Percutaneous transforaminal endoscopic discectomy for different types of lumbar disc herniation: A retrospective study

Objective To introduce the concept of ‘nerve root as the core’ and to investigate the surgical procedure and curative effect of percutaneous translaminar endoscopic discectomy (PTED) surgery in the treatment of different types of lumbar disc herniation (LDH). Methods This retrospective study analysed the clinical data from patients with LDH that underwent single-segment PTED surgery. They were divided into three groups based on LDH location: central canal zone group, lateral recess zone group and foraminal/far lateral zone group. Different working cannula placement methods were used for the different types of LDH. All patients were followed for at least 12 months. Clinical and follow-up data were compared between the three groups. Results A total of 130 patients were enrolled in the study: 44 (33.8%) in the central canal zone group, 72 (55.4%) in the lateral recess zone group and 14 (10.8%) in the foraminal/far lateral zone group. All three groups of patients achieved good postoperative results. The improvements in leg pain and disability were most marked in the first postoperative month in all three groups. Conclusion PTED achieved adequate decompression for different types of LDH. The concept of ‘nerve root as the core’ facilitated the accurate placement of the working cannula.

The Slit-binding Ig1 domain is required for multiple axon guidance activities of Drosophila Robo2

Drosophila Robo2 is a member of the evolutionarily conserved Roundabout (Robo) family of axon guidance receptors. The canonical role of Robo receptors is to signal midline repulsion in response to their cognate Slit ligands, which bind to the N-terminal Ig1 domain in most Robo family members. In the Drosophila embryonic ventral nerve cord, Robo1 and Robo2 cooperate to signal Slit-dependent midline repulsion, while Robo2 also regulates the medial-lateral position of longitudinal axon pathways and acts non-autonomously to promote midline crossing of commissural axons. Although it is clear that Robo2 signals midline repulsion in response to Slit, it is less clear whether Robo2's other activities are also Slit-dependent. To determine which of Robo2's axon guidance roles depend on its Slit-binding Ig1 domain, we have used a CRISPR/Cas9-based strategy replace the endogenous robo2 gene with a robo2 variant from which the Ig1 domain has been deleted (robo2ΔIg1). We compare the expression and localization of Robo2ΔIg1 protein with that of full-length Robo2 in embryonic neurons in vivo, and examine its ability to substitute for Robo2 to mediate midline repulsion and lateral axon pathway formation. We find that removal of the Ig1 domain from Robo2ΔIg1 disrupts both of these axon guidance activities. In addition, we find that the Ig1 domain of Robo2 is required for its proper subcellular localization in embryonic neurons, a role that is not shared by the Ig1 domain of Robo1. Finally, we report that although FasII-positive lateral axons are misguided in embryos expressing Robo2ΔIg1, the axons that normally express Robo2 are correctly guided to the lateral zone, suggesting that Robo2 may guide lateral longitudinal axons through a cell non-autonomous mechanism.

Defining a Safe Corridor of Cervical Branch Preservation in Lateral Platysmaplasty Surgery During Facial Rejuvenation Surgery

Background During rhytidectomies, the cervical branch of the facial nerve (CBFN) can easily be encountered, and potentially injured, when releasing the cervical retaining ligaments in the lateral neck. This nerve has been shown to occasionally co-innervate the depressor anguli oris muscle, and damage to it can thus potentially compromise outcomes with a post-operative palsy. Objectives To examine the lateral cervical anatomy specific to the CBFN, to ascertain if the position of the nerve can be predicted, enhancing safety of the platysmal flap separation and dissection from this lateral zone of adhesion. Methods Eleven cadaveric hemifaces were dissected and the distance between the medial border of sternocleidomastoid (SCM), and the CBFN was measured at three key points: (1) ‘Superior’: the distance between SCM and the nerve at the level of the angle of the mandible in neutral. (2) ‘Narrowest’: the narrowest distance measurable between the ‘superior’ and ‘inferior’ points as the CBFN descends into the neck medial to the SCM. (3) ‘Inferior’: the distance at the most distal part of the cervical nerve identified before its final intramuscular course. Results The average distances (in mms) were: Superior = 12.1 (range: 10.1-15.4), Narrowest = 8.8 (range: 5.6-12.2) and Inferior = 10.9 (range: 7.9-16.7). Conclusions There is a narrow range between the nerve and the anterior border of SCM. We thus propose a safe corridor where lateral deep plane dissection can be performed to offer cervical retaining ligament release, with reduced risk of endangering the CBFN.

Ultrasound Diagnosis of Abnormalities in the Development of the Uterus and Vagina with Impaired Menstrual Blood Flow in Girls

The objective: to study and analyze the indicators of the diagnostic informativeness of the echographic study of anomalies in the development of the uterus and vagina with impaired outflow of menstrual blood in girls. Materials and methods. For the study, a group of 37 patients (n=37), from 10 to 19 years old, was selected, who were divided into 2 subgroups: 1 subgroup – patients with doubling of the uterus and vagina without disturbing the outflow of menstrual blood (n=25), 2 subgroup – patients with doubling uterus and vagina with partial aplasia of one vagina (n=12). Most of the subjects – 26 girls (10,3 %) – applied for a referral to clarify the diagnosis, 11 (29,7 %) – without complaints from the genitals for differential diagnosis. Results. At vaginoscopy at all patients the mucous membrane of pink color with well expressed folding. According to ultrasound of the pelvic organs in 1 subgroup in 17 patients the vagina was divided into 2 parts full, and in 8 – incomplete septum, two uteruses were located, parallel to each other, the contours were smooth, clear, M-echo was determined in both uteruses, two cervix with cervical canals. In subgroup 2, 9 patients showed protrusion of different sizes of one of the walls of the vagina, 2 patients in the lateral, 1 – in the upper lateral zone of the vagina was determined by a punctate hole with an inflammatory roller – fistulous entrance to the second vagina. In all patients from the side of the aplasia of the vagina, the uterine cavity is expanded from 10 to 25 mm, filled with echonegative contents. The reliability of the results of ultrasound scanning of anomalies of genital development is equal: the sensitivity of the method – 84,0 %, specificity – 90,9 %, accuracy – 89,1 %. Conclusions. Manifestation of malformations of the genitals with impaired outflow of menstrual blood occurs at puberty, as after menarche above the aplastic segment of the genital tract accumulates menstrual blood and tumor formation, accompanied by characteristic clinical manifestations. Diagnosis of this pathology is quite complex, which can lead to errors in determining the nature of the pathological condition and, as a consequence, unwarranted surgery. Thus, the need to further improve the methods of diagnosis and management of patients with doubling of the uterus and vagina with impaired menstrual blood flow remains relevant, which will identify diseases at an earlier age or immediately after the appearance of complaints and symptoms.

Pathogenesis clue from early clinical presentation of 300 hospitalized COVID-19 patients

The global spread of COVID-19 has been lasted more than half a year. Except for the gene sequence and virus structure of SARS-CoV-2, its clinical characteristics, pathological mechanism and corresponding measures have not been fully revealed. Objective: To speculate the possible pathological mechanism from the early clinical manifestations of the patients with COVID-19. Methods: The onset symptoms, laboratory examination and CT findings on admission of 300 cases in two wards of Wuhan Third Hospital from January 28 to March 15 were analyzed retrospectively. Results: There was no difference in incidence between men and women, but women were hospitalized later after onset. Upper respiratory symptoms and sputum were seldom. The incidence of fever was 71%. Blood lymphocytes count decreased significantly on admission, which was related to the severity of the disease. In the moderate type of patients, who without hypoxia, thrombocytopenia occurred in 12.37%, CRP rose in 64.43 %, BUN elevated in 20.62 %, creatinine rose in 17.53 %, D-dimer elevated in 74.74%, creatine kinase and α-hydroxybutyrate dehydrogenase elevated in 45.36% and 54.12% patients respectively. The early CT showed a small amount of infiltration in the subpleural, the lateral zone of the lung and thickening of the interlobular septum. About 5 days later, infiltration had been worse in a part of the patients, and the affected lung was negatively correlated with the lymphocyte count. Conclusion: There was no gender difference in patients with SARS-CoV-2 invasion. Alveolar cells and T lymphocytes maybe main targets of the virus and apoptosis maybe primary pathogenesis. The virus entering the lung maybe transmitted through lymph or blood channels, rather than direct diffused in the respiratory tract. Early damage of multiple organs maybe caused by immune response.

Airborne Lidar and Electro-Optical Imagery along Surface Ruptures of the 2019 Ridgecrest Earthquake Sequence, Southern California

Surface rupture from the 2019 Ridgecrest earthquake sequence, initially associated with the Mw 6.4 foreshock, occurred on 4 July on a ∼17 km long, northeast–southwest-oriented, left-lateral zone of faulting. Following the Mw 7.1 mainshock on 5 July (local time), extensive northwest–southeast-oriented, right-lateral faulting was then also mapped along a ∼50 km long zone of faults, including subparallel splays in several areas. The largest slip was observed in the epicentral area and crossing the dry lakebed of China Lake to the southeast. Surface fault rupture mapping by a large team, reported elsewhere, was used to guide the airborne data acquisition reported here. Rapid rupture mapping allowed for accurate and efficient flight line planning for the high-resolution light detection and ranging (lidar) and aerial photography. Flight line planning trade-offs were considered to allocate the medium (25 pulses per square meter [ppsm]) and high-resolution (80 ppsm) lidar data collection polygons. The National Center for Airborne Laser Mapping acquired the airborne imagery with a Titan multispectral lidar system and Digital Modular Aerial Camera (DiMAC) aerial digital camera, and U.S. Geological Survey acquired Global Positioning System ground control data. This effort required extensive coordination with the Navy as much of the airborne data acquisition occurred within their restricted airspace at the China Lake ranges.

Size and shape of eggs of Neognathae: effects of developmental mode and phylogeny

We evaluated the variation in absolute size and shape of birds’ eggs and the effects of developmental mode and phylogenetic relatedness on these traits. Eggs were characterized by length, diameter, and three indices of egg shape. Indices of egg shape were calculated as the ratio of radii that described the curvature of pointed end (cloacal zone), blunt end (infundibular zone), and lateral zone to egg diameter. We found that eggs shape was less variable than the absolute size of eggs. Index of the cloacal zone was the most changeable and index of the infundibular zone was very conservative. Size and shape of eggs could be better explained with phylogenetic relatedness than developmental mode.

Distribution of Subchondral Bone Puncture Strength in the Talus and Tibial Plafond: A Biomechanical Study

We investigated talus and tibial plafond subchondral bone puncture strength based on surface location. Puncture tests of the subchondral bone were performed in 9 equal zones on the articular surface of 12 cadaver specimens aged 49.1 years (range, 36-56 years). Compressive load was applied through a microfracture awl at 2 mm/min. Puncture strength was defined as the first load drop in load-deflection curves. In the talus, zone 1 (215 ± 91 N) and zone 2, the anterior medial and anterior middle zones, had significantly greater puncture strength than zones 7, 8, and 9, the posterior medial, middle, and lateral zones (104 ± 43 N, 115 ± 43 N, and 102 ± 35 N, respectively; P < .001). In the tibial plafond, zone 3, the anterior-lateral zone, and zone 7, the posterior medial zone, had significantly greater strength than zone 8, the posterior middle zone (202 ± 72 N, 206 ± 121 N, and 112 ± 65 N, respectively; P < .001) These results suggest that the subchondral bone is significantly weaker to penetrative force in the posterior region than in the anterior region of the talar dome and of the tibial plafond. These findings may have implications for microfracture awl design and for understanding the complex anatomy and physiology of the ankle joint. Levels of Evidence: Controlled laboratory study

Morphological Characterization of Buds Being Donors of Apex for Molecular Confirmation of Differentiation of Meristem into Permanent Tissues of Stone Fruit Trees (Prunus sp.)

Molecular confirmation of the process of differentiation of meristematic tissue of plants is primarily based on histomorphological characterization of the tissues carrying these processes. For perennial plants – fruit trees, the knowledge of these processes is important to define runtime type and pomotechnical treatments but also to identify the genes responsible for determination of the apices into a generative phase of differentiation. Which apex extraction techniques will be applied depends on the structure of buds, i.e. whether an apex differentiates only into generative elements – pure flower buds, or the differentiation goes into two directions: differentiation of leaf primordium with axillar meristematic dome and differentiation of generative elements of flowers in the peak or lateral zone of an apex – mixed buds. The fruit trees of the genus Prunus have purely flower buds and for this purpose the whole apex is taken, between protection – cover leaves, on lateral positions of all collateral buds at shoot nodes. The moment of initiation of determination and the dynamics of differentiation of generative buds are different at different type of shoots on a tree. It is therefore necessary to know the shoots growth cessation time which is in correlation with apex determination. Fruit trees of the genus Prunus are ending the growth of shoots by rejection of shoot peaks, and the cast away time depends on the type, length and the position of shoots.