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This review explores some of the complex mechanisms underlying antitumor T-cell response, with a specific focus on the balance and cross-talk between selected co-stimulatory and inhibitory pathways. The tumor microenvironment (TME) fosters both T-cell activation and exhaustion, a dual role influenced by the local presence of inhibitory immune checkpoints (ICs), which are exploited by cancer cells to evade immune surveillance. Recent advancements in IC blockade (ICB) therapies have transformed cancer treatment. However, only a fraction of patients respond favorably, highlighting the need for predictive biomarkers and combination therapies to overcome ICB resistance. A crucial aspect is represented by the complexity of the TME, which encompasses diverse cell types that either enhance or suppress immune responses. This review underscores the importance of identifying the most critical cross-talk between inhibitory and co-stimulatory molecules for developing approaches tailored to patient-specific molecular and immune profiles to maximize the therapeutic efficacy of IC inhibitors and enhance clinical outcomes. [ABSTRACT FROM AUTHOR]

The craniocervical junction (CCJ) forms the bridge between the skull and the spine, a highly mobile group of joints that allows the mobility of the head in every direction. The CCJ plays a major role in protecting the inferior brainstem (bulb) and spinal cord, therefore also requiring some stability. Children are subjected to multiple constitutive or acquired diseases involving the CCJ: primary bone diseases such as in FGFR‐related craniosynostoses or acquired conditions such as congenital torticollis, cervical spine luxation, and neurological disorders. To design efficient treatment plans, it is crucial to understand the relationship between abnormalities of the craniofacial region and abnormalities of the CCJ. This can be approached by the study of control and abnormal growth patterns. Here we report a model of normal skull base growth by compiling a collection of geometric models in control children. Focused analyses highlighted specific developmental patterns for each CCJ bone, emphasizing rapid growth during infancy, followed by varying rates of growth and maturation during childhood and adolescence until reaching stability by 18 years of age. The focus was on the closure patterns of synchondroses and sutures in the occipital bone, revealing distinct closure trajectories for the anterior intra‐occipital synchondroses and the occipitomastoid suture. The findings, although based on a limited dataset, showcased specific age‐related changes in width and closure percentages, providing valuable insights into growth dynamics within the first 2 years of life. Integration analyses revealed intricate relationships between skull and neck structures, emphasizing coordinated growth at different stages. Specific bone covariation patterns, as found between the first and second cervical vertebrae (C1 and C2), indicated synchronized morphological changes. Our results provide initial data for designing inclusive CCJ geometric models to predict normal and abnormal growth dynamics. [ABSTRACT FROM AUTHOR]

Background: Previous analyses have suggested variations in cervical spine canal morphology according to ethnicity, possibly in part due to variations in the posterior elements. The potential for these variations to affect the placement of instrumentation is uncertain. The aim of this study was to report on the feasibility of C2 lamina screw insertion in a New Zealand cohort including analysis of Māori, the indigenous people of New Zealand. Methods: A trauma computed tomography database was accessed to identify suitable images. On axial images, where the isthmus was at its widest, the outer diameter (OD) and inner diameter (ID) of the lamina were measured. Screw length was measured from a proposed entry point to the contralateral junction of the lamina and lateral mass. The spinolaminar angle was measured as the angle subtended by the screw trajectory and midsagittal plane. A 5.5-mm OD was accepted as a threshold for the feasibility of lamina screw placement. Results: One hundred eighty-seven images were assessed: 115 New Zealand European and 72 Māori. The mean age of the cohort was 41.9 years (SD 19.6), and most patients (64%) were men. For the entire cohort, mean OD was 6.6 and 6.8 mm on the right and left, respectively; the mean inner diameter was 3.5 and 3.8 mm; mean screw length was 31.5 and 31.5 mm; and mean spinolaminar angle was 46.0° and 46.1°. C2 lamina screw placement was feasible in a majority of patients. Considering only Māori patients, placement was feasible in 96% of right and 94% of left laminae in men but 72% of right and 72% of left laminae in women. Conclusions: In a majority of patients, C2 lamina screw placement is feasible. However, advanced imaging must be carefully assessed preoperatively because data suggest that Māori women may not necessarily have optimal anatomy. Clinical Relevance: Care needs to be taken when assessing and planning surgery inpatients of different ethnicities because variations may exist in the morphology of the posterior elements of C2, leading to variation in optimal fixation strategy. Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

This is a report of a series of 14 patients who presented with a range of "atypical" cranial, spinal, and systemic symptoms that started after they suffered a relatively severe injury to the head and/or neck several months or years before surgical treatment. The implications of diagnosing and treating central or axial atlantoaxial dislocation (CAAD) is discussed. Also, the role of dynamic rotatory and lateral head tilt imaging in the diagnosis and treatment is analyzed. Of the 14 patients, 7 were men and 7 were women, with an age range of 21–64 years (average, 42 years). Due to the severity of the presenting neurological and non-neurological symptoms, all the patients had lost their occupation and were heavily dependent on painkillers and/or antidepressant drugs. In addition to other characteristic clinical and radiological evidence, CAAD was diagnosed made based on the facet alignments on lateral profile imaging in the neutral head position. Dynamic head flexion-extension, lateral head tilt, and neck rotation imaging findings confirmed and subclassified CAAD. All 14 patients underwent atlantoaxial fixation surgery. A personalized self-assessment clinical scoring parameter and the World Health Organization Disability Assessment Schedule 2.0 was used to evaluate the outcome. One patient did not follow-up after surgery. At a minimum follow-up of 6 months after atlantoaxial fixation surgery, the remaining 13 patients experienced relief from all major symptoms. Diagnosing and treating CAAD can have major therapeutic implications for patients presenting with progressively worsening disabling clinical symptoms following relatively severe head and/or neck trauma. [ABSTRACT FROM AUTHOR]

Objective Both two‐level anterior cervical corpectomy and fusion (t‐ACCF) and posterior open‐door laminoplasty (ODLP) are effective surgical procedures for the treatment of ossification of the posterior longitudinal ligament (OPLL). Previous studies have identified different effects of different surgical procedures on the upper and subaxial cervical spine (UCS, SCS), however, there are no studies on the effects of t‐ACCF and ODLP on the occipito‐atlantoaxial complex. Therefore, the purpose of this study is to compare the changes in sagittal parameters and range of motion (ROM) of the occipito‐atlantoaxial complex in OPLL patients treated with t‐ACCF and ODLP. Methods This was a retrospective study that included 74 patients who underwent t‐ACCF or ODLP for the treatment of OPLL from January 2012 to August 2022 at our institution. Preoperative, 3‐month, and 1‐year postoperative cervical neutral, flexion‐extension, and lateral flexion radiographs were taken. Sagittal parameters including Cobb angle of C2‐7, C0‐2, C0‐1, C1‐2, C2 slope, and the ROM were measured. The clinical outcome was assessed using the JOA, VAS, and NDI scores preoperatively and at 3 and 12 months postoperatively. Multiple linear regression was employed to identify factors influencing changes in UCS. Results In the ODLP group, the SCS (C2‐7) Cobb angle was significantly reduced (12.85 ± 10.0 to 7.68 ± 11.27; p

Objective To analyze and compare the effects of transverse ligament injury on the stability and stress distribution of atlantoaxial complex fractures using 3D finite element method. Methods A male volunteer with a normal cervical spine was selected. The cranio-cervical region (C0-C3) was scanned using a 64-slice spiral CT scanner. Software such as Simpleware 3.0, Geomagic 12.0, and Hypermesh 12.0 were used to create a three-dimensional finite element model (FEM/Intact) of the C0-C3 segment. On the validated model, the anterior and posterior arches of C1 and the base of the odontoid process were fractured to create a composite fracture model (FEM/Fracture) simulating Jefferson/Type Ⅱ odontoid fracture. Two additional models were created: one with a ruptured transverse ligament of the atlas (FEM/RTL) and another with an intact transverse ligament (FEM/TL). The models were subjected to loading conditions of flexion, extension, lateral bending, and rotation, and the Von Mises stress distribution and vertebral segment motion were analyzed for each model under different loading conditions. Results The three-dimensional nonlinear finite element model of the atlantoaxial complex created in this study had a realistic appearance and good geometric similarity. The motion of each vertebral segment in the model was consistent with the results of Panjabi's in vitro experimental analysis. The composite fracture model of Jefferson/Type Ⅱ odontoid fracture with or without transverse ligament injury also had a realistic appearance and good geometric similarity. After combining the transverse ligament injury with the Jefferson/Type Ⅱ odontoid fracture, the instability of the upper cervical spine primarily concentrated at the atlantoaxial joint, with varying degrees of increased motion in flexion, extension, lateral bending, and axial rotation compared to the normal group. Conclusion Transverse ligament injury significantly affects the stability and stress distribution of atlantoaxial complex fractures. The finite element models established in this study can be used for biomechanical analysis of Jefferson/Type Ⅱ odontoid fracture combined with transverse ligament injury, and provide strong theoretical support for the selection of fixation methods in atlantoaxial complex fractures.

Lucan's invocation to Nero (1.33-66) is notorious for its seemingly contradictory praise and condemnation of the emperor. While analyses of this passage often turn to Virgil's Georgics (1.24-28, 489-497, 500-515) to begin to explain this inherent paradox, Grimal (2010) has demonstrated the importance of Manilius' Astronomica as a cosmological framework for these lines which invites a more positive reading of Nero's presentation here. By examining the presence of two Manilian models in Lucan's invocation to Nero, their contributions to the Lucanian cosmos, and their consequences for our understanding of the options laid out for the emperor's heavenly future, this study argues for a more pragmatic—even hopeful—reading of Nero's apotheosis and the implications of this for Lucan's commentary on the Neronian present. [ABSTRACT FROM AUTHOR]

Objective: Both two‐level anterior cervical corpectomy and fusion (t‐ACCF) and posterior open‐door laminoplasty (ODLP) are effective surgical procedures for the treatment of ossification of the posterior longitudinal ligament (OPLL). Previous studies have identified different effects of different surgical procedures on the upper and subaxial cervical spine (UCS, SCS), however, there are no studies on the effects of t‐ACCF and ODLP on the occipito‐atlantoaxial complex. Therefore, the purpose of this study is to compare the changes in sagittal parameters and range of motion (ROM) of the occipito‐atlantoaxial complex in OPLL patients treated with t‐ACCF and ODLP. Methods: This was a retrospective study that included 74 patients who underwent t‐ACCF or ODLP for the treatment of OPLL from January 2012 to August 2022 at our institution. Preoperative, 3‐month, and 1‐year postoperative cervical neutral, flexion‐extension, and lateral flexion radiographs were taken. Sagittal parameters including Cobb angle of C2‐7, C0‐2, C0‐1, C1‐2, C2 slope, and the ROM were measured. The clinical outcome was assessed using the JOA, VAS, and NDI scores preoperatively and at 3 and 12 months postoperatively. Multiple linear regression was employed to identify factors influencing changes in UCS. Results: In the ODLP group, the SCS (C2‐7) Cobb angle was significantly reduced (12.85 ± 10.0 to 7.68 ± 11.27; p < 0.05), and the UCS (C0‐2) Cobb angle was significantly compensated for at 1 year postoperatively compared with the t‐ACCF group (3.05 ± 4.09 vs 0.79 ± 2.62; p < 0.01). The SCS and lateral flexion ROM of the ODLP group was better maintained than t‐ACCF (14.51 ± 6.00 vs 10.72 ± 3.79; 6.87 ± 4.56 vs 3.81 ± 1.67; p < 0.01). The compensatory increase in C0‐2, C0‐1, and C1‐2 ROM was pronounced in both groups, especially in the ODLP group. The results of multiple linear regression showed that only the surgical procedure was a significant factor influencing UCS. Conclusion: The loss of the SCS Cobb angle was more pronounced in ODLP relative to t‐ACCF, resulting in a significant compensatory increase in UCS and atlantoaxial Cobb angle. The ROM of the UCS, atlantooccipital, and atlantoaxial joints was significantly increased in both groups, this may accelerate degenerative changes in the occipital‐atlantoaxial complex, may leading to poorer outcomes in the long‐term; of these, ODLP should receive more attention. In contrast, t‐ACCF better maintains normal curvature of the SCS and occipito‐atlantoaxial complex but loses more ROM. [ABSTRACT FROM AUTHOR]

BACKGROUND: It has been suggested that CT multiplanar reconstruction should be performed prior to the placement of axial pedicle screws to determine the anatomy of the C2 pedicle in each patient, to design the appropriate screw locus and diameter, and to evaluate the feasibility of screw placement to reduce the incidence of surgery-related complications. OBJECTIVE: To evaluate the feasibility of axis pedicle screw placement by morphologic classification of pediculoisthmic component with CT multiplanar reconstruction. METHODS: The CT data of 200 patients (400 axial pedicle screws) with cervical spine were retrospectively studied by using Siemens Syngo.Via software. According to the direction of the axis of the pedicle, the CT multiplanar reconstruction positioning line was adjusted to reconstruct the sectional image of the narrowest part of the pediculoisthmic component. According to its morphological characteristics, the narrowest part of the pediculoisthmic component was divided into three types: type 1, “hook” type: Type 1a outer diameter width (a1)> 0.4 cm, type 1b outer diameter width (a1)≤0.4 cm; type 2, “like circle/ellipse” type; type 3, “horizontal ellipse” type. The outer diameter width of the narrowest part of pediculoisthmic component (d1), medullary cavity width (d2), outer diameter height (a1), and medullary cavity height (a2) were compared among the three types, and the feasibility of pedicle screw placement of the three types was evaluated. RESULTS AND CONCLUSION: (1) A total of 400 axial pedicles included 269 cases of type 1, 130 cases of type 2, and 1 case of type 3. (2) The mean external diameter height between types 1 and 2 was not significantly different (P > 0.05). The mean medullary cavity height, mean outer diameter widths, and mean medullary cavity width were significantly different (P < 0.001). There were 42 cases (15.6%) of type 1 and 0 cases (0.00%) of type 2 with mean external diameter width ≤ 0.4 cm, and the difference was significant (P<0.001). There was only one case of type 3, whose external diameter height, medullary cavity height, outer diameter width and medullary cavity width were 1.20 cm, 0.84 cm, 0.64 cm and 0.31 cm, respectively. (3) These results confirm that axial pedicle screws can be safely inserted in patients with types 1a, 2 and 3, which requires no further measurement and assessment. Pedicle screw insertion should be performed with caution in type 1b patients. Therefore, in type 1 patients, the width of the narrowest outer diameter of the pediculoisthmic component should be further measured to evaluate the feasibility of axial pedicle screw placement. [ABSTRACT FROM AUTHOR]

[Display omitted] The typical mammalian neck consisting of seven cervical vertebrae (C1–C7) was established by the Late Permian in the cynodont forerunners of modern mammals. This structure is precisely adapted to facilitate movements of the head during feeding, locomotion, predator evasion, and social interactions. Eutheria, the clade including crown placentals, has a fossil record extending back more than 125 million years revealing significant morphological diversification in the Mesozoic. Yet very little is known concerning the early evolution of eutherian cervical morphology and its functional adaptations. A specimen of Zalambdalestes lechei from the Late Cretaceous of Mongolia boasts exceptional preservation of an almost complete series of cervical vertebrae (C2–C7) revealing a highly modified axis (C2). The significance of this cervical morphology is explored utilizing an integrated approach combining comparative anatomical examination across mammals, muscle reconstruction, geometric morphometrics and virtual range of motion analysis. We compared the shape of the axis in Zalambdalestes to a dataset of 88 mammalian species (monotremes, marsupials, and placentals) using three-dimensional landmark analysis. The results indicate that the unique axis morphology of Zalambdalestes has no close analog among living mammals. Virtual range of motion analysis of the neck strongly implies Zalambdalestes was capable of exerting very forceful head movements and had a high degree of ventral flexion for an animal its size. These findings reveal unexpected complexity in the early evolution of the eutherian cervical morphology and suggest a feeding behavior similar to insectivores specialized in vermivory and defensive behaviors in Zalambdalestes akin to modern spiniferous mammals. [ABSTRACT FROM AUTHOR]

Introduction: Pathological destruction of the axis vertebra leads to a highly unstable condition in an upper cervical spine. As surgical resection and anatomical reconstruction of the second cervical vertebrae represents a life threatening procedure, less radical approaches are preferred and only few cases of C2 prosthesis are described in literature. Case Description: The focus of this case report is a 21-year-old man with a pathological fracture of C2 managed primarily surgically with the C1-C3 dorsal fusion. Due to the progression of giant cell tumor and destruction of the axis vertebra, C2 prosthesis through anterior approach and dorsal occipito-cervical fusion C0-C4 were performed. Postoperative infection was managed surgically with a 2-staged dorsal debridement, ostheosynthesis material change and autologous bone graft. After a 4 week-intravenous therapy with the ceftriaxone in combination with the amoxicillin/clavulanate, followed by 12 week per oral therapy with amoxicillin/clavulanate in combination with ciprofloxacin, the complete recovery of the infection was achieved. Radiotherapy was initiated 2 months after the last revision surgery and the patient showed a good clinical outcome with stable construct at a 1 year follow-up. A review of literature of all reported C2 prosthesis cases was performed Conclusion: C2 prosthesis allows a more radical resection in pathological processes involving the axis vertebra. Combined with the posterior fusion, immediate stability is achieved. Anterior surgical approach is through a highly unsterile oral environment which presents a high-risk of postoperative infection. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective study. Objective. To evaluate the feasibility of C2 pedicle screw fixation with the "in-out-in" technique in patients with basilar invagination (BI). Summary of Background Data. The "in-out-in" technique is a fixation technique in which the screw enters the vertebrae through the parapedicle. The technique has been used in upper cervical spine fixation. However, anatomic parameters associated with the application of this technique in patients with BI are unclear. Materials and Methods. We measured the C2 pedicle width (PW), the distance between the vertebral artery (VA) and the transverse foramen (VATF), the safe zone, and the limit zone. The lateral safe zone is the distance from the medial/lateral cortex of the C2 pedicle to the VA (LPVA/MPVA), and the medial safe zone is the distance from the medial/lateral cortex of the C2 pedicle to the dura (MPD/LPD). The lateral limit zone is the sum of LPVA/MPVA and VATF (LPTF/MPTF), and the medial limit zone is the distance from the medial/lateral cortex of the C2 pedicle to the spinal cord (MPSC/LPSC). PW, LPVA, MPVA, and VATF were measured on the reconstructed CT angiography. PW, MPD, LPD, MPSC, and LPSC weremeasured onMRI.We define a width greater than 4mmas safe for screw. The t-test was used to compare the parameters between male and female, left and right sides in all patients, and PW in CTA and MRI data in the same patient. For intrarater reliabilities, interclass correlation coefficients were calculated. Results. A total of 154 patients (49 CTA, 143 MRI) were included. The average PW, LPVA, MPVA, LPTF, MPTF, MPD, LPD, MPSC, and LPSC were 5.30 mm, 1.28 mm, 6.60 mm, 2.45 mm, 8.94 mm, 2.09 mm, 7.07 mm, 5.51 mm, and 10.48 mm, respectively. Furthermore, in patients with PW < 4 mm, 53.6% of MPVA, 86.2% of LPTF, and all limit zones were larger than 4 mm. Conclusions. In patients with BI, there is sufficient space medially and laterally to the C2 pedicle for partial screw encroachment to achieve "in-out-in" fixation, even if the pedicle is small. [ABSTRACT FROM AUTHOR]

This article probes culture as a site of both cooperation and rivalry by examining two exhibitions, of 1939 and 1942, which were jointly supported by Hitler's Germany and Mussolini's Italy. These under-researched exhibitions reveal how the two regimes shared a common belief in culture as a tool of mobilization, but differed in their visions of race, culture, ideology and war. [ABSTRACT FROM AUTHOR]

In setting the scene for the articles featured in the special issue, the Introduction provides a brief overview of the literature on the Axis between Fascist Italy and Nazi Germany from its origins until the present day. While traditionally the historiography has overlooked culture as a point of contact between the two regimes, there is a small, but growing, body of recent research on the topic, which is often inspired by transnational, comparative, and global history. Thus, the introduction presents the cultural entanglements of Fascism and National Socialism as fertile ground for new research. [ABSTRACT FROM AUTHOR]

A special evaluation of modern wind turbine blade designs is provided, masking most theoretical performance, momentum, real performance and blade loads. The article presents a complete review of the rotor blade designs of wind mills and indicates that modern wind mills nearly completely use rotors with a horizontal axis. The aerodynamic layout principles of a current wind turbine blade are defined in detail, inclusive of blade shape, number, choice of airfoils, and best angles of attack. A complete examine of wind turbine blade layout constraints is presented, detailing aerodynamic, gravitational, centrifugal, gyroscopic, and operational conditions. [ABSTRACT FROM AUTHOR]

We have studied how first-year university science students construct graphs based on hypothetical qualitative physics scenarios. We gave students a questionnaire that asked them to complete two Cartesian graphs in one of three different scenarios (a ball rolling down a track, a beaker being filled with water, the resistance between different points on a metal bar) given as a written piece of text accompanied by a diagram of a hypothetical experiment that included three evenly spaced points on the set-up. Two of the three points were also indicated on the position axis of the partially drawn graph. We found that students can find it hard to translate equal spatial intervals in the experiment to a line graph. We found that most students either did not explain why they put the third point on the graph where they did, or did not plot the point at all. Some students drew unequal intervals on the position axis to indicate unequal time or resistance intervals. The difficulties became more prevalent as the levels of abstraction increased. Our findings suggest that constructing a scale on a qualitative graph requires significant mental effort from the students. [ABSTRACT FROM AUTHOR]

Background: Temporomandibular disorders are the most common condition affecting the orofacial region, resulting in pain and dysfunction. Objective: This study aimed to elucidate the ambiguous association between cervical features and temporomandibular disorders by measuring the rotations between the skull‐atlas, atlas‐axis and mandible‐atlas and examining the relationship between these rotations and temporomandibular disorders. Methods: Cone‐beam computed tomography (CBCT) images from 176 patients, 97 females and 79 males with an average age of 25.7 years were used in this study. The patients were divided into two groups: those with joint dysfunction (n = 88) and those without (n = 88). The study employed various methods to determine rotations in the skull‐atlas, atlas‐axis and mandible atlas based on anatomical landmarks and measurements. These methods include the use of specific planes, angles and distances to identify and measure rotation. Data analysis was performed using the TURCOSA statistical software (Turcosa Analytics Ltd Co, Turkey, www.turcosa.com.tr). Results: The results showed that the degree of rotation between the skull and the atlas was higher in the TMD group than in the control group (p <.001). Similarly, Atlas‐axis rotation was significantly higher in the TMD group (p <.001). However, no significant difference was found between mandible atlas rotations in the two groups (p =.546). The study also found a significant difference between the direction of rotation between the atlas and axis and the direction of mandible atlas rotation (p <.001) as well as between skull and atlas rotations and mandible‐atlas rotations (p <.001). Conclusion: Overall, the study suggests that there is a relationship between the skeletal structures of the cranio‐cervico‐mandibular system and TMD. Skull‐atlas and atlas‐axis rotations may play an important role in the aetiology of TMD in individuals with TMD. Therefore, it is important to evaluate rotations in the skull‐atlas‐axis region for the treatment of TMD. [ABSTRACT FROM AUTHOR]

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The prevalence rate of acute respiratory distress syndrome (ARDS) is estimated at approximately 10% in critically ill patientsworldwide,with the mortality rate ranging from 17% to 39%. Currently, ARDS mortality is usually higher in patients with COVID-19, giving another challenge for ARDS treatment. However, the treatment efficacy for ARDS is far from satisfactory. The relationship between the gut microbiota and ARDS has been substantiated by relevant scientific studies. ARDS not only changes the distribution of gut microbiota, but also influences intestinal mucosal barrier through the alteration of gut microbiota. The modulation of gut microbiota can impact the onset and progression of ARDS by triggering dysfunctions in inflammatory response and immune cells, oxidative stress, cell apoptosis, autophagy, pyroptosis, and ferroptosis mechanisms. Meanwhile, ARDS may also influence the distribution of metabolic products of gut microbiota. In this review, we focus on the impact of ARDS on gut microbiota and how the alteration of gut microbiota further influences the immune function, cellular functions and related signaling pathways during ARDS. The roles of gut microbiota-derived metabolites in the development and occurrence of ARDS are also discussed. [ABSTRACT FROM AUTHOR]

Language about time is an integral part of how we spatialise time. Factors like temporal focus can be related to time spatialisation as well. The current study investigates the role of language in how we spatialise time, using a temporal diagram task modified to include the lateral axis. We asked participants to place temporal events provided in non-metaphorical, sagittal metaphorical, and non-sagittal metaphorical scenarios on a temporal diagram. We found that sagittal metaphors elicited sagittal spatialisations of time, whereas the other two types elicited lateral spatialisations. Participants sometimes used the sagittal and lateral axes in combination to spatialise time. Exploratory analyses indicated that individuals' time management habits, temporal distance, and event order in written scenarios were related to time spatialisations. Their temporal focus scores, however, were not. Findings suggest that temporal language plays an important role in how we map space onto time. [ABSTRACT FROM AUTHOR]

Due to the wide variety of cervical vertebral congenital anomalies, knowledge of their types and related clinical conditions can prove to be helpful for physicians and surgeons in the diagnosis and treatment of patients. The aim of this study is to report on a rare case of unstable cervical vertebral congenital anomaly in which the patient had a defect in the body of the C3 vertebra in addition to defects in the posterior arch of C1 and posterior element of C2. This type of anomaly has not been reported so far in the literature. To reduce the patient’s related neurological disorders, our treatment choice for this patient was occipitocervical fusion (OCF) surgery. At the 3-year postoperative follow-up, all sensory and motor problems related to this anomaly affecting the patient's upper and lower limbs and causing shoulder and neck pain were eliminated. In this rare type of anomaly, OCF surgery seems to be an effective choice in relieving the patient's neurological symptoms.

This technical report illustrates the technique to perform computed tomography (CT)-guided bone biopsies in the body and dens of the axis (C2 vertebra) through a posterior transpedicular approach with the use of preoperative contrast-enhanced scans to highlight the course of the vertebral artery. The technique is presented through two exemplification cases: a pediatric patient with osteoblastoma and secondary aneurysmal bone cyst and one adult patient with melanoma metastasis. This case highlights the potential of the CT-guided posterolateral/transpedicular approach for performing safe and effective biopsies in the body and dens of C2, even in pediatric patients.

BACKGROUND: The relationship between the mind, gut, and sleep is not static and requires proper harmony for optimal emotional health. Recent evidence suggests that gut health is a key player in regulating mental and physical health via bidirectional communication between the brain and gut. MATERIALS AND METHODS: A cross-sectional comparative study was undertaken on 200 participants aged 25-40 years old for two months at a tertiary care hospital. A community-based method was used to select the participants from in and around Pune. The survey was conducted online with the help of a self-designed well-structured detailed questionnaire that included a demographic profile, medical history, history of sleep pattern, gut health status, emotional well-being status about gut and sleep physiology, and lifestyle-related issues and problems was administered to all the study participants. RESULTS: A statistically significant correlation was observed between the duration of sleep; and gastrointestinal (GI) symptoms including heartburn (P=0.03) constipation (P=0.03), bloating (P=0.04), and indigestion (P=0.051). Specific GI symptoms as mentioned above were found to affect the study participants' emotional well-being significantly. Regular physical exercise demonstrated a significant correlation with an increased duration of sleep (P=0.003). Consumption of tobacco, alcohol; smoking, and consumption of stimulants like tea, coffee, and coke showed a significant effect on both the duration and quality of sleep (P=0.004). Gut and sleep disturbances were more common in north Indian subjects as compared to south Indian subjects (P=0.003). The upper socioeconomic population had more GI; sleep and emotional disturbances as compared to the lower socioeconomic study subjects (P=0.002). CONCLUSION: The relationship between sleep patterns, emotional well-being gut health is bidirectional. Prioritizing good sleep hygiene, managing stress through mindfulness or relaxation techniques, and maintaining a balanced diet that supports gut health are crucial steps in promoting overall well-being.

This technical report illustrates the technique to perform computed tomography (CT)-guided bone biopsies in the body and dens of the axis (C2 vertebra) through a posterior transpedicular approach with the use of preoperative contrast-enhanced scans to highlight the course of the vertebral artery. The technique is presented through two exemplification cases: a pediatric patient with osteoblastoma and secondary aneurysmal bone cyst and one adult patient with melanoma metastasis. This case highlights the potential of the CT-guided posterolateral/transpedicular approach for performing safe and effective biopsies in the body and dens of C2, even in pediatric patients. [ABSTRACT FROM AUTHOR]

A "fusion law" is a collection of multiplication rules among eigenspaces of an idempotent. This terminology is relatively new and is closely related to primitive axial algebras, introduced recently by Hall, Rehren and Shpectorov. Axial algebras are closely related to 3-transposition groups and vertex operator algebras. In earlier work we studied primitive axial algebras, not necessarily commutative, and showed that they all have Jordan type. In this paper, we show that all finitely generated primitive axial algebras are direct sums of specifically described flexible finite-dimensional noncommutative algebras, and commutative axial algebras generated by primitive axes of the same type. In particular, all primitive axial algebras are flexible. They also have Frobenius forms. We give a precise description of all the primitive axes of axial algebras generated by two primitive axes. [ABSTRACT FROM AUTHOR]

Taiyi 太一, the void and dark central region of the celestial sphere, carries symbolic implications that resonate with the essence of ultimate reality in the philosophical framework of the Laozi 老子. It assumes a metaphorical representation of the ultimate reality and its movement pattern, serving as the axis from which the fundamental concepts and principal branches of this philosophy unfurl. The concept of Taiyi exerts a profound and far-reaching impact on the philosophical discourse of the Laozi. It assumes the mantle of a signifier for the ultimate reality within the philosophical framework of the Laozi, while its dynamic motion patterns imbue the cosmological principles of this philosophy. On a pragmatic level, Taiyi unveils profound and nuanced insights into human nature and the epistemology expounded by the Laozi. [ABSTRACT FROM AUTHOR]

Abstract Purpose To develop a bidirectional slide guide to assist screw placement in the axial lamina and to preliminarily discuss the accuracy and feasibility of auxiliary screw placement. Methods CT data from 40 randomly selected patients were imported into the software for modelling, and cross-pinning was used to simulate pinning. According to the different crossing methods of the upper and lower laminar screws, they are divided into two groups. In the software, the position of the needlepoint of each screw is accurately measured, and the needle point is kept unchanged to simulate the movable range of the screw tail under the condition that the body does not penetrate the cortical bone. The data were compared by grouping and gender. Finally, the guide was designed by combining the screw exit point and fine adjustment angle data of all patients with the centripetal principle of the slide rail. Results The needle exit data L1/L2/L3/L4 were 6.44 ± 0.52 mm, 7.05 ± 0.48 mm, 3.55 ± 0.75 mm and 5.09 ± 0.74 mm, respectively, and the fine adjustment angle of the slide rail was 10.51° ± 0.87°. There was no significant difference between the two groups or between men and women (p > 0.05). Conclusion In this experiment, using the data obtained from the simulation of screw insertion, a two-way slide guide was designed to assist the insertion of axial laminar screws. The guide locks the screw outlet point to position and guides the screw inlet point, which improves the accuracy and safety of screw placement.

The influence of the reamer's elastic guide plates on the quality of the machined hole is studied by means of a mathematical model. Recommendations are made for reducing the defects (fracturing) to an acceptable level. [ABSTRACT FROM AUTHOR]

Dens fractures are an increasingly common injury, yet their epidemiology and its implications remain underexamined. We retrospectively analyzed all traumatic dens fracture patients managed at our institution over a 10-year period, examining demographic, clinical, and outcomes data. Patient subsets were compared across these parameters. Among 303 traumatic dens fracture patients, we observed a bimodal age distribution with a strong goodness of fit centered at age 22.3 ± 5.7 (R = 0.8781) and at 77.7 ± 13.9 (R = 0.9686). A population pyramid demonstrated a bimodal distribution among male patients, but not female patients, which was confirmed with a strong goodness of fit for male patient subpopulations age <35 (R = 0.9791) and age ≥35 (R = 0.8843), but a weaker fit for a second female subpopulation age <35. Both age groups were equally likely to undergo surgery. Patients younger than age 35 were more likely to be male (82.4% vs. 46.9%, odds ratio [OR] = 5.29 [1.54, 17.57], P = 0.0052), have motor vehicle collision as their mechanism of injury (64.7% vs. 14.1%, OR = 11.18 [3.77, 31.77], P < 0.0001), and to have a severe trauma injury severity score (17.6% vs. 2.9%, OR = 7.23 [1.88, 28.88], P = 0.0198). Nevertheless, patients age <35 were less likely to have fracture nonunion at follow (18.2% vs. 53.7%, OR = 0.19 [0.041, 0.76], P = 0.0288). The dens fracture patient population comprises 2 subpopulations, distinguished by differences in age, sex, injury mechanism and severity, and outcome, with male dens fracture patients demonstrating a bimodal age distribution. Young, male patients were more likely to have high-energy injury mechanisms leading to severe trauma, yet were less likely to have fracture nonunion at follow-up. [ABSTRACT FROM AUTHOR]

Due to the wide variety of cervical vertebral congenital anomalies, knowledge of their types and related clinical conditions can prove to be helpful for physicians and surgeons in the diagnosis and treatment of patients. The aim of this study is to report on a rare case of unstable cervical vertebral congenital anomaly in which the patient had a defect in the body of the C3 vertebra in addition to defects in the posterior arch of C1 and posterior element of C2. This type of anomaly has not been reported so far in the literature. To reduce the patient's related neurological disorders, our treatment choice for this patient was occipitocervical fusion (OCF) surgery. At the 3-year postoperative follow-up, all sensory and motor problems related to this anomaly affecting the patient's upper and lower limbs and causing shoulder and neck pain were eliminated. In this rare type of anomaly, OCF surgery seems to be an effective choice in relieving the patient's neurological symptoms. [ABSTRACT FROM AUTHOR]

Background: Vertebroplasty has been recently described in the literature as a potential treatment for C2 metastatic lesions. Stentoplasty may represent a safest and equally alternative to the latter. Objective: To describe a novel technique, stentoplasty, as an alternative for the treatment of metastatic involvement of C2 and to assess its efficacy and safety. To systematically evaluate the pertinent literature regarding the clinical outcomes and complications of C2 vertebroplasty in patients with metastatic disease. Methods: A systematic review of C2 vertebroplasty, in the English language medical literature was conducted for the needs of this study. Additionally, a cohort of five patients, presenting with cervical instability (SINS > 6) and/or severe pain (VAS > 6) from metastatic involvement of C2 and treated with stentoplasty in our department is presented. Outcomes evaluated include, pain control, stability, and complications. Results: Our systematic review yielded 8 studies that met the inclusion criteria, incorporating 73 patients that underwent C2 vertebroplasty for metastatic disease. There was a reduction in VAS scores following surgery from 7.6 to 2.1. Eleven patients had complications (15%), 3 (4%) required additional stabilization and decompression, 6 (8.2%) had odynophagia and the incidence of cement leak was 31.5% (23/73). With regard to our cohort, all 5 patients presented with severe neck pain (average VAS 6.2 (2–10)) with or without instability (average SINS 10 (6–14)) and underwent C2 stentoplasty. Mean duration of the procedures was 90 min (61–145) and 2.6 mls (2–3) of cement was injected. Postoperatively VAS improved from 6.2 to 1.6 (P = 0.033). No cement leak or other complications were recorded. Conclusion: A systematic review of the literature demonstrated that C2 vertebroplasty can offer significant pain improvement with a low complication rate. At the same time, this is the first study to describe stentoplasty in a small cohort of patients, as an alternative for the treatment of C2 metastatic lesions in selected cases, offering adequate pain control and improving segmental stability with a high safety profile. [ABSTRACT FROM AUTHOR]

Many accounts of the formation of American and British grand strategy during World War II between the fall of France and the Pearl Harbor attacks stress the differences between the two sides' strategic thinking. These accounts argue that while the Americans favored a 'direct' Germany-first approach to defeating the Axis powers, the British preferred the 'indirect' or 'peripheral' method. However, a review of Anglo-American strategic planning in this period shows that before official U.S. wartime entry, both sides largely agreed the British 'peripheral' approach was the wisest grand strategy for winning the war. [ABSTRACT FROM AUTHOR]

RGB-D sensors can be a low-cost solution for an accurate silo's content monitoring which is fundamental for its efficient management. Some reference information such as the position and orientation of the sensor with respect to the silo's geometry is fundamental for obtaining correct content measurements from acquired data. Since in real cases this information is not always known, a new method to obtain these measurements is proposed. This, taking as input sensor acquired data (represented as a point cloud), automatically computes the silo's axis to provide a new reference system from which the point cloud can be easily processed. The z-axis of this reference system coincides with the gravity axis and the xy-plane is parallel to the ground plane. It is obtained in a six-step process that exploits the silo geometry properties and an estimation of the shape tensors of the acquired points. The method has been implemented and tested on both synthetic and real silos, considering a complete silo's discharge process and different camera positions. Data acquired at each discharge has been transformed using the new reference system and compared with the silo's ground truth (manually obtained for the real silos). To evaluate the accuracy the input point cloud to adjusted point cloud average distance has been considered. In all the tests, the well-performance of the proposal has been demonstrated, achieving a maximum average distance error of less than 6 cm. [ABSTRACT FROM AUTHOR]

Context: A wild population of non-native hog deer has established in the Gippsland region of Victoria, Australia, and there is particular concern about its impact on native vegetation in Wilsons Promontory National Park (WPNP). Since 2015, there has been annual culling of hog deer at WPNP to reduce deer abundances and impacts. Aims: The aims of this study were to use a kinship approach based on genotyping to assess contemporary dispersal of hog deer across WPNP, by identifying close kin, to determine whether dispersal of deer into culled sites from unculled sites may affect the long-term success of management there. Differences in the dispersal of male and female hog deer were also investigated. Methods: In total, 91 hog deer tissue samples were collected across WPNP and surrounding sites. Single nucleotide polymorphism (SNP) markers were sequenced, and a final dataset comprising 8275 SNPs was used for analysis. First-order, second-order, and intermediate relative pairs were identified, and the geographic distance between these pairs was assessed to determine inter-pair distances to infer dispersal. Spatial autocorrelation between male and female samples was evaluated to measure the effects of sex-biased dispersal. Key results: Only seven second-order relative pairs were found across different sites, with a 30 km distance between the furthest pair observed. However, most inter-pair distances across sites were ~5–10 km. Analyses of sex-biased dispersal showed that movement by deer was not strongly influenced by one sex. Conclusions: Although hog deer in WPNP are genetically similar, most relatives that were sampled were not widely dispersed. This suggests that there is limited dispersal of hog deer across this park. Implications: Recolonisation of hog deer at culled sites via dispersal is likely to be infrequent in WPNP. Kinship analysis provides an effective method of assessing contemporary dispersal and could be applied to other species to assess fine-scale movement across landscapes. Introduced hog deer (Axis porcinus) are considered overabundant in Wilsons Promontory National Park in Victoria, Australia, and annual culling of the species has been conducted there since 2015. To determine if hog deer are likely to recolonise culled sites through dispersal, analysis of kinship was undertaken by identifying closely related kin and their distribution across the landscape. Hog deer kin did not appear to disperse large distances across the sites sampled within Wilsons Promontory National Park, suggesting that long-term culling success is unlikely to be hampered by dispersal. Photograph by David Young, provided courtesy of the Victorian Game Management Authority. [ABSTRACT FROM AUTHOR]

Abstract Background Hangman fracture is the second most common injury of the upper cervical spine, and neurological deficit with Hangman fracture is not rare. To our knowledge, few reports have statistically analyzed the predisposing factors for this injury. The objective of this study was to describe the clinical characteristics of neurological deficit associated with Hangman fracture and evaluate its risk factors. Methods In this retrospective study, 97 patients with Hangman fractures were included. Data on the age, sex, injury etiology, neurological deficits, and associated injuries were obtained and evaluated. The pretreatment parameters, anterior translation and angulation of C2/3, presence of the posterior vertebral wall (PVW) fractures of C2, and presence of spinal cord signal changes were measured. Twenty-three patients with neurological deficits after Hangman fractures comprised group A, and 74 patients without neurological deficit comprised group B. Student’s t-test or a nonparametric test and the chi-square test were used to evaluate the differences between groups. Binary logistic regression analysis was used to identify the risk factors for neurological deficit. Results Among the 23 patients in group A, 2 were American Spinal Injury Association (ASIA) scale B, 6 were C, and 15 were D, and spinal cord magnetic resonance imaging signal change was observed at the level of C2–C3 disc, C2, or both. Patients with the combination of PVW fractures and ≥ 50% significant translation or angulation of C2/3 were significantly more likely to have a neurological deficit. Both factors remained significant in binary logistic regression analysis. Conclusions Neurological deficit after Hangman fractures always presents clinically as a partial neurological impairment. The combination of PVW fractures with ≥ 1.8 mm of translation or ≥ 5.5° of angulation of C2/3 was the predisposing factor for neurological deficit with Hangman fractures.

Objective C2 pedicle screw insertion is very important in posterior upper cervical surgery. The traditional screw placement technique requires us to consider both medial inclination and cephalad angle, it is difficult to operate intraoperatively. This paper is to explore a novel method of C2 pedicle screw placement compared with traditional C2 pedicle screw. Methods A total of 44 patients diagnosed with atlantoaxial fracture or instability from May 2018 to November 2020 were involved in this retrospective study, and they were divided into C2‐PPS group (perpendicular to the coronal plane C2 screw, 24 patients) and C2‐TPS group (traditional C2 pedicle screw, 20 patients). The diameter of the maximum tangential circle, distance between geometric center and median sagittal plane and screw length of PPS and TPS were measured based on the 3D model of C2, respectively. Then the 3D printed navigation templated were designed and manufactured by 3D printing to assisted the PPS and TPS placement, respectively. The surgical time and radiation exposure times during operation were recorded; the post‐operative grading criteria, deviation of screw entry point and deviation of screw angle of two groups were evaluated, respectively. Results A total of 48 screws were inserted in the C2‐PPS group, and 40 screws were inserted in the C2‐TPS group. There were 46 screws with grade 0 (95.8%) in the PPS group and 31 screws with grade 0 (77.5%) in the TPS group, (P = 0.03). The radiation exposure times in the C2‐PPS group and C2‐TPS group were 4.7 ± 1.5 and 7.8 ± 3.8, respectively, (P = 0.045). The deviations of screw entry point in the C2‐PPS group and C2‐TPS group were 1.2 ± 0.8 mm and 3.2 ± 1.3 mm, respectively; the deviations of screw angle in the C2‐PPS group and C2‐TPS group were 2.1 ± 1.6° and 4.8 ± 2.0°, respectively, (P = 0.000). The diameters of the maximum tangential circle in the C2‐PPS group and C2‐TPS group were 5.5 ± 1.0 mm and 5.3 ± 0.9 mm, respectively. The distances between the geometric center and median sagittal plane in the C2‐PPS group and C2‐TPS group were 15.4 ± 2.3 mm and 18.0 ± 3.3 mm, respectively; The screw lengths in the C2‐PPS group and C2‐TPS group were 25.9 ± 3.2 mm and 27.6 ± 3.7 mm, respectively, (P = 0.000). Conclusion Eighty percent of C2‐PPS corridor can accommodate a 3.5 mm diameter screw, and with an average screw length of 26 mm. Navigation templates assisted the C2‐PPS placement is less surgical time, less radiation exposure times, more safe and more accurate than C2‐TPS.

Abstract Objective To observe the precise anatomical location and pattern of the fracture lines in Hangman’s fracture. Methods Three-dimensional computed CT images of 210 patients with Hangman’s fracture were collected. According to the involvement of anatomical structures, the injuries were classified into facet joint injury and pure bony injury. The C2 ring was also divided into: anterior, middle, and posterior elements. The anatomical structures involvement and fracture patterns were observed. Result Total 520 anatomical structures injuries were involved in 210 patients Hangman’s fractures, including 298 facet joints injuries (57.3%) and 222 bony injuries (42.7%). The most common facet joints injury was superior articular facet injury of C2, and the most common pure bony injury was pediculoisthmic component fracture. The injuries of anterior element (60.6%) were more common than that of middle (20.4%) or posterior (19.0%) element. One injury in anterior element on one side and another injury located in the anterior, middle or posterior element other side was the most common fracture pattern. Injury of middle element on one side with another injury located in the middle or posterior element could be also observed. Conclusion In Hangman’s fractures, fracture lines could occur in any part of C2 ring. Facet joints injuries were more common than pure bony injuries, and the injuries of anterior element were also more common than that of middle or posterior element. The high prevalence of facet joints injuries means that most of Hangman’s fractures may be involved with intra-articular injuries.

Introduction: C2 fractures are one of the most common traumatic injuries of the cervical spine, with high rates of morbidity and mortality. Current literature on the incidence of C2 fractures is limited to populations outside of the United States (US), prior to 2014, or specific age cohorts. The purpose of this study is to report the incidence rate (IR) of C2 fractures and associated patient demographics in the US between 2002 and 2021 using the National Electronic Injury Surveillance System (NEISS) database. Methods: This study analyzed the NEISS database to identify cases of C2 fractures presenting to US Emergency Departments (EDs) from 2002 to 2021. Annual and overall numbers of fractures, IR, and patient demographics were analyzed. IR is expressed as the number of fractures per 100,000 person-years at risk (PYR). Patients were split into three different age groups for comparison (children and young adults, 0–64 years; older adults, 65–79 years; elderly individuals, 80 + years). Results: A national estimate of n = 72,764 patients (95% confidence interval [CI] = 54,371–91,156) presented to US EDs with a C2 fracture (IR was 1.17/PYR; 95% CI = 0.87–1.46), and elderly individuals had the highest IR overall (IR = 15.9; P < 0.05). The IR of C2 fractures between 2002 and 2021, reported as average annual percent change (AAPC), increased significantly, regardless of age or sex (AAPC = 10.9; 95% CI = 6.3–15.6; P < 0.0001). Conclusion: C2 fractures occur at higher rates than previous years, with especially high IR in elderly individuals. Emphasis of public health efforts toward osteoporosis and coordination difficulties in elderly individuals would likely significantly reduce the overall IR of these injuries.

Objective To summarize the variation types of the axis in patients with basilar invagination (BI), then propose a classification scheme of the axis deformity. Methods From December 2013 to September 2020, 92 patients (male 42, female 50) who were diagnosed with BI were studied retrospectively. Based on the imaging data of CT, the width and height of the axis pedicle and the sagittal diameter of the lateral mass were measured in each patient. According to the development of axis pedicle and lateral mass, the types of axis variation were summarized, and then the classification scheme of axis deformity was put forward. Results All cases were analyzed and axis deformities were divided into four types. Type I: the axis is basically normal (53 cases, 57.6%). Type II: axis lateral mass is dysplasia (eight cases, 8.7%), which includes two subtypes: type IIA, the axis unilateral lateral mass is dysplasia (three cases); type IIB, the axis bilateral lateral masses are all dysplasia (five cases). Type III: axis pedicle is dysplasia (11 cases, 12%), which is subdivided into two subtypes: type IIIA, the axis unilateral pedicle is dysplasia (six cases); type IIIB, the axis bilateral pedicles are all dysplasia (five cases). Type IV: axis pedicle and lateral mass are all dysplasia (20 cases, 21.7%), this type contains the following four subtypes: type IVA, the unilateral axis pedicle and unilateral lateral mass (contralateral or ipsilateral) are all hypoplasia (four cases); type IVB, the unilateral axis pedicle and bilateral lateral masses are all hypoplasia (five cases); type IVC, the bilateral axis pedicles and unilateral lateral mass are all dysplasia (seven cases); type IVD, the bilateral axis pedicles and bilateral lateral masses are all dysplasia (four cases). The left and right abnormal lateral mass sagittal diameter (Type II) was (7.23 ± 1.39) mm and (5.96 ± 1.37) mm, respectively, the left and right abnormal pedicle width (Type III) was (2.61 ± 1.01) mm and (3.23 ± 0.66) mm, respectively, left and right abnormal pedicle height (Type III) was (5.43 ± 2.19) mm and (4.92 ± 1.76) mm, respectively. Moreover, the classification scheme has good repeatability and credibility. Conclusions The classification about axis deformity could provide personalized guidance for axis screw placement in the BI and other upper cervical surgery, and axis screw placement errors would be effectively avoided.