Miracle-dz/UniFAR-FTUs huggingface dataset:
Incidence and Prevention of Intervertebral Cage Overhang With Minimally Invasive Lateral Approach Fusions

Study Design. Radiographic review. Objective. To evaluate the incidence and degree of cage overhang in minimally invasive spinal (MIS) fusions, when using either the direct lateral interbody fusion (DLIF) or extreme lateral interbody fusion (XLIF) techniques. Summary of Background Data. Among the difficulties surgeons face during a MIS lateral interbody fusion is to assess the proper placement of the cage without the use of direct visualization. Determining the proper length of the cage using AP view fluoroscopy can be misleading. As the axial profile of the vertebral body is oval, inserting the cage anterior or posterior to the maximal width point requires adjustment of the cage's length. Methods. The incidence and degree of cage overhang were measured using magnetic resonance imaging (MRI) and computed tomography (CT) studies from patients that underwent a MIS lateral interbody fusion. To determine the adjustment needed when the cage is inserted at various sagittal sites, the coronal spans of normal vertebral endplates were measured. Results. Forty-five percent of the cages were placed in the central portion, 34% were located in the anterior 1/3, and 7% were located in the posterior 1/3 of the disc space. Of the anterior positioned cages, 45% were found to be overhanging outside of the boundaries of the intervertebral disc space. The average measured lateral protrusion was 7.8 ± 3.6 mm, and anterior protrusion was 9.8 ± 3.3 mm. The vertebral body width measured 41.7 ± 6 mm at the anterior 1/3, 50 ± 4 mm at the mid, and 49 ± 1 mm at the posterior 1/3. Compared with the midvertebral width, the vertebral body width at the anterior 1/3 was decreased by 16.5% ± 0.9% (P < 0.05). Conclusion. The risk of placing an excessively long cage, when the insertion site is located in the anterior 1/3 of the disc, is relatively high, when performing MIS lateral approach interbody fusions. When using an anterior entry point for the insertion of the cage, choosing a 15% shorter cage length compared with that measured on the AP should prevent anterolateral protrusion of the cage.
Nutritional practices associated with low energy availability in Division I female soccer players

Abstract The purpose of this study was to examine macronutrient intake, energy density and energy intake distribution that may be associated with low energy availability (EA) in Division I female soccer players. The energy intake, exercise energy expenditure and EA of 19 participants (18–21 years) was assessed during the pre-, mid- and postseasons. Repeated measures analysis of variance was performed to examine the changes across the season. Chi-square analysis was performed to examine the distribution of participants meeting the American College of Sports Medicine recommendations for carbohydrate and protein consumption. Independent t-tests were used to compare differences between groups. The proportion of athletes who did not meet the American College of Sports Medicine recommendations for carbohydrate intake (6–10 g . kg–1 BW) was significantly greater in the low (<30 kcal . kg–1 LBM) than higher (≥30 kcal . kg–1 LBM) EA group (χ2 (1) = 7.5; P = 0.006). Participants with low compared to higher EA consumed a lower energy dense dinner (0.8 ± 0.1 vs. 1.4 ± 0.1 kcal . g–1; P = 0.004) after a soccer match during midseason. No differences in the percentage (%) of kilocalories from food (84.5 ± 2.0% vs. 84.7 ± 2.6%), sports drinks (7.3 ± 1.4% vs. 6.0 ± 3.2%), other drinks (7.6 ± 1.5 % vs. 6.0 ± 1.5%) or bars/gels/beans (1.7 ± 0.6 vs. 3.0 ± 1.5) were observed in participants with low compared to higher EA (P > 0.05) during the pre- and midseasons. Identifying inadequate carbohydrate intake and the practice of consuming lower energy dense meals may be important in preventing low EA conditions and consequently the Female Athlete Triad.
Differential changes in axonal conduction following CNS demyelination in two mouse models

Transgenic and disease model mice have been used to investigate the molecular mechanisms of demyelinating diseases. However, less attention has been given to elucidating changes in nerve conduction in these mice. We established an experimental system to measure the response latency of cortical neurons and examined changes in nerve conduction in cuprizone‐induced demyelinating mice and in myelin basic protein‐deficient shiverer mice. Stimulating and recording electrodes were placed in the right and left sensori‐motor cortices, respectively. Electrical stimulation of the right cortex evoked antidromic responses in left cortical neurons with a latency of 9.38 ± 0.31 ms (n = 107; mean ± SEM). While response latency was longer in mice at 7 days and 4 weeks of cuprizone treatment (12.35 ± 0.35 ms, n = 102; 11.72 ± 0.29 ms, n = 103, respectively), response latency at 7 days and 4 weeks after removal of cuprizone was partially restored (10.72 ± 0.45 ms, n = 106; 10.27 ± 0.34 ms, n = 107, respectively). Likewise, electron microscopy showed cuprizone‐induced demyelination in the corpus callosum and nearly complete remyelination after cuprizone removal. We also examined whether the myelin abnormalities in shiverer mice affected their response latencies. But there were no significant differences in response latencies in shiverer (9.83 ± 0.24 ms, n = 103) and wild‐type (9.33 ± 0.22 ms, n = 112) mice. The results of these electrophysiological assessments imply that different demyelinating mechanisms, differentially affecting axon conduction, are present in the cuprizone‐treated and shiverer mice, and may provide new insights to understanding the pathophysiology of demyelination in animal models in the CNS.
Effect of custom-made and prefabricated insoles on plantar loading parameters during running with and without fatigue

Abstract Controversy exists whether custom-made insoles are more effective in reducing plantar loading compared to prefabricated insoles. Forty recreational athletes ran using custom-made, prefabricated, and the original insoles of their running shoes, at rest and after a fatigue run. Contact time, stride rate, and plantar loading parameters were measured. Neither the insole conditions nor the fatigue state modified contact time and stride rate. Addressing prevention of running injuries, post-fatigue loading values are of great interest. Custom-made insoles reduced the post-fatigue loading under the hallux (92 vs. 130 kPa, P < 0.05), medial midfoot (70 vs. 105 kPa, P < 0.01), and lateral midfoot (62 vs 96 kPa, P < 0.01). Prefabricated insoles provoked reductions in post-fatigue loading under the toes (120 vs. 175 kPa, P < 0.05), medial midfoot (71 vs. 105 kPa, P < 0.01), and lateral midfoot (68 vs. 96 kPa, P < 0.01). Regarding both study insoles, custom-made insoles reduced by 31% and 54% plantar loading under the medial and lateral heel compared to the prefabricated insoles. Finally, fatigue state did not influence plantar loading regardless the insole condition. In long-distance races, even a slight reduction in plantar loading at each foot strike may suppose a significant decrease in the overall stress experienced by the foot, and therefore the use of insoles may be an important protective mechanism for plantar overloading.
Return to play management after concussion in football: recommendations for team physicians

Abstract A concussion is a rare but potentially serious injury of football players. Thus, an immediate and valid diagnosis, estimate of severity and therapeutic management is required. To summarise the published information on management of concussion with respect to a safe return to play (RTP), a literature search was conducted. Current guidelines on concussion in sports and significant studies on concussion in football were analysed. After concussion, management and RTP decision should remain in the area of clinical judgement on an individualised basis according to the current international guidelines. If a concussion is suspected, the player should not be allowed to RTP the same day. The RTP programme should follow a gradual step-wise procedure. A concussed player should not RTP unless he/she is asymptomatic and the neurological and neuropsychological examinations are normal. Untimely RTP bears an increased risk of sustaining another more severe brain injury and repetitive brain injury of long-term sequelae. In football, the management of concussion should primarily follow the recommendations proposed by the Concussion in Sports Group. Information and education of players and their medical and coaching team help to protect the players’ health. Future studies on concussion should include validated and detailed information on RTP protocols.
RAGE blockade and hepatic microcirculation in experimental endotoxaemic liver failure

Activation of the receptor for advanced glycation endproducts (RAGE) causes sustained activation of multiple inflammatory pathways. Therefore, RAGE has potential as a new therapeutic target in sepsis. The aim of this study was to analyse whether RAGE blockade in vivo prevents microcirculatory dysfunction and subsequent tissue injury in endotoxaemic liver failure.
Effects of Bilateral Carotid Artery Ligation on Brain Metabolism in Spontaneously Hypertensive and Normotensive Rats

Bilateral carotid artery ligation may cause the more severe hemodynamic changes in SHR than in NR, resulting in cerebral ischemic damage to be pronounced in the former rats. The lower limit of cerebral autoregulation shifted to the higher level is necessary to explain the mechanism of hemodynamic crisis following carotid occlusion in SHR.
The H‐current secures action potential transmission at high frequencies in rat cerebellar parallel fibers

Most axons in the mammalian brain are unmyelinated and thin with pre‐synaptic specializations (boutons) along their entire paths. The parallel fibers in the cerebellum are examples of such axons. Unlike most thin axons they have only one branch point. The granule cell soma, where they originate, can fire bursts of action potentials with spike intervals of about 2 ms. An important question is whether the axons are able to propagate spikes with similarly short intervals. By using extracellular single‐unit and population‐recording methods we showed that parallel fibers faithfully conduct spikes at high frequencies over long distances. However, when adding 20 μm ZD7288 or 1 mm Cs+, or reducing the temperature from 35 to 24°C, the action potentials often failed even when successfully initiated. Ba2+(1 mm), which blocks Kir channels, did not reproduce these effects. The conduction velocity was reduced by ZD7288 but not by Ba2+. This suggests that the parallel fibers have an H‐current that is active at rest and that is important for their frequency‐following properties. Interestingly, failures occurred only when the action potential had to traverse the axonal branch point, suggesting that the branch point is the weakest point in these axons.
Age-Related Variation in Cell Density of Human Lumbar Intervertebral Disc

Study Design. Changes in cell density of endplate (EP), nucleus pulposus (NP), and anulus fibrosus (AF) during ageing were systematically investigated in defined regions of interest in complete human motion segments. Objectives. To elucidate cell density and total cell number in distinct anatomic regions of the intervertebral disc; to test effects of gender, level and age on cell density; and to correlate changes in cell density with histologic signs of disc degeneration. Summary of Background Data. The available information on the cell density within intervertebral discs and its age-related changes is sparse. This knowledge, however, is a crucial prerequisite for cell-based tissue engineering approaches of the intervertebral disc. Methods. In 49 complete cross-sections from lumbar motion segments (newborn to 86 years) from 22 specimens, cell density was determined by the Abercrombie method in EP, NP, and AF, and total cell number was counted per region of interest. Results. Cell density in EP, NP, and AF decreased significantly from 0 to 16 years with the main changes occuring from 0 to 3 years for NP and AF. No significant variations were observed thereafter. We found a significant correlation of cell density and histologic degeneration score between 0 and 1, but not for scores >1. Gender and disc level did not influence cell density. Conclusion. This study provides data concerning the total number of cells in the various regions of the intervertebral disc for different age groups. This knowledge will be beneficial for cell-based treatment approaches, which may evolve in the future.
Perceptual stability during dramatic changes in olfactory bulb activation maps and dramatic declines in activation amplitudes

We compared the concentration dependence of the ability of rats to identify odorants with the calcium signals in the nerve terminals of the olfactory receptor neurons. Although identification performance decreased with concentrations both above and below the training stimuli it remained well above random at all concentrations tested (between 0.0006% and 35% of saturated vapor). In contrast, the calcium signals in the same awake animals were much smaller than their maximum values at odorant concentrations <1% of saturated vapor. In addition, maps of activated glomeruli changed dramatically as odorant concentration was reduced. Thus perceptual stability exists in the face of dramatic changes in both the amplitude and the maps of the input to the olfactory bulb. The data for the concentration dependence of the response of the most sensitive glomeruli for each of five odorants was fitted with a Michaelis–Menten (Hill) equation. The fitted curves were extrapolated to odorant concentrations several orders of magnitude lower the smallest observed signals and suggest that the calcium response at low odorant concentrations is > 1000 times smaller than the response at saturating odorant concentrations. We speculate that only a few spikes in olfactory sensory neurons may be sufficient for correct odorant identification.
Surgical Versus Nonsurgical Treatment of Selected Patients With Discogenic Low Back Pain: A Small-Sized Randomized Trial

Low back pain (LBP) is a common clinical problem and is of major socioeconomic importance. Although any of the spinal structures (intervertebral discs, facet joints, vertebral bodies, ligaments, and muscles) may be a source of LBP, the most likely cause is a lumbar intervertebral disc.1–3 Many autho
Spatial attention can modulate audiovisual integration at multiple cortical and subcortical sites

The role of attention in multisensory integration (MI) is presently uncertain, with some studies supporting an automatic, pre‐attentive process and others suggesting possible modulation through selective attention. The goal of this functional magnetic resonance imaging study was to investigate the role of spatial attention on the processing of congruent audiovisual speech stimuli (here indexing MI). Subjects were presented with two simultaneous visual streams (speaking lips in the left and right visual hemifields) plus a single central audio stream (spoken words). In the selective attention conditions, the auditory stream was congruent with one of the two visual streams. Subjects attended to either the congruent or the incongruent visual stream, allowing the comparison of brain activity for attended vs. unattended MI while the amount of multisensory information in the environment and the overall attentional requirements were held constant. Meridian mapping and a lateralized ‘speaking‐lips’ localizer were used to identify early visual areas and to localize regions responding to contralateral visual stimulations. Results showed that attention to the congruent audiovisual stimulus resulted in increased activation in the superior temporal sulcus, striate and extrastriate retinotopic visual cortex, and superior colliculus. These findings demonstrate that audiovisual integration and spatial attention jointly interact to influence activity in an extensive network of brain areas, including associative regions, early sensory‐specific visual cortex and subcortical structures that together contribute to the perception of a fused audiovisual percept.
Molecular diversity of deep short‐axon cells of the rat main olfactory bulb

Local circuit GABAergic interneurons comprise the most diverse cell populations of neuronal networks. Interneurons have been characterized and categorized based on their axo‐somato‐dendritic morphologies, neurochemical content, intrinsic electrical properties and their firing in relation to in‐vivo population activity. Great advances in our understanding of their roles have been facilitated by their selective identification. Recently, we have described three major subtypes of deep short‐axon cells (dSACs) of the main olfactory bulb (MOB) based on their axo‐dendritic distributions and synaptic connectivity. Here, we investigated whether dSACs also display pronounced molecular diversity and whether distinct dSAC subtypes selectively express certain molecules. Multiple immunofluorescent labeling revealed that the most commonly used molecular markers of dSACs (e.g. vasoactive intestinal polypeptide, calbindin and nitric oxide synthase) label only very small subpopulations (< 7%). In contrast, voltage‐gated potassium channel subunits Kv2.1, Kv3.1b, Kv4.3 and the GABAA receptor α1 subunit are present in 70–95% of dSACs without showing any dSAC subtype‐selective expression. However, metabotropic glutamate receptor type 1α mainly labels dSACs that project to the glomerular layer (GL‐dSAC subtype) and comprise ∼20% of the total dSAC population. Analysing these molecular markers with stereological methods, we estimated the total number of dSACs in the entire MOB to be ∼13 500, which is around a quarter of the number of mitral cells. Our results demonstrate a large molecular heterogeneity of dSACs and reveal a unique neurochemical marker for one dSAC subtype. Based on our results, dSAC subtype‐specific genetic modifications will allow us to decipher the role of GL‐dSACs in shaping the dynamic activity of the MOB network.
CONTINUOUS SUBARACHNOID DRAINAGE FOR MENINGITIS BY MEANS OF A URETERAL CATHETER

Repeated spinal drainage has proved advantageous in the treatment of meningitis. It occurred to me that the discomfort of repeated lumbar and cisternal punctures could be avoided by introducing a ureteral catheter, through a specially constructed spinal cannula, into the subarachnoid space and leaving the catheter in place for continuous drainage. For several years, in the neurosurgical service at the Mayo Clinic, a ureteral catheter frequently has been introduced into one of the lateral ventricles, either to secure gradual decompression in cases of internal hydrocephalus or to control the increased intracranial pressure associated with hydrocephalus, of patients who had inoperable neoplasms of the brain, while they were undergoing roentgen therapy. The ureteral catheter is threaded through a flanged ventricular cannula, previously introduced into the ventricle, with its obturator, through a burr hole placed over the posterior horn of one of the lateral ventricles. The ventricles tolerate well the presence of a ureteral
2010 Young Investigator Award Winner: Therapeutic Aprotinin Stimulates Osteoblast Proliferation but Inhibits Differentiation and Bone Matrix Mineralization

Study Design. Analysis of the effect of antifibrinolytics on in vitro bone formation. Objective. As the direct effect of antifibrinolytics on bone formation is unknown, we examined whether antifibrinolytics routinely used in spine surgery, namely, aprotinin and aminocaproic acid, affect osteoblast function in vitro. Summary of Background Data. Antifibrinolytics are used in spine surgery to prevent intraoperative blood loss and decrease the need for transfusion. They are either delivered systemically or included as a component of most tissue sealants. Although the role of the fibrinolytic system in wound healing is well established, reports of indirect effects on normal bone biology are emerging. This suggests that the pharmacological targeting of this system may also influence skeletal mass and integrity. Methods. Osteoblast progenitor cells were cultured with therapeutic doses of aprotinin and aminocaproic acid. The effect of the antifibrinolytics on osteoblast development was determined by measuring cellular viability and proliferation, quantification of matrix mineralization, and genetic analysis of osteoblast differentiation markers. Protease inhibition profiles of the antifibrinolytics were determined by amidolytic chromogenic assays. Results. Therapeutic concentrations of aprotinin dose-dependently inhibited plasmin's proteolytic activity, stimulated osteoblast proliferation, and inhibited osteoblast differentiation and matrix mineralization. Aprotinin inhibition of osteoblast differentiation and matrix mineralization could be recovered by removing aprotinin from culture or stimulating cells with bone morphogenetic protein-2 or plasmin. Conversely, aminocaproic acid inhibited plasmin's proteolytic activity significantly less than aprotinin and had no effect on osteoblast proliferation, differentiation, or matrix mineralization in its therapeutic range. Conclusion. These findings demonstrate that the antifibrinolytics have drastically different effects on osteoblasts due in part to different efficacies of protease inhibition. Further, this work suggests that the fibrinolytic proteases and their inhibitors have great potential to regulate bone by affecting the processes that control osteoblast growth and differentiation.
Robot-Assisted Anterior Lumbar Interbody Fusion in a Swine Model In Vivo Test of the da Vinci Surgical-Assisted Spinal Surgery System

Study Design. The use of the da Vinci Surgical System to perform an anterior lumbar interbody fusion in a swine model to identify the technical properties, processes, merits, demerits, and limitations of a video-assisted robotic surgical system. Objective. This study was designed to demonstrate the feasibility of using a robotic surgical system to perform spinal surgery. Summary of Background Data. Video-assisted laparoscopic anterior fusion was first reported in 1995 and afterward was spotlighted for several years. However, this technique has not become popular because of technical difficulties and complications associated with video-assisted procedures on the spine. As such, there is a demand for investigations to improve this technology. The da Vinci Surgical System provides 3-dimensional visualization as well as uniquely dexterous instruments that are remarkably similar to human hands. Video-assisted surgery with the da Vinci Surgical System robot has already provided great value to the fields of urology, cardiology, gynecology, and general surgery over the last decade. Preclinical studies for application of this system in spinal surgery have recently been conducted. Methods. A pig underwent anterior lumbar interbody fusion using da Vinci Surgical System assistance, with Tyche expandable cages used for preparation of endplates and cage placement. The setup time, operation time, amount of bleeding, and the number of complications associated with robotic manipulation were recorded. Before euthanasia, the animal underwent radiologic examination to confirm proper placement of cages. Results. The total duration of the procedure took 6 hours, with some complications related to frozen armsand robotic arm collision. Even so, there was neither any significant nerve or vessel injury nor peritoneal organ damage. Furthermore, radiologic assessment confirmed proper position of the cage in the center of the disc space. Conclusion. Use of the da Vinci Surgical System to perform an anterior spinal procedure was shown to be safe and effective in a swine animal model. The utilization of this advanced technology shows promise to reduce the incidence of complications compared with other approaches. It requires further testing in animal models and cadavers, along with serial comparisons to current procedures.