influence of many factors. Our findings suggest that its incidence is increasing with the pathological processes initiated by hypermobility. It seems that, at least, it carries equal importance as compared to age. Fusion surgeries damage the adjacent segments under the influence of the passage of time beyond the physiological aging of the patient.

Performance of butyl rubber-based macroporous sorbents as passive samplers.

In this study, two macroporous butyl rubber (BR)-based sorbents prepared in benzene (H-BR) and in cyclohexane (L-BR) with different porosities were synthesized by cryogelation technique. Their performances as a passive sampler were studied and then compared with commercially available silicon rubber (polydimethylsiloxane, PDMS) passive sampler. For that aim, polycyclic aromatic hydrocarbon (PAH) absorption rates of the sorbents in the short-term and their accumulation capacities in the long-term periods were investigated. Four PAHs (naphthalene, phenanthrene, fluoranthene, and pyrene) with a different number of aromatic rings were utilized. The concentrations of the PAHs in solutions were quantified by fluorescence spectrophotometer. The results showed that the BR sampler prepared in benzene (H-BR) generally has the highest absorption rates for all PAHs. The rate constants k (h-1) of the H-BR, L-BR, and PDMS samplers were found as 1.07, 0.55, and 0.55 for naphthalene; 0.73, 0.16, and 0.09 for phenanthrene; 0.24, 0.26, and 0.08 for fluoranthene; and 0.97, 0.38, and 0.17 for pyrene, respectively. The highest PAH absorption capacity was found for the BR sorbents prepared in benzene for all PAHs. Thus, benzene was selected as the organic solvent rather than cyclohexane for further studies in the preparation of butyl rubber-based samplers. The H-BR possessing the highest absorption rate and capacity underlines their usage as a capable passive sampler for both short- and long-term monitoring activities in the aquatic environments.

Clinical and radiological outcomes after correction of degenerative lumbar scoliosis with dynamic stabilization (with the help of a rigid rod); and describing an alternative technique.

Sharing clinical and radiological results in patients with degenerative lumbar scoliosis (DLS) treated surgically with dynamic system and describing an alternative technique for scoliosis correction. Between 2013 and 2018, 48 patients with flexible degenerative lumbar scoliosis (DLS) were operated with dynamic stabilization with Polyetheretherketone Rod (PEEK rod) after rigid rod application. Preoperative and postoperative scoliosis angles (standing and supine) were statistically compared. Preoperative and postoperative low back pain (LBP) Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores were compared. In addition, preoperative C7 Sagittal Vertical Axis (SVA) values and lumbar lordosis angles were compared with postoperative values. The mean follow-up period of the patients was 48.3 months (range 30-76), the mean age was 67.08 (range 49-84). While the average Cobb angle of all patients was 9.65 in preoperative supine position, the average Cobb angle with standing position was 19.73. The mean standing Cobb angle of the patients after surgery was 3.52. The mean Cobb angle in the supine position after surgery was 3.02. The difference between the preoperative and postoperative patients' Cobb angles in standing and supine position were statistically significant (p:0,000, p:0,000, respectively). The differences of VAS and ODI scores between preoperative and postoperative period were statistically significantly (p:0,000, p:0,000; respectively). Especially in patients with flexible LDS, the technique we have defined and dynamic stabilization with PEEK rod provides significant correction. There was no loss of correction in our patients during postoperative follow-up period. PEEK rod is insufficient for lordosis increase and correction of SVA values.

Characterization of dendritic cells in human and experimental myocarditis.

AIMS: Dendritic cells (DCs) are central mediators of adaptive immunity, and there is growing evidence of their role in myocardial inflammatory disease. We hypothesized that plasmacytoid and myeloid DCs are involved in the mechanisms of myocarditis and analysed these two main subtypes in human myocarditis subjects, as well as in a murine model of experimental autoimmune myocarditis (EAM). METHODS AND RESULTS: Circulating DCs were analysed by flow cytometry in patients with acute myocarditis, dilated cardiomyopathy, and controls. Myocardial biopsies were immunostained for the presence of DCs and compared with non-diseased controls. In a mouse model of acute myocarditis induced through synthetic cardiac myosine peptide injection, effects of immunomodulation including DC inhibition through MCS-18 versus placebo treatment were tested at the peak of inflammation (Day 21), as well as 1 week later (partial recovery). Circulatory pDCs and mDCs were significantly reduced in myocarditis patients compared with controls (P < 0.01 for both) and remained so even after 6 months of follow-up. Human myocarditis biopsies showed accumulation of pDCs (two-fold CD304+/three-fold CD123+, all P < 0.05) compared with controls. Myocardial pDCs and mDCs accumulated in EAM (P for both <0.0001). MCS-18 treatment reduced pDC levels (P = 0.009), reduced myocardial inflammation (myocarditis score reduction from 2.6 to 1.8, P = 0.026), and improved ejection fraction (P = 0.03) in EAM at Day 21 (peak of inflammation). This effect was not observed during the partial recovery of inflammation on Day 28. CONCLUSIONS: Circulating DCs are reduced in human myocarditis and accumulate in the inflamed myocardium. MCS-18 treatment reduces DCs in EAM, leading to amelioration of inflammation and left ventricular remodelling during the acute phase of myocarditis. Our data further elucidate the role of DCs and their specific subsets in acute inflammatory cardiomyopathies.

Investigating the effects of subthalamic Nucleus-Deep brain stimulation on the voice quality.

Introduction: Deep brain stimulation (DBS) is a standard surgical treatment method which is generally applied to subthalamic nucleus in Parkinson's patients in cases where medical treatment is insufficient in treating the motor symptoms. It is known that Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) treats many motor symptoms. However, the results of studies on speech and voice vary. The aim of the study is analysing the effect of STN-DBS on the characteristics of voice.Materials/methods: A total of 12 patients, (8 male-4 female) with an age average of 58.8 ± 9.6, who have been applied DBS surgery on STN included in the study. The voice recordings of the patients have been done prior to surgery and 6 months after the surgery. The evaluation of voice has been carried out through the instrumental method. The patients' voice recordings of the /a,e,i/ vowels have been done. The obtained recordings were evaluated by the Praat programme and the effects on jhitter, shimmer, fundamental frequency (F0) and noise harmonic rate (NHR) were analysed.Results: Numerical values of F0 of all female participants have been decreased for all of the vowels postoperatively. In the females; jhitter and fraction parameters were found to be significantly different (0.056 and 0.017, perspectively) for the vowel /e/. In addition, p values in the shimmer for vowels /e,i/ were thought to be clinically significant (.087, .079 and .076) respectively. All these changes in second measurements were found to indicate worsening vocal quality after the DBS in females. In males, there is not any significant difference observed between two measures in any of the parameters of any vowels.Conclusions: Acoustic voice quality deteriorated after STN-DBS predominantly for females however this deterioration was not prominent audio-perceptually. This finding commented as a result of the fact that that voice quality deviance of the participants was not severe.

The effect of subthalamic nucleus - Deep brain stimulation and different stimulation frequencies on cerebral hemodynamics in Parkinson's disease: A transcranial doppler study.

OBJECTIVES: To investigate the effect of deep brain stimulation of the subthalamic nucleus (STN-DBS) and to compare low-frequency versus high-frequency STN-DBS on hemodynamic parameters of the middle cerebral artery between patients with advanced Parkinson's disease and age-sex matched healthy controls. PATIENTS AND METHODS: Eighteen patients with advanced Parkinson's disease (PD) with bilateral STN-DBS and 18 control subjects underwent Transcranial Doppler Ultrasound (TCDU) were included in the study. The hemodynamic parameters including blood flow velocity (FV), pulsatility index (PI) and, resistance index (RI) of the right middle cerebral artery (MCA) were measured and compared during the phases using TCDU. The first DBS-off, the second low-frequency DBS of 60 Hz, and the third high-frequency DBS of 130 Hz were compared. RESULTS: PD patients had significantly higher MCA-PI values compared with controls (0.99 ± 0.27 vs. 0.82 ± 0.14) (p = 0.031). Also, the MCA-PI values were higher in the low-frequency DBS (0.94 ± 0.14) and high-frequency DBS (0.93 ± 0.16) than in the controls (0.82 ± 0.14) (p = 0.022 and p = 0.041, respectively). There were no significant differences of FV and RI values among the DBS-on, DBS-off and, controls. The RI values were higher in the PD patients than in the controls, although these were not statistically significant. Also, PI values of the MCA decrease in different frequencies (60 Hz or 130 Hz). CONCLUSION: The results of this study showed that MCA-PI values are higher in advanced PD compared with controls. These indices indicate that MCA resistances and impedances are increased in advanced PD. Low- or high-frequency DBS treatment have beneficial effect to reduce high PI in advanced PD patients.

Analysis of the effects of subthalamic nucleus deep brain stimulation on somatosensation in Parkinson's disease patients.

OBJECTIVE: Despite the subthalamic nucleus (STN) deep brain stimulation (DBS) is a treatment commonly used to ameliorate the motor symptoms of Parkinson's disease (PD), its effects on somatosensation is unclear. The purpose of this study was to investigate the potential effects of DBS on temperature, proprioceptive, tactile, exteroceptive, pain and cortical sensations, and odor identification in PD patients. METHODS: The study included 14 patients (with a mean age of 59.78 ± 11.03 years; range, 44-70 years) with idiopathic PD who underwent DBS surgery for movement disorders caused by PD at the same Neurosurgery Department. All patients were tested while DBS was turned on (DBS-ON) and off (DBS-OFF). To clearly observe the effect of removing stimulation off, DBS devices were turned off by experimental clinical personnel for a minimum duration of 30 min prior to examination. Temperature, proprioceptive, tactile, exteroceptive, pain and cortical sensations, and odor identification were examined. RESULTS: We found that two-point discrimination was significantly lower during DBS-ON than DBS-OFF (p = 0.031). Tactile sensation and kinesthesia deviation degree were lower during DBS-ON than DBS-OFF, but were non-significant (p > 0.05). The number of correct answers on an assessment of graphesthesia was higher during DBS-ON, but was non-significant as well (p > 0.05). Odor identification was better during DBS-OFF. CONCLUSIONS: DBS may have an effective role to improve somatosensation and DBS-related benefits may not be explained by improvements in motor function alone, but rather by enhanced somatosensory processing. Further studies with larger study groups are needed.

Single-, Double-, and Triple-Network Macroporous Rubbers as a Passive Sampler.

Over the past decades, large quantities of organic compounds including polycyclic aromatic hydrocarbons (PAHs) entering aquatic systems create acutely toxic effects and chronic abnormalities in aquatic organisms. Passive sampling is an effective technique to detect organic compounds at very low concentrations in water by accumulating them in their structure to a measurable concentration level. Polymeric passive samplers reported so far have a nonporous structure, and hence, the absorption of organic compounds into the passive sampler is governed by their slow diffusion process. We present here novel macroporous rubber sorbents as monophasic passive samplers with tunable pore morphologies, extraordinary mechanical properties, and high sorption rates and capacities for PAHs. Sorbent materials based on single-network (SN), double-network (DN), and triple-network (TN) butyl rubber were prepared via the cryogelation technique from butyl rubber solutions in benzene as the solvent at -18 °C using a sulfur monochloride cross-linker. To obtain macroporous rubbers with DN and TN structures, the reactions were conducted in the macropores of SN and DN rubber networks, respectively. The porous morphology and the mechanical behavior of the rubbers can be tuned by adjusting the weight ratio wR of the network components. The rubbers exhibit two generations of pores, namely, large and small pores with diameters 40-240 and 14-54 µm, respectively. The sizes of both large and small pores decrease and approach each other as wR is increased. Four PAH compounds, namely, naphthalene, phenanthrene, fluoranthene, and pyrene with two to four aromatic rings, dissolved in filtered seawater with a salinity of 22 ppt were used to highlight the correlations between the properties of macroporous rubbers and their absorption rates and capacities. Nonporous silicone rubber reported before as a passive sampler has the lowest absorption rate and capacity as compared to the macroporous rubbers. The SN rubber absorbs most rapidly PAHs because of its largest porosity, whereas the TN rubber with the smallest pores exhibits the highest sorption capacity.

Pollution and toxicity of sediment in potential dredging sites of the Marmara Sea, Turkey.

This study aims to assess the impact of the sediment in the potential dredging areas of the Marmara Sea. To that aim, sediments were analyzed for polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), and heavy metals, sources were discussed, and toxicity tests were applied. For assessment, lower and upper limits of Turkish draft regulation (LTR, UTR) and UNEP-MAP's guidance document (LCT, UCT), and effects range low and median (ERL, ERM) were used. Total concentrations were found between 562 and 8643 µg kg-1 for PAHs, 4-36 µg kg-1 for PCBs, and 14-190 µg kg-1 for OCPs. The highest ∑PAH concentrations were measured in Golden Horn, and none of the PAH compounds was above ERM. ERL and UCT were exceeded in Istinye and Golden Horn stations. The highest ∑PCBs and ∑OCPs levels were determined in Izmit Bay (IB). ΣPCBs in IB were higher than ERL and LTR, while ΣDDT were found above ERM and UCT. High concentrations of chromium (∼190 mg kg-1) and copper (∼180 mg kg-1) in Golden Horn and mercury in IB (∼4 mg kg-1) were detected. The highest toxicities were observed in Istinye and Izmit Bay. According to the regulations, none of the sediments can be dumped.

Cellular inflammation in pulmonary hypertension: Detailed analysis of lung and right ventricular tissue, circulating immune cells and effects of a dual endothelin receptor antagonist.

Growing evidence suggests that inflammation is crucially involved in the pathogenesis of pulmonary hypertension (PH) and consecutive right heart failure. The present study analyzed the inflammatory response in lung and right ventricle in a rat model of PH and evaluated the effects of the dual endothelin receptor antagonist (ERA) Macitentan. PH was induced by monocrotalin (60 mg/kg body weight s.c.) in Sprague-Dawley rats (PH, n = 10) and compared to healthy controls (CON, n = 10) as well as monocrotalin-induced, macitentan-treated rats (THER, n = 10). Detection of Dendritic cells (DCs), regulatory T cells (Tregs) and others as well as RT-PCR based inflammatory gene expression analysis were performed. Circulating DCs and Tregs were quantified by flow cytometry in the rat model and in PH patients (n = 70) compared to controls (n = 52). Inflammatory cells were increased in lung and right ventricular tissue, whereas DCs and Tregs were decreased in blood. Expression of 17 genes in the lung and 20 genes in the right ventricle were relevantly (>2.0 fold) regulated in the PH group. These effects were, at least in part, attenuated in response to Macitentan treatment. In humans as well as rats, immune cells showed significant correlations to clinical, echocardiographic, and haemodynamic parameters. PH is accompanied by a distinct inflammatory response in lung and right but not left ventricular tissue attenuated by Macitentan. Correlations of circulating DCs as well as tissue resident immune cells with parameters reflecting right ventricular function raise the idea of both, promising biomarkers and novel treatment strategies.

Comparison of Dural Splitting and Duraplasty in Patients with Chiari Type I Malformation: Relationship between Tonsillo-Dural Distance and Syrinx Cavity.

AIM: To compare the clinical and radiological results of dural splitting and duraplasty in patients with Chiari Type I Malformation. MATERIAL AND METHODS: This study includes 113 adult patients with Chiari Type I malformation treated between 2009 and 2013. The patients were divided into two groups according to the surgical method (Group 1: dural splitting, Group 2: duraplasty). Neurological examinations and magnetic resonance imaging (MRI) scans were recorded periodically on 3rd, 6th,and 12th months at the postoperative period. The tonsillo-dural distance (TDD) and regression rate of the syrinx cavity were measured on T1 and T2 weighted sagittal MRI scans at the postoperative period. RESULTS: The ratio of syrinx regression was %49.6 in the Group 1 and %54.6 in the Group 2. This result was statistically significant. The TDD increased in Group 2 and this result was statistically significant (p < 0.05). Postoperative pain and numbness decreased in both groups and no statistically significant difference was detected. CONCLUSION: There was no relationship between tonsillar herniation length and the width of syringomyelic cavity. The syrinx cavity more regressed in the group 2 than group 1. There was no relation between the TDD and the ratio of syrinx regression.

Complications of 2-Level Dynamic Stabilization: A Correlative Clinical and Radiological Analysis at Two-Year Follow-up on 103 Patients.

AIM: To investigate the postoperative complications, such as screw loosening, screw breakage and adjacent segment disease (ASD), in patients who underwent surgery with 2-level dynamic stabilization systems. MATERIAL AND METHODS: Postoperative complications, clinical improvements and radiological parameters in patients who underwent surgery using a dynamic system for 2-level lumbar stabilization were retrospectively reviewed. A total of 103 patients with lumbar degenerative spinal instability underwent 2-level dynamic stabilization. Clinical findings were reviewed at 2-year followup. Screw breakage and loosening were evaluated during this duration together with clinical findings. RESULTS: Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were significantly decreased at the four-month evaluation, and they were also decreased at the 1-year follow up and at the 24th postoperative month. ASD was diagnosed in twelve (8 females, 4 males) of the 103 patients in the follow-up radiological and clinical controls. There were 9 screw breakages and 4 screw loosening cases. The complication rate of 2-level dynamic stabilization was high in this study. CONCLUSION: Our results showed that complications (screw loosening or breakage and adjacent segment disease) are not rare after 2-level dynamic stabilization, unlike the acceptable results with the single-level dynamic system. The most probable explanation is that the instrument system behaves more rigidly with every additional segment.

High Infection Rates in Patients with Long-Segment Dynesys System.

BACKGROUND: Infection follow-up in patients stabilized with the Dynesys system. Infection rates were determined in patients who had ≥5 segments stabilized with the Dynesys system. METHODS: Eighty-three patients with various etiologies were stabilized with the Dynesys system. Long-level stabilization patients were separated from the main group as a result of their high rates of infection. RESULTS: Long-level stabilizations were performed in 8 of 83 patients. Five patients were determined to have infections including 4 deep infections and 1 superficial infection. In patients with deep infections, 3 of them exhibited chronic infections that lasted for approximately 2 years and the system was removed. A deep infection in 1 patient and a superficial infection in 1 patient were diagnosed after 1 month. The early-diagnosed deep infection patient was treated with wound irrigation and antibiotics. The system was not removed, and the wound was closed with daily dressing after 45 days. One superficial infection patient was only treated with daily dressing, and the infection healed within 2 weeks. The infectious agent was determined in 2 patients. Three patients in the chronic infection group underwent a surgical procedure to remove the system. Specific antibiotic treatments were administered to patients whose infectious agents were identified. The remaining patients were treated with wide-spectrum antibiotics. CONCLUSIONS: We report that long-level stabilization with the Dynesys system results in a high infection rate.

Investigating the effect of STN-DBS stimulation and different frequency settings on the acoustic-articulatory features of vowels.

INTRODUCTION: Parkinson's disease (PD) is the second most frequent progressive neuro-degenerative disorder. In addition to motor symptoms, nonmotor symptoms and voice and speech disorders can also develop in 90% of PD patients. The aim of our study was to investigate the effects of DBS and different DBS frequencies on speech acoustics of vowels in PD patients. METHODS: The study included 16 patients who underwent STN-DBS surgery due to PD. The voice recordings for the vowels including [a], [e], [i], and [o] were performed at frequencies including 230, 130, 90, and 60 Hz and off-stimulation. The voice recordings were gathered and evaluated by the Praat software, and the effects on the first (F1), second (F2), and third formant (F3) frequencies were analyzed. RESULTS: A significant difference was found for the F1 value of the vowel [a] at 130 Hz compared to off-stimulation. However, no significant difference was found between the three formant frequencies with regard to the stimulation frequencies and off-stimulation. In addition, though not statistically significant, stimulation at 60 and 230 Hz led to several differences in the formant frequencies of other three vowels. CONCLUSION: Our results indicated that STN-DBS stimulation at 130 Hz had a significant positive effect on articulation of [a] compared to off-stimulation. Although there is not any statistical significant stimulation at 60 and 230 Hz may also have an effect on the articulation of [e], [i], and [o] but this effect needs to be investigated in future studies with higher numbers of participants.

Spinal cord stimulation may improve not only intractable pain but also necrotic wounds.

Spinal cord stimulation (SCS), an implantable neuromodulation modality, is one of the most exciting developments in chronic pain syndromes. In addition, SCS may improve intractable pain and may help ischemic wound healing. Herein, we report a 59-year-old female patient with persistent neuropathic pain and peripheral arterial disease in the lower limb which was treated successfully with SCS.