59 research outputs found
Whole spine MRI is not required in investigating uncomplicated paediatric lumbosacral lipoma. A retrospective single-institution review
No full textPURPOSE: Lumbosacral lipoma (LSL) is a severe occult spinal dysraphism, frequently associated with neurological, urological and orthopaedic complications. Whole spine imaging is typically performed to identify concomitant, but spatially separate, congenital anomalies. Our hypothesis: the incidence of additional, clinically significant abnormalities of the neuraxis is low; thus, imaging should be optimised at the lumbosacral region. We aim to assess the prevalence and relevance of LSL-associated lesions. METHOD: A single-centre, retrospective, radiological review using a prospectively maintained operative database. INCLUSION CRITERIA: children (< 16 years) with confirmed diagnosis of LSL and received whole spine MRI. Fatty filum, syndromic cases and cutaneous stigmata above lesion level were excluded. Data was extracted from radiological imaging, reports and clinical correspondence. RESULTS: One hundred twelve patients (40:72, M:F) aged 0.5 years (0.2-2.7) (median ± IQR) with LSL had whole spine MRI between 2001 and 2017. Classification of LSL: transitional 48 (43%); dorsal 30 (27%); caudal 28 (25%) and chaotic 6 (5%). Additional anomalies included syringohydromyelia 44 (39%), subcutaneous tract 19 (17%), abnormal vertebral segmentation 18 (16%), dermoid cyst 1 and 1 Chiari I deformity. There were no Chiari II malformations. No child required surgery for an associated lesion. Binary logistic regression revealed no factors associated with predicting secondary lesions. CONCLUSIONS: In congenital LSL, additional anomalies of the neuraxis are typically loco-regional rather than pan-CNS and additional lesions are rarely clinically significant. The loco-regional distribution of anomalies suggests that only lumbosacral spinal imaging is required in the initial evaluation of LSL. Such a policy would lessen the anaesthetic/sedation time for children and reduce imaging cost per patient. MRI protocols could be refined to optimise imaging quality at the region of interest
New Aspects of Thromboangiitis obliterans (von Winiwarter-Buerger's Disease)
No full textThe existence of thromboangiitis obliterans as a clinical entity has been a matter of debate for many years. In contrast to other immunovasculitides there is no organ involvement while peripheral vessels are affected. Heavy smokers under 40 years of age have a high predisposition for the disease. The cerebral form shows relapsing brain infarctions which can be visualized in CCT while panarteriography remains negative. Apart from unspecific inflammatory signs in blood and CSF there are distinctive laboratory findings proving the autoimmunological character of von Winiwarter-Buerger's disease. In the serum anti-elastin antibodies, IgE and anticollagen antibody activity are detectable. In 3 patients the authors detected specific immunohistochemical findings in a biopsy specimen of the temporal artery. In addition to platelet-inhibiting substances corticoids in acute and azathioprine in chronic treatment becomes necessary
The utility of brain biopsy in pediatric cryptogenic neurological disease
No full textOBJECTIVE:
The authors’ aim was to characterize a single-center experience of brain biopsy in pediatric cryptogenic neurological disease.
METHODS:
The authors performed a retrospective review of consecutive brain biopsies at a tertiary pediatric neurosciences unit between 1997 and 2017. Children < 18 years undergoing biopsy for neurological pathology were included. Those with presumed neoplasms and biopsy performed in the context of epilepsy surgery were excluded.
RESULTS:
Forty-nine biopsies in 47 patients (25 females, mean age ± SD 9.0 ± 5.3 years) were performed during the study period. The most common presenting symptoms were focal neurological deficit (28.6%) and focal seizure (26.5%). Histopathological, microbiological, and genetic analyses of biopsy material were contributory to the diagnosis in 34 cases (69.4%). Children presenting with focal seizures or with diffuse (> 3 lesions) brain involvement on MRI were more likely to yield a diagnosis at biopsy (OR 3.07 and 2.4, respectively). Twelve patients were immunocompromised and were more likely to yield a diagnosis at biopsy (OR 6.7). Surgery was accompanied by severe complications in 1 patient. The most common final diagnoses were infective (16/49, 32.7%), followed by chronic inflammatory processes (10/49, 20.4%) and occult neoplastic disease (9/49, 18.4%). In 38 cases (77.6%), biopsy was considered to have altered clinical management.
CONCLUSIONS:
Brain biopsy for cryptogenic neurological disease in children was contributory to the diagnosis in 69.4% of cases and changed clinical management in 77.6%. Biopsy most commonly revealed underlying infective processes, chronic inflammatory changes, or occult neoplastic disease. Although generally safe, the risk of severe complications may be higher in immunocompromised and myelosuppressed children
Artificial intelligence in brain tumour surgery-an emerging paradigm.
No full textArtificial intelligence (AI) platforms have the potential to cause a paradigm shift in brain tumour surgery. Brain tumour surgery augmented with AI can result in safer and more effective treatment. In this review article, we explore the current and future role of AI in patients undergoing brain tumour surgery, including aiding diagnosis, optimising the surgical plan, providing support during the operation, and better predicting the prognosis. Finally, we discuss barriers to the successful clinical implementation, the ethical concerns, and we provide our perspective on how the field could be advanced
Catch-bond mechanism of the bacterial adhesin FimH
No full textLigand-receptor interactions that are reinforced by mechanical stress, so-called catch-bonds, play a major role in cell-cell adhesion. They critically contribute to widespread urinary tract infections by pathogenic Escherichia coli strains. These pathogens attach to host epithelia via the adhesin FimH, a two-domain protein at the tip of type I pili recognizing terminal mannoses on epithelial glycoproteins. Here we establish peptide-complemented FimH as a model system for fimbrial FimH function. We reveal a three-state mechanism of FimH catch-bond formation based on crystal structures of all states, kinetic analysis of ligand interaction and molecular dynamics simulations. In the absence of tensile force, the FimH pilin domain allosterically accelerates spontaneous ligand dissociation from the FimH lectin domain by 100,000-fold, resulting in weak affinity. Separation of the FimH domains under stress abolishes allosteric interplay and increases the affinity of the lectin domain. Cell tracking demonstrates that rapid ligand dissociation from FimH supports motility of piliated E. coli on mannosylated surfaces in the absence of shear force
Author Correction:: The IDEAL framework for surgical robotics: development, comparative evaluation and long-term monitoring (Nature Medicine, (2024), 30, 1, (61-75), 10.1038/s41591-023-02732-7)
No full text\ua9 The Author(s), under exclusive licence to Springer Nature America, Inc. 2024.three authors were missing from The IDEAL Robotics Colloquium. Art Sedrakyan (Weill Cornell Medical College, New York, NY, USA), Joel Horowitz (Maimonides Medical Center, New York, NY, USA) and Arsenio Paez (Centre de Recherche de l’Institut Universitaire de G\ue9riatrie de Montr\ue9al (CRIUGM), Montreal, Quebec, Canada) have all been added in the HTML and PDF versions of the article
Integrated disease management using environmental control in tea fields
No full textThe occurrence of plant disease depends on interactions between the host plant, a pathogen, and the environment in a dynamic called "the disease triangle". Bacterial shoot blight (BSB) disease, caused by _Pseudomonas syringae_ pv. _theae_ (_Pst_), is a major bacterial disease of tea plants in Japan and substantially reduces tea productivity. BSB mainly occurs in the low-temperature season, and lesion formation by _Pst_ is enhanced by both low temperature and the presence of ice nucleation-active _Xanthomonas campestris_ (INAX), which catalyses ice formation at -2 to -4^o^C and is frequently co-isolated with _Pst_ from tea plants^5^. Low temperature is thus the most important environmental factor to influence the incident; however, the effects of environmental controls in fields on the occurrence of the disease are poorly understood. Here we show that the natural incidence of BSB in the field is closely related to low temperatures in late autumn. Frost protection in late autumn, which protected tea plants against extremely low temperatures, significantly decreased the incidence of BSB, and frost protection combined with bactericide application held the incident under the economic threshold level. Our data indicate that environmental control in the field based on microbial interactions in the host offers a new strategy for plant disease control using integrated plant disease management based on the disease triangle concept
Microsurgery for intracranial aneurysms: A qualitative survey on technical challenges and technological solutions
No full textINTRODUCTION:
Microsurgery for the clipping of intracranial aneurysms remains a technically challenging and high-risk area of neurosurgery. We aimed to describe the technical challenges of aneurysm surgery, and the scope for technological innovations to overcome these barriers from the perspective of practising neurovascular surgeons.
MATERIALS AND METHODS:
Consultant neurovascular surgeons and members of the British Neurovascular Group (BNVG) were electronically invited to participate in an online survey regarding surgery for both ruptured and unruptured aneurysms. The free text survey asked three questions: what do they consider to be the principal technical barriers to aneurysm clipping? What technological advances have previously contributed to improving the safety and efficacy of aneurysm clipping? What technological advances do they anticipate improving the safety and efficacy of aneurysm clipping in the future? A qualitative synthesis of responses was performed using multi-rater emergent thematic analysis.
RESULTS:
The most significant reported historical advances in aneurysm surgery fell into five themes: (1) optimising clip placement, (2) minimising brain retraction, (3) tissue handling, (4) visualisation and orientation, and (5) management of intraoperative rupture. The most frequently reported innovation by far was indocyanine green angiography (84% of respondents). The three most commonly cited future advances were hybrid surgical and endovascular techniques, advances in intraoperative imaging, and patient-specific simulation and planning.
CONCLUSIONS:
While some surgeons perceive that the rate of innovation in aneurysm clipping has been dwarfed in recent years by endovascular techniques, surgeons surveyed highlighted a broad range of future technologies that have the potential to continue to improve the safety of aneurysm surgery in the future
Definitions of Guidelines for Introducing an Integrated Management System to Small and Medium Sized Enterprises
No full textTo survive and achieve to develop their activities in an increasingly competitive
environment, small and medium sized enterprises have to increase their
competitiveness and, progressively, reduce their operational cost. It is therefore the
objective of this research project to develop a flexible and unique management system
for these enterprises to use to integrate all management systems or activities related to
quality, safety and environmental issues and continuously improve their overall
business performance and also to get prepared for certification according to the
relevant international standards.
The research project has been based on the edition of 2000 of the ISO 9001 standard:
"Quality Management Systems
-
Requirements", the ISO 14001: 1996 standard:
"Environmental Management Systems
-
Specification with Guidance for Use", the BS
8800: 1996 standard: "Guide to Occupational Health and Safety Management
Systems" and the Business Excellence Model.
The thesis author carried out a data collection procedure to determine the special
characteristics of small and medium sized enterprises and to specify their needs for
survival and development. The results of the research reinforced the conclusions of
the relevant literature that was reviewed. The areas of literature examined related to
quality management systems as platforms for integration, to safety and environmental
management systems and to business process analysis and the conclusions were taken
under consideration from a point of view of small and medium sized enterprises.
The output of the research project is a practical guide for small and medium sized
enterprises. It is a route-map of activities for the implementation of the integrated
management system, incorporating tools addressing specific management areas using
quality, safety and environmental issues to focus them. The route-map has the
potential to integrate the overall management activities of an organization and has an
internal metric mechanism to indicate the rate of integration. The tools of the route-
map were partially implemented to two (2) SMEs, giving positive validation of the
concepts.
Immune-evasive gene switch enables regulated delivery of chondroitinase after spinal cord injury.
No full textChondroitinase ABC is a promising preclinical therapy that promotes functional neuroplasticity after CNS injury by degrading extracellular matrix inhibitors. Efficient delivery of chondroitinase ABC to the injured mammalian spinal cord can be achieved by viral vector transgene delivery. This approach dramatically modulates injury pathology and restores sensorimotor functions. However, clinical development of this therapy is limited by a lack of ability to exert control over chondroitinase gene expression. Prior experimental gene regulation platforms are likely to be incompatible with the non-resolving adaptive immune response known to occur following spinal cord injury. Therefore, here we apply a novel immune-evasive dual vector system, in which the chondroitinase gene is under a doxycycline inducible regulatory switch, utilizing a chimeric transactivator designed to evade T cell recognition. Using this novel vector system, we demonstrate tight temporal control of chondroitinase ABC gene expression, effectively removing treatment upon removal of doxycycline. This enables a comparison of short and long-term gene therapy paradigms in the treatment of clinically-relevant cervical level contusion injuries in adult rats. We reveal that transient treatment (2.5 weeks) is sufficient to promote improvement in sensory axon conduction and ladder walking performance. However, in tasks requiring skilled reaching and grasping, only long term treatment (8 weeks) leads to significantly improved function, with rats able to accurately grasp and retrieve sugar pellets. The late emergence of skilled hand function indicates enhanced neuroplasticity and connectivity and correlates with increased density of vGlut1‰+ innervation in spinal cord grey matter, particularly in lamina III–IV above and below the injury. Thus, our novel gene therapy system provides an experimental tool to study temporal effects of extracellular matrix digestion as well as an encouraging step towards generating a safer chondroitinase gene therapy strategy, longer term administration of which increases neuroplasticity and recovery of descending motor control. This preclinical study could have a significant impact for tetraplegic individuals, for whom recovery of hand function is an important determinant of independence, and supports the ongoing development of chondroitinase gene therapy towards clinical application for the treatment of spinal cord injury
- …
