Minimally invasive bilateral decompressive lumbar laminectomy with unilateral approach: patient series.

BACKGROUND: Minimally invasive bilateral decompressive lumbar laminectomy with a unilateral approach is a less destructive procedure compared to the traditional open bilateral laminectomy. The objective of this study is to report the authors' experience with this technique. The first 26 cases performed using the unilateral approach for bilateral decompression are described. Baseline characteristics, operative time, blood loss, and intraoperative complications were collected retrospectively. No specific surgical equipment is needed for this technique. OBSERVATIONS: Twenty-six patients and a total of 40 lumbar levels were treated. Mean operative time was 82 minutes per level and mean estimated blood loss was 40.4 mL per level. Mean length of hospitalization was 1.65 days. Cerebrospinal fluid leak occurred in 1 of 26 (3.85%) cases. LESSONS: Although improved stabilization needs to be proven in future long-term studies to clearly show a decrease in need for fusion, the initial experience with a unilateral approach is positive and continued use in minimally invasive spine surgery seems promising.

Traumatic Pseudoaneurysm of the Ascending Cervical Artery Treated with N-butyl Cyanoacrylate Embolization: A Case Report and Review of the Literature.

Pseudoaneurysms of the thyrocervical trunk and its branches are commonly iatrogenic in nature; however, trauma is often an inciting mechanism. Open surgical repair was considered the main treatment modality until recent advances in endovascular therapy proved to be a viable treatment option. We report a case of a traumatic pseudoaneurysm arising from the ascending cervical artery with an associated arteriovenous fistula (AVF) that was treated using n-butyl cyanoacrylate (NBCA) embolization. The use of a liquid embolysate such as NBCA provided an efficient and effective means of achieving both pseudoaneurysm occlusion and AVF disconnection.

Posterior Epidural Migration of a Lumbar Disc Herniation Causing Cauda Equina Syndrome: A Case Report.

We report an uncommon case of posterior epidural migration of a lumbar disc fragment (PEMLDF) in a patient presenting with acute, progressive back pain, radiculopathy, and weakness. PEMLDF can be mistaken for neoplastic or infectious etiologies on imaging, presenting a diagnostic and management challenge. Our patient underwent an urgent decompressive lumbar laminectomy, which revealed a PEMLDF intraoperatively. He went on to achieve good neurologic recovery.

Rational Structure-Based Rescaffolding Approach to De Novo Design of Interleukin 10 (IL-10) Receptor-1 Mimetics.

Tackling protein interfaces with small molecules capable of modulating protein-protein interactions remains a challenge in structure-based ligand design. Particularly arduous are cases in which the epitopes involved in molecular recognition have a non-structured and discontinuous nature. Here, the basic strategy of translating continuous binding epitopes into mimetic scaffolds cannot be applied, and other innovative approaches are therefore required. We present a structure-based rational approach involving the use of a regular expression syntax inspired in the well established PROSITE to define minimal descriptors of geometric and functional constraints signifying relevant functionalities for recognition in protein interfaces of non-continuous and unstructured nature. These descriptors feed a search engine that explores the currently available three-dimensional chemical space of the Protein Data Bank (PDB) in order to identify in a straightforward manner regular architectures containing the desired functionalities, which could be used as templates to guide the rational design of small natural-like scaffolds mimicking the targeted recognition site. The application of this rescaffolding strategy to the discovery of natural scaffolds incorporating a selection of functionalities of interleukin-10 receptor-1 (IL-10R1), which are relevant for its interaction with interleukin-10 (IL-10) has resulted in the de novo design of a new class of potent IL-10 peptidomimetic ligands.

Reduced false positives in PDZ binding prediction using sequence and structural descriptors.

Abstract­Identifying the binding partners of proteins is a problem of fundamental importance in computational biology. The PDZ is one of the most common and well-studied protein binding domains, hence it is a perfect model system for designing protein binding predictors. The standard approach to identifying the binding partners of PDZ domains uses multiple sequence alignments to infer the set of contact residues that are used in a predictive model. We expand on the sequence alignment approach by incorporating structural information to generate descriptors of the binding site geometry. Furthermore, we generate a real-value score for binary predictions by applying a filter based on models that predict the probability distributions of contact residues at each of the canonical PDZ ligand binding positions. Under training cross validation, our model produced an order of magnitude more predictions at a false positive proportion (FPP) of 10 percent than our benchmark model chosen from the literature. Evaluated using an independent cross validation, with computationally predicted structures, our model was able to make five times as many predictions as the benchmark model, with a Matthews' correlation coefficient (MCC) of 0.33. In addition, our model achieved a false positive proportion of 0.14, while the benchmark model had a 0.25 false positive proportion.