Intraoperative Spinal Angiography during Microsurgical Occlusion of Spinal Dural Arteriovenous Fistula within the Hybrid Operation Room

Background Spinal dural arteriovenous fistula (SDAVF) is a rare cause of progressive myelopathy in predominantly middle-aged men. Treatment modalities include surgical obliteration and endovascular embolization. In surgically treated cases, failure of obliteration is reported in up to 5%. The aim of this technical note is to present a safe procedure with complete SDAVF occlusion, verified by intraoperative digital subtraction angiography (DSA). Methods We describe four patients with progressive leg weakness who underwent surgical obliteration of SDAVF with spinal intraoperative DSA in the prone position after cannulation of the popliteal artery. All surgeries took place in our hybrid operating room (OR) and were accompanied by electrophysiologic monitoring. Surgeries and cannulation of the popliteal artery were performed in the prone position. Ultrasound was used to guide the popliteal artery puncture. A 5-Fr sheath was inserted and the fistula was displayed using a 5-Fr spinal catheter. Spinal intraoperative DSA was performed prior to and after temporary clipping of the fistula point as well after the final SDAVF occlusion. Results The main feeder of the SDAVF fistula in the first patient arose from the right T11 segmental artery, which also supplied the artery of Adamkiewicz. The second patient initially underwent endovascular treatment and deteriorated 5 months later due to recanalization of the SDAVF via a small branch of the T12 segmental artery. The third and fourth cases were primarily scheduled for surgical occlusion. Access through the popliteal artery for spinal intraoperative DSA proved to be beneficial and safe in the hybrid OR setting, allowing the sheath to be left in place during the procedure. During exposure and after temporary and permanent occlusion of the fistulous point, intraoperative indocyanine green (ICG) video angiography was also performed. In one case, the addition of intraoperative DSA showed failure of fistula occlusion, which was not visible with ICG angiography, leading to repositioning of the clip. Complete fistula occlusion was documented in all cases. Conclusion Spinal intraoperative DSA in the prone position is a feasible and safe intervention for rapid localization and confirmation of surgical SDAVF occlusion.

SOME TOPOGRAPHICAL AND HISTOLOGICAL STUDIES OF THYROID AND PARATHYROD GLANDS OF MOORHEN (Gallinula c. chloropus)

The thyroid gland of Moorhen has two separated lobes. These lobes were located in the throracic inlet and receive blood supply from the cranial, middle and caudal thyroid arteries. The histological organization of the thyroid gland in Moorhen is surrounded by a distinct connective tissue capsule and the parenchymal cells were arranged into colloid filled follicles enmeshed in the highly vascular interstitial connective tissue. The bilaterally paired, round to oval, parathyroid glands in Moorhen were located intrathoracically near or close to the caudal pole of the thyroid glands. They receive blood by short branches from caudal thyroid artery and small branch from the common carotid artery. The parathyroid glands in Moorhen have a thin connective tissue capsule. Its parenchymal cells were arranged into an irregular, anastomosing cords of chief cells. No oxyphil cells were found in the parathyroid glands of Moorhen.

Choosing an appropriate planting scheme for intensive apple gardens

This article describes the intensive planting of varieties of apples belonging to local and foreign selection in soil and climatic conditions of Tashkent region in 4 different (4.0x2.5; 4.0x2.0; 4.0x1.5 and 4.0x1.0 m.) planting schemes, mainly in varieties with low tree height and small branch size, the effect of planting schemes on tree habitat is small. In contrast, in varieties with high biological growth rate, the effect of planting schemes was found to be high. However, data have shown that as the length of the main branches in apple tree trees decreases, they cause an increase in ring-shaped fruit branches, which in turn affects the yield in the trees by reducing the feeding area.

Case Report: Genomic Characteristics of the First Known Case of SARS-CoV-2 Imported From Spain to Sichuan, China

The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been basically under control in China since March 2020, but the import of domestic SARS-CoV-2 has begun to increase. This study reported the first case of asymptomatic SARS-CoV-2 infection imported from Spain into Sichuan Province, China, on March 11, 2020. The infected male had a body temperature of 37.5°C, normal blood oxygen saturation levels, and a computed tomography (CT) examination showed that his lungs had no shadows. However, a throat swab from the subject tested positive for SARS-CoV-2 using qPCR assay. In this study, we conducted transcriptome sequencing on respiratory throat swabs from the subject and found that the dominant SARS-CoV-2 sequence (Gene Bank ID: MW301121) was a spike protein D614G mutant strain, which is currently popular throughout world. We downloaded and analyzed SARS-CoV-2 sequences collected from cases in China and Spain for comparison and tracing purposes. After March 11, 2020, the Chinese domestic clade was naturally divided into the imported SARS-CoV-2 D614G mutant strain and evolutionarily-related similar sequences and that of sequences collected in the original Wuhan area. The sequence reported in this study was located on a small branch, far from the evolution of Wuhan sequences. As expected, the identified sequence was closely related to the evolution of the SARS-CoV-2 D614G mutant strain circulating in Spain.

Double plastic stent implantation for recurrent acute pancreatitis with incomplete pancreas divisum: a case report and literature review

Pancreas divisum (PD) is a common pancreatic malformation caused by the failure of fusion between ventral and dorsal pancreatic ducts. There is a small branch of communication between the two systems in incomplete PD, and this variation has an incidence of 15%. A 43-year-old female patient presented to our department with recurrent abdominal pain. Magnetic resonance cholangiopancreatography (MRCP) showed that the ventral pancreatic duct was curved, with a local pouchlike dilatation. Endoscopic ultrasonography supported the diagnosis of incomplete PD and showed a thin branch of communication between ventral and dorsal pancreatic ducts. Endoscopic retrograde cholangiopancreatography (ERCP) and papillotomy of the minor papilla with double plastic stent implantation were performed. One pancreatic plastic stent was inserted across the minor and major papilla over the guide wire, creating a U-shape. The other wire-guided plastic stent was inserted through the minor papilla into the dorsal pancreatic duct. The pancreatic fluid drained smoothly after stent placement. During the 6-month follow-up, the patient remained well, without recurrence of pancreatitis.

Single-photon emission tomography of the lungs in the diagnosis of coagulopathyin patients in the postcovid period

Introduction. Exposure to SARS-CoV-2 leads to damage and dysfunction of the microvasculature of the lungs. The development of vasculitis, an increase in the permeability of the vessel wall, changes in the vascular-platelet and coagulation hemostasis, lead to the development of thrombosis / thromboembolism and hemorrhages. Single-photon emission tomography of the lungs is optimal for assessing changes in microcirculation in the lungs of patients with COVID-19 infection, since CT angiography can detect these formidable complications only in the large vessels of the lungs.Оbjective оf the work. To assess changes in the microvasculature of the lungs in patients with the development of postcovid syndrome and to assess the possibilities of single photon emission computed tomography in the diagnosis of thromboembolism, thrombosis and hemorrhages.Material and methods. The data of radiological studies performed in 138 patients in the postcovid period were analyzed, directed for examination to assess changes in blood circulation in the lungs and identify complications of the disease (thromboembolism, thrombosis, hemorrhages).Results. In patients who underwent an infection caused by the SARS-CoV-2 virus in a mild form, we identified changes in microcirculation most characteristic of manifestations of vasculitis and small local blood flow defects close to a triangular shape (microthrombosis), which correlated with an increase in fibrinogen (4.32 ± 0.21 g/L) (rs = 0.97; p = 0.001). Signs of microthrombosis, pulmonary embolism were detected in 35.9% of moderately severe patients who did not receive anticoagulant therapy or was prescribed it on day 10–12 of illness, and in 67.2% of severe and extremely severe patients who received anticoagulant therapy during the illness. Signs of postthromboembolic changes were detected in 16 patients (59.2%) in the late postcovid period, which correlated to a high degree (rs = 0.81; p = 0.03) with an increase in the level of fibrinogen (4.5 ± 1.9 mg/l).Conclusions. The severity of microcirculation disorders in the lungs depends on the severity of the disease and the timing of the postcovid period. Signs of small branch thromboembolism / thrombosis are detected in the early postcovid period. In patients who have undergone COVID-19 with the development of thrombosis, signs of postponed pulmonary embolism are revealed and zones of local pneumosclerosis are formed.

Musculocutaneous nerve as a branch from median nerve: A case report

The brachial plexus is the most variable part of the peripheral nervous system. The Musculocutaneous nerve is a terminal branch of the lateral cord of the brachial plexus in a normal individual. It is not uncommon for variations in the origin, branching termination, and connection patterns. During routine dissection in the Anatomy Department, College of Medicine, King Saud University, we found the lateral cord after giving a small branch to the coracobrachialis muscle join the medial root of the medial cord to form the median nerve. Knowledge of these variations is essential for anatomists, orthopedics, neurologists, and anesthesiologists.

A NEW BRANCH OF THE ANIO NOVUS AQUEDUCT (ROME, ITALY) REVEALED BY ARCHAEOLOGY AND GEOPHYSICS

The area south-east of Rome is characterised by the presence of several roman aqueducts which brought water to the eternal city from the Apennine and Alban Hills springs. In the last 40 years, several pieces of evidence about these aqueducts were acquired during the realisation of archaeological test trenches before building activities. In 2019, a small branch of a subterranean aqueduct unknown to the Latin sources was unearthed in Via dei Sette Metri. Here we show that this aqueduct is a lateral branch of the Anio Novus, a major imperial aqueduct built between 38 and 52 CE. To achieve this result, we employed detailed photogrammetric restitution of the new aqueduct and an integrated geophysical survey focused in the area where the Anio Novus was supposed to pass. Electrical Resistivity Tomography (ERT) and Ground Penetrating Radar (GPR) methods were used to reconstruct aqueduct paths and their relative heights. Different light conditions were tested during the picture acquisition step to determine the best practice in the photogrammetric restitution. The results obtained in this study confirmed the great effectiveness of the integration between geophysical investigation methods and the modern archaeology approach in detecting buried ancient structures.

Advanced Neural Interface toward Bioelectronic Medicine Enabled by Micro-Patterned Shape Memory Polymer

Recently, methods for the treatment of chronic diseases and disorders through the modulation of peripheral and autonomic nerves have been proposed. To investigate various treatment methods and results, experiments are being conducted on animals such as rabbits and rat. However the diameter of the targeted nerves is small (several hundred μm) and it is difficult to modulate small nerves. Therefore, a neural interface that is stable, easy to implant into small nerves, and is biocompatible is required. Here, to develop an advanced neural interface, a thiol-ene/acrylate-based shape memory polymer (SMP) was fabricated with a double clip design. This micro-patterned design is able to be implanted on a small branch of the sciatic nerve, as well as the parasympathetic pelvic nerve, using the shape memory effect (SME) near body temperature. Additionally, the IrO2 coated neural interface was implanted on the common peroneal nerve in order to perform electrical stimulation and electroneurography (ENG) recording. The results demonstrate that the proposed neural interface can be used for the modulation of the peripheral nerve, including the autonomic nerve, towards bioelectronic medicine.

Clinical Features and Treatment of Inactive Proliferative Diabetic Retinopathy

Background To investigate the clinical features and results after vitrectomy for inactive proliferative diabetic retinopathy (IPDR).Methods Retrospective review of 40 eyes of 21 IPDR patients who underwent 23G or 25G minimally invasive vitrectomy between January 2018 and December 2019 in Tianjin Medical University Eye Hospital.The average follow-up period was 8.7 months. Outcome measures were best-corrected visual acuity (BCVA), clinical features and intraoperative findings of IPDR.Results All eyes were performed with panretinal photocoagulation (PRP) for average 1.6 years before operation. Fundus examination showed the optic disc was pale, and a mass of yellowish-white fibroproliferative membrane was around the optic disc and vascular arcade. Thirty-three eyes (82.5%) were accompanied by tractional retinal detachment, and macula was involved in 9 eyes (22.5%). The vitreous adhered with the retina tightly. The mid-peripheral retina was thin. Thirty-one eyes (77.5%) were accompanied by small branch retinal artery and vein occlusion. Fourteen eyes (35.0%) occurred iatrogenic retinal break during vitrectomy. The median LogMAR of BCVA significantly improved from 1.0 (20/200)preoperatively to 0.92 (20/167) postoperatively (P = 0.000).Conclusions The fundus manifestation of IPDR was quiet and special. Vitrectomy could improve patients’ visual acuity, but the incidence of iatrogenic retinal break was high.Vitrectomy could be performed by well-skilled vitro-retinal surgeons according to the minimum quantitative principle.