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Background: Comparative studies of posterior lumbar interbody fusion with cortical bone trajectory and pedicle screw in older patients, particularly in those aged ≥ 80 years, are rare. This study aimed to retrospectively analyze the clinical and surgical outcomes following posterior lumbar interbody fusion with pedicle screw fixation compared to cortical bone trajectory in patients aged ≥ 80 years with degenerative lumbar spine disease. Methods: We included 68 patients aged ≥ 80 years who underwent degenerative lumbar spinal surgery at our spine center between January 2011 and December 2020. Of these 68 patients, 24 and 44 underwent posterior lumbar interbody fusion with cortical bone trajectory and pedicle screw, respectively. Results: The Visual Analog Scale for back pain was significantly lower in the cortical bone trajectory group than in the pedicle screw group at 6 months postoperatively (P = 0.049). The Oswestry Disability Index was significantly lower in the cortical bone trajectory group than in the pedicle screw group at 6 months postoperatively (P = 0.05). The estimated blood loss and operation time were significantly lower in the cortical bone trajectory group than in the pedicle screw group (P = 0.017 and P < 0.001, respectively). Postoperative morbidity was also lower in the cortical bone trajectory group (P = 0.049). Conclusions: Despite these limitations, our study findings indicate that cortical bone trajectory is not inferior to posterior lumbar interbody fusion with pedicle screw fixation if there is a need for fusion in older patients aged ≥ 80 years. [ABSTRACT FROM AUTHOR]

Objective: Spinal stenosis is a prevalent condition; however, the optimal surgical treatment for central lumbar stenosis remains controversial. This study compared the clinical outcomes and radiological parameters of 3 surgical methods: unilateral laminectomy bilateral decompression with unilateral biportal endoscopy (ULBD-UBE), conventional subtotal laminectomy (STL), and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods: This retrospective study included 86 patients, divided into ULBD-UBE (n=34), STL (n=24), and MIS-TLIF (n=28) groups. We evaluated demographics and perioperative factors and assessed clinical outcomes using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and neurogenic intermittent claudication (NIC). Radiological parameters assessed included lumbar lordosis, L4S1 Cobb angle (L4S1), T12S1 Cobb angle (T12S1), increased cross-sectional dural area (CSA), dynamic angulation (DA), dynamic slip (DS), and development of postoperative instability. Results: The ULBD-UBE group showed a significantly shorter hospital stay duration and operation time and reduced blood loss than the other groups (p<0.001). ULBD-UBE group showed a trend towards greater VAS and ODI improvement at 1 month and postoperative NIC symptom relief. Radiologically, MIS-TLIF group exhibited lower postoperative DA and DS (p<0.001), indicating higher postoperative stability. Postoperative instability was lower in the ULBD-UBE group (2.9%) than in the STL group (16.7%) and similar to the MIS-TLIF group (0.0%) (p=0.028). The CSA was highest in the MIS-TLIF group (295.5%) compared to that in the other groups (ULBD-UBE, 216.3%; STL, 245.2%) (p<0.001). Conclusion: Compared to other procedures, ULBD-UBE is a safe, effective, and viable surgical procedure for treating lumbar central stenosis. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the incidence of delayed-onset neurological deficits (DONDs), DOND-related reoperation rates following adult spinal deformity (ASD) surgery, and efficacy of transverse process hooks (TPHs) at the uppermost instrumented vertebra (UIV) compared to pedicle screws (PSs). Methods: We included 90 consecutive patients who underwent instrumented fusion from the sacrum to the distal thoracic spine for ASD, with a minimum follow-up of 24 months. Clinical and radiological outcomes were compared between 33 patients in the TPH group and 57 patients in the PS group, using the Scoliosis Research Society-22 Outcomes questionnaire (SRS-22), Medical Outcomes Study Questionnaire Short-Form 36 (SF-36), and various spinal sagittal parameters. Results: While absent in the TPH group, myelopathy occurred in 15.8% of the PS group, wherein 15 patients underwent reoperation. The change in the proximal junctional angle, from the pre- to postoperative assessment, was lower in the TPH group than in the PS group (0.2 vs. 6.6, p=0.002). Postoperative facet degeneration in the PS group progressed more significantly than in the TPH group (0.5 vs. 0.1, p=0.002). Surgical outcomes were comparable for both groups, except for the back visual analogue scale (3.5 vs. 4.1, p=0.010) and SRS-22 domains, including pain and satisfaction (3.3 vs. 2.9, p=0.033; 3.7 vs. 3.3, p=0.041). No intergroup difference was observed in SF-36. Conclusion: Using TPHs at the UIV level can prevent DOND, and thereby prevent postoperative myelopathy that necessitates reoperation; thus, TPHs is preferable over PSs in ASD surgery. [ABSTRACT FROM AUTHOR]

Objective: Spinal intramedullary hemangioblastoma is a rare and highly vascularized benign tumor. The characteristics of the tumor, its corresponding location, and surgical outcomes remain unknown. The purpose of this study was to identify risk factors and strategies for neurologic deterioration following hemangioblastoma surgery. Methods: A comprehensive retrospective analysis was undertaken to evaluate patients who underwent surgical intervention for intramedullary hemangioblastoma at our institution from 1993 to 2022. Patients with at least 1 year of follow-up data were included. The analysis covered patient demographics, pre- and post-operative modified McCormick scale (MMCS), tumor location, and tumor size. Results: This study included 25 cases. One-year after surgery, neurological deterioration was observed in five cases (20.0%), and neurological improvement was found in nine cases (36.0%). Five cases were ventrally located, and twelve cases were dorsally located. Ventrally located cases were larger in tumor axial size (p=0.029) than dorsal location tumors, resulting in poorer follow-up MMCS and a higher prevalence of von Hippel-Lindau syndrome (VHL) (p=0.042). Three of them were confirmed to be supplied by the anterior spinal artery. In the case of dorsally located cases, there was no neurologic deterioration. Conclusion: In intramedullary spinal cord hemangioblastomas, cases located ventrally had a higher incidence of neurological deterioration following surgery than those located dorsally or in intramedullary extramedullary cases. Ventrally located hemangioblastomas were larger than those in other locations. They were mainly supplied by the anterior spinal artery in VHL patients. [ABSTRACT FROM AUTHOR]

Conventional open laminectomy has long been considered one of the important surgical options for lumbar central stenosis owing to its positive outcomes. However, newer approaches have emerged as alternatives, including full-endoscopic and biportal endoscopic laminectomy. Therefore, a comparison of the outcomes that are associated with each of these surgical methods is warranted. This prospective multicenter trial, initiated in February 2019, compared the outcomes of three lumbar central stenosis surgical approaches: open laminectomy (OPEN), uniportal endoscopy (UNIPORT), and biportal endoscopy (BIPORT). Among 115 participants from seven centers, one-year follow-ups assessed laboratory, radiological, and clinical outcomes. Despite all groups showing adequate decompression and clinical improvement, the OPEN group exhibited less improvement in Visual analog scale (VAS) for back pain scores (p < 0.05) and significant postoperative increases in most laboratory markers. Furthermore, the OPEN group experienced a significant decrease in multifidus muscle cross-sectional area compared to endoscopic groups (p < 0.001). Each surgical techniques produced similar clinical outcomes and dural space expansion. However, endoscopic surgery was associated with better muscle preservation and better relief of back pain. Endoscopic surgery is a reasonable alternative to conventional laminectomy for treating lumbar central stenosis. This trial was registered on CRIS (Clinical Research Information Service, KCT0004355). [ABSTRACT FROM AUTHOR]

Background: Glioblastoma (GBM), one of the most lethal tumors, exhibits a highly infiltrative phenotype. Here, we identified transcription factors (TFs) that collectively modulate invasion-related genes in GBM. Methods: The invasiveness of tumorspheres (TSs) were quantified using collagen-based 3D invasion assays. TF activities were quantified by enrichment analysis using GBM transcriptome, and confirmed by cell-magnified analysis of proteome imaging. Invasion-associated TFs were knocked down using siRNA or shRNA, and TSs were orthotopically implanted into mice. Results: After classifying 23 patient-derived GBM TSs into low- and high-invasion groups, we identified active TFs in each group—PCBP1 for low invasion, and STAT3 and SRF for high invasion. Knockdown of these TFs reversed the phenotype and invasion-associated-marker expression of GBM TSs. Notably, MRI revealed consistent patterns of invasiveness between TSs and the originating tumors, with an association between high invasiveness and poor prognosis. Compared to controls, mice implanted with STAT3- or SRF-downregulated GBM TSs showed reduced normal tissue infiltration and tumor growth, and prolonged survival, indicating a therapeutic response. Conclusions: Our integrative transcriptome analysis revealed three invasion-associated TFs in GBM. Based on the relationship among the transcriptional program, invasive phenotype, and prognosis, we suggest these TFs as potential targets for GBM therapy. [ABSTRACT FROM AUTHOR]

Pain generator-based lumbar spinal decompression surgery is the backbone of modern spine care. In contrast to traditional image-based medical necessity criteria for spinal surgery, assessing the severity of neural element encroachment, instability, and deformity, staged management of common painful degenerative lumbar spine conditions is likely to be more durable and cost-effective. Targeting validated pain generators can be accomplished with simplified decompression procedures associated with lower perioperative complications and long-term revision rates. In this perspective article, the authors summarize the current concepts of successful management of spinal stenosis patients with modern transforaminal endoscopic and translaminar minimally invasive spinal surgery techniques. They represent the consensus statements of 14 international surgeon societies, who have worked in collaborative teams in an open peer-review model based on a systematic review of the existing literature and grading the strength of its clinical evidence. The authors found that personalized clinical care protocols for lumbar spinal stenosis rooted in validated pain generators can successfully treat most patients with sciatica-type back and leg pain including those who fail to meet traditional image-based medical necessity criteria for surgery since nearly half of the surgically treated pain generators are not shown on the preoperative MRI scan. Common pain generators in the lumbar spine include (a) an inflamed disc, (b) an inflamed nerve, (c) a hypervascular scar, (d) a hypertrophied superior articular process (SAP) and ligamentum flavum, (e) a tender capsule, (f) an impacting facet margin, (g) a superior foraminal facet osteophyte and cyst, (h) a superior foraminal ligament impingement, (i) a hidden shoulder osteophyte. The position of the key opinion authors of the perspective article is that further clinical research will continue to validate pain generator-based treatment protocols for lumbar spinal stenosis. The endoscopic technology platform enables spine surgeons to directly visualize pain generators, forming the basis for more simplified targeted surgical pain management therapies. Limitations of this care model are dictated by appropriate patient selection and mastering the learning curve of modern MIS procedures. Decompensated deformity and instability will likely continue to be treated with open corrective surgery. Vertically integrated outpatient spine care programs are the most suitable setting for executing such pain generator-focused programs. [ABSTRACT FROM AUTHOR]

Study design: This is a retrospective study. Objective: Implant nonfusion is an important prognostic factor for patients after anterior cervical discectomy and fusion (ACDF). This study aimed to investigate endplate-specific pseudarthrosis after ACDF, to determine if the rate of fusion is inferior in the lower endplate, and to identify any differences in clinical and radiological results. Summary of background data: Research comparing each endplate on which the endplate affects nonfusion is limited. Methods: We analyzed 71 patients with 142 total spinal levels who underwent double-level ACDF (C4-5-6 and C5-6-7) with an allograft and plate at our hospital between January 2012 and December 2018. Fusion grades were assessed using computed tomography and the Bridwell fusion grade system at 1 year postoperatively. Radiological parameters were obtained from lateral cervical radiographs collected preoperatively and at 1 month and 1 year after surgery. Results: There was no difference in fusion between the C4-5-6 and C5-6-7 ACDF procedures, but the fusion rate and Bridwell fusion grade at the caudal surgery level were lower than those at the cranial surgery level (93 vs. 79%, p < 0.001). The lower endplate of the caudal fusion level showed the most common pseudarthrosis (18 of 71 [25%]). There was no difference in radiological parameters and clinical outcomes between the fusion and pseudarthrosis groups. Conclusion: In double-level ACDF procedures, the nonfusion rate was higher at the caudal fusion levels, especially at the lower endplates of the caudal fusion levels. [ABSTRACT FROM AUTHOR]

Three-dimensional visualization of cellular and subcellular-structures in histological-tissues is essential for understanding the complexities of biological-phenomena, especially with regards structural and spatial relationships and pathologlical-diagnosis. Recent advancements in tissue-clearing technology, such as Magnified Analysis of Proteome (MAP), have significantly improved our ability to study biological-structures in three-dimensional space; however, their wide applicability to a variety of tissues is limited by long incubation-times and a need for advanced imaging-systems that are not readily available in most-laboratories. Here, we present optimized MAP-based method for paper-thin samples, Paper-MAP, which allow for rapid clearing and subsequent imaging of three-dimensional sections derived from various tissues using conventional confocal-microscopy. Paper-MAP successfully clear tissues within 1-day, compared to the original-MAP, without significant differences in achieved optical-transparency. As a proof-of-concept, we investigated the vasculature and neuronal-networks of a variety of human and rodent tissues processed via Paper-MAP, in both healthy and diseased contexts, including Alzheimer's disease and glioma. [ABSTRACT FROM AUTHOR]

Cell‐penetrating peptides (CPPs) are short amino acid sequences known to act as a vehicle for enhancing the intracellular translocating efficiency of extracellular molecules. Although many groups have attempted to develop peptides with high cell‐penetrating efficiencies, very few have demonstrated efficient cellular uptake of CPPs at low concentrations. Here, we describe a newly synthesized peptide derived from Arabidopsis, Ara‐27, which exhibits significant improvement in cell‐penetrating efficiency compared to existing CPPs. The cell‐penetrating efficiency of Ara‐27 was compared with the commonly used Tat‐protein transduction domain (Tat‐PTD) and membrane translocating sequence (MTS) in human dermal fibroblast (HDF) and human dental pulp stem cells (hDPSC). Cell‐penetrating efficiency of fluorescein isothiocyanate (FITC)‐labeled CPPs were assessed by flow cytometry and visualized by confocal microscopy. Flow cytometric analysis revealed >99% cell‐penetrating efficiency for 2 μM Ara‐27 in both HDF and hDPSC. In contrast, 2 μM Tat‐PTD and MTS showed <10% cell‐penetrating efficiency in both cells. In support, relative fluorescence intensities of FITC‐labeled Ara‐27 were around 8 to 22 times higher than those of Tat‐PTD and MTS in both cells. Confocal analysis revealed internalization of 0.2 and 2 μM Ara‐27 in both human cells, which was not observed for Tat‐PTD and MTS at either concentration. In conclusion, this study describes a novel CPP, Ara‐27, which exhibit significant improvement in intracellular uptake compared to conventional CPPs, without affecting cell viability. Thus, development of Ara‐27 based peptides may lead to improved delivery of functional cargo such as small molecules, siRNA, and drugs for in vivo studies. [ABSTRACT FROM AUTHOR]

Background: Many patients with cervical radiculopathy experience stenosis of the neural foramens due to cumulative osteophyte or uncovertebral joint hypertrophy. For cervical foraminal stenosis, complete uncinate process resection (UPR) is often conducted concurrently with anterior discectomy and fusion (ACDF). The aim of this study was to assess the clinical and radiological outcomes of ACDF with complete UPR versus ACDF without UPR.Methods: In total, 105 patients who performed one-level ACDF with a cage-and-plate construct between 2011 and 2015 were retrospectively reviewed. Among them, 37 patients had ACDF with complete UPR, and 68 patients had ACDF without UPR. Radiologic outcomes of disc height, C2-C7 lordosis, T1 slope, C2-C7 sagittal vertical axis (SVA), center of the sella turcica-C7 SVA (St-SVA), spino-cranial angle (SCA), and fusion rate were evaluated on plain X-ray at pre-operation, immediately post-operation, and at 2-year follow-up. For statistically matched pairs analysis, ACDF with UPR group (24 patients) and ACDF without UPR (24 patients) were compared.Results: All of the clinical parameters improved at the 2-year follow up (P < 0.0001). Improvement in visual analogue scale (VAS) scores for arm pain was significantly improved in the ACDF with complete UPR group immediately post-operation. All cervical sagittal parameters, including cervical lordosis, segmental angle, disc height, C2-C7 SVA, St-SVA, T1 slope, and SCA, except for preoperative St-SVA, SCA, and disc height of 2 years follow-up, were similar between the ACDF with complete UPR and ACDF without UPR groups. Differences in disc height, C2-C7 SVA, and SCA at 2-year follow up after preoperative examination, however, were statistically significant (p < 0.05). Subsidence occurred in 9 patients (ACDF with complete UPR: 8 cases [33%] versus ACDF without UPR: 1 cases [4%]; p < 0.05).Conclusions: Cervical sagittal alignment after ACDF with complete UPR is not significantly different from that achieved with ACDF without UPR. However, subsidence appears to occur more often after ACDF with complete UPR than after ACDF without UPR, although with little to no clinical impact. More precise and careful selection of patients is needed when deciding on additional complete UPR. [ABSTRACT FROM AUTHOR]

Clival chordoma with occipito-cervical (OC) joint invasion can result in preoperative and postoperative instability. The authors investigate the appropriate timing of OC fusion to prevent instability-, fusion-, and surgery time-related morbidity. Twenty-two consecutive patients underwent surgery for clival chordoma from December 2008 to September 2014. OC fusion was performed for patients with OC joint invasion and instability due to preoperative destruction of the occipital condyle or extensive postoperative condylectomy. The data in relation to OC joint instability, fusion, and surgery time were analyzed retrospectively and compared between OC fusion before and after tumor resection. Of the 22 patients, 8 with tumor invasion of the OC joint underwent OC fusion. OC fusion was performed after tumor resection in one-stage for four patients and before tumor resection in two-stage for four patients. There was OC joint instability from tumor destruction of the occipital condyle in seven patients (87.5%). Patients with OC fusion after tumor resection encountered complications such as surgery site wound dehiscence, encephalitis, and cardiac arrest with consequent mortality in one patient. These complications were avoided in subsequent patients where OC fusion was performed before tumor resection. There were no differences in the extent of tumor resection between OC fusion before and after tumor resection. Two-stage OC fusion before tumor resection can reduce instability-, fusion-, and surgery time-related morbidity and achieve feasible tumor resection when OC joint instability is expected. The extent of tumor invasion and brain stem compression should be considered when fusion precedes tumor resection. [ABSTRACT FROM AUTHOR]

Background: Transdural disc herniation (TDH) is a rare event accounting for 0.3–1.5% of all disc herniation cases. Considering the risk of leakage of the cerebrospinal fluid from the dural defect after removal of TDH or incomplete removal, it is very important to recognize TDH before surgery. This study is a retrospective case analysis to analyze the imaging findings of seven cases and to construct a preoperative prediction model for TDH. Methods: Retrospective radiographic examination was performed among patients operated for TDH in two institutions from 2008 to 2018. The radiographic images were analyzed according to the following eight signs: including absence of dural tent, complete block of spinal canal, hawk-beak sign, double-layered lesion, increased distance between the dura and cauda equina, rim enhancement, dural tent enhancement, and epidural gas. To clarify the predictive ability of these radiographic signs, consecutive 131 surgically confirmed epidural disc herniation (EDH) patients for the last 2 years were set as a control group for TDH. The sum of radiographic findings was compared between TDH and EDH patients to determine the cutoff value. Results: There were 1 thoracic and 6 lumbar TDHs among 75 thoracic and 6674 lumbar disc herniation cases with an incidence of 1.33% and 0.09%, respectively. Dural tent (p = 0.000, odds ratio = 106.67), double-layered lesion (p = 0.000, odds ratio = 22.69), and distance between the dura and cauda equina (p = 0.007, odds ratio = 52.00) were statistically significantly different between TDH and EDH. According to the receiver operating characteristic curve, the cutoff value of 1.5 had 85.7% sensitivity and 90.8% specificity. Conclusion: Preoperative imaging can be useful for TDH diagnosis. It is safe to consider the possibility of TDH in patients with more than two findings in the preoperative images. [ABSTRACT FROM AUTHOR]

Purpose: Numerous factors affect the surgical outcomes in patients with adult spinal deformity (ASD). However, no study has examined the relationship between residence and physical factors and surgical outcomes in patients with ASD. Here, we analysed the impact of residence and physical factors on the post-operative outcomes of patients with ASD residing in urban (U) and rural (R) environments.Methods: We retrospectively reviewed data from patients who had undergone ASD surgery with sacropelvic fixation at a single institution between June 2011 and May 2017 with a minimum 1 year follow-up. We divided the patients into two groups (U and R). Preoperative demographic data were reviewed, and radiographic parameters were measured preoperatively, immediately postoperatively, at 1, 3, and 6 months, and at the final follow-up. The L4 axial paraspinal muscles were measured preoperatively using magnetic resonance imaging.Results: There were 25 and 34 patients in the U and R groups, respectively. Both groups had similar preoperative demographic and radiological parameters. There were no differences between the groups in post-operative radiographic parameters, clinical outcomes, and complications, but proximal junctional kyphosis (PJK) was significantly higher in the R group. Additionally, muscle mass in the multifidus and erector spinae was lower in the R than in the U group.Conclusions: Patient residence influenced PJK in patients with ASD. Mass reduction in the trunk extensor muscle is an important and existing risk factor for PJK. Surgeons should be aware of this information for preoperative counselling, informed consent, and post-operative education of patients with ASD. These slides can be retrieved from Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical and radiographic results between open transforaminal interbody fusion (TLIF-O) and minimally invasive TLIF (TLIF-M) for single-level low grade isthmic spondylolisthesis (IS). Methods: This study enrolled 45 patients who underwent single-level TLIF with low grade IS. The patients were divided into two groups according to operative method: TLIF-M (20 patients) and TLIF-O (25 patients). TLIF-O group was matched with TLIF-M. Results: At one-year postoperatively, there were no significant differences in any radiologic parameters between the two groups. Perioperative results such as blood loss, operation time, and hospital stay were superior in TLIF-M than in TLIF-O. Fusion was achieved in 17 of 20 patients (85.0%) in TLIF-M and 23 of 25 (92.0%) patients in TLIF-O. Back Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores of TLIF-O were significantly lower than TLIF-M at one (back VAS, ODI) and six months (ODI) postoperatively. Conclusions: TLIF-M and TLIF-O produced similar clinical and radiological outcomes, including reduction of spondylolisthesis and disc space height restoration at one-year follow-up for single-level low grade IS. However, considering perioperative outcomes, back pain, and quality of life, TLIF-M might be a better option for single-level low grade IS compared to TLIF-O. [ABSTRACT FROM AUTHOR]

Purpose: To determine the biologic behavior and prognostic factors of spinal cord astrocytoma, we reviewed surgical and clinical outcomes. Due to the rarity of spinal cord astrocytoma, there is a lack of research regarding this type of tumor and malignant transformation.Methods: We retrospectively reviewed the data from all patients on whom we performed spinal cord tumor removal between 1983 and 2014. Twenty-six patients were pathologically confirmed to have spinal cord astrocytoma or glioblastoma. Surgical extent and disease progression were confirmed by the surgeon based on operative findings, postoperative MRI, and outpatient department (OPD) follow-up.Results: Pain or neurological deficit was the chief complaint for all patients. With MRI studies, there is a tendency for high-grade astrocytomas to show as enhanced and heterogeneous images. Two of the low-grade astrocytomas showed malignant transformation over the course of 4 and 11 months, respectively. The overall survival (OS) for low-grade astrocytoma was 28-480 months (mean 156.38 months); the OS for high-grade astrocytoma was 1-36 months (mean 12.00 months).Conclusions: Two of 12 low-grade cases showed malignant transformations at 4 and 11 months, respectively, based on pathological confirmation. With spinal cord astrocytomas, enhanced MRI results appeared similar to those of a malignant lesion. We suggest close observation and image correlation of low-grade astrocytomas, even when pathologically confirmed as low-grade. In this review, we found that histologic grade is the most important prognostic factor, although it is not always concordant with biologic behaviors. [ABSTRACT FROM AUTHOR]

Objective. To determine if preendoscopy Rockall score (PERS) enables safe outpatient management of New Zealanders with upper gastrointestinal haemorrhage (UGIH). Methods. Retrospective analysis of adults with UGIH over 59 consecutive months. PERS, diagnosis, demographics, need for endoscopic therapy, transfusion or surgery and 30-day mortality and 14-day rebleeding rate, and sensitivity and specificity of PERS for enabling safe discharge preendoscopy were calculated. Results. 424 admissions with UGIH. Median age was 74.3 years (range 19–93 years), with 55.1% being males. 30-day mortality was 4.6% and 14-day rebleeding rate was 6.0%. Intervention was required in 181 (46.6%): blood transfusion (147 : 37.9%), endoscopic intervention (75 : 19.3%), and surgery (8 : 2.1%). 42 (10.8%) had PERS = 0 with intervention required in 15 (35.7%). Females more frequently required intervention, OR 1.73 (CI: 1.12–2.69). PERS did not predict intervention but did predict 30-day mortality: each point increase equated to an increase in mortality of OR 1.46 (CI: 1.11–1.92). Taking NSAIDs/aspirin reduced 30-day mortality, OR 0.22 (CI: 0.08–0.60). Conclusion. PERS identifies 10.8% of those with UGIH as low risk but 35.7% required intervention or died. It has a limited role in assessing these patients and should not be used to identify those suitable for outpatient endoscopy. [ABSTRACT FROM AUTHOR]

Purpose: We measured the length, width, height, and angles related to both Meyerding grading system and Marchetti-Bartolozzi classification in L5-S1 spondylolytic spondylolisthesis patients to investigate the anatomical characteristics of fifth lumbar pedicles. Methods: Seventy patients with L5-S1 spondylolytic spondylolisthesis and general spinal disease were included. Patient attributes, Meyerding grading system and Marchetti-Bartolozzi classification of spondylolisthesis, length, width, height of L4 and L5 pedicle, and the angle between pedicle and vertebral midline were measured. The heights of L5 vertebral body, divided as anterior, mid, and posterior were also measured. Results: The pedicle is elongated and the angle of the pedicle is wider in cases of L5-S1 spondylolysis. Vertebral body shape was more posteriorly wedged in L5-S1 spondylolysis. Pedicles were more narrow and shorter in L5-S1 spondylolysis. Conclusions: In L5-S1 spondylolytic spondylolisthesis, a longer screw is suitable for insertion of L5 pedicle and the screw should be inserted more medially compared to patients without spondylolysis. [ABSTRACT FROM AUTHOR]

Purpose: The posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) techniques are commonly used surgical methods for wide indications such as degeneration or trauma. Although they are rarely required for lumbar disk disease in younger patients, there are a few children and adolescents who are indicated for PLIF or TLIF for other reasons, such as congenital severe stenosis with or without lumbar instability that requires wide decompression or severe bony spur that need to be removed. In such cases, different pathophysiology and outcomes are expected compared with adult patients. Methods: We retrospectively reviewed data of 23 patients who underwent PLIF or TLIF surgery when less than 20 years old. Clinical and radiographic outcomes were assessed during a mean of 36.4 months follow-up period. The indications of lumbar interbody fusion, success of fusion, complications, and visual analog scale (VAS) were analyzed. Results: Radiographs of all patients taken 6 months after the surgery showed fusion. Clinical outcome was also satisfactory, with improvement of VAS score from 7.7 preoperatively to 2.3 at 6 months after surgery. Only one patient had reoperation due to adjacent segment disease. Conclusions: For adolescent patients with severe bony spur, massive central disk rupture, or severe spondylolisthesis, lumbar interbody fusion surgery has good surgical outcome with few complications. [ABSTRACT FROM AUTHOR]

Recent developments in tissue clearing methods have significantly advanced the three-dimensional analysis of biological structures in whole, intact tissue, providing a greater understanding of spatial relationships and biological circuits. Nonetheless, studies have reported issues with maintaining structural integrity and preventing tissue disintegration, limiting the wide application of these techniques to fragile tissues such as developing embryos. Here, we present an optimized passive tissue clearing technique (PACT)-based embryo clearing method, initial embedding PACT (IMPACT)-Basic, that improves tissue rigidity without compromising optical transparency. We also present IMPACT-Advance, which is specifically optimized for thin slices of mouse embryos past E13.5. We demonstrate proof-of-concept by investigating the expression of two relatively understudied PR domain (PRDM) proteins, PRDM10 and PRDM13, in intact cleared mouse embryos at various stages of development. We observed strong PRDM10 and PRDM13 expression in the developing nervous system and skeletal cartilage, suggesting a functional role for these proteins in these tissues throughout embryogenesis. [ABSTRACT FROM AUTHOR]