Search

Objective Minimally invasive spine surgery (MISS) employs small incisions and advanced techniques to minimize tissue damage while achieving similar outcomes to open surgery. MISS offers benefits such as reduced blood loss, shorter hospital stays, and lower costs. This review analyzes complications associated with MISS over the last 10 years, highlighting common issues and the impact of technological advancements. Methods A systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines was conducted using PubMed, MEDLINE, Embase via OVID, and Cochrane databases, covering publications from January 2013 to March 2024. Keywords related to MISS and complications were used. Studies on adult patients undergoing MISS with tubular, uniportal, or biportal endoscopy, reporting intraoperative or postoperative complications, were included. Non-English publications, abstracts, and small case series were excluded. Data on MISS approach, patient demographics, and complications were extracted and reviewed by 2 independent researchers. Results The search identified 880 studies, with 137 included after screening and exclusions. Key complications in cervical MISS were hematomas, transient nerve root palsy, and dural tears. In thoracic MISS, complications included cerebrospinal fluid leaks and durotomy. In lumbar MISS, common complications were incidental dural injuries, postoperative neuropathic conditions, and disc herniation recurrences. Complications varied by surgical approach. Conclusion MISS offers reduced anatomical disruption compared to open surgery, potentially decreasing nerve injury risk. However, complications such as nerve injuries, durotomies, and hardware misplacement still occur. Intraoperative neuromonitoring and advanced technologies like navigation can help mitigate these risks. Despite variability in complication rates, MISS remains a safe, effective alternative with ongoing advancements enhancing its outcomes.

Granulomatous mastitis (GM) is a long-term inflammatory disease of the breast that usually occurs in women of reproductive age. Autoimmune mastitis is one of the most common pathological breast conditions necessitating tailored treatment. However, GM as a first clinical manifestation of sarcoidosis is uncommon. Simultaneous occurrence of GM, erythema nodosum (EN), and arthritis, termed "GMENA" syndrome, is a rare clinical entity associated with autoimmune rheumatic diseases. Herein, we report the case of a 31-year-old female patient with GMENA syndrome, who presented with a painful nodule of the left breast. Initial treatment entailed antibiotics under the presumption of a breast abscess, yielding negligible improvement. During this period, the patient developed polyarthritis and bilateral EN on the lower extremities. Histopathologic examination of the breast tissue exhibited noncaseating granulomas. The patient responded positively to prednisolone and methotrexate treatment. Literature review revealed a coherent pattern across GMENA cases. Our findings suggest that the "GMENA" syndrome represents a unique acute manifestation of sarcoidosis and highlight the necessity for heightened awareness, accurate diagnosis, and tailored therapeutic approaches for GMENA syndrome. Further research is warranted to elucidate its cause and optimize patient management. This case highlights the importance of identifying and effectively managing such interrelated clinical presentations.

This study aimed to consolidate rupatadine fumarate (RF) into nanoparticles to control its release. Ten RF nanoparticles were developed by nanoprecipitation using poly (lactic-co-glycolic acid) (PLGA) , polyvinyl alcohol (PVA), and Poloxamer 407 (Kolliphor P 407) in different percentages. A valid reverse-phase HPLC method was developed to assess RF in the formulated nanoparticles. The RF nanoparticles were tested chemically and morphologically. RF nanoparticles containing PLGA and PVA and Kolliphor P 407 have zeta potentials ranging from -24.4 mV±0.24 to -26.7 mV±0.05, higher than other formulations, and their release profiles were optimised. The formula (RPX3) had the best zeta potential (-26.7 mV±0.05), released about 86% of RF after 8 h and extended for 24 h. In summary, the formulation (RPX3), including 2:10:3:1.5 ratios of the drug PLGA: PVA: Kolliphor P 407 was the optimised RF-loaded nanoparticles formulation.

Minimally invasive surgery has continued to grow as an alternative approach to traditional open methods of treating cervical and thoracic spine pathologies, with similar efficacy, shorter hospitalizations and decreased tissue destruction. This manuscript presents a review of the literature and summarizes complications seen in cervical and thoracic spine surgery, focusing on different types of minimally invasive procedures. Overall, our review suggests that minimally invasive approaches have less severe complications than open approaches, and indicates the need for prospective studies to examine this finding further.

Purpose: To study the individual course of retinal changes caused by healthy aging using deep learning. Design: Retrospective analysis of a large data set of retinal OCT images. Participants: A total of 85 709 adults between the age of 40 and 75 years of whom OCT images were acquired in the scope of the UK Biobank population study. Methods: We created a counterfactual generative adversarial network (GAN), a type of neural network that learns from cross-sectional, retrospective data. It then synthesizes high-resolution counterfactual OCT images and longitudinal time series. These counterfactuals allow visualization and analysis of hypothetical scenarios in which certain characteristics of the imaged subject, such as age or sex, are altered, whereas other attributes, crucially the subject’s identity and image acquisition settings, remain fixed. Main Outcome Measures: Using our counterfactual GAN, we investigated subject-specific changes in the retinal layer structure as a function of age and sex. In particular, we measured changes in the retinal nerve fiber layer (RNFL), combined ganglion cell layer plus inner plexiform layer (GCIPL), inner nuclear layer to the inner boundary of the retinal pigment epithelium (INL-RPE), and retinal pigment epithelium (RPE). Results: Our counterfactual GAN is able to smoothly visualize the individual course of retinal aging. Across all counterfactual images, the RNFL, GCIPL, INL-RPE, and RPE changed by −0.1 μm ± 0.1 μm, −0.5 μm ± 0.2 μm, −0.2 μm ± 0.1 μm, and 0.1 μm ± 0.1 μm, respectively, per decade of age. These results agree well with previous studies based on the same cohort from the UK Biobank population study. Beyond population-wide average measures, our counterfactual GAN allows us to explore whether the retinal layers of a given eye will increase in thickness, decrease in thickness, or stagnate as a subject ages. Conclusion: This study demonstrates how counterfactual GANs can aid research into retinal aging by generating high-resolution, high-fidelity OCT images, and longitudinal time series. Ultimately, we envision that they will enable clinical experts to derive and explore hypotheses for potential imaging biomarkers for healthy and pathologic aging that can be refined and tested in prospective clinical trials. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Date palm is one of the most important trees for economic and social development in many countries and its fruits with high nutritional value. This aimed to determine the role of salicylic (SA) and jasmonic acids (JA) as antioxidants against salt stress. Salt stress was applied with water irrigation to two-year-old date palm offshoots by using 200 mM NaCl alone or in combination with foliar sprays of JA and SA at 1, 2 and 3 mgL-1. Results indicate that salinity at 200 mM NaCl remarkably increased the content of osmolytes (e.g., proline, glycine betaine and soluble sugars) in date palm leaves. Moreover, with the combination of 2 and 3 mg.L-1 SA and 1 mg.L-1 JA with salinity, the osmolyte content was remarkably higher than in salinity treatment alone. When date palm was exposed to salinity alone, the levels of oxidative markers, Malondialdehyde as a lipid peroxidation marker and H2O2 as a ROS accumulation marker, substantially increased compared with the control. Importantly, the levels of these oxidative markers remarkably decreased when plants were subjected to combined salinity and treatment with at 2 and 3 mg.L-1 SA and 3 mg.L-1 SA compared with the salinity treatment alone. In addition, spraying 2 and 3 mg.L-1 SA and 3 mg.L-1 JA on leaves combined with salinity treatment remarkably decreased the salinity effect on membrane stability index. Moreover, when 2 or 3 mg.L-1 were sprayed, no remarkable difference was detected for any investigated characteristics, and SA had a greater effect than JA in alleviating the salinity effect.

Purpose: We construct the analytical approximate resiual power fuzzy series solutions of fuzzy conformable fractional differential equations in an [Formula: see text]-level depiction in the sense of strongly generalized [Formula: see text]-fuzzy conformable derivative in which of the all initial conditions are taken to be fuzzy numbers.Methodology: The certain fuzzy conformable fractional differential equation under strongly generalized [Formula: see text]-fuzzy derivative is converted to a crisp one as a family of differential inclusions and solved via resiual power method. The main drawback concerning the use of differential inclusions is that it does not contain a fuzzification of the differential operator; instead, the solution is not essentially a fuzzy valued function.Findings: (i) To show the efficiency of our proposed method: Several important and attractive test examples, which included the fractional conformable fuzzy integro-differential equation are discussed and solved in detail.(ii) To show the stability of approximate solutions to specific problems: some graphical results, numerical comparisons and tabulate data are created and discussed at different values ofValue: Using the residual power series analysis methos is a powerful and easy-to-use analytic tool to solve initial problems on fuzzy conformable fractional differential equations and it successfully applied to solve real life problems such as the inductance–resistance–capacitance, RLC-series circuit.

Background. Appendiceal lymphoma is a very rare entity accounting for 0.015% of all gastrointestinal lymphoma cases. Acute appendicitis is the most common presentation of primary appendix neoplasms. Burkitt’s lymphoma presenting as an acute appendicitis is a rare entity with around 21% of the cases presenting as a lower iliac fossa mass. Case Presentation. A 23-year-old male was admitted to the surgical ward as a case of acute appendicitis with localized tenderness in the right iliac fossa, positive rebound tenderness, a positive Rovsing’s sign, and ultrasound findings of suspected complicated appendicitis. Appendectomy was performed. Histopathological examination of the appendectomy specimen revealed a double-expressor non-Hodgkin diffuse large cell lymphoma with Burkitt’s-like morphology. He was sent for chemotherapy treatment. Conclusion. Only 34 cases of Burkitt’s lymphoma have been reported to present as acute appendicitis. Histological examination following appendectomy for an apparent appendicitis is essential. Furthermore, complete blood count and a computed tomography scan aid the diagnosis of lymphoma. Double-expressor lymphoma has been shown to have poor outcomes. Therefore, prompt and aggressive treatment is vital.

Objectives. Aneurysmal bone cyst (ABC) is a benign but locally aggressive tumor. It has several challenging features. The aim of this study is to identify challenges in the diagnosis and treatment of ABC especially in patients with unusual features. Methods. This retrospective study involved medical record review of primary ABC patients with one or more of the following features: unusual clinical presentation with a mass or a pathological fracture especially at an unusual age, rare locations, radiological findings suggesting other diagnoses especially sarcoma, and a nondiagnostic histopathology of biopsy samples. Results. 25 patients (17 males and 8 females) were included. Most patients were either younger than 10 or older than 20 years. 10 patients presented with a mass or a pathological fracture. Unusual locations include the scapula, the olecranon, the hamate, the calcaneus, and the first metatarsal bone. Extension into the epiphysis occurred in 2 patients with proximal fibula and olecranon ABCs. Two separate synchronous cysts existed in the proximal epiphysis and middiaphysis of one humerus. Radiological imaging suggested other primary diagnoses in 8 patients. Core needle biopsy was diagnostic in only 2 of 7 patients. The main treatment was intralesional resection/curettage with bone grafting. Wide resection was performed in 4 patients. Recurrence rate was 28%. Recurrence risk factors included the following: age less than 10 years, male gender, and proximal femur location. Late recurrence occurred in 3/7 patients. One patient with asymptomatic radiological recurrence showed subsequent spontaneous resolution one year later. Conclusions. This study presented multiple unusual features of ABC including: unusual age, rare locations, and nondiagnostic radiological and histopathological findings. These features can complicate the diagnosis and management. Given these features, especially with pathological fractures, a well-planned incision, the use of frozen section examination, and the application of either external fixation or plate osteosynthesis for fracture fixation can be recommended.

Hepatitis G virus (HGV) infection is a worldwide health problem causing acute and chronic non A- E hepatitis. Because HGV and hepatitis C virus (HCV) share same modes of transmission, co-infection with the two viruses is not uncommon especially among people at high risk of parenteral infection. The aim of this study was to determine the prevalence of HGV among HCV virus cases, and to determine the degree of concurrent association between HGV and other prevalent infections in Egypt as Schistosoma, and hepatitis B virus (HBV) infections. This study included 100 blood donors attending Alexandria University Blood Bank in EL Shatby, proved to be positive for HCV antibodies by enzyme linked immunosorbant assay (ELISA) technique. Blood samples were collected and tested for the detection of HBV surface antigen (HBsAg) and Schistosoma antibodies by ELISA technique and HGV RNA by nested polymerase chain reaction (PCR) technique. Out of 100 anti-HCV positive blood donors, 39(39%) had HGV RNA in their serum, of them 10 (25.6%) were positive for HBsAg, on the other hand 34(87.2%) were positive for Schistosoma antibodies. From this study it could be concluded that HGV is a common co-infection in HCV cases, however there was no significant statistical relation between the presence of HGV RNA and the presence of HBsAg and /or Schistosoma antibodies. Screening for HGV among blood donors in addition to the routinely screened HBV and HCV may have a beneficial effect in reducing its transmission among the population.

This study presents the numerical fluid-structure interaction (FSI) modelling of a vibrating turbine blade using the commercial software ANSYS-12.1. The study has two major aims: (i) discussion of the current state of the art of modelling FSI in gas turbine engines and (ii) development of a “tuned” one-way FSI model of a vibrating turbine blade to investigate the correlation between the pressure at the turbine casing surface and the vibrating blade motion. Firstly, the feasibility of the complete FSI coupled two-way, three-dimensional modelling of a turbine blade undergoing vibration using current commercial software is discussed. Various modelling simplifications, which reduce the full coupling between the fluid and structural domains, are then presented. The one-way FSI model of the vibrating turbine blade is introduced, which has the computational efficiency of a moving boundary CFD model. This one-way FSI model includes the corrected motion of the vibrating turbine blade under given engine flow conditions. This one-way FSI model is used to interrogate the pressure around a vibrating gas turbine blade. The results obtained show that the pressure distribution at the casing surface does not differ significantly, in its general form, from the pressure at the vibrating rotor blade tip.

Although antenna selection is a simple and efficient technique for enhancing the downlink performance of multiuser diversity systems, the large antenna interelement spacing required for achieving spatial diversity is prohibitive for user terminals due to size restrictions. In order to allay this problem, we propose miniaturized switched beam receiver designs assisted by low-cost passive reflectors. Unlike conventional spatial receive diversity systems, the proposed angular diversity architectures occupy a small volume whereas the antenna system properties are optimized by controlling the strong reactive fields present at small dimensions. The systems are designed for maximum antenna efficiency and low interbeam correlation, thus yielding N practically uncorrelated receive diversity branches. The simulation results show that the proposed enhanced diversity combining systems improve the average throughput of a multiuser network outperforming classical antenna selection especially for small user populations and compact user terminal size.

Purpose. Meningioangiomatosis (MA) is a rare, benign lesion that commonly mimics other intracranial malformations in clinical presentation and appearance on imaging. The case presented and the literature review performed highlight the importance of combining MRI and CT results to better characterize intracranial lesions and including MA on the list of differential diagnoses of patients presenting with seizures. Methods. The case described is of a 19-year-old male with a 10-year history of worsening seizures refractory to multiple drug regimens. MRI revealed an atypical vascular malformation. The patient underwent surgical resection of the epileptogenic cortex. Results. Although the radiologic impression of the lesion was a vascular malformation, pathological examination revealed MA. A literature search performed highlights the variability of the appearance of MA on CT and MRI and suggests the utility of the T2 GRE sequence in illustrating the presence of calcification and, in a lesion with other characteristic features, the diagnosis of MA. Conclusion. MA can be a difficult diagnosis to make based on imaging findings alone. However, in a patient with a characteristic history and presentation, the presence of a calcified mass on CT and MRI brain susceptibility artifact on a T2 GRE sequence may suggest MA.

Introduction: The escalation of United States (U.S.) spine surgery volume has been accompanied by considerable advancements in our understanding of spine physiology and technology. Together with implant development over the past decades, these improvements have led to shifts in implant usage. This investigation aimed to elucidate the trends in spinal implant utilization in the U.S. from 2013 to 2022. Materials and Methods: Spine implant utilization and pricing averages between 2013 and 2022 were extracted from Orthopedic Network News. The total sample composed of 664,310 spine procedure purchase orders. Prices were adjusted for inflation based on 2022 prices. Trends were analyzed using linear regression. Results: The U.S. spine procedure volume increased significantly from around 800,000 procedures per year in 2013 to over 1.1 million in 2022, with 73% comprising lumbar and cervical fusions. The proportion of procedures performed in patients over 64 years old increased significantly in both lumbar and cervical cases, constituting 50% and 37% of procedures, respectively. In lumbar spine in 2022, 46% of procedures utilized both pedicle screws (PSs) and interbody devices, 37% PSs only, and 13% interbody devices only. Lumbar PS price decreased significantly to $923 each despite stable lumbar and cervical fusion procedure costs. Polyetheretherketone (PEEK) and allograft interbody device usage declined while metal increased significantly. Conclusion: Nationwide spine procedure volume rose notably from 2013 to 2022, with the majority constituting lumbar and cervical fusions. The most frequent treatment for a lumbar fusion is a PS construct with an interbody fusion device. Interbody fusion device materials witnessed decline in the use of PEEK and allograft, with metals becoming the preferred material. Level of Evidence: III [ABSTRACT FROM AUTHOR]

Objective: Minimally invasive spine surgery (MISS) employs small incisions and advanced techniques to minimize tissue damage while achieving similar outcomes to open surgery. MISS offers benefits such as reduced blood loss, shorter hospital stays, and lower costs. This review analyzes complications associated with MISS over the last 10 years, highlighting common issues and the impact of technological advancements. Methods: A systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines was conducted using PubMed, MEDLINE, Embase via OVID, and Cochrane databases, covering publications from January 2013 to March 2024. Keywords related to MISS and complications were used. Studies on adult patients undergoing MISS with tubular, uniportal, or biportal endoscopy, reporting intraoperative or postoperative complications, were included. Non-English publications, abstracts, and small case series were excluded. Data on MISS approach, patient demographics, and complications were extracted and reviewed by 2 independent researchers. Results: The search identified 880 studies, with 137 included after screening and exclusions. Key complications in cervical MISS were hematomas, transient nerve root palsy, and dural tears. In thoracic MISS, complications included cerebrospinal fluid leaks and durotomy. In lumbar MISS, common complications were incidental dural injuries, postoperative neuropathic conditions, and disc herniation recurrences. Complications varied by surgical approach. Conclusion: MISS offers reduced anatomical disruption compared to open surgery, potentially decreasing nerve injury risk. However, complications such as nerve injuries, durotomies, and hardware misplacement still occur. Intraoperative neuromonitoring and advanced technologies like navigation can help mitigate these risks. Despite variability in complication rates, MISS remains a safe, effective alternative with ongoing advancements enhancing its outcomes. [ABSTRACT FROM AUTHOR]

Granulomatous mastitis (GM) is a long-term inflammatory disease of the breast that usually occurs in women of reproductive age. Autoimmune mastitis is one of the most common pathological breast conditions necessitating tailored treatment. However, GM as a first clinical manifestation of sarcoidosis is uncommon. Simultaneous occurrence of GM, erythema nodosum (EN), and arthritis, termed "GMENA" syndrome, is a rare clinical entity associated with autoimmune rheumatic diseases. Herein, we report the case of a 31-year-old female patient with GMENA syndrome, who presented with a painful nodule of the left breast. Initial treatment entailed antibiotics under the presumption of a breast abscess, yielding negligible improvement. During this period, the patient developed polyarthritis and bilateral EN on the lower extremities. Histopathologic examination of the breast tissue exhibited noncaseating granulomas. The patient responded positively to prednisolone and methotrexate treatment. Literature review revealed a coherent pattern across GMENA cases. Our findings suggest that the "GMENA" syndrome represents a unique acute manifestation of sarcoidosis and highlight the necessity for heightened awareness, accurate diagnosis, and tailored therapeutic approaches for GMENA syndrome. Further research is warranted to elucidate its cause and optimize patient management. This case highlights the importance of identifying and effectively managing such interrelated clinical presentations. [ABSTRACT FROM AUTHOR]