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Surgical Anatomy of the Pterion and its Relationship to the Middle Meningeal Artery in Optimizing Pterional Craniotomies: A Cadaveric Perspective
No full textPurpose: The pterion is an anatomic landmark formed via junction of the temporal, sphenoid, parietal, and frontal bones on the lateral aspect of the cranium. Due to the proximity to the middle meningeal artery (MMA), pterion-based surgical approaches have a potential risk of arterial rupture, leading to subsequent epidural hematoma formation. This study characterized the localization of the pterion and its relationship to the MMA in the four main pterion configurations.
Methods: Ninety-one pterions were exposed, and suture patterns were uncovered to determine pterion classification. Dura mater was removed to expose the groove for the MMA and relationship to the pterion, documenting the presence or absence of a bony bridge. Skull thickness at the pterion center was collected for each specimen.
Results: Sphenoparietal (Type I) pterions were present in 67.03%, Frontotemporal (Type II) in 10.99%, Stellate (Type III) in 16.48%, and Epipteric (Type IV) in 5.49% of specimens, with non-identical pterion types located bilaterally in 47.62%. A significant difference was found in five of the eight measurements obtained between male and female cadavers, including the distance to the frontozygomatic suture (FZMS). The distance between pterion center and the groove for the MMA, as well as skull thickness, also demonstrated statistical significance, with the smallest distance and skull thickness demonstrated in Type III pterions.
Conclusion: Type I is the most prevalent pterion configuration, with Type III most closely situated to the course of the MMA. This study demonstrates the importance of determining pterion type pre-operatively to ensure vascular preservation of MMA
Circle of Willis Variations and Features in an American Midwestern Cadaver Population
Full text linkBackground: The Circle of Willis (CoW) is a critical cerebral arterial network. This study investigates CoW variants in a Midwestern U.S. cadaveric population.
Methods: The CoWs of 25 formalin-fixed human cadavers were evaluated with vessel measurements obtained through ImageJ software. Variations were classified per a previously published system with R Studio statistical analysis, including comparisons by sex and body mass index (BMI).
Results: A typical CoW configuration was identified in 2 of 25 specimens (8 %), with the remaining 92 % demonstrating anatomical variants. The most common variations were unilateral hypoplasia (38.3 %), bilateral hypoplasia (21.3 %), and duplications (12.8 %). Variations most commonly involved the posterior communicating artery (73.9 %; PComA; especially PComA hypoplasia), the anterior communicating artery (60.9 %; AComA), and the anterior cerebral artery (52.2 %). Rare anatomical variants included quadruplication of the A2 segment, fetal-type PComA, and AComA aplasia. Males exhibited significantly greater vessel diameters and lengths across most segments, except for PComA diameter, which was larger in females (p \u3c 0.05). Non- overweight body mass index (BMI \u3c 25) correlated positively with the diameter of the extra triplicated A2, and increased BMI ( ≥ 25) showed a significant increase in the right A1 ACA diameter (p \u3c 0.05). No statistically significant differences were observed in arterial lengths.
Conclusions: This study highlights the high prevalence of CoW anatomical variations in the Midwestern population, including several distinctive variants, adding to the literature. Significant differences based on sex and BMI were identified, suggesting potential implications for neurosurgical and vascular surgery considerations. Further research with additional cohorts is necessary to validate and expand upon these observations
Combination Hyaluronic Acid and Multipotent Stromal Cells Fails to Improve Rat Knee OA Outcomes Compared to Cells Alone
Full text linkIntroduction: Multipotent Stromal Cells (MSCs) are utilized as therapeutic agents for addressing musculoskeletal conditions, including knee osteoarthritis (OA). However, major challenges in the clinical application include maintenance of the cells in the joint capsule. Hyaluronic acid (HA) is endogenous in synovial joints and commercially available as a joint lubricant. We tested the hypothesis that delivery of MSCs in HA into an OA rat knee model could improve outcomes.
Methods: Rat bone marrow MSCs were suspended in a commercially available HA paste, and cell viability measured with live/dead stains. Biomarkers for MSC chondrogenesis and osteogenesis were monitored with PCR. MSCs with or without HA were injected into the knees of OA rats and histology conducted 6 weeks later.
Results: Suspending MSC in HA resulted in a slight reduction in viability. The gene expression profile showed an increase in MSC biomarkers for cells in HA with a decrease in osteogenic markers. Four groups of treatment (vehicle, MSCs alone, HA alone, MSCs + HA) were injected into the knees of osteoarthritic rats. Pain scores, collected weekly, showed no difference between the groups. Immunohistochemistry for inflammatory markers illustrated no obvious differences between groups. Proteoglycans, indicative of cartilage, showed a loss in the vehicle group and modest signs of cartilage with MSCs alone, but when mixed with the HA, any benefit was lost. OARSI Histological Scoring completed by 2 independent technicians concluded no improvement in joint integrity with the addition of HA.
Conclusion: A commercially available HA failed to enhance joint regeneration compared to MSCs alone
Impact of Left Ventricular Assist Devices on the Quality of Life and Functional Outcomes in Advanced Heart Failure: A Comprehensive Review
Full text linkManaging advanced heart failure (HF) remains a major clinical challenge, especially for patients who no longer respond to conventional treatment options, or are not candidates for heart transplantation. In such cases, left ventricular assist devices (LVADs) have become an important option, offering mechanical support that has the potential to extend life and improve daily functioning. With ongoing advancements in technology, there is growing interest in understanding how LVADs impact not just survival, but also patients\u27 quality of life (QoL) and overall recovery.
This narrative review explores the role of LVAD therapy in improving functional status and QoL in patients with advanced HF. It draws on clinical research from the past 15 years to examine physical, psychological, and social outcomes, as well as the challenges and complications associated with this treatment. A structured PubMed search was performed using predefined MeSH terms and keywords related to LVADs. After removing duplicates, 68 articles were identified. Eleven reviewers screened titles and abstracts, followed by full-text review and data extraction. Studies were included if they involved adults, were conducted in the past 15 years, and used clinical or observational study designs. Non-English, pediatric, and pregnancy-related studies were excluded. A total of 44 studies met the criteria. LVADs were associated with improvements in physical function, exercise capacity, and QoL. However, patients often faced psychological stress and medical complications. Better pre-implant health and strong support systems contributed to more favorable outcomes. LVADs offer meaningful improvements in both survival and QoL, but holistic, patient-centered care remains key to optimizing outcomes
Feasibility of Osteopathic Manipulative Treatment for Low Back Pain in Rural Chimaltenango, Guatemala: A Pilot Study
No full textBackground
Low back pain (LBP) is a global health issue that primarily affects underserved communities with limited access to healthcare. Osteopathic manipulative treatment (OMT) offers non-pharmacological, hands-on interventions that align with its core principle of holistic care. However, little is known about the feasibility and perception of OMT in rural Chimaltenango, Guatemala. This pilot study assesses the feasibility, effectiveness, and participant perception of osteopathic principles in managing LBP complaints.
Methods
Adult participants experiencing LBP were recruited by the research team during Kansas City University College of Osteopathic Medicine’s (KCUCOM) global health mission trip, following their one-day primary care visit. Pre- and post-treatment Visual Analog Scale scores (VAS), Oswestry Disability Questionnaire (ODQ), and modified Osteopathic Survey of Health Care in America (OSTEOSURV) surveys were used in the study to assess pain, activities of daily living, satisfaction, and awareness of OMT. Manipulative techniques were tailored based on the participants\u27 complaints and delivered by a trained fourth-year medical student under the supervision of an osteopathic physician.
Results
The data showed that 62.5% (n = 5/8) of participants reported a baseline pain score of VAS ≥ 8. Posttreatment, the majority, 75% (n = 6/8), reported greater than 50% pain relief, and 12.5% (n = 1/8) were painfree (VAS = 0). All participants (100%, n = 8/8) were unfamiliar with OMT before the session. However, 75% (n = 6/8) reported satisfaction with the treatment following manipulation.
Conclusion
OMT is a feasible and acceptable modality for LBP management in rural Guatemala. These findings support further investigation that includes a larger sample size and the possibility for future integration of osteopathic care into global health outreach, particularly for under-resourced populations that lack access to conventional pain management
Understanding the Training Needs of Parents Whose Children Have Been Diagnosed with Autism Spectrum Disorder
No full textAutism spectrum disorder (ASD) is a highly heritable and heterogeneous neurodevelopmental disorder that results in language deficits, social communication challenges, and sensory/repetitive behaviors. Those with ASD may struggle with communication, social situations, and daily tasks. Being diagnosed with autism can have lifelong implications for children and their families, often requiring lifelong therapeutic services. This demand can cause significant stress on the family and lead to parents needing significant assistance on how to manage behaviors. The purpose of the current study was to understand the training needs of parents whose children attend an ABA center. Parents were asked to answer five questions centered around parental stress and training needs. The current study found that parents report significantly higher levels of stress and have to provide constant care for their children. Parents reported feeling alone and reported a number of skills they would like their child to improve on including communication, adaptive behaviors, and social skills. Parents indicated the need for more generalized training where they could be included in their child’s care. This study showed a clear need for more communication between professionals and families and a need for parental support services that provide specific skill training for families within the natural environment. Future interventions should be developed to provide care in naturalized settings, allowing parents to learn directly through observation or real-time practice with their children and their child’s providers