Biomedicine (Journal)
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A Staged-OLIF Approach Can Minimize Construct Lengths In Adult Spinal Deformity- A Case Series And Literature Review
No full textBackground:
Adult Spinal Deformity (ASD) is one of the challenging conditions to treat for spine surgeons. One of the important dilemmas in the management of these patients is the decision on the number of levels of instrumentation and the overall length of the construct. OLIF has the advantage of providing a minimally invasive approach to address this complex pathology also allowing us to stage the procedure and thus help clinicians reassess if the patient requires an additional decompression, long fusion lengths, or need for osteotomies.
Aim:
Our study aims to evaluate the possibility of minimizing the construct length following a staged OLIF approach in ASD patients and also to analyze the clinical and radiological outcomes following a staged OLIF surgery.
Methods:
We present three cases of ASD, where the patients had a significant imbalance in either the coronal/ sagittal profiles, and by using a staged approach, the surgeon was able to reduce the construct lengths and also operate on these deformities using an all Minimally Invasive Surgical (MIS) approach.
Results:
Overall sagittal and coronal profiles improved in all three cases with satisfactory fusion rates and VAS scores (back pain) post-operatively. Two of the three patients had an all-MIS approach (OLIF with MIS Ponte osteotomy and robotic guided pedicle screw instrumentation) and in one patient a four-rod construct was preferred to improve the stability. No complications were observed during a mean follow-up period of 4 years.
Conclusion:
A staged approach in ASD (lateral OLIF and posterior instrumentation) is a valuable surgical strategy for better correction of the coronal and sagittal plane deformities with relatively lesser construct length. It reduces the problems associated with prolonged anesthesia, in addition, it helps the surgeon in reassessing the pelvic parameters, thereby helping to decide on the need for additional osteotomies during the second procedure
ACUTE PHANTOSMIA AS THE FIRST MANIFESTATON OF BRAIN METASTASES IN A PATIENT WITH BREAST CANCER. CASE REPORT
No full textPhantosmia belongs to the group of olfactory dysfunctions. It is more commonly described in psychiatric conditions and some cases of viral infections, but it has been also rarely described in cancer patients who develop primary or metastatic central nervous system tumors; the early identification of this symptom in this population is crucial, as it could lead to timely diagnosis and treatment through a multidisciplinary approach.
With the current report we present the case of a 60-year-old lady with metastatic breast cancer and without known preexisting brain metastases, who developed acute phantosmia without other neurological deficits; computed tomography of the brain revealed multiple brain metastases, which were attributed to the malignancy, and for which she was effectively treated with whole brain irradiation and antipsychotic as well as anticonvulsant medications. Furthermore, we underline the value of cooperation between the various specialties that could aid in diagnosis and management of this symptomatology.
Phantosmia is an extremely rare symptom in cancer patients, and its appearance should alarm physicians to rapidly investigate a possible progression of disease in the central nervous system.
Multidisciplinary approach is needed for the optimal management of these patients
Covered Stent Salvage for Iatrogenic Vertebral Artery Injury in Traumatic Cervical Spine Injury: A Case Report and Literature Review
No full textWe report the case of a 70-year-old woman who sustained complex traumatic injuries in a motor vehicle accident, including cervical spine fractures and a high suspicion of traumatic vertebral artery injury (VAI). Initial digital subtraction angiography (DSA) revealed no evidence of vertebral artery (VA) involvement. She subsequently underwent anterior cervical discectomy and fusion (ACDF); however, an iatrogenic injury to the right VA occurred intraoperatively, necessitating emergent endovascular stenting for vascular repair. This case underscores the importance of comprehensive preoperative imaging, intraoperative vigilance, and coordinated multidisciplinary management in cervical spine trauma with potential vascular involvement
Investigating the association between hyperthyroidism and the risk of herpes zoster in a cohort study in Taiwan
No full textBackground: The aim of this cohort study was to investigate the association between hyperthyroidism and the likelihood of developing herpes zoster in Taiwan.
Methods: Using the National Health Insurance Research Database (NHIRD) in Taiwan, we selected individuals aged 20-84 who were newly diagnosed with hyperthyroidism between 2013 and 2020 as the hyperthyroidism group. These individuals were then matched with a control group without hyperthyroidism in a 1:1 propensity score matching for sex, age, and baseline comorbidities. The occurrence of herpes zoster was tracked in both groups until the end of the study period or until a diagnosis of herpes zoster was made. The Cox proportional hazards regression analysis was used to determine the hazard ratio (HR) and 95% confidence interval
(CI) for the risk of herpes zoster associated with hyperthyroidism. Results: A total of 202,069 individuals with hyperthyroidism and 202,069 individuals without hyperthyroidism were included in the analysis. The incidence rate of herpes zoster was higher in the hyperthyroidism group compared to the non-hyperthyroidism group (6.10 per 1,000 person-years for the hyperthyroidism group versus 5.53 per
1,000 person-years for the non-hyperthyroidism group, incidence rate ratio = 1.10, 95%CI = 1.07-1.14, and P value \u3c 0.001). After adjusting for covariables, individuals with hyperthyroidism were found to have a higher risk of developing herpes zoster compared to those in the non-hyperthyroidism group (adjusted HR = 1.19, 95%CI= 1.15-1.23 , and P \u3c 0.001).Conclusion: This cohort study suggests that individuals with hyperthyroidism in Taiwan may have a greater risk of developing herpes zoster compared to those without hyperthyroidism
In-Silico Study of Rosmarinic Acid Roles in Inhibiting Breast Cancer Progression
No full textBackground: Breast cancer is the highest cancer incidence in the world. Chemotherapy is currently one of the main breast cancer treatments besides surgery. It is capable of evolving to become resistant to chemotherapy agents. Chemotherapy also has significant side effects. Rosmarinic acid could become an anti-cancer agent candidate for the treatment of breast cancer, but its molecular mechanism is still unclear.
Aim: This study aimed to clarify the molecular mechanism of rosmarinic acid anti-breast cancer properties via an in-silico study.
Methods: Web-based screening tools such as SwissTargetPrediction, Similarity Ensemble Approach (SEA), and TargetNet were used as initial screening. From web-based screening, potential proteins that interact with rosmarinic acid could be determined. Intersected proteins from 3 web-based screenings were assessed via literature review. We found 11 intersected proteins, and 6 of 11 proteins are involved in breast cancer development and progression. Those
6 proteins are MMP-1, MMP-2, MMP-9, MMP-12, aldose reductase, and M-phase Inducer Phosphatase 2 (CDC25B). Then molecular docking using Autodock 4.6.2 was used in ligand and protein interaction simulation. Those 6 proteins were selected as macromolecules in the docking study.
Results: Based on the docking result, we found that rosmarinic acid can bind MMP-1, MMP2, MMP-9, and MMP-12 active sites. The binding profile of rosmarinic acid with aldose reductase has similarities with other confirmed inhibitors. Docking with CDC25B showed that rosmarinic acid also binds in the same place as cyclin-dependent kinases (CDKs).
Conclusion: The ability of rosmarinic acid to inhibit MMP-1, MMP-2, MMP-9, aldose reductase, and CDC25B activity may underlie how rosmarinic acid is able to inhibit the development of breast cancer
Distal femur fractures: The use of a fibular strut allograft with dual locking plates allows for early weight bearing
No full textIntroduction: Distal femur fractures result in high morbidity and mortality - comparable to that of hip fractures. The commonly used surgical fixation techniques today, locked plating and intramedullary nailing, have shown high postoperative complication rates. Thus, many surgeons temporarily keep patients non-weight bearing in the early post-operative stage. Increased time to ambulation after surgery is known to increase systemic complications in patients. We aim to investigate if an augmented fixation technique involving the use of a fibular strut allograft with dual locking plates helps to allow early mobilization postoperatively without adverse outcomes.
Methods: Five geriatric patients (four female, one male) with distal femur fractures (native or periprosthetic) were treated in our institution with the aforementioned technique, and were allowed early postoperative weight-bearing. These patients were followed up for postoperative outcomes. The primary outcomes studied were non union, implant failure and wound complications. Secondary outcomes studied include time to union, and Sander’s functional score.
Results: There were no cases of non-union, implant failure or wound related infection. All patients achieved radiological union (mean = 12.6 weeks). Using Sander’s functional scoring, two patients achieved excellent, two achieved good and one had fair outcomes. All patients were followed up for at least 6 months after operation.
Conclusion: Our method of augmented fixation with fibular strut allografts potentially allows for early weight bearing without adverse outcomes. Further studies with larger sample sizes are required to validate our findings
Nutraceutical benefits and neuro-protective potent of four colored peppers (Capsicum annuum var. grossum)
No full textBackground: Four colored peppers (Capsicum annuum var. grossum), orange, purple, yellow and red, are plant foods served as salad or stir-fry for meals in Taiwan and many countries.
Purpose: This study aimed to investigate the multiple nutraceutical properties of aqueous extracts prepared from colored peppers.
Methods: Vitamin C content and phytochemical profiles of these peppers were analyzed. In vitro effects of anti-oxidative, anti-a-amylase, anti-a-glucosidase, antilipase and anti-acetylcholinesterase (AchE) of pepper aqueous extracts at 0.25, 0.5 and 1 mg were evaluated. The neuronal protective potent of pepper aqueous extracts at 0.5 and 1 mg in high glucose treated nerve growth factor (NGF)-differentiated PC12 cells were examined.
Results: Vitamin C content in these peppers was in the range of 60-96 mg/100 g fresh weight. The content of phenolic acids, flavonoids, anthocyanins and triterpenoids in these peppers was in the range of 860-2185 mg/100 g dry weight. Pepper aqueous extracts at 0.25, 0.5 and 1 mg exhibited concentration-dependent radical scavenging effects, iron-chelating effects and reducing power, as well as effectively inhibited aamylase, a-glucosidase, lipase and AchE activities. High glucose increased Bax mRNA expression, decreased mitochondrial membrane potential and Na+-K+ ATPase activity, caused DNA fragmentation and massive Ca2+ release, stimulated oxidative and inflammatory responses, and led to death of NGF-differentiated PC12 cells. Pretreatments of pepper aqueous extracts at 0.5 and 1 mg reversed these changes, and increased the viability of NGF-differentiated PC12 cells.
Conclusions: These novel findings suggest that colored peppers offered many biofunctions, which might benefit the prevention of diabetes associated complications such as diabetic neuropathy
Neurenteric Cysts: A Neurosurgical Case Series and Treatment Perspectives
No full textNeurenteric cysts (NC) are rare lesions of endodermal origin lined by mucin-secreting cuboidal or columnar epithelium of an intestinal or respiratory type. They occur more frequently spinally than cranially. From the radiological view, NC may be confused with other lesions of the central nervous system, like arachnoid or epidermoid cysts. However, due to advances in neuroimaging, there is an increasing trend in preoperative diagnosis of NC. We are reporting three cases of NC, each exhibiting markedly distinct symptoms and postoperative courses. The first patient, a 45year-old woman, had NC in the fourth ventricle. Although she underwent surgery, the lesion recurred 55 months later. The second patient, a 66-year-old woman, had NC in the left cerebellopontine angle. After partial removal, the remaining cyst maintained its size for 94 months. The third patient, a 55-year-old man, presented with NC close to the medullary cone. Despite tumor reduction, a hemorrhagic cyst developed 41 months later, which was accompanied by increased lumbosacral pain. A review of knowledge of current treatment strategies and challenges of NC is discussed. Surgical intervention is the primary therapeutic approach for patients with NC, particularly those experiencing symptoms. The primary challenge in treating NC is preventing cyst recurrence. The complete resection of NC is critical for minimizing the probability of cyst recurrence. Continuous lifelong follow-up is essential, as NC recurrences can occur even after decades
Effect of garcinol against arsenic-induced neurobehavioral alterations and liver and kidney dysfunction in albino mice
No full textThe extended exposure to inorganic arsenic is commonly linked to brain damage through oxidative and apoptotic processes. The compound known as Garcinol (GCL) has garnered significant interest due to its potential advantages for human well-being. Nevertheless, the ability of GCL to protect against toxicity generated by arsenic in the brain has not yet been investigated. Hence, our study aimed to examine the neuroprotective effectiveness of GCL in mitigating the detrimental impacts of sodium arsenite (SA) on behavioral patterns, the molecular mechanisms, apoptotic markers, and oxidative stress parameters in the brain, liver, and kidney of mice. The mice were categorized into four distinct groups for the duration of 28 days: Group I, referred to as the Control group, received a 5% v/v solution of DMSO; Group II, referred to as the SA group, received a dosage of 20 mg/kg of SA; Group III, referred to as the SA+GCL group, received a combined dosage of 20 mg/kg of SA and 50 mg/kg of GCL; and Group IV, referred to as the GCL group, received a dosage of 50 mg/kg of GCL. Following the administration of the drug, an evaluation was conducted to analyze the behavior of the animals. Additionally, the levels of AchE, ATP hydrolysis, and angiotensin I-converting enzyme (ACE), which are known to be associated with cognitive function, were examined. The findings of our study demonstrated that the administration of GCL led to enhancements in cognitive behavior. Additionally, GCL was found to mitigate the cholinergic deficit, as evidenced by the reduction of acetylcholinesterase (AchE) activity. Furthermore, GCL was observed to increase the signaling of glycogen synthase kinase 3 beta (GSK3β) and cAMP response elementbinding protein (CREB) in mice treated with SA. In addition, it was observed that GCL exhibited an enhancement in redox equilibrium and provided defense against oxidative harm generated by SA in the brains of mice. This effect was mediated through the activation of NRF2/HO-1 proteins and resulted in a noteworthy decrease in malondialdehyde concentrations. Thus, treatment with GCL ameliorated neurobehavior, modulated cognitive function-associated biomarkers, and protected mice from SA-induced neurotoxicity, according to the findings of this pre clinical study
Endoscopic Management of Ureteric Stenosis and Calculi in Bilateral Incomplete Renal Duplication: A Case Study
No full textRenal duplication anomalies are one of the most frequent congenital urological conditions in the general population all over the world. Bilateral incomplete duplication, however, is exceedingly rare. We present a case of a 29-year-old female with bilateral incomplete duplex kidneys complicated by mid-ureteric stenosis on the right side and calculi in the left ureter and upper moiety of the left duplex kidney. Diagnostic imaging, including ultrasound, computed tomography (CT), and intravenous urography (IVU) confirmed these findings. The patient underwent successful bilateral ureteroscopy (URS) and left-sided retrograde intra-renal surgery (RIRS) for management of the above mentioned complications related to the duplex kidneys in this patient. Postoperative recovery was uneventful, and a further right-sided percutaneous nephrolithotomy (PCNL) was planned. This case underscores the importance of comprehensive diagnostic evaluation and individualized therapeutic strategies in managing complex urological anomalies