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ABSTRACT Objective To evaluate and compare the efficacy of high-flow nasal cannula treatment and that of bilevel positive airway pressure treatment as respiratory physiotherapy interventions for pediatric patients who are hospitalized because of asthma exacerbation. Methods During a randomized clinical trial, treatment was performed using a high-flow nasal cannula and bilevel positive airway pressure for hospitalized children with asthma. After randomization, data regarding lung function, vital signs, and severity scores (pulmonary index, pediatric asthma severity, and pediatric asthma scores) were collected. Results Fifty patients were included in this study (25 in the Bilevel Group and 25 in the high-flow nasal cannula group). After 45 minutes of therapy, an improvement in the forced expiratory volume in 1 second was observed. The high-flow nasal cannula group required fewer days of oxygen (O2) use, used fewer bronchodilators (number of salbutamol puffs), and required shorter hospitalization periods than the Bilevel Group (6.1±1.9 versus 4.3±1.3 days; 95% confidence interval, -5.0 to -0.6) Conclusion A high-flow nasal cannula is a viable option for the treatment of asthma exacerbation because it can reduce the hospitalization period and the need for O2 and bronchodilators. Additionally, it is a safe and comfortable treatment modality that is as effective as bilevel positive airway pressure. ClinicalTrials.gov Identifier: NCT04033666.

Background: Craniofacial fibrous dysplasia (CFD) typically occurs in the facial bones and anterior cranial vault and can produce both disfigurement and functional limitations for patients disfigurement. Treatment consists of reducing the abnormal bone. Bone contouring can become challenging when the exposure does not extend to the corresponding normal contralateral structures for comparison or when normal landmarks are not available, which may compromise the overall aesthetic outcome. We describe a technique using dynamic mirroring to accurately contour the involved part of the cranium in a case of giant CFD. Observations: A 49-year-old male presented with a giant deforming fibrous dysplasia of the right mastoid and parieto-temporo-occiput that was causing functional limitations due to the size of the bony mass. This was managed with multidisciplinary bony reduction. Several neurovascular structures were in proximity to the areas of planned drilling of the expansile lesion, and dynamic mirroring of the uninvolved left skull was utilized to maximize safety and symmetry of reduction. High-speed drilling of the right occipital bone was performed until the navigation system alerted the surgeon that symmetric depth had been achieved. There were no complications from the procedure and this technique maximized the limits of symmetric reduction without significantly increasing surgical complexity or duration. Lessons: Dynamic mirroring of bony structures in the posterior cranium is not commonly employed in neurosurgical practice. This technique may help improve the aesthetic outcomes of bony reduction in craniofacial dysplasia and a variety of similarly managed bony lesions, contour cranioplasties, and in unilateral craniosynostosis surgery. [ABSTRACT FROM AUTHOR]

The immune system involves several immune response mechanisms that are essential for the body to remain in balance and protected. Among these mechanisms, there is the expression of anti-inflammatory and immunomodulatory cytokines, such as interleukin-10 (IL-10). This anti-inflammatory cytokine plays a crucial role in the immune system, since it performs numerous biological functions. Studies have shown that photobiomodulation therapy (PBMT) has been effective in modulating the cytokine IL-10, increasing its expression, in various diseases of an inflammatory character. Although the mechanism of action of PBMT is not yet fully understood, it has been shown to be a promising therapy for these diseases. Therefore, the objective of this work was to review clinical studies in which they evaluated the release / expression of the cytokine IL-10 in several pathologies in response to PBMT, and to discuss the current and potential evidences of photobiomodulation.

Objectives Our objective was to determine if decreased contrast enhancement on postoperative magnetic resonance imaging (MRI) is associated with an increased risk of complication in patients who have undergone nasoseptal flap (NSF) reconstruction. Design/Setting This was a single-institution retrospective study of patients who underwent a first-time endoscopic endonasal approach (EEA) with NSF reconstruction. Participants Patients underwent an EEA to the skull base with NSF reconstruction and received postoperative MRI within 3 weeks of the operation. Main Outcome Measures MR exams were scored on the degree of contrast enhancement at first postoperative MRI. An enhancement score of 4 indicated ≥75% enhancement of the NSF. A score of 3 indicated enhancement ≥50% and <75% enhancement of the NSF. A score of 2 indicated ≥25% and <50% enhancement of the NSF. Complications (e.g., cerebrospinal fluid [CSF] leak, meningitis, empyema, cerebritis, brain abscess, flap necrosis, and flap migration) were retrieved from our institution's skull base database. Logistic regression was used to determine the effect of the MRI enhancement score on the odds of developing a complication. Results Out of 99 patients in the study, six had complications. Patients who underwent NSF reconstruction of skull base defects were found to have 19 times higher odds of complication (p = 0.007) if they had had an NSF enhancement score of 2 on their postoperative MRI when compared with patients with complete or near complete NSF enhancement (score 4). Conclusion Quantifying NSF enhancement with an MRI may help surgeons better predict which of their patients are at an increased risk of complication. [ABSTRACT FROM AUTHOR]

Objective To assess changes in juvenile idiopathic arthritis (JIA) treatments and outcomes in Canada, comparing 2005–2010 and 2017–2021 inception cohorts. Methods Patients enrolled within three months of diagnosis in the Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) and the Canadian Alliance of Pediatric Rheumatology Investigators Registry (CAPRI) cohorts were included. Cumulative incidences of drug starts and outcome attainment within 70 weeks of diagnosis were compared with Kaplan–Meier survival analysis and multivariable Cox regression. Results The 2005–2010 and 2017–2021 cohorts included 1128 and 721 patients, respectively. JIA category distribution and baseline clinical juvenile idiopathic arthritis disease activity (cJADAS10) scores at enrolment were comparable. By 70 weeks, 6% of patients (95% CI 5, 7) in the 2005–2010 and 26% (23, 30) in the 2017–2021 cohort had started a biologic DMARD (bDMARD), and 43% (40, 47) and 60% (56, 64) had started a conventional DMARD (cDMARD), respectively. Outcome attainment was 64% (61, 67) and 83% (80, 86) for inactive disease (Wallace criteria), 69% (66, 72) and 84% (81, 87) for minimally active disease (cJADAS10 criteria), 57% (54, 61) and 63% (59, 68) for pain control (<1/10), and 52% (47, 56) and 54% (48, 60) for good health-related quality of life (≥9/10). Conclusion Although baseline disease characteristics were comparable in the 2005–2010 and 2017–2021 cohorts, cDMARD and bDMARD use increased with a concurrent increase in minimally active and inactive disease. Improvements in parent and patient-reported outcomes were smaller than improvements in disease activity. [ABSTRACT FROM AUTHOR]

Study Design: Technical Report Objective: Cerebrospinal fluid (CSF) leak secondary to anterior osteophytes at the cervico-thoracic junction is a rare cause of intracranial hypotension. In this article we describe a technique for anterior repair of spontaneous ventral cerebrospinal fluid leaks in the upper thoracic spine. Methods: In this technical report and operative video, we describe a 23-year-old male who presented with positional headaches and bilateral subdural hematoma. Dynamic CT myelography demonstrated a high flow ventral cerebrospinal fluid leak associated with a ventral osteophyte at the level of the T1-T2 disc space. Targeted blood patch provided only temporary improvement in symptoms. An anterior approach was chosen to remove the offending spur and micro-surgically repair the dural defect. Results: The patient had complete resolution of his preoperative symptoms after primary repair. Conclusions: In select cases, an anterior approach to the upper thoracic spine is effective to repair Type 1 cerebrospinal fluid leaks. [ABSTRACT FROM AUTHOR]

Aims:To evaluate the autonomic modulation and clinical responses during testing of exercise-induced bronchoprovocation (EIB) and when applying non-invasive ventilation (NIV). Methods:A cross-sectional study that evaluated the heart rate variability at rest, during testing of EIB, in rest after 10 minutes of EIB, and during NIV with bilevel pressure with inspiratory positive airway pressure 12 cmH2O and expiratory positive airway pressure 8 cmH²O. Anthropometric evaluation was performed, examining inflammation and lung function. Clinical control was assessed by questionnaire (Asthma Control Questionnaire 6 [ACQ6]). Results: A cohort of 55 children aged 10.0±3.3 years were split in response to bronchial provocation test results into a responding group (RG) (n=39) or non-responding group (NRG) (n=16). There was a significant difference between the RG and NRG in clinical control as assessed by ACQ6 (RG=1.16 [0.33–2.0] partially controlled and NRG=0.58 [0.2–1.3] controlled). There was a significant difference in both the time domain and the frequency domain of the heart rate variability, indicating an inhibition of the parasympathetic nervous system during testing of EIB that did not return to baseline levels after 10 minutes and only started to return after the use of NIV in both groups, but the parasympathetic inhibition during the bronchial provocation test in the RG was higher than in the NRG. Conclusions:The RG presented with worse clinical control in addition to a less effective autonomic regulation. In both groups, NIV assisted in the return of autonomic activity basal levels after the bronchial provocation test.

Background: The use of virtual reality and video games has gained traction in physical rehabilitation medicine. In respiratory rehabilitation, their use is more recent, and for the application of this tool in this area it is necessary to examine the intensity of the effort reached in the activity. To evaluate the intensity of effort achieved in the ‘Reflex Ridge’ Xbox 360™ (Microsoft, Redmond, Washington, USA) game compared to the current gold standard treatment, the cardiopulmonary exercise test (CPET), in asthmatic children. Methods: A cross-sectional study evaluating children participating in a CPET and the Reflex Ridge active video game (AVG), played using an Xbox 360 Kinect,TM over two different days. Results: Thirty children who had a mean age of 7.86±1.9 years were evaluated. The maximum heart rate using the AVG reached 87% of the maximum predicted value and 93% of that obtained in the CPET. The intensity of the exercise using AVG reached 8.46±1.86 MET; this corresponded to 81% of the intensity reached in the CPET. There were no episodes of exercise-induced bronchospasm. Conclusion: Using AVG can promote high intensity physical exercise. AVG playing may be considered a safe mechanism for the physical treatment of asthmatic children.

This article, titled "Clipping of Bilateral MCA Aneurysms Necessitating a Contralateral Anterior Clinoidectomy," discusses a surgical procedure for treating bilateral MCA (middle cerebral artery) aneurysms. The authors describe a case in which they performed a unilateral approach with contralateral anterior clinoidectomy. They successfully clipped both aneurysms and confirmed their treatment efficacy through a postoperative angiogram. The article provides valuable insights into the surgical management of bilateral MCA aneurysms. [Extracted from the article]

We present an operative video illustrating the technique for clipping a ventrally located ruptured PICA aneurysm through an endoscopic endonasal transclival approach. After soft tissue dissection, the clivus is drilled and the dura exposed. Important landmarks identified during this approach include the hypoglossal nerve located between the jugular tubercle and occipital condyle. The dura was opened, and the aneurysm identified, dissected, and clipped with no residual on postoperative angiogram.By Bhuvic Patel; David Fernandez-Cabral; Carl H. Snyderman and Georgios A. ZenonosReported by Author; Author; Author; Author [Extracted from the article]

This article discusses the use of a suction nerve stimulator technique for the resection of pituitary adenomas that invade the cavernous sinus. The cavernous sinus is a complex region with many neurovascular structures, making surgical resection challenging. The study reviewed the cases of 50 patients who underwent the endoscopic endonasal approach for pituitary adenoma resection using the suction nerve stimulator device. The results showed that most patients with preoperative cranial nerve palsy experienced full recovery, and no new postoperative cranial neuropathies were reported. The authors suggest that this technique is safe and valuable in managing pituitary adenomas with cavernous sinus invasion, and further research could establish it as a standard protocol to minimize post-surgical complications. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, discusses the use of the endoscopic endonasal approach (EEA) for the resection of diaphragma sellae meningiomas. The study involved a retrospective review of patients who underwent EEA for the removal of these tumors between 2000 and 2023. The results showed that EEA was successful in achieving gross total resection in the majority of cases, with minimal postoperative complications. The study suggests that EEA is a viable and safe option for managing diaphragma sellae meningiomas, with potential advantages in preserving visual and pituitary function. [Extracted from the article]

This article examines the relationship between patient age and clinical characteristics and outcomes in endoscopic endonasal surgery (EES) for pediatric skull base neurosurgery. The study analyzes data from a single pediatric center over a 23-year period. The research finds that there are age-dependent differences in pathology, with younger patients more likely to have certain types of tumors and older patients more likely to have others. However, the study concludes that EES can be safely performed in patients of all age ranges, with no significant difference in complication rates. [Extracted from the article]

This article presents a case series of patients with Tuberculum Sella Meningiomas (TSMs) who underwent endoscopic endonasal resection. TSMs are challenging to diagnose and treat due to their location near critical neurovascular structures and the optic chiasm. The study included 74 patients, predominantly female, with a median age of 56.7 years. The surgical approach resulted in a high rate of gross total resection and improved visual outcomes. However, CSF leak remains a concern, although it has decreased over time. Overall, the endoscopic endonasal approach is considered a safe and effective treatment for TSMs. [Extracted from the article]

This article presents a retrospective review of pediatric patients who underwent endoscopic endonasal surgery (EES) for skull base pathologies at a large tertiary pediatric hospital between 1999 and 2022. The study included 243 patients with a median age of 14.2 years, with a male predominance. Various pathologies were treated, including juvenile nasopharyngeal angiofibroma, craniopharyngioma, chordoma, pituitary adenoma, encephalocele, Rathke cleft cyst, and basilar invagination or odontoid pannus. Most patients were treated with EES alone, and the overall rate of postoperative complications was 14%. CSF leak was the most common complication. The study concludes that EES is an effective approach for pediatric skull base pathologies, with lower neurovascular complication rates compared to traditional open approaches. [Extracted from the article]

This article discusses the learning curve and changes in practice patterns for pediatric endoscopic endonasal surgery (EES) over a 23-year period at a single institution. The authors analyzed data from 243 patients with skull base pathologies treated with EES between 1999 and 2022. They found an increase in the proportion of patients with chordoma and a decrease in the proportion with pituitary adenoma. There were also changes in the anatomical locations of the pathologies treated and an increase in the utilization of advanced reconstruction techniques and adjunctive preoperative treatments. Overall, the authors observed minimal increased morbidity despite treating more complex cases. [Extracted from the article]

This article discusses the outcomes of the endoscopic endonasal approach (EEA) for nonfunctional pituitary adenomas (NFPAs) in elderly patients. The study involved a retrospective review of NFPAs in patients aged 65 and older who underwent EEA between 2007 and 2022 at a single medical center. The results showed that EEA was a safe and effective option for NFPA resection in elderly patients, with high rates of visual recovery postoperatively and acceptable rates of gross total resection (GTR). The study also identified risk factors for progression and subtotal resection, but found no associations between postoperative complications and age or frailty scores. [Extracted from the article]

Objective: To evaluate and compare the efficacy of high-flow nasal cannula treatment and that of bilevel positive airway pressure treatment as respiratory physiotherapy interventions for pediatric patients who are hospitalized because of asthma exacerbation. Methods: During a randomized clinical trial, treatment was performed using a high-flow nasal cannula and bilevel positive airway pressure for hospitalized children with asthma. After randomization, data regarding lung function, vital signs, and severity scores (pulmonary index, pediatric asthma severity, and pediatric asthma scores) were collected. Results: Fifty patients were included in this study (25 in the Bilevel Group and 25 in the high-flow nasal cannula group). After 45 minutes of therapy, an improvement in the forced expiratory volume in 1 second was observed. The high-flow nasal cannula group required fewer days of oxygen (O2) use, used fewer bronchodilators (number of salbutamol puffs), and required shorter hospitalization periods than the Bilevel Group (6.1±1.9 versus 4.3±1.3 days; 95% confidence interval, -5.0 to -0.6) Conclusion: A high-flow nasal cannula is a viable option for the treatment of asthma exacerbation because it can reduce the hospitalization period and the need for O2 and bronchodilators. Additionally, it is a safe and comfortable treatment modality that is as effective as bilevel positive airway pressure. [ABSTRACT FROM AUTHOR]