scholarly journals Vertebral Artery Variations at the Craniovertebral Junction in “Sandwich” Atlantoaxial Dislocation Patients

Neurospine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. 770-777
Author(s):  
Yinglun Tian ◽  
Nanfang Xu ◽  
Ming Yan ◽  
Jinguo Chen ◽  
Kan-Lin Hung ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Craniovertebral Junction ◽  
Atlantoaxial Dislocation ◽  
Preoperative Imaging ◽  
Control Group ◽  
Bone Deformity ◽  
3 Dimensional ◽  
Vertebral Arteries ◽  
Two Sides ◽  
Different Levels

Objective: To summarize the vertebral artery (VA) pattern of 96 “sandwich” atlantoaxial dislocation (AAD) patients and to describe the strategies of reducing the injury of VA during surgery.Methods: From 2009 to 2020, we retrospectively reviewed the 3-dimensional computed tomography angiography data of 96 AAD patients combined with atlas occipitalization and C2–3 fusion, which were diagnosed as “sandwich” AAD and 96 patients as control group patients who were without atlas occipitalization, C2–3 fusion and any other cervical bone deformity at our institution. The variations of each side of VA were described in 3 different parts (C0–1, C1–2, and C2–3) according to the characteristics of the 3-part pathological structures in “sandwich” subgroup.Results: One hundred ninety-two sides of VAs in every group of patients were analyzed and every VA was described separately at 3 different level regions. There were different variations in these 3 different regions: 4 variations in the upper fusion region, 5 variations in the sandwiched region, and 6 variations in the lower fusion region in sandwich AAD patients. And the rate of VA deformity in sandwich AAD patients was much higher and more types of VA variations existed.Conclusion: In “sandwich” AAD patients, deformities of vertebral arteries in craniovertebral junction are more common, and the same VA may have deformities at different levels that severely affect surgical procedures. Therefore, preoperative imaging examination of VA for “sandwich” AAD patients is vital of guiding surgeons to avoid injury of VA during surgery.

Operative nuances to safeguard anomalous vertebral artery without compromising the surgery for congenital atlantoaxial dislocation: untying a tough knot between vessel and bone

2014 ◽  
Vol 20 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Pravin Salunke ◽  
Sameer Futane ◽  
Sushant K. Sahoo ◽  
Mandeep S. Ghuman ◽  
Niranjan Khandelwal
Keyword(s):  
Vertebral Artery ◽  
Preoperative Evaluation ◽  
Posterior Inferior Cerebellar Artery ◽  
Vascular Anatomy ◽  
Craniovertebral Junction ◽  
Atlantoaxial Dislocation ◽  
Lateral Mass ◽  
3D Ct ◽  
Ct Angiogram ◽  
Pars Interarticularis

Object Stabilization of the craniovertebral junction (CVJ) by using lateral masses requires extensive dissection. The vertebral artery (VA) is commonly anomalous in patients with congenital CVJ anomaly. Such a vessel is likely to be injured during dissection or screw placement. In this study the authors discuss the importance of preoperative evaluation and certain intraoperative steps that reduce the chances of injury to such vessels. Methods A 3D CT angiogram was obtained in 15 consecutive patients undergoing surgery for congenital atlantoaxial dislocation. The course of the VA and its relationship to the C1–2 facets was studied in these patients. The anomalous VA was exposed intraoperatively, facet surfaces were drilled in all, and the screws were placed according to the disposition of the vessel. Results A skeletal anomaly was found in all 10 patients who had an anomalous VA. Four types of variations were noted: 1) the first intersegmental artery in 5 patients (bilateral in 1); 2) fenestration of VA in 1 patient; 3) anomalous posterior inferior cerebellar artery crossing the C1–2 joint in 1 patient; and 4) medial loop of VA in 5 patients. The anomalous vessel was dissected and the facet surfaces were drilled in all. The C-1 lateral mass screw was placed under vision, taking care not to compromise the anomalous vessel, although occipital screws or sublaminar wires were used in the initial cases. A medial loop of the VA necessitated placement of transpedicular or C-2 lateral mass screws instead of pars interarticularis screws. The anomalous vessel was injured in none. Conclusions Preoperative 3D CT angiography is a highly useful method of imaging the artery in patients with CVJ anomaly. It helps in identifying the anomalous VA or its branch and its relationship to the C1–2 facets. The normal side should be surgically treated and distracted first because this helps in opening the abnormal side, aiding in dissection. In the posterior approach the C-2 nerve root is always encountered before the anomalous vessel. The defined vascular anatomy helps in choosing the type of screw. The vessel should be mobilized so as to aid the drilling of facets and the placement of screws and spacers under vision, avoiding its injury (direct or indirect) or compression. With these steps, C1–2 (short segment) rigid fusion can be achieved despite the presence of anomalous VA.

A differentiated approach to the dental caries prevention in children with different levels of caries risk

2020 ◽  
Vol 20 (3) ◽  
pp. 211-215
Author(s):  
T. N. Tserakhava ◽  
N. V. Shakavets ◽  
E. I. Melnikava ◽  
M. I. Klenovskaya ◽  
D. N. Naumovich ◽  
...  
Keyword(s):  
Oral Hygiene ◽  
Calcium Phosphates ◽  
Clinical Effectiveness ◽  
Control Group ◽  
Caries Risk ◽  
Health Group ◽  
High Caries Risk ◽  
Permanent Molars ◽  
Different Levels ◽  
First Permanent Molars

Relevance. Prevention of caries of the first permanent molars is one of the most relevant problems in pediatricdentistry.Purpose – to develop an algorithm for prevention of first permanent molars caries in children with differentlevels of caries risk.Materials and methods. The article presents the results of the implementation of the algorithm for prevention of first permanent molars caries in children with different levels of caries risk. This algorithm includes a comprehensive assessment of the values of indices dmft, DMFT, OHI-S, and the patient's health group is also taken into account. The study involved 253 children aged 6-7 years divided into 4 groups: 3 groups of children depending on the health group and the control group. 3 subgroups were identified in each group – with a low, medium, and high caries risk. We developed preventive measures schemes were for children of each group including training in oral hygiene; controlled and home toothbrushing using fluoride-containing toothpastes; applications of varnishes containing fluoride, calcium, phosphates from 2 to 3 times a year; fissure sealing of the first permanent molars. We carried out these activities were for 24 months, and then evaluated theirs effectiveness. Children in the control group were trained in oral hygiene. The clinical effectiveness of medical prophylaxis was evaluated by changes in the above clinical indicators.Results. In group of children with medium caries risk the increase in caries was 0.09, and the reduction in caries was 89.65%. In children with a low and high caries risk no increase in caries was observed; the reduction in the intensity of caries was 100%. A significant decrease in OHI-S oral hygiene index values was noted in all groups (p < 0.05). We noted high preventive efficacy of fissures sealing in the first permanent molars. No occlusal surface caries developed in sealed fissures.Conclusions. The application of the proposed preventive schemes in patients demonstrates high efficacy of fluoride and calcium-containing varnishes and sealing the fissures of the first permanent molars. 

scholarly journals Impact of Different Levels of Supervision on the Recovery of Severely Malnourished Children Treated by Community Health Workers in Mali

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 367
Author(s):  
Pilar Charle-Cuéllar ◽  
Noemí López-Ejeda ◽  
Mamadou Traore ◽  
Adama Balla Coulibaly ◽  
Aly Landouré ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Low Income ◽  
Community Intervention ◽  
Health Workers ◽  
Acute Malnutrition ◽  
Control Group ◽  
Supportive Supervision ◽  
Supervision Group ◽  
Different Levels

(1) Background: The Ministry of Health in Mali included the treatment of severe acute malnutrition (SAM) into the package of activities of the integrated community case management (iCCM). This paper evaluates the most effective model of supervision for treating SAM using community health workers (CHWs). Methods (2): This study was a prospective non-randomized community intervention trial with two intervention groups and one control group with different levels of supervision. It was conducted in three districts in rural areas of the Kayes Region. In the high supervision group, CHWs received supportive supervision for the iCCM package and nutrition-specific supervision. In the light supervision group, CHWs received supportive supervision based on the iCCM package. The control group had no specific supervision. (3) Results: A total of 6112 children aged 6–59 months with SAM without medical complications were included in the study. The proportion of cured children was 81.4% in those treated by CHWs in the high supervision group, 86.2% in the light supervision group, and 66.9% in the control group. Children treated by the CHWs who received some supervision had better outcomes than those treated by unsupervised CHWs (p < 0.001). There was no difference between areas with light and high supervision, although those with high supervision performed better in most of the tasks analyzed. (4) Conclusions: Public policies in low-income countries should be adapted, and their model of supervision of CHWs for SAM treatment in the community should be evaluated.

Time-Dependent Changes in Excitability After One-Trial Conditioning of Hermissenda

1997 ◽  
Vol 78 (6) ◽  
pp. 3460-3464 ◽  
Author(s):  
Terry Crow ◽  
Vilma Siddiqi
Keyword(s):  
Time Dependent ◽  
Control Group ◽  
Type B ◽  
Control Groups ◽  
Phototactic Behavior ◽  
Parallel Processes ◽  
Short And Long Term ◽  
A Site ◽  
Different Levels

Crow, Terry and Vilma Siddiqi. Time-dependent changes in excitability after one-trial conditioning of Hermissenda. J. Neurophysiol. 78: 3460–3464, 1997. The visual system of Hermissenda has been studied extensively as a site of cellular plasticity produced by classical conditioning. A one-trial conditioning procedure consisting of light paired with the application of serotonin (5-HT) to the exposed, but otherwise intact, nervous system produces suppression of phototactic behavior tested 24 h after conditioning. Short- and long-term enhancement (STE and LTE) of excitability in identified type B photoreceptors is a cellular correlate of one-trial conditioning. LTE can be expressed in the absence of STE suggesting that STE and LTE may be parallel processes. To examine the development of enhancement, we studied its time-dependent alterations after one-trial conditioning. Intracellular recordings from identified type B photoreceptors of independent groups collected at different times after conditioning revealed that enhanced excitability follows a biphasic pattern in its development. The analysis of spikes elicited by 2 and 30 s extrinsic current pulses at different levels of depolarization showed that enhancement reached a peak 3 h after conditioning. From its peak, excitability decreased toward baseline control levels 5–6 h after conditioning followed by an increase to a stable plateau at 16 to 24 h postconditioning. Excitability changes measured in cells from unpaired control groups showed maximal changes 1 h posttreatment that rapidly decremented within 2 h. The conditioned stimulus (CS) elicited significantly more spikes 24 h postconditioning for the conditioned group as compared with the unpaired control group. The analysis of the time-dependent development of enhancement may reveal the processes underlying different stages of memory for this associative experience.

Immediate postoperative regression of retroodontoid pannus after lateral mass reconstruction in a patient with rheumatoid disease of the craniovertebral junction

2008 ◽  
Vol 9 (3) ◽  
pp. 273-276 ◽  
Author(s):  
Atul Goel ◽  
Nitin Dange
Keyword(s):  
Bone Graft ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Postoperative Phase ◽  
Complete Disappearance ◽  
Lateral Mass ◽  
Rheumatoid Disease ◽  
Mass Reconstruction

The authors report the case of a 35-year-old man who had polyarthritic affliction with rheumatoid disease. He presented with complaints of quadriparesis that had progressed over the course of 2 years. Investigations revealed telltale evidence of rheumatoid disease of the craniovertebral junction with retroodontoid pannus, basilar invagination, and “fixed” atlantoaxial dislocation. The patient underwent lateral mass reconstruction with distraction of the facets and impaction of a spiked metal spacer and bone graft within the joint. Investigations done in the immediate postoperative phase showed complete disappearance of retroodontoid pannus in addition to reduction of basilar invagination and atlantoaxial dislocation. He had remarkable and sustained relief from symptoms. The authors also review the pathogenesis and treatment of retroodontoid pannus.

Cerebral Blood Flow Volume in Posterior Circulation Ischemic Disorders

2021 ◽  
pp. 154431672110539
Author(s):  
Anastasiya Yu. Vishnyakova ◽  
Nataliya M. Medvedeva ◽  
Alexander B. Berdalin ◽  
Svetlana E. Lelyuk ◽  
Vladimir G. Lelyuk
Keyword(s):  
Blood Flow ◽  
Healthy Volunteers ◽  
Internal Carotid ◽  
Duplex Sonography ◽  
Posterior Circulation ◽  
Control Group ◽  
Vertebrobasilar Insufficiency ◽  
Flow Volume ◽  
Blood Flow Volume ◽  
Vertebral Arteries

Objective: The aim of this study was to determine blood flow volume (BFV) in the normal state and its features in patients with acute posterior circulation ischemic strokes (PCIS) and vertebrobasilar insufficiency (VBI) using color duplex sonography (DS).Methods: The study included DS data from 96 patients with verified PCIS (66 men and 30 women, aged 64±13 years) and 29 adults with VBI (17 men and 12 women, aged 66±11 years). The control group consisted of 65 healthy male volunteers of different ages.Results: In asymptomatic healthy volunteers, there was a significant decrease in BFV in the internal carotid artery (ICA) with age (502 ml/min in young people, 465 ml/min in the older subgroup) with rS = −0.24 ( p = 0.05), and the aggregated BFV in the vertebral arteries (VAs) turned out to be almost constant (141–143 ml/min). In patients with VBI, the aggregated BFV in the VAs (144 ml/min) did not differ from that in healthy volunteers, but the BFV values in the ICAs were significantly lower (325 ml/min). In patients with PCIS, the aggregated BFV in the ICAs was also significantly lower (399 ml/min) than in the control group but did not significantly differ from that in patients with VBI. In patients with PCIS, there was a significant decrease in the aggregated BFV in the VAs (105 ml/min), which distinguished this group from other examined patients.Conclusions: A significant decrease the BFV in the VA was observed only in patients with PCIS and was associated with the presence of steno-occlusive diseases (SOD) more often in the left VA. Patients with VBI had the most pronounced decrease in BFV in the ICA.

Hemostasis in rats with different levels of motor activity after vital stress

2019 ◽  
Author(s):  
Ю.А. Бондарчук ◽  
О.В. Алексеева ◽  
И.И. Шахматов ◽  
Ю.Б. Лебедева ◽  
Е.Ю. Медведева
Keyword(s):  
Motor Activity ◽  
Male Rats ◽  
Control Group ◽  
Psychoemotional Stress ◽  
Partner Death ◽  
Mental Trauma ◽  
Total Body ◽  
Antithrombin Iii Activity ◽  
Different Levels ◽  
Body Response

Введение. Психоэмоциональный стресс, связанный с риском для жизни и здоровья (витальный стресс), вызывает комплексную ответную реакцию всего организма. Система гемостаза, обеспечивающая жидкостные характеристики циркулирующей крови, играет существенную роль в формировании процессов адаптации или дезадаптации. Нарушения равновесия в процессах свертывания и противосвертывания вместе с изменениями микроциркуляции являются основой патогенеза острых и хронических заболеваний с развитием тромботических либо геморрагических осложнений. Цель исследования: оценить состояние системы гемостаза у крыс с разным уровнем двигательной активности после острой психогенной травмы в виде витального стресса. Материалы и методы. Исследования выполнены на 44 лабораторных половозрелых крысахсамцах линии Wistar, которые составили 2 экспериментальные группы с низкой (n 15) и высокой (n 15) двигательной активностью и контрольную группу интактных животных (n 14). Спонтанную двигательную активность оценивали с помощью теста открытое поле . В качестве острого психотравмирующего воздействия использовали модель психической травмы у крыс в виде витального стресса, вызванного переживанием гибели партнера от действий хищника. Результаты. Острое психотравмирующее воздействие у животных с низкой двигательной активностью вызывало угнетение агрегации тромбоцитов. В группе животных с высокой двигательной активностью была выявлена гиперкоагуляция по внешнему пути активации плазменного гемостаза, а также на конечных этапах коагуляции. В обеих экспериментальных группах наблюдали укорочение времени полимеризации фибринмономера, снижение уровня фибриногена, а также активности антитромбина III на фоне активации фибринолиза. Заключение. Изменения состояния системы гемостаза у крыс с разным уровнем двигательной активности после острого психоэмоционального стресса имели одинаковую направленность, но различную степень выраженности ответной реакции. Полученные результаты позволяют охарактеризовать однократное психоэмоциональное воздействие как не выходящее за рамки эустресса (по данным коагулограммы). Introduction. Psychoemotional stress associated with the risk to life and health (vital stress) causes a complex total body response. Hemostasis supports fluid characteristics of circulating blood and plays a significant role in the formation of adaptation or disadaptation processes. Imbalance in the processes of coagulation and anticoagulation with microcirculation changes are the basis of pathogenesis of acute and chronic diseases with the development of thrombotic or hemorrhagic complications. Aim: to assess hemostasis state in rats with different levels of motor activity after acute psychogenic trauma (vital stress). Materials and methods. The studies were performed on 44 laboratory matured Wistar male rats that were divided into 2 experimental groups with low (n 15) and high (n 15) motor activity and a control group of intact animals (n 14). Spontaneous motor activity was assessed using the open field test. A model of mental trauma was used for the formation of acute psychotraumatic effect in rats in the form of vital stress caused by the experience of partner death from a predator. Results. Acute psychotraumatic effect in animals with low motor activity caused inhibition of platelet aggregation. In animals with high motor activity, hypercoagulation was revealed in the external pathway of plasma hemostasis activation, as well as at the final stages of coagulation. Shortening of fibrin monomer polymerization time, decreasing of fibrinogen level and antithrombin III activity with fibrinolysis activation were observed in both experimental groups. Conclusion. After acute psychoemotional stress hemostasis changes in rats with different levels of motor activity had the same direction, but different intensity of response. The obtained results allow to characterize a single psychoemotional effect as not exceeding the limits of eustress (according to the coagulogram data).

Clinical Application of Scalp Cluster Needling Combined with Bobath Technique in Upper Limb Spastic Paralysis After Stroke of Vertebral Artery Type

2021 ◽  
Author(s):  
Aimin Gong ◽  
Mengjie Zeng ◽  
Zhiquan Wu
Keyword(s):  
Treatment Group ◽  
Acupuncture Therapy ◽  
Vertebral Artery ◽  
Upper Limb ◽  
Training Group ◽  
Control Group ◽  
Upper Limbs ◽  
Spastic Paralysis ◽  
Rehabilitation Training ◽  
The Difference

To observe the difference in clinical effects of scalp-point cluster acupuncture combined with rehabilitation training in treating spastic paralysis of upper limbs after stroke. Using a randomized controlled design, 96 patients with upper limb spastic paralysis after stroke were randomly divided into two groups: treatment group (scalp acupuncture plus rehabilitation training group 48 cases), control group (rehabilitation training group 48 cases). After 2 courses of treatment, it was judged by observing clinical efficacy evaluation, Ashworth classification, and Fugl-Meyer (FMA) score. The total effective rate was 91.7% in the treatment group and 68.7% in the control group; the difference between the two groups was statistically significant (P <0.05). Before treatment, the difference in Ashworth classification between the two groups was not statistically significant (P> 0.05); after treatment, the difference between the two groups was statistically significant (P <0.01). After treatment, the difference between the two groups was statistically significant (P＜0.05). The Fugl-Meyer (FMA) scores of the two groups of patients before treatment were comparable (P>0.05), and there were significant differences between the two groups after treatment (P <0.05). The difference of Fugl-Meyer (FMA) scores between the two groups was statistically significant (P < 0.01). Scalp cluster acupuncture therapy is more effective than traditional acupuncture therapy alone in treating vertebral artery type cervical spondylosis. Scalp cluster acupuncture combined with Bobath technique is effective in treating spastic paralysis of upper limbs after stroke, and it is worthy of clinical application.

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