Notes

Regularized Semiparametric Appraisal pertaining to Normal Differential Equations.
Although carcinoma metastasis to primary intracranial neoplasms has occasionally been reported, metastasis to a cerebral arteriovenous malformation (AVM) has been exceedingly rare, with only 5 cases reported to date. In the present study, we have reported a case of lung carcinoma that had metastasized to a cerebral AVM. To the best of our knowledge, the present report is the first case in which the pathological examination detected the bleeding mechanism of this rare condition, showing destruction of the feeders by the metastatic tumor.

A 61-year-old man who had had a tumor shadow in the right middle lung field identified at a medical examination 5 weeks previously had suddenly experienced a disturbance of consciousness. Head computed tomography and computed tomography angiography revealed a right occipital subcortical hemorrhage with abnormal vessels, suggesting a ruptured AVM. Magnetic resonance imaging with gadolinium-based contrast agents did not show any other lesions. Cerebral angiography revealed a Spetzler-Martin grade III AVM in the right occipital lobe. Endovascular feeder embolization and subsequent removal of the AVM were performed. Histopathological examination of the resected mass showed a small cell carcinoma that had metastasized to the AVM. The tumor cells had infiltrated to the vessel walls of the feeders, which might have elicited the bleeding.

Although rare, clinicians should recognize that undifferentiated carcinomas can metastasize to AVMs and cause bleeding. Because the preoperative diagnosis can be difficult, even using the latest imaging modalities, careful examination of the resected specimen is required to reveal such pathological conditions.
Although rare, clinicians should recognize that undifferentiated carcinomas can metastasize to AVMs and cause bleeding. Because the preoperative diagnosis can be difficult, even using the latest imaging modalities, careful examination of the resected specimen is required to reveal such pathological conditions.
Radiographic nonunion rates in the literature for posterolateral lumbar fusions with pedicle screws (PLFs) range from 8.1% to 43.3% but may not represent nonunion rates. https://www.selleckchem.com/products/ml349.html A few small studies have reported reoperations for symptomatic nonunions (operative nonunions) to range from 3.2% to 13.9%. The objective of this study is to determine operative nonunion rates for 1-level, 2-level, 3-level, and ≥4-level PLFs and to determine the risks for these nonunions.

A retrospective cohort study, using data from the Kaiser Permanente Spine Registry, identified adult patients (≥18 years old) who underwent PLFs for degenerative disc disease. Multivariable Cox proportional hazards regression and Kaplan-Meier survival estimates using the log-rank statistic were used to evaluate operative nonunion rates.

The cohort consisted of 2591 patients with single-level and multilevel PLFs with mean follow-up of 4.6 years, time to operative nonunion of 1.52 years, and 2-year operative nonunion rate of 1.08%. Compared with single-level fusions, patients with 3-level and ≥4-level fusion had 2.8 and 3.7 times higher risk of operative nonunions. Patients with PLFs involving L5-S1 had 2.5 times the risk of an operative nonunion compared with those without.

Our study reports results from one of the largest cohort of patients for the first time with single-level and multilevel instrumented PLFs and found a 2-year operative nonunion rate of 1.08% with increased risk of nonunion for constructs that included L5-S1 and ≥3-level fusions. Operative nonunion combines clinical and radiographic data and provides an alternative measure of fusion rates.
Our study reports results from one of the largest cohort of patients for the first time with single-level and multilevel instrumented PLFs and found a 2-year operative nonunion rate of 1.08% with increased risk of nonunion for constructs that included L5-S1 and ≥3-level fusions. Operative nonunion combines clinical and radiographic data and provides an alternative measure of fusion rates.
The aim of the study was to evaluate the effect of systemically administrated curcumin on the prevention of peridural fibrotic tissue and adhesion formation in a rat laminectomy model.

Thirty-two Wistar albino rats were randomly selected and equally divided into 4 groups as follows negative control group (group I) did not undergo operation; positive control group (group II) underwent laminectomy without treatment; group III (low-dose curcumin; 100 mg/kg); and group IV (high-dose curcumin; 200 mg/kg). link2 Curcumin was administered intraperitoneally per day for 7 days after surgery starting from day 0. Twenty-eight days after surgery, T12 and L4 vertebral columns, paraspinal tissues, and epidural scar tissue were dissected en bloc and prepared for histopathologic examinations. All specimens were examined for inflammation, epidural fibrosis (EF), foreign body reaction, medulla spinalis retraction, granulation tissue, and arachnoid involvement. A Kruskal-Wallis test followed by a Dunn multiple comparison test wer Our results suggest that antiinflammatory activities of curcumin are beneficial for attenuation of EF formation.
Heterotopic ossification (HO) is a potential and severe complication of cervical disc replacement (CDR). However, the underlying mechanism of CDR and its association with preoperative disc height loss (DHL) and postoperative degree of distraction remain unclear. We hypothesized that DHL and postoperative degree of distraction could predict HO after CDR.

Data were obtained from 127 patients who underwent single-level CDR with a minimum follow-up of 2 years. DHL and adjusted degree of distraction (ADD) were obtained from lateral radiographs, and HO was evaluated at the last follow-up appointment. Receiver operating characteristic curves were calculated to verify the diagnostic value of DHL and ADD in predicting HO.

Both DHL and ADD were significantly larger in the HO group than in the non-HO group (P < 0.05). DHL ≥24.97% increased the risk of HO by 5 times (P= 0.003, 95% confidence interval 1.62-15.49), and ADD ≥36.67% increased the risk of HO by 3.87 times (P < 0.001, 95% confidence interval 1.81-8.27). A combined DHL and ADD (combined parameter) cutoff of 60.36 had a sensitivity of 87.18%, specificity of 67.35%, and area under the curve of 0.77 for predicting HO.

DHL and ADD are associated with the development of HO after CDR. The cutoff value of DHL may narrow the criteria for CDR with the aim of reducing HO formation. The combined parameter may help surgeons to select the most suitable implant height to reduce the prevalence of HO.
DHL and ADD are associated with the development of HO after CDR. The cutoff value of DHL may narrow the criteria for CDR with the aim of reducing HO formation. The combined parameter may help surgeons to select the most suitable implant height to reduce the prevalence of HO.
We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials from January 1980 to April 2018 for adolescents with mild traumatic brain injury (mTBI) to explore the value of aerobic exercise in sport-related concussion (SRC) and mTBI treatment.

A meta-analysis for the postconcussion symptom scale (PCSS) score and time to recovery was performed with STATA software.

We found that aerobic exercise versus usual treatment significantly decreased the PCSS score (weighted mean difference= 6.51, 95% confidence interval 0.29, 12.72; P= 0.040), as well as the time to recovery (weighted mean difference=-3.87; 95% confidence interval-6.50,-1.23; P= 0.004). However, aerobic exercise showed no significant improvement in immediate postconcussion assessment and cognitive testing (P= 0.471/0.129/0.648/0.800, respectively, in verbal memory, visual memory, visual motor speed, and reaction time).

Compared with usual treatment, aerobic exercise promoted mTBI adolescents' recovery, assessed by PCSS and time to recovery. However, aerobic exercise may not help with neurocognitive function recovery.
Compared with usual treatment, aerobic exercise promoted mTBI adolescents' recovery, assessed by PCSS and time to recovery. However, aerobic exercise may not help with neurocognitive function recovery.
Three-dimensional (3D) printing has emerged as a visualization tool for clinicians and patients. link3 We sought to use patient-specific 3D-printed anatomic modeling for preoperative planning and live intraoperative guidance in a series of complex primary spine tumors.

Over 9 months, patients referred to a single neurosurgical provider for complex primary spinal column tumors were included. Most recent spinal magnetic resonance and computed tomography (CT) imaging were semiautomatically segmented for relevant anatomy and models were printed using polyjet multicolor printing technology. Models were available to surgical teams before and during the operative procedure. Patients also viewed the models preoperatively during surgeon explanation of disease and surgical plan to aid in their understanding.

Tumor models were prepared for 9 patients, including 4 with chordomas, 2 with schwannomas, 1 with osteosarcoma, 1 with chondrosarcoma, and 1 with Ewing-like sarcoma. Mean age was 50.7 years (range, 15-82 years), including 6 males and 3 females. Mean tumor volume was 129.6 cm
(range, 3.3-250.0 cm
). Lesions were located at cervical, thoracic, and sacral levels and were treated by various surgical approaches. Models were intraoperatively used as patient-specific anatomic references throughout 7 cases and were found to be technically useful by the surgical teams.

We present the largest case series of 3D-printed spine tumor models reported to date. 3D-printed models are broadly useful for operative planning and intraoperative guidance in spinal oncology surgery.
We present the largest case series of 3D-printed spine tumor models reported to date. 3D-printed models are broadly useful for operative planning and intraoperative guidance in spinal oncology surgery.
Achieving optimal brain relaxation is paramount in aneurysm surgery. Despite proper positioning and the use of newer anesthetic drugs and the administration of decongestants, it is often not possible to achieve satisfactory relaxation, which can lead to neurological deficits owing to excessive brain retraction. The present study aimed to provide detailed surgical notes regarding the novel technique of temporal horn tapping for intraoperative ventriculostomy.

The hospital records of anterior circulation aneurysm surgery performed during the previous 5 years were retrieved. Only those cases in which we had used temporal horn tapping were included. Ventriculostomy was performed only in those cases in which the brain was tense despite the administration of decongestants. A small corticectomy was performed over the middle temporal gyrus and deepened to access the temporal horn.

This technique was used in 84 surgical cases. The mean patient age was 52.8 years. The male/female ratio was 11.4. Anterior communicmplications such as retraction contusions and resultant cerebral edema.
Central nervous system involvement is commonly seen in patients with human immunodeficiency virus (HIV) infection, with up to 2%-10% of patients presenting with intracranial mass lesions. The management of these lesions depends largely on their etiology and their relative frequency in the local population.

We performed a retrospective chart review of patients with HIV and evidence of intracranial mass lesions on cranial magnetic resonance imaging or computed tomography from 2007 to 2018. Demographic data, clinical features, etiology, surgical management, and outcomes were collected.

The prevalence of intracranial mass lesions in our cohort was 2.2% (45/2032). Patients were predominantly male (98%), with a mean age at diagnosis of 28 years. The most common clinical manifestations were headache (75%), focal weakness (49%), and seizures (32%). The most common diagnoses were toxoplasmic encephalitis (51%) and tuberculosis (24%). Biopsy or excision was performed in 10% of cases, leading to a definitive diagnosis in 60% of these cases.
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