bluuebunny/crossref_metadata_2025 huggingface dataset:
DiVersity Matters: A Review of the Diversity Initiative of the Association of American Veterinary Medical Colleges
Authors: Greenhill Lisa M.
Published: January 2010

In 2004, the Association of American Veterinary Medical Colleges took the bold step of prioritizing diversity as a core value through the hiring of a full-time staff person. The organization then pressed forward in 2005 by launching a national plan devoted to increasing diversity in academic veterinary medicine. In the years since its inception, the DiVersity Matters initiative has overseen significant diversity changes in US colleges of veterinary medicine. Dedicated diversity programming can have a positive impact on academic veterinary medicine and the larger veterinary profession. This paper provides an overview of DiVersity Matters since its 2005 launch and how the initiative is evolving under the Association of American Veterinary Medical Colleges' Strategic Plan.
Increasing Minorities in Veterinary Medicine: National Trends in Science Degrees, Local Programs, and Strategies
Authors: Chubin Daryl E. , Mohamed Sabira
Published: January 2010

An “outsider” analysis of veterinary medicine in the context of national participation trends in science, technology, engineering, and mathematics suggests research to explain why students gravitate—or not—to the discipline and how the future of the profession may turn on the composition of the veterinary medicine faculty. Interventions to effect change in a range of classroom and institutional practices will determine the competitive advantage of the discipline relative to other health professions.
A Public-Policy Practicum to Address Current Issues in Human, Animal, and Ecosystem Health
Authors: Herrmann John A. , Johnson Yvette J. , Troutt H. Fred , Prudhomme Thomas
Published: January 2010

There are recognized needs for cross-training health professionals in human, animal, and ecosystem health and for public health policy to be informed by experts from medical, science, and social science disciplines. Faculty members of the Community Health and Preventive Medicine Section at the University of Illinois at Urbana-Champaign, College of Veterinary Medicine, and the Institute of Government and Public Affairs, University of Illinois at Urbana-Champaign, have offered a public-policy course designed to meet those needs. The course was designed as a practicum to teach students the policy-making process through the development of policy proposals and to instruct students on how to effectively present accurate scientific, demographic, and statistical information to policy makers and to the public. All students substantially met the learning objectives of the course. This course represents another model that can be implemented to help students learn about complex, multifactorial issues that affect the health of humans, animals, and ecosystems, while promoting participation in public health policy development.
Undergraduate Veterinary Students' Perceptions of the Usefulness, Focus, and Application of Epidemiology Before and After Epidemiology Courses
Authors: Toribio Jenny-Ann L.M.L. , Morton John M. , Morton Jeanette M.
Published: January 2010

Student perception of the relevance of a topic is known to influence learning outcomes. To determine student perceptions of the usefulness, focus, and application of epidemiology, we conducted a study at two Australian veterinary schools in 2005. Veterinary students in year 3 at the University of Sydney and in year 5 at the University of Queensland completed a self-administered questionnaire at the commencement and conclusion of an epidemiology course. At both universities, while over 95% of students considered epidemiology to be “essential” or “quite useful” in cattle and sheep practice and in government practice, at the course end between 10% and 30% of students still did not consider epidemiology to be “essential” or “quite useful” in small-animal or equine practice. However, the percentage of students who considered that all veterinary work involved the application of epidemiological principles increased from 7% at course start to 15% at course end at the University of Sydney (p=0.188), and from 3% to 25% at the University of Queensland (p<0.001). The results indicate that, although some veterinary students, even at completion of an epidemiology course, still do not link epidemiology with an evidence-based medicine approach to patient care, undergraduate courses can positively change student perception of the usefulness, focus, and application of epidemiology. These findings will be used to refine the epidemiology courses analyzed to improve the learning outcomes of our students.
Evaluation of Radiographic Interpretation Competence of Veterinary Students in Finland
Authors: Koskinen Heli I. , Snellman Marjatta
Published: January 2010

In the evaluation of the clinical competence of veterinary students, many different definitions and methods are approved. Due to the increasing discussion of the quality of outcomes produced by newly graduated veterinarians, methods for the evaluation of clinical competencies should also be evaluated. In this study, this was done by comparing two qualitative evaluation schemes: the well-known structure of observed learning outcome (SOLO) taxonomy and a modification of this taxonomy. A case-based final radiologic examination was selected and the investigation was performed by classifying students' outcomes. These classes were finally put next to original (quantitative) scores and the statistical calculations were initiated. Significant correlations between taxonomies (0.53) and the modified taxonomy and original scores (0.66) were found and some qualitative similarities between evaluation methods were observed. In addition, some supplements were recommended for the structure of evaluation schemes, especially for the structure of the modified SOLO taxonomy.
Genetic association studies in patients with traumatic brain injury
Authors: Dardiotis Efthimios , Fountas Kostas N. , Dardioti Maria , Xiromerisiou Georgia , Kapsalaki Eftychia , Tasiou Anastasia , Hadjigeorgiou Georgios M.
Published: December 2009

Traumatic brain injury (TBI) constitutes a major cause of mortality and disability worldwide, especially among young individuals. It is estimated that despite all the recent advances in the management of TBI, approximately half of the patients suffering head injuries still have unfavorable outcomes, which represents a substantial health care, social, and economic burden to societies.

Considerable variability exists in the clinical outcome after TBI, which is only partially explained by known factors. Accumulating evidence has implicated various genetic elements in the pathophysiology of brain trauma. The extent of brain injury after TBI seems to be modulated to some degree by genetic variants.

The authors' current review focuses on the up-to-date state of knowledge regarding genetic association studies in patients sustaining TBI, with particular emphasis on the mechanisms underlying the implication of genes in the pathophysiology of TBI.
Genetic basis of Parkinson disease
Authors: Xiromerisiou Georgia , Dardiotis Efthimios , Tsimourtou Vaïa , Kountra Persa Maria , Paterakis Konstantinos N. , Kapsalaki Eftychia Z. , Fountas Kostas N. , Hadjigeorgiou Georgios M.
Published: December 2009

Over the past few years, considerable progress has been made in understanding the molecular mechanisms of Parkinson disease (PD). Mutations in certain genes are found to cause monogenic forms of the disorder, with autosomal dominant or autosomal recessive inheritance. These genes include alpha-synuclein, parkin, PINK1, DJ-1, LRRK2, and ATP13A2. The monogenic variants are important tools in identifying cellular pathways that shed light on the pathogenesis of this disease. Certain common genetic variants are also likely to modulate the risk of PD. International collaborative studies and meta-analyses have identified common variants as genetic susceptibility risk/protective factors for sporadic PD.
Elucidating novel mechanisms of brain injury following subarachnoid hemorrhage: an emerging role for neuroproteomics
Authors: King Melanie D. , Laird Melissa D. , Ramesh Sangeetha Sukumari , Youssef Patrick , Shakir Basheer , Vender John R. , Alleyne Cargill H. , Dhandapani Krishnan M.
Published: December 2009

Subarachnoid hemorrhage (SAH) is a devastating neurological injury associated with significant patient morbidity and death. Since the first demonstration of cerebral vasospasm nearly 60 years ago, the preponderance of research has focused on strategies to limit arterial narrowing and delayed cerebral ischemia following SAH. However, recent clinical and preclinical data indicate a functional dissociation between cerebral vasospasm and neurological outcome, signaling the need for a paradigm shift in the study of brain injury following SAH. Early brain injury may contribute to poor outcome and early death following SAH. However, elucidation of the complex cellular mechanisms underlying early brain injury remains a major challenge. The advent of modern neuroproteomics has rapidly advanced scientific discovery by allowing proteome-wide screening in an objective, nonbiased manner, providing novel mechanisms of brain physiology and injury. In the context of neurosurgery, proteomic analysis of patient-derived CSF will permit the identification of biomarkers and/or novel drug targets that may not be intuitively linked with any particular disease. In the present report, the authors discuss the utility of neuroproteomics with a focus on the roles for this technology in understanding SAH. The authors also provide data from our laboratory that identifies high-mobility group box protein-1 as a potential biomarker of neurological outcome following SAH in humans.
Symptomatic ectopic bone formation after off-label use of recombinant human bone morphogenetic protein-2 in transforaminal lumbar interbody fusion
Authors: Chen Nan-Fu , Smith Zachary A. , Stiner Eric , Armin Sean , Sheikh Hormoz , Khoo Larry T.
Published: December 2009

Object

Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been approved for use in the lumbar spine in conjunction with the lumbar tapered cage. However, off-label use of this osteoinductive agent is observed with anterior fusion applications as well as with both posterior lumbar interbody fusion and transforaminal lumbar interbody fusion (TLIF). Complications using rhBMP-2 in the cervical spine have been reported. Although radiographic evidence of ectopic bone in the lumbar spine has been described following rhBMP-2 use, this finding was not previously believed to be of clinical relevance.

Methods

This study was a retrospective review of 4 patients who underwent minimally invasive spinal TLIF (MIS-TLIF) in which bone fusion was augmented with rhBMP-2 applied to an absorbable collagen sponge. Case presentations, operative findings, imaging data, and follow-up findings were reviewed.

Results

Four cases with delayed symptomatic neural compression following the off-label use of rhBMP-2 with MIS-TLIF were identified.

Conclusions

Although previously believed to be only a radiographic finding, the development of ectopic bone following rhBMP-2 use in lumbar fusion can be clinically significant. This paper describes 4 cases of delayed neural compression following MIS-TLIF. The reader should be aware of this potential complication following the off-label use of rhBMP-2 in the lumbar spine.
Rosette-forming glioneuronal tumors of the posterior fossa
Authors: Shah Manish N. , Leonard Jeffrey R. , Perry Arie
Published: December 2009

Rosette-forming glioneuronal tumor (RGNT) of the fourth ventricle is a rare, recently described WHO Grade I neoplasm. The authors report 6 examples of RGNT arising primarily from the cerebellar vermis. All the patients were female, and the mean age of presentation was 24.8 years. The original diagnoses included pilocytic astrocytoma, ependymoma, cerebellar dysembryoplastic neuroepithelial tumor (DNT), and oligodendroglioma. The cases showed classic pathological characteristics, although in 2 cases the lesions included DNT-like “floating neurons” involving Purkinje cells, a feature which has not been previously reported to the authors' knowledge. The clinical outcome was excellent with no recurrences after complete resection. These cases expand the known clinical and histological spectrum of this rare tumor type. Given the lack of fourth ventricle involvement in most of these cases, the authors suggest revising the name to RGNT of the posterior fossa.
The transsphenoidal resection of pediatric craniopharyngiomas: a case series
Authors: Jane John A. , Prevedello Daniel M. , Alden Tord D. , Laws Edward R.
Published: December 2009

Object

The majority of pediatric craniopharyngiomas are treated using a transcranial approach. Although there is an increasing acceptance of transsphenoidal resection in adults, there are few reports describing this approach in the pediatric population. The purpose of this study is to report the outcomes after transsphenoidal surgery in a consecutive series of pediatric patients with craniopharyngiomas treated at a single institution with the goal of gross-total resection (GTR).

Methods

Twenty-three patients with pathologically proven craniopharyngiomas were identified who were 18 years of age or less at the time of surgery. The medical records and imaging studies of the patients were retrospectively reviewed. One patient who was lost to follow-up after surgery was excluded.

Results

Among the 22 patients included in the study, 11 underwent transsphenoidal surgery as the primary procedure and 11 underwent transsphenoidal surgery as a secondary procedure after a previous procedure. All patients had at least some sellar component to their tumor and all had either anterior or posterior pituitary dysfunction at presentation. In the entire cohort, a GTR was achieved in 15 (68%) of 22 patients, a radical subtotal resection in 4 (18%) of 22 patients, a subtotal resection in 1 patient, and a partial resection in 2 patients. The degree of resection was higher in the primary transsphenoidal group. After a mean follow-up of 82 months, 4 patients (18%) experienced recurrence. Recurrence occurred in 13% after GTR compared with 28.5% after all other degrees of resection. Tumor recurred in 9% of the primary transsphenoidal group and in 30% of patients who had undergone other therapies prior to the transsphenoidal operation. No patient who had panhypopituitarism experienced a gain of function postoperatively, 67% developed new panhypopituitarism, and 56% experienced new diabetes insipidus. Vision improved or normalized in 9 (64%) of 14 patients presenting with visual loss. Complications included 1 death 3 weeks postoperatively, 2 CSF leaks, and new obesity in 37%.

Conclusions

Transsphenoidal resection of pediatric craniopharyngiomas results in a high rate of both visual improvement and GTR with a low associated risk of recurrence. The transsphenoidal approach should be considered in selected pediatric patients with craniopharyngioma, especially those with infradiaphragmatic origin.
Subarachnoid dissemination of intraventricular tumors following simultaneous endoscopic biopsy and third ventriculostomy
Authors: Luther Neal , Stetler William R. , Dunkel Ira J. , Christos Paul J. , Wellons John C. , Souweidane Mark M.
Published: December 2009

Object

Endoscopic biopsy with concomitant third ventriculostomy (ETV) is a well-established diagnostic and therapeutic maneuver in patients presenting with noncommunicating hydrocephalus resulting from a tumor of the pineal region or posterior third ventricle. Fenestration of the floor of the third ventricle theoretically provides a conduit for the subarachnoid dissemination of an intraventricular tumor. The aim of this study was to ascertain the rate of leptomeningeal dissemination following this surgical procedure.

Methods

The authors conducted a review of all patients for whom an ETV and simultaneous endoscopic biopsy procedure or tumor resection had been performed at their institutions between 1995 and 2008. Patients were divided into high or low risk groups by leptomeningeal metastatic potential based on pathology. All available postoperative clinical and radiographic data, including MR imaging of the brain and spinal cord, as well as CSF sampling were evaluated when available. A review of the literature was then conducted to establish rates of distant leptomeningeal dissemination for comparative purposes.

Results

Thirty-two patients satisfied the criteria for study inclusion. Pathology revealed that 22 had a high risk for leptomeningeal dissemination. New leptomeningeal disease (1 yolk sac tumor and 1 pineoblastoma) occurred in 2 patients. The median clinical and brain MR imaging follow-ups overall were 34 (range 2–103 months) and 38 months (range 1–94 months), respectively. Follow-up MR imaging of the spine was performed in 12 patients (median 7 months postoperation), and CSF was analyzed in 15 patients (median 1 month postoperation). A Kaplan-Meier survival analysis predicted a 2-year metastasis-free survival of 94.7% for high-risk patients. Baseline rates of dissemination when ETV was not performed were in general between 8 and 24% for various high-risk pathologies according to a literature review.

Conclusions

The rate of leptomeningeal metastasis of tumors in this biopsy and ETV study was not increased when compared with rates from large series in the literature.
A safe approach to explore/identify the V2 segment of the vertebral artery during anterior approaches to cervical spine and/or arterial repairs: anatomical study
Authors: Nourbakhsh Ali , Yang Jinping , Gallagher Sean , Nanda Anil , Vannemreddy Prasad , Garges Kim J.
Published: December 2009

Object

The purpose of this study was to find a landmark according to which the surgeon can dissect the cervical spine safely, with the lowest possibility of damaging the vertebral artery (VA) during anterior approaches to the cervical spine or the VA.

Methods

The “safe zone” for each level of the cervical spine was described as an area where the surgeon can start from the midline in that zone and dissect the soft tissue laterally to end up on the transverse process and cross the VA while still on the transverse process. In other words, safe zone signifies the narrowest width of the transverse process at each level. In such an approach, the VA is protected from the inadvertent deep penetration of the instruments by the transverse process. The surgical safe zone for each level was the common area among at least 95% of the safe zones for that level. For the purpose of defining the upper and lower borders of the safe zone for each level, the line passing from the upper vertebral border perpendicular to the midline (upper vertebral border line) was used as a reference.

Cervical spines of 64 formalin-fixed cadavers were dissected. The soft tissue in front of the transverse process and intertransverse space was removed. Digital pictures of the specimens were taken before and after removal of the transverse processes, and the distance to the upper and lower border of the safe zone from the upper vertebral border line was measured on the digital pictures with Image J software. The VA diameter and distance from the midline at each level were also measured. To compare the means, the authors used t-test and ANOVA.

Results

The surgical safe zone lies between 1 mm above and 1 mm below the upper vertebral border at the fourth vertebra, 2 mm above and 1 mm below the upper vertebral border at the fifth vertebra, and 1 mm above and 2 mm below the upper vertebral border of the sixth vertebra. The VA was observed to be tortuous in 13% of the intertransverse spaces. There is a positive association between disc degeneration and tortuosity of the VA at each level (p < 0.001). The artery becomes closer to the midline (p < 0.001) and moves posteriorly during its ascent.

Conclusions

Dissection of the soft tissue off the bone along the surgical safe zone and removal of the transverse process afterward can be a practical and safe approach to avoid artery lacerations. The findings in the present study can be used in anterior approaches to the cervical spine, especially when the tortuosity of the artery mandates exposure of the VA prior to uncinate process resection, tumor excision, or VA repair.
Anterior fixation of odontoid fractures in an elderly population
Authors: Dailey Andrew T. , Hart David , Finn Michael A. , Schmidt Meic H. , Apfelbaum Ronald I.
Published: December 2009

Object

Fractures of the odontoid process are the most common fractures of the cervical spine in patients over the age of 70 years. The incidence of fracture nonunion in this population has been estimated to be 20-fold greater than that in patients under the age of 50 years if surgical stabilization is not used. Anterior and posterior approaches have both been advocated, with excellent results reported, but surgeons should understand the drawbacks of the various techniques before employing them in clinical practice.

Methods

A retrospective review was undertaken to identify patients who had direct fixation of an odontoid fracture at a single institution from 1991 to 2006. Patients were followed up using flexion-extension radiographs, and stability was evaluated as bone union, fibrous union, or nonunion. Patients with bone or fibrous union were classified as stable. In addition, the incidence of procedure- and nonprocedure-related complications was extracted from the medical record.

Results

Of the 57 patients over age 70 who underwent placement of an odontoid screw, 42 underwent follow-up from 3 to 62 months (mean 15 months). Stability was confirmed in 81% of these patients. In patients with fixation using 2 screws, 96% demonstrated stability on radiographs at final follow-up. Only 56% of patients with fixation using a single screw demonstrated stability on radiographs. In the immediate postoperative period, 25% of patients required a feeding tube and 19% had aspiration pneumonia that required antibiotic treatment.

Conclusions

Direct fixation of Type II odontoid fractures showed stability rates > 80% in this challenging population. Significantly higher stabilization rates were achieved when 2 screws were placed. The anterior approach was associated with a relatively high dysphagia rate, and patients must be counseled about this risk before surgery.
Meralgia paresthetica secondary to lipoma
Authors: Rau Cheng-Shyuan , Hsieh Ching-Hua , Liu Yueh-Wei , Wang Lin-Yi , Cheng Ming-Hsiung
Published: December 2009

Meralgia paresthetica (MP) consists of pain or dysthesia in the lateral thigh caused by entrapment of the lateral femoral cutaneous nerve (LFCN) underneath the inguinal ligament. The causes include iliac crest bone graft harvesting, seat belt injury associated with motor vehicle accident, diabetes mellitus, and trauma. The authors present the case of a 50-year-old woman who had a 1-year history of right-sided MP. The patient's history and the results of physical and radiological examinations were otherwise unremarkable except for the finding of a lipoma over the surface of the right sartorius muscle. Electrophysiological studies were interpreted as demonstrating peripheral neuropathy only. Conservative treatment, including heat or ice packing and local anesthetic and steroid injections, failed to control the patient's symptoms. Although sectioning or neurolysis of the LFCN appears to offer good-to-excellent results, the patient underwent excision of the lipoma. The symptoms resolved completely.

To the best of the authors' knowledge this is the first case of MP associated with compression caused by a lipoma. The authors conclude that lipoma compression can cause MP, and in such cases, total excision of the lipoma may resolve the condition.
Transoral robotic surgery of craniocervical junction and atlantoaxial spine: a cadaveric study
Authors: Lee John Y. K. , O'Malley Bert W. , Newman Jason G. , Weinstein Gregory S. , Lega Bradley , Diaz Jason , Grady M. Sean
Published: December 2009

Object

The goal of this study was to determine the potential role and current limitations of the da Vinci surgical robot in transoral decompression of craniocervical junction (CCJ).

Methods

The da Vinci Surgical System was used in 2 cadaver heads with neck and clavicles intact. Both neurosurgeons and otolaryngologists familiar with the open microscopic procedure, as well as the transoral robotic surgical procedure, undertook dissection and decompression of the CCJ.

Results

The robotic system provided superb illumination and 3D depth perception even several centimeters deep to the posterior oropharyngeal mucosa. The 30° endoscope improved cephalad visualization, eliminating the need to split the soft palate for exposure of the lower clivus. The “intuitive” nature of the da Vinci surgical robot arms provided an advantage in allowing the ability to suture the dura mater in a deep, dark corridor. Because visualization was excellent, tremor-free closure was possible.

Conclusions

The authors' findings suggest that transoral robotic surgery, with the da Vinci robot system, holds great potential for decompression of the CCJ as well as resection of both extra- and intradural tumors of this region. Further instrument development is necessary and continued investigation is warranted.
“Skip” corpectomy in the treatment of multilevel cervical spondylotic myelopathy and ossified posterior longitudinal ligament
Authors: Dalbayrak Sedat , Yilmaz Mesut , Naderi Sait
Published: December 2009

Object

The authors reviewed the results of “skip” corpectomy in 29 patients with multilevel cervical spondylotic myelopathy (CSM) and ossified posterior longitudinal ligament (OPLL).

Methods

The skip corpectomy technique, which is characterized by C-4 and C-6 corpectomy, C-5 osteophytectomy, and C-5 vertebral body preservation, was used for decompression in patients with multilevel CSM and OPLL. All patients underwent spinal fixation using C4–5 and C5–6 grafts, and anterior cervical plates were fixated at C-3, C-5, and C-7.

Results

The mean preoperative Japanese Orthopaedic Association score increased from 13.44 ± 2.81 to 16.16 ± 2.19 after surgery (p < 0.05). The cervical lordosis improved from 1.16 ± 11.74° to 14.36 ± 7.85° after surgery (p < 0.05). The complications included temporary hoarseness in 3 cases, dysphagia in 1 case, C-5 nerve palsy in 1 case, and C-7 screw pullout in 1 case. The mean follow-up was 23.2 months. The final plain radiographs showed improved cervical lordosis and fusion in all cases.

Conclusions

The authors conclude that the preservation of the C-5 vertebral body provided an additional screw purchase and strengthened the construct. The results of the current study demonstrated effectiveness and safety of the skip corpectomy in patients with multilevel CSM and OPLL.
Evidence that atypical juxtafacet cysts are joint derived
Authors: Spinner Robert J. , Hébert-Blouin Marie-Noëlle , Maus Timothy P. , Atkinson John L. D. , Desy Nicholas M. , Amrami Kimberly K.
Published: December 2009

Object

Juxtafacet cysts (JFCs) in usual locations have recently been shown to have joint connections. The pathogenesis of JFCs in unusual locations has remained obscure. The authors hypothesize that all JFCs, including atypical ones, are joint derived.

Methods

In this study the authors sought to explain the occurrence and formation of clinical outliers of spinal JFCs. In Part I, they performed an extensive literature search to identify case reports of spinal intraneural cysts that have been unappreciated despite the fact that they should occur. In Part II, they studied far-lateral (extraforaminal) cysts treated at their institution and reported in the literature. The presence of a joint connection was specifically looked for since this finding has not been widely appreciated.

Results

In Part I, 3 isolated case reports of spinal intraneural JFCs without reported joint connections were identified: 2 involving L-5 and 1, C-8. In Part II, 6 cases involving patients with far-lateral JFCs treated at the authors' institution were reviewed and all 6 had joint connections. Two of these cases had been previously published, although their joint connections were not appreciated. In 2 of the newly reported cases, arthrography confirmed a communication between the facet and the cyst. Only 1 of 5 cases in the literature had a recognized joint connection.

Conclusions

The authors believe that all JFCs are joint derived. This explanation for intraneural and extraneural JFCs in typical locations would be consistent with the unified articular (synovial) theory and the pathogenesis for intraneural and extraneural ganglion cyst formation in the limbs. Facet joints appear no different from other synovial joints occurring elsewhere. Understanding the pathogenesis of these cysts will help target treatment to the joint, improve surgical outcomes, and decrease recurrences.
Posterior decompression surgery for extraforaminal entrapment of the fifth lumbar spinal nerve at the lumbosacral junction
Authors: Matsumoto Morio , Watanabe Kota , Ishii Ken , Tsuji Takashi , Takaishi Hironari , Nakamura Masaya , Toyama Yoshiaki , Chiba Kazuhiro
Published: December 2009

Object

In this paper, the authors' goal was to elucidate the clinical features and results of decompression surgery for extraforaminal stenosis at the lumbosacral junction.

Methods

Twenty-eight patients with severe leg pain caused by extraforaminal stenosis at the lumbosacral junction (18 men and 10 women; mean age 68.2 ± 8.9 years) were treated by posterior decompression without fusion using a microendoscope in 19 patients and a surgical microscope or loupe in 9 patients. The decompression procedures consisted of partial resection of the sacral ala, the L-5 transverse process, and the L5–S1 facet joint along the L-5 spinal nerve. The following items were investigated: 1) preoperative neurological findings; 2) preoperative radiological findings, including plain radiographs, CT scans, selective radiculography of L-5; 3) surgical outcome as evaluated using the Japanese Orthopaedic Association scale for low-back pain (JOA score); and 4) need for revision surgery.

Results

All patients presented with neurological deficits compatible with a diagnosis of L-5 radiculopathy such as weakness of the extensor hallucis longus muscle and sensory disturbance in the L-5 area together with neurogenic claudication. On plain radiographs, 21 patients (75%) and 17 patients (60.7%) exhibited lumbar scoliosis (≥ 5°) and wedging of the L5–S1 intervertebral space (≥ 3°), respectively. The CT scans demonstrated marked osteophyte formation at the posterolateral margin of the L5–S1 vertebral bodies, and a selective L-5 nerve root block was effective in all patients. All patients reported pain relief immediately after surgery. The mean JOA scores were 11.3 ± 3.8 before surgery and 24.3 ± 3.4 at the time of the final follow-up examination; the recovery rate was 68.6 ± 16.5%. The mean estimated blood loss was 66.6 ± 98.6 ml, and the mean surgical time was 135.3 ± 46.5 minutes. No significant difference in the recovery rate of the JOA scores or in the surgical time and blood loss was observed between the 2 surgical approaches. Four patients underwent revision posterior interbody fusion for the recurrence of radicular pain as a result of intraforaminal stenosis in 3 patients and insufficient decompression of the extraforaminal area in the remaining patient at an average of 19.5 months after surgery.

Conclusions

Extraforaminal stenosis at the lumbosacral junction is a rare but distinct pathological condition causing L-5 radiculopathy. Decompression surgery without fusion using a microendoscope or a surgical microscope/ loupe is a feasible and less invasive surgical option for elderly patients with extraforaminal stenosis at the lumbosacral junction.
Early functional outcomes and histological analysis after spinal cord compression injury in rats
Authors: Lonjon Nicolas , Kouyoumdjian Pascal , Prieto Monica , Bauchet Luc , Haton Henri , Gaviria Manuel , Privat Alain , Perrin Florence E.
Published: December 2009

Object

Neuroprotective and repair strategies in spinal cord injuries (SCIs) have been so far largely unsuccessful. One of the prerequisites is the use of appropriate preclinical models to decipher pathophysiological mechanisms; another is the identification of optimal time windows for therapeutic interventions. The authors undertook this study to characterize early motor, sensory, autonomic, and histological outcomes after balloon compression of the spinal cord at the T8–9 level in adult rats.

Methods

A total of 91 rats were used in this study. Spinal cord balloon compression was performed at T8–9 in adult rats by inflation of a 2 Fr Fogarty catheter into the epidural space. The authors first characterized early motor, sensory, and autonomic outcomes of 2 volumes of compression (10 and 15 μl) using behavioral tests and then examined histological outcomes in the spinal cord using Luxol fast blue staining. To further substantiate the characterization of the epidural balloon-compression model, they used a noncompetitive N-methyl-d-aspartate antagonist, GK11, and demonstrated the involvement of excitotoxicity in this model.

Results

Proportional and reproducible functional impairment resulted from compression caused by balloon inflation with either 10 or 15 μl of water and corresponded to the extent of the lesion. Indeed, during the early phase following SCI (1 week postinjury), recovery of locomotor function and bladder control correlated with the volume of inflation, whereas outcomes with respect to sensory function and reflexes were independent of compression severity. Treatment with GK11 significantly improved motor function in all groups of rats 1 week after injury and bladder voiding in the 10-μl injured rats compared to the 15-μl injured rats.

Conclusions

The results of this study demonstrate that spinal balloon-compression injury in the rat is a well-characterized, reproducible, and predictable model to analyze early events following SCI.
Recurrence of fibrous hamartoma of infancy excised 14 years after the primary surgery
Authors: Miyamoto Masabumi , Tsunoda Ryu , Gembun Yoshikazu , Konno Shunsuke , Hagiwara Yusuke , Liu Xinyu , Ito Hiromoto
Published: December 2009

Fibrous hamartoma of infancy is a rare, benign, superficial soft-tissue mass. It usually occurs within the first 2 years of life at the axial regions, upper arms, and external genital areas. There have been some recurrences within the 1st year of the surgery, although no cases have been reported to recur after 1 year. The authors present a recurrent case of fibrous hamartoma of infancy 14 years after the primary surgery, and they show the clinical and histopathological findings.
Simultaneous choroid plexus carcinoma and pilocytic astrocytoma in a pediatric patient
Authors: Karami Kristophe J. , Poulik Janet , Rabah Raja , Krass Joshua , Sood Sandeep
Published: December 2009

Simultaneous primary brain tumors in pediatric patients without prior chemotherapy or radiotherapy, phacomatosis, or known familial history are a rare occurrence. The authors report the case of a 4-year-old boy with simultaneous choroid plexus carcinoma and pilocytic astrocytoma with features of oligodendroglioma. Magnetic resonance imaging studies revealed diffuse heterogeneously enhancing left intraventricular and posterior fossa tumors initially believed most consistent with multicentric choroid plexus carcinomas. A multiple staged resection was carried out for each tumor and gross-total resection was achieved. Upon gross inspection intraoperatively as well as postoperative histological analysis, 2 distinct simultaneous tumors were identified: choroid plexus carcinoma and pilocytic astrocytoma. To the authors' knowledge this is the first case report published identifying 2 distinct tumor types with similar radiological appearances in a pediatric patient with no prior history of radiotherapy, chemotherapy, or phacomatosis.
Seizure control outcomes after resection of dysembryoplastic neuroepithelial tumor in 50 patients
Authors: Chang Edward F. , Christie Catherine , Sullivan Joseph E. , Garcia Paul A. , Tihan Tarik , Gupta Nalin , Berger Mitchel S. , Barbaro Nicholas M.
Published: December 2009

Object

Dysembryoplastic neuroepithelial tumors (DNETs) are a subset of relatively rare glioneuronal tumors that typically present with epilepsy during childhood. The authors' aim was to identify factors that predict seizure control following excision.

Methods

The authors reviewed the cases of 50 patients who underwent resection of DNETs at the University of California, San Francisco, between 1990 and 2006. Demographic, seizure history, radiographic, and histopathological data were collected and analyzed for statistical association with postoperative seizure control.

Results

Of the 50 patients, 86% presented with intractable epilepsy. The median age at surgery was 21 years (range 4–46 years; 40% were < 18 years old at time of surgery), with a median duration of 8 years from onset of seizures (24% were adult-onset seizures). Fifty-two percent of the cases were associated with adjacent focal cortical dysplasia. Complete resection was achieved in 78% of cases. Intraoperative electrocorticography in 23 patients identified extralesional interictal activity in 16 cases, which led to extended lesionectomy or lobectomy. The remaining patients underwent lesionectomy alone. The median follow-up was 5.6 years, during which time tumor progression occurred after subtotal resection. The proportional estimates of seizure freedom (Engel Class I outcome) were 0.86 at 1 year and 0.85 at 5 years. Seizure freedom was predicted by complete or extended resection (OR 1.68, 95% CI 1.39–2.03; p < 0.0001) and extratemporal location (OR 1.20, 95% CI 1.02–1.42; p = 0.03) on multivariate analysis. Secondary analysis for intraoperative electrocorticography cases demonstrated that seizure outcome was better when extralesional spiking foci were detected (94% seizure free) compared with when they were absent (43% seizure free).

Conclusions

Excision of DNETs and, when present, adjacent dysplastic cortex was highly effective for seizure control. Excellent seizure-free outcomes and tumor control were seen with lesionectomy alone in most cases. Electrocorticography with extended resection was useful for patients with pharmacoresistant epilepsy.
Application of Remote-sensing Data and Decision-Tree Analysis to Mapping Salt-Affected Soils over Large Areas
Authors: Elnaggar Abdelhamid  A. , Noller Jay  S.
Published: December 2009

Expert assessments for crop and range productivity of very-large arid and semiarid areas worldwide are ever more in demand and these studies require greater sensitivity in delineating the different grades or levels of soil salinity. In conjunction with field study in arid southeastern Oregon, we assess the merit of adding decision-tree analysis (DTA) to a commonly used remote-sensing method. Randomly sampled surface soil horizons were analyzed for saturation percentage, field capacity, pH and electrical conductivity (EC). IFSAR data were acquired for terrain analysis and surficial geological mapping, followed by derivation of layers for analysis. Significant correlation was found between EC values and surface elevation, bands 1, 2, 3 and 4 of the Landsat TM image, and brightness and wetness indices. Maximum-likelihood supervised classification of the Landsat images yields two salinity classes: non-saline soils (EC < 4 dSm–1), prediction accuracy of 97%, and saline soils (EC < 4 dSm–1), prediction accuracy 60%. Addition of DTA results in successful prediction of five classes of soil salinity and an overall accuracy of about 99%. Moreover, the calculated area of salt-affected soil was overestimated when mapped using remote sensing data only compared to that predicted by additionally using DTA. DTA is a promising approach for mapping soil salinity in more productive and accurate ways compared to only using remote-sensing analysis.
PIYAS-Proceeding to Intelligent Service Oriented Memory Allocation for Flash Based Data Centric Sensor Devices in Wireless Sensor Networks
Authors: Rizvi Sanam Shahla , Chung Tae-Sun
Published: December 2009

Flash memory has become a more widespread storage medium for modern wireless devices because of its effective characteristics like non-volatility, small size, light weight, fast access speed, shock resistance, high reliability and low power consumption. Sensor nodes are highly resource constrained in terms of limited processing speed, runtime memory, persistent storage, communication bandwidth and finite energy. Therefore, for wireless sensor networks supporting sense, store, merge and send schemes, an efficient and reliable file system is highly required with consideration of sensor node constraints. In this paper, we propose a novel log structured external NAND flash memory based file system, called Proceeding to Intelligent service oriented memorY Allocation for flash based data centric Sensor devices in wireless sensor networks (PIYAS). This is the extended version of our previously proposed PIYA [1]. The main goals of the PIYAS scheme are to achieve instant mounting and reduced SRAM space by keeping memory mapping information to a very low size of and to provide high query response throughput by allocation of memory to the sensor data by network business rules. The scheme intelligently samples and stores the raw data and provides high in-network data availability by keeping the aggregate data for a longer period of time than any other scheme has done before. We propose effective garbage collection and wear-leveling schemes as well. The experimental results show that PIYAS is an optimized memory management scheme allowing high performance for wireless sensor networks.
Optimal Transport Time and Conditions for Cartilage Tissue Samples and Expanded Chondrocyte Suspensions
Authors: Yilmaz Banu Coskun , Yilmaz Cengiz , Yilmaz Necat S. , Balli Ebru , Tasdelen Bahar
Published: January 2010

For autologous chondrocyte implantation, the chondral tissue obtained is transferred from the operating room to the laboratory using specialized carrier systems within 24 hours. Similar expenses are used for the transport of cultured chondrocytes. The purpose of this study was to find the optimal temperature, size of tissue, and time that the chondrocytes can stand without losing viability and proliferative capacity.

Fresh calf cartilage was harvested and divided into 24 groups. Half of the samples were diced into 1- to 2-mm
3
pieces. All 12 groups were kept at either 4°C, 25°C, or 37°C for 1, 3, 5, or 7 days and were seeded for cell culture. Times to reach confluence values were compared. Produced cell suspensions were grouped similarly and tested similarly. Neither the temperature nor the waiting days caused any difference in the proliferative capacity of the cells. Diced tissues yielded a shorter time to reach confluence values.

Chondral tissue obtained from the patient can be transferred to the laboratory at temperatures ranging from 4°C to 37°C in up to 7 days. These conditions did not affect the proliferative capacity or the viability of the chondrocytes. Dicing the tissue prior to transport will shorten total culturing time. The expanded cell suspensions should be transferred at temperatures from 4°C to 25°C within 3 days. Specialized carrier systems to get the chondral tissue from the operating room to the laboratory and to take the expanded chondrocytes back to the operating room within hours may not be necessary.
Use of the Gartland Classification System for Treatment of Pediatric Supracondylar Humerus Fractures
Authors: Mallo Gregory , Stanat Scott J.C. , Gaffney John
Published: January 2010

The extension-type pediatric supracondylar humerus fracture accounts for nearly two-thirds of all pediatric hospitalizations due to elbow trauma. The Gartland classification guides the standard of care for treatment of this entity. Type I injuries are treated with cast immobilization while type II and III injuries are treated operatively. The reported interobserver reliability ranges from moderate to full agreement, which is on par with other frequently referenced classification systems such as Lauge-Hansen for adult ankle fractures.

In this study, 4 fellowship-trained pediatric orthopedic surgeons reviewed radiographs of 72 pediatric supracondylar fractures and classified them based on Gartland's system. They recommended their preferred treatment of cast immobilization for type I fractures and of closed reduction and pinning in the operating room for type II and type III fractures. The interobserver and intraobserver reliability for each set of radiographs was then analyzed.

There was moderate agreement comparing all fractures and comparing types I and II fractures, while there was full agreement for type III fractures. There was full agreement for the intraobserver reliability. The preferred treatment (casting vs operative intervention) differed in 35% of patients, if based on the fracture classification.
Matrix Metalloproteinase-8 Inactivates Macrophage Inflammatory Protein-1α To Reduce Acute Lung Inflammation and Injury in Mice
Authors: Quintero Pablo A. , Knolle Martin D. , Cala Luisa F. , Zhuang Yuehong , Owen Caroline A.
Published: December 2009

To determine the role of matrix metalloproteinase-8 (MMP-8) in acute lung injury (ALI), we delivered LPS or bleomycin by the intratracheal route to MMP-8−/− mice versus wild-type (WT) mice or subjected the mice to hyperoxia (95% O2) and measured lung inflammation and injury at intervals. MMP-8−/− mice with ALI had greater increases in lung polymorphonuclear neutrophils (PMNs) and macrophage counts, measures of alveolar capillary barrier injury, lung elastance, and mortality than WT mice with ALI. Bronchoalveolar lavage fluid (BALF) from LPS-treated MMP-8−/− mice had more MIP-1α than BALF from LPS-treated WT mice, but similar levels of other pro- and anti-inflammatory mediators. MIP-1α−/− mice with ALI had less acute lung inflammation and injury than WT mice with ALI, confirming that MIP-1α promotes acute lung inflammation and injury in mice. Genetically deleting MIP-1α in MMP-8−/− mice reduced the increased lung inflammation and injury and mortality in MMP-8−/− mice with ALI. Soluble MMP-8 cleaved and inactivated MIP-1α in vitro, but membrane-bound MMP-8 on activated PMNs had greater MIP-1α–degrading activity than soluble MMP-8. High levels of membrane-bound MMP-8 were detected on lung PMNs from LPS-treated WT mice, but soluble, active MMP-8 was not detected in BALF samples. Thus, MMP-8 has novel roles in restraining lung inflammation and in limiting alveolar capillary barrier injury during ALI in mice by inactivating MIP-1α. In addition, membrane-bound MMP-8 on activated lung PMNs is likely to be the key bioactive form of the enzyme that limits lung inflammation and alveolar capillary barrier injury during ALI.
TLR2-Dependent Inflammatory Response to Porphyromonas gingivalis Is MyD88 Independent, whereas MyD88 Is Required To Clear Infection
Authors: Burns Elia , Eliyahu Tal , Uematsu Satoshi , Akira Shizuo , Nussbaum Gabriel
Published: December 2009

Porphyromonas gingivalis is a Gram-negative anaerobe considered to be a major periodontal pathogen. TLR2 plays a central role in the response to P. gingivalis infection in vivo. In its absence there is a weak inflammatory response; however, bacteria are cleared rapidly compared with wild-type mice. We examined the role of the TLR adaptor proteins MyD88 and TLR/IL-1R–domain-containing adaptor-inducing IFN-β in the inflammatory response to P. gingivalis in vivo and in the ability to clear the bacterial infection. Proinflammatory cytokine production in response to P. gingivalis infection depends on TLR2, but it does not require MyD88 or TLR/IL-1R–domain-containing adaptor-inducing IFN-β. In contrast, the generation of intracellular toxic oxygen species and the ultimate clearance of P. gingivalis infection depend critically on MyD88, independent of TLR2. Thus, robust cytokine production and bacterial clearance are independent events mediated by distinct signaling pathways following infection with P. gingivalis.