C6 C7 Research Articles

Hydrogen Production by Steam Reforming of Pyrolysis Oil from Waste Plastic over 3 wt.% Ni/Ce-Zr-Mg/Al2O3 Catalyst

Sustained increase in plastic use has placed a significant burden on waste disposal infrastructure. Pyrolysis is the process of decomposing high-molecular-weight compounds by heating waste plastics at 500–1000 °C without oxygen. This process considerably reduces greenhouse gas emissions and has a high alternative energy effect (0.57 TOE ton−1). After a separation process, the oil produced by pyrolysis (C5–C20) can yield naphtha oil (C6–C7). Subsequently, hydrogen can be produced through a reforming reaction of this naphtha oil. Here, we produced hydrogen from waste plastic pyrolysis oil over a Ni/Ce-Zr-Mg/Al2O3 catalyst using a steam reforming process. A model oil combining the major substances of C6 and C7 (hexane, hexene, heptane, heptene, and toluene) was formed. From the reaction products, the hydrogen yield was obtained based on analysis of H2, CO, and CO2 concentrations using gas chromatography. The effect of N2 and O2 addition on hydrogen yield was analyzed within a temperature range of 750–850 °C, steam/carbon (S/C) ratio of 0.6–4, and space velocity of 7600–19,100 h−1. In addition, a durability test was performed using 3 wt.% Ni/Ce-Zr-Mg/Al2O3 catalysts for 100 h; a hydrogen yield of 91.3% was maintained from the refined waste plastic oil.

Demographics and functional outcome of shallow water diving spinal injuries in northern Germany - A retrospective analysis of 160 consecutive cases

AimTo describe demographic findings, typical injuries and functional neurological outcomes in patients with cervical trauma and tetraplegia sustained after diving into shallow water. Patients and methodsA retrospective study was performed including all patients treated in BG Klinikum Hamburg suffering from tetraplegia after jumping into shallow water between 1st June 1980 and 31st July 2018. ResultsOne hundred and sixty patients with cervical spinal injuries and tetraplegia following a dive into shallow water were evaluated. Of these, 156 patients (97.5%) were male. The mean age was 24.3 years ± 8.1 and the accidents occurred most often in inland waters (56.2%) and mostly between May and August (90.6%). In all cases there was one vertebra fractured, whereas in 48.1% of cases, two vertebrae were severed. In the majority of cases (n = 146), a surgical procedure was performed. Overall, the mean hospital stay was 202 days (±72, range: 31–403) and one patient died. On admission, 106 patients (66.2%) showed a complete lesion according to AIS A, with incomplete lesions in the remaining 54 patients (AIS B: n = 25 [15.6%], AIS C: n = 26 [16.3%], AIS D: n = 3 [1.9%]). In two thirds of the patients, the level of paralysis on admission was at the level of segments C4 (31.9%) or C5 (33.7%). Seventeen patients (10.6%) needed prehospital resuscitation. In 55 patients (34.4%), the neurological findings improved during the course of inpatient treatment and rehabilitation. Sixty-eight patients (42.5%) developed pneumonia, of which 52 patients (76.5%) were ventilated. In addition, 56.5% of patients with paralysis levels C0–C3 required ventilation, whereas only 6.3% of patients with paralysis levels C6–C7 were affected. Three patients (1.9%) were discharged from hospital with continuous ventilation. Overall, 27.4% of all AIS A patients, 56% of all AIS B patients and 46.2% of all AIS C patients improved neurologically, with 17% of all patients being able to walk. ConclusionsThe consequences of a cervical spine injury after diving into shallow water are severe and lifelong. Functionally, patients may benefit from care in a specialised centre, both in the acute phase and during rehabilitation. The more incomplete the primary paralysis, the greater the possibility of neurological recovery.

A novel de novo nonsense mutation in SALL4 causing duane radial ray syndrome: a case report and expanding the phenotypic spectrum

BackgroundSALL4, a member of the SALL genes family, encodes a zinc-finger transcriptional factor that either activates or represses gene transcription depending on cell type during embryonic development. SALL4 mutations cause extremely variable conditions including Duane-radial ray (DRR), Okihiro, Holt-oram, Acro-renal ocular and IVIC syndromes, all with autosomal dominant inheritance pattern. However, all these syndromes with different terminologies are actually the same entity termed SALL4 related disorders.Case presentationHerein, we examine an Iranian patient suspected to DRR syndrome which has not been previously described in the population. Whole-exome sequencing (WES) was performed to examine pathogenic genes in the proband. Subsequently, Sanger sequencing was used to confirm the mutation found. To elucidate the effects of the identified mutation, clinical data of patient was collected. Morever, the possible impact of the mutation found on the corresponding protein was evaluated using bioinformatics tools. WES identifed a novel de novo heterozygous nonsense mutation in exon 2 of SALL4 gene (c.712 C > T:p.Q238X). Subsequently, segregation and phenotype-genotype correlation analysis as well as in-silico approaches confirmed the autosomal dominance inheritance and disease-causing nature of the identified mutation. In addition, studied patient had features not described previously, including kyphoscoliosis, dimple presacral sinus, barrel chest and artric disc (C6–C7). These manifestations could be additional characteristics of the growing phenotypic spectrum of SALL4 related disorders.ConclusionOur findings could extend the pathogenic mutations and phenotypic spectrum of SALL4 related disorders. Such reports can also aid to conduct genetic counseling, prenatal diagnosis and clinical management for individuals at high risk of SALL4 related disorders.

Measurements and morphometric landmarks of the human spinal cord: A cadaveric study.

The topographical neuroanatomy of the human spinal cord (SC) is currently based on the adjacent vertebrae. This morphometric study sought to develop a dataset allowing for statistical analysis of human SC segment characteristics. Overall, 32 human SCs were dissected (18 female and 14 male donors), and individual SC segments were identified. Anterior and posterior lengths, thicknesses and widths were measured by two examiners. Statistical analyses included t-tests, as well as intraclass and Pearson's correlation coefficients. The SC length was significantly shorter in females than males. The cranial (C4) and caudal (T1/T2) limits of the cervical enlargement, along with its maximal width (C6-C7), were identified by combining widths and thicknesses of the segments. The thoracic region, T2 to T12, could be identified using segments widths and thicknesses values. The length of the lumbosacral region, from segments L2 to S5, was particularly stable, independently of SC length and sex. The lumbar enlargement was characterized by a thickness increase between the segments L2 and S1 which reached its maximum at the level of L3, L4, and L5, whereas the width was not significantly increased. From the S2 to S5 segments, width and thickness were equal, with both decreasing of 1 mm per segment. The morphometrical analysis of 32 human SCs provided a dataset allowing for statistical analysis of segmental measures with significant results. A combined approach mostly using widths and thicknesses provided landmarks of potential interest for the localization of SC segments in a clinical MRI setting.

Bone wax causing a middle trunk plexopathy following vertebral artery injury: a neuroradiological pitfall

BackgroundBone wax is a hemostatic agent widely used in surgery. Since it is neither absorbed nor metabolized, its use remains risky and a potential cause of complications. Even though its MRI radiological characteristics are distinguishable, it is generally misinterpreted as postoperative hematoma or trapped air. We report the first case in literature of brachial plexopathy due to the compressive mass effect of bone wax and the main clues that led us to establish this diagnosis prior to its surgical resection.Case presentationA 20-year-old male, victim of stabbing presented with an open wound of the right latero-cervical region with a vascular injury of the V2 segment of the right vertebral artery on CT angiography. He was first admitted for bleeding from the neck uncontrollable with external pressure. The patient underwent an emergency surgical vertebral artery ligation. Forty-eight hours later, he reported a feeling of paresthesia of right arm with right-sided weakness. Neurologic examination revealed a motor deficit of the right triceps and wrist extensor muscles and absence of the triceps reflex. A postoperative compression of the C7 cervical root or the middle trunk of brachial plexus was initially suspected. A cervical MRI demonstrated a T1- and T2-weighted images well-defined right mass located laterally to the spinal cord in the epidural space at the level of C6–C7 vertebrae with a signal-intensity void on both sequences. T2*-weighted images showed no signal attenuation. It did not enhance after contrast administration. An epidural hematoma was less probable since acute hematoma is typically hypointense on T2*-weighted images. Computed tomography helped rule out residual postoperative air trapped in the epidural space based on the density study of the mass compared to air. Finally, a residual surgical foreign material used for packing during the procedure was suspected. The massive use of bone wax was ultimately confirmed by the surgeon and surgically removed with complete immediate postoperative recovery.ConclusionsThis case highlights the importance of a nuanced critical approach of neurosurgeons and neuroradiologists when interpreting postoperative neuroimaging scans of the spine. It is crucial to always consider foreign body-related complications and to review the per-operative procedure in details.

Functional State of the Cortical-Spinal Tract and Motor-Cognitive Reactions of Athletes Who Train Speed, Endurance and Coordination of Movement

The aim of the work was to study the cortical-spinal excitability and conducting ability of the motor system using muscle potentials caused by magnetic stimulation of the motor cortex of the brain and spinal segments at the level of the C6–C7 and T12–L1 vertebrae in athletes of different specializations, and to correlate these parameters with psychophysiological characteristics. The researches revealed: 1) the stayers had the highest level of excitability of cortical neurons and motor neurons of the cervical and lumbar thickenings of the spinal cord, controlling the activity of shoulder, forearm, hip and shin muscles; the sprinters had the lowest level, while that of the basketball players’ was in between; 2) the sprinters and the basketball players displayed the highest conductive capacity of the corticospinal tract (CST), the stayers had the lowest one; 3) sprinters and basketball players had a higher rate of simple and complex sensorimotor reactions as an indicator of neuromotor (lability and mobility of the nervous system) and cognitive processes than stayers; 4) basketball players had the highest accuracy of complex sensorimotor reactions and the ability to anticipate the course of events as a sign of cognitive success than other athletes; 5) cortical-spinal excitability positively correlated with the accuracy of movements (in basketball players) and negatively with the conductive ability of the CST and the speed of simple and complex sensorimotor reactions (in sprinters and stayers). Athletes who train speed, endurance and coordination of movement have distinctive features and the relationship between the functional state of the CST and motor-cognitive reactions.

Ultrasound-guided Percutaneous Laser Disc Decompression (PLDD) with Fluoroscopic Validation for the Treatment of Cervical Disc Herniation: Technical Note.

Percutaneous laser disc decompression (PLDD) has been regarded as an effective alternative for the treatment of cervical soft disc herniations. Repeated X-Ray scanning is essential when performing this technique. Technical note. We present a new method for the treatment of cervical disc herniation using ultrasound to guide the needle entry to the cervical disc, to avoid excess of radiation exposure during the surgical procedure. We evaluated the efficacy of this cervical approach. We retrospectively reviewed the clinical data of 14 cases who underwent a PLDD under ultrasound guidance for the treatment of contained cervical disc herniation using a 1,470 Nm diode laser. The lower cervical discs (C5-C6 and C6-C7) were the most affected sites, accounting for 78.6% of surgical discs. A significant NRS reduction between baseline and 1 month (P = .0002) and between baseline and 12 months (P = .0007) was observed. Our results support the conclusion that ultrasound guided PLDD with fluoroscopic validation is a minimally invasive technique for patients affected by herniated cervical discs, but proper choice of patients is critical. This approach should not be performed except after adequate training under close supervision of surgeons experienced in this procedure and in interventional US.

Intradural extramedullary cervical metastasis from Merkel cell carcinoma: a case report and literature review

BackgroundMerkel cell carcinoma (MCC) is a rare aggressive primary skin carcinoma with an incidence of 44 cases per 100,000.The natural course of MCC often results in rapid growth and early metastasis. On the other hand, the spinal cord is rarely affected and frequently features the end stage of the disease. The aim of this paper was to clarify the management of patients with spine metastasis from a skin lesion and showed a case-based update.Case presentationA 73-year-old female was admitted to the Neurosurgical Department in December 2021 for a sudden right hemiparesis with bladder dysfunction and a history of cutaneous Merkel cell carcinoma. A magnetic resonance imaging (MRI) of the central nervous system (CNS) showed an intradural-extramedullary right-sided C6–C7 tumor with mass effect and edema of the cervical cord. The patient underwent a C6–C7 laminectomy with microsurgical total resection of the intradural extramedullary lesion. The neuropathological examination identified a metastasis from Merkel cell carcinoma. Nowadays, evidence for spinal metastasis from malignities skin cancer is generally lacking, probably because they are extremely rare. The exact time of life expectancy is controversial, and some clinicians use a cutoff of 3 months to determine whether surgical intervention should be offered, while others advocate at least 6 months of life expectancy.ConclusionsTo the best of our knowledge, we showed the first case of solitary intradural extramedullary cervical spine metastasis from MCC. We recommend to consider metastasis of MCC in the differential diagnosis of spinal metastasis.

Development of a Finite Element Model of the Cervical Spine and Validation of a Functional Spinal Unit

The cervical spine is a common site of injury in the vertebral column, with severe injuries often associated with damage to the spinal cord. Several studies have been performed to better understand the mechanisms of such situations and develop ways to treat or even prevent them. Among the most advantageous and most widely used methods are computational models, as they offer unique features such as providing information on strains and stresses that would otherwise be difficult to obtain. Therefore, the main objective of this work is to help better understand the mechanics of the neck by creating a new finite element model of the human cervical spine that accurately represents most of its components. The initial geometry of the cervical spine was obtained using the computer tomography scans of a 46-year-old female. The complete model was then sectioned, and a functional spinal unit consisting of the C6–C7 segment was simulated to initiate the validation process. The reduced model was validated against experimental data obtained from in vitro tests that evaluated the range of motion of various cervical segments in terms of flexion–extension, axial rotation, and lateral bending.

Disc Space Involvement in Cervical Spondylotic Myelopathy: A Prospective Study

Introduction: Cervical spondylotic myelopathy (CSM) most frequently occur in old age because of degenerative change in the cervical vertebrate, intervertebral disc, and hypertrophy of ligamentum flava that create pressure on the spinal cord. Cervical spondylotic myelopathy manifests as long-tract clinical findings in the upper and lower extremities caused by spinal cord compression. Cervical myelopathy is a clinical syndrome that may result from cervical spondylosis. When cervical myelopathy is a result of spondylosis, it is referred to as cervical spondylotic myelopathy. The study aimed to analyze the involvement of the disc space of the vertebral column in cervical spondylotic myelopathy. Methods: This study was carried out at the department of orthopaedics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study was conducted on 30 participants from March 2012 to September 2014. Result: Among the 30 cases, 24 (80%) cases were male and 6 (20%) cases were female. The age range was from 31-60 years. 15(50%) were manual workers, 12(40%) were sedentary workers and 3(10%) were housewives. the majority of the patients 15(50%) had suffered from the symptoms for 10 to 12 months. The most common level of myelopathy was the C5/6 level 13 (44.44%). Among the 30 patients, 27 (90%) cases were presented with myelopathy and the other 3(10%) cases were presented with myeloradiculopathy. Conclusion: Cervical spondylotic myelopathy is a progressive neurological disease that requires surgical intervention in most cases. In terms of interspace disc involvement, C5 C6 was the most frequent space which is 66.7%. C4 C5 and C6 C7 had the same frequency of involvement which was 10% indicating the second most common spaces concurrently.

Biomechanical influence of T1 tilt alteration on adjacent segments after anterior cervical fusion

Background: Anterior cervical fusion (ACF) has become a standard treatment approach to effectively alleviate symptoms in patients with cervical spondylotic myelopathy and radiculopathy. However, alteration of cervical sagittal alignment may accelerate degeneration at segments adjacent to the fusion and thereby compromise the surgical outcome. It remains unknown whether changes in T1 tilt, an important parameter of cervical sagittal alignment, may cause redistribution of biomechanical loading on adjacent segments after ACF surgery. Objective: The objective was to examine the effects of T1 tilt angles on biomechanical responses (i.e.range of motion (ROM) and intradiscal VonMises stress) of the cervical spine before and after ACF. Methods: C2-T1 FE models for pre- and postoperative C4-C6 fusion were constructed on the basis of our previous work. Varying T1 tilts of -10°, -5°, 0°, 5°, and 10° were modeled with an imposed flexion-extension rotation at the T1 inferior endplate for the C2-T1 models. The flexion-extension ROM and intradiscal VonMises stress of functional spinal units were compared between the pre- and postoperative C2-T1 FE models of different T1 tilts. Results: The spinal segments adjacent to ACF demonstrated higher ROM ratios after the operation regardless of T1 tilt. The segmental ROM ratio distribution was influenced as T1 tilt varied and loading conditions, which were more obvious during displacement-control loading of extension. Regardless of T1 tilt, intradiscal VonMises stress was greatly increased at the adjacent segments after the operation. As T1 tilt increased, intradiscal stress at C3-C4 decreased under 30° flexion and increased under 15° extension. The contrary trend was observed at the C6-C7 segment, where the intradiscal stress increased with the increasing T1 tilt under 30° flexion and decreased under 15° extension. Conclusion: T1 tilt change may change biomechanical loadings of cervical spine segments, especially of the adjacent segments after ACF. Extension may be more susceptible to T1 tilt change.

Incorporating strategy in hybrid surgery for continuous two-level cervical spondylosis from a biomechanical perspective

Background and objectiveHybrid surgery, incorporating cervical disc replacement and anterior cervical discectomy and fusion, has shown good clinical results in the treatment of multilevel cervical spondylosis according to early follow-ups. This study investigated the surgical strategy of hybrid surgery for two-level cervical spondylosis by distinguishing the biomechanical characteristics with different incorporating modes. MethodA finite element model of a healthy cervical spine including C2-T1 was developed, and hybrid surgery was simulated by replacing at one level with Prestige-LP and fusion at another level with the anterior plate in C3–C5 (Hybrid-S1: replaced at C3–C4, Hybrid-S2: replaced at C4–C5), and in C4–C6 (Hybrid-M1: replaced at C4–C5, Hybrid-M2: replaced at C5–C6) and in C5–C7 (Hybrid-U1: replaced at C5–C6, Hybrid-U2: replaced at C6–C7). The motion of C2 vertebrae in flexion, extension, axial rotation, and lateral bending was imposed on all hybrid models following the displacement control testing protocol. ResultsThe largest range of motion (ROM) in a healthy spine was observed at C5-C6, followed by C3-C4, C4-C5 and C6-C7. On average, the ROM at the replaced segment increased by 175.7%, 202.7%, 176.3%, 117.1%, 139.4%, and 236.0% in Hybrid-S1, Hybrid-S2, Hybrid-M1, Hybrid-M2, Hybrid-U1, and Hybrid-U2, respectively. The facet joint stress at the replaced segment increased by 186.9%, 124.4%, 111.1%, 60.3%, 62.7%, and 144.7%, and the adjacent intradiscal pressure (IDP) increased by 45.2%, 38.7%, 2.7%, 2.1%, 13.9%, and 20.1%. ConclusionsIncorporating mode in hybrid surgery affects cervical biomechanics. Hybrid surgery with replacement at a segment with a greater ROM and fusion at a segment with a lower ROM can results in fewer changes in terms of overall cervical stiffness, ROM at the operative level, facet joint stress, and adjacent IDP. In hybrid surgery, it is better to implement disc replacement at a level with a greater ROM and fusion of another segment.

Solar-driven semi-conductor photocatalytic water treatment (TiO2, g-C3N4, and TiO2+g-C3N4) of cyanotoxins: Proof-of-concept study with microcystin-LR

Cyanobacteria and their toxins are a threat to drinking water safety as increasingly cyanobacterial blooms (mass occurrences) occur in lakes and reservoirs all over the world. Photocatalytic removal of cyanotoxins by solar light active catalysts is a promising way to purify water at relatively low cost compared to modifying existing infrastructure. We have established a facile and low-cost method to obtain TiO2 and g-C3N4 coated floating photocatalysts using recycled glass beads. g-C3N4 coated and TiO2+g-C3N4 co-coated beads were able to completely remove microcystin-LR in artificial fresh water under both natural and simulated solar light irradiation without agitation in less than 2 h. TiO2 coated beads achieved complete removal within 8 h of irradiation. TiO2+g-C3N4 beads were more effective than g-C3N4 beads as demonstrated by the increase reaction rate with reaction constants, 0.0485 min−1 compared to 0.0264 min−1 respectively, with TiO2 alone found to be considerably slower 0.0072 min−1. g-C3N4 based photocatalysts showed a similar degradation pathway to TiO2 based photocatalysts by attacking the C6–C7 double bond on the Adda side chain.

Synthesis of Clionastatins A and B through Enhancement of Chlorination and Oxidation Levels of Testosterone

Comprehensive SummaryA full account of semisyntheses of polychlorinated marine steroids clionastatins A and B is described. We have developed a unique two‐stage chlorination‐oxidation strategy that enabled concise and divergent semisyntheses of clionastatins A and B in 16 steps from inexpensive testosterone. Key transformations in chlorination stage include (a) conformationally controlled, stereospecific dichlorination through an unusual β‐chloronium intermediate to install the diequatorial C1,C2‐dichloride; (b) C4‐OH directed C19–H oxygenation followed by challenging neopentyl chlorination to install the C19–Cl. The high oxidation level was constructed through (a) the desaturation at C6–C7 through one‐pot photochemical dibromination–reductive debromination; (b) regioselective anti‐Markovnikov oxidation of the C6–C7 double bond by photoredox‐metal dual catalysis to forge the B ring enone; (c) late‐stage desaturation with SeO2 to introduce C8–C9 double bond. Wharton transposition was used to forge the D‐ring enone, and thermodynamically driven epimerization secured the cis‐fused C/D ring system. Furthermore, we also provided a 14‐step approach to clionastatin A by optimizing the construction of the D‐ring enone with a dehydration‐oxidation sequence.

Comparison of Separation Alternatives for Two Industrial C6–C7 Aliphatic Hydrocarbon Mixtures Including Stacked Complex Sequences

Comparison of Separation Alternatives for Two Industrial C6–C7 Aliphatic Hydrocarbon Mixtures Including Stacked Complex Sequences

A significant quantitative trait locus on chromosome Z and its impact on egg production traits in seven maternal lines of meat-type chicken

BackgroundEgg production is economically important in the meat-type chicken industry. To better understand the molecular genetic mechanism of egg production in meat-type chicken, genetic parameter estimation, genome-wide association analyses combined with meta-analyses, Bayesian analyses, and selective sweep analyses were performed to screen single nucleotide polymorphisms (SNPs) and other genetic loci that were significantly associated with egg number traits in 11,279 chickens from seven material lines.ResultsYellow-feathered meat-type chickens laid 115 eggs at 43 weeks of age and white-feathered chickens laid 143 eggs at 60 weeks of age, with heritability ranging from 0.034–0.258. Based on meta-analyses and selective sweep analyses, one region (10.81–13.05 Mb) on chromosome Z was associated with egg number in all lines. Further analyses using the W2 line was also associated with the same region, and 29 SNPs were identified that significantly affected estimation of breeding value of egg numbers. The 29 SNPs were identified as having a significant effect on the egg number EBV in 3194 birds in line W2. There are 36 genes in the region, with glial cell derived neurotrophic factor, DAB adaptor protein 2, protein kinase AMP-activated catalytic subunit alpha 1, NAD kinase 2, mitochondrial, WD repeat domain 70, leukemia inhibitory factor receptor alpha, complement C6, and complement C7 identified as being potentially affecting to egg number. In addition, three SNPs (rs318154184, rs13769886, and rs313325646) associated with egg number were located on or near the prolactin receptor gene.ConclusionOur study used genomic information from different chicken lines and populations to identify a genomic region (spanning 2.24 Mb) associated with egg number. Nine genes and 29 SNPs were identified as the most likely candidate genes and variations for egg production. These results contribute to the identification of candidate genes and variants for egg traits in poultry.

Использование большой грудной мышцы для восстановления активного сгибания предплечья у детей с амиоплазией

Introduction Amyoplasia is the most common type of arthrogryposis multiplex congenita. Some patients may lack active elbow flexion due to aplasia of the forearm flexor muscles. The objective was to identify the optimal age for pectoralis major muscle transfer to improve elbow flexion in children with amyoplasia and estimate outcomes of the procedure depending on the level of spinal cord injury. Material and methods Restoration of active elbow flexion was performed for 34 children with amyoplasia (39 upper limbs) between 2011 and 2020 using partial monopolar pectoralis major muscle transfer. The age of patients ranged between 1.5 and 15.5 years (6.24 ± 4.24 years). The patients were divided into 3 groups depending on the level of spinal cord injury: C6–C7 (n = 4; 11.8 %), C5–C7 (n = 24; 70.6 %), C5–Th1 (n = 6; 17.6 %). The outcomes were estimated at 6 to 99 months (44.53 ± 31.72 months). The patients underwent preoperative and postoperative clinical and neurological examination. The results were statistically analyzed. Results Active elbow flexion improved by 56.8 degrees (p < 0.0001), forearm flexor muscles strengthened by 2.0 points (p < 0.0001) and extension deficit improved by 14.5 degrees (p < 0.0001) were postoperatively statistically significant. Results were rated as good in 15 (38.5 %); as fair, in 8 (20.5 %) and poor in 16 (41 %) cases. Greater differences were found between the group of patients with the level of C6-C7 spinal cord injury in relation to the group of patients with the level of C5-Th1 (p < 0.05). There were no statistically significant differences between patients with C6–C7 and C5–C7 lesion levels (p > 0.05). Children of different age groups showed no differences in the results of treatment (p > 0.05). Conclusion Pectoralis major muscle could be used for active elbow flexion restoration in patients with amyoplasia. The best results were observed in patients with C6–C7, C5–C7 segmental lesions of the spinal cord. There was no correlation between age of patient at the time of surgery and the effectiveness of operation.

Complete tracheal obstruction during anaesthesia for ventral slot decompression surgery in a dog

AbstractAn 8‐year‐old, female Yorkshire terrier presented to the neurology department with a 3‐month history of progressive ambulatory tetraparesis. A diagnosis of intervertebral disc protrusions at the levels of C3–C4 and C6–C7 was made using magnetic resonance imaging. Ventral slot decompressive surgery was carried out at both sites. When accessing the C6–C7 disc space, placement of Gelpi retractors resulted in complete tracheal obstruction, characterised by an absence of end tidal carbon dioxide measurement. This occurred in conjunction with the cessation of abdominal and thoracic respiratory movement despite the use of positive pressure ventilation. Removal of the Gelpi retractors resolved the tracheal occlusion and permitted the resumption of ventilatory support. To facilitate this surgical approach, the trachea was reintubated with a longer endotracheal tube to protect the patency of the airway. To the authors’ knowledge, this is the first report of tracheal obstruction as a complication of a ventral slot procedure.

Application of transcranial doppler in patients after stent-assisted coil embolization

Background and purposePatients with intracranial aneurysms treated with stent-assisted coil embolization (SACE) require radiological and clinical follow-up in view of in-stent stenosis (ISS). The aim of the study was to evaluate transcranial Doppler (TCD) as an alternative to more invasive digital subtraction angiography (DSA) in monitoring patients with SACE. MethodsOver the course of 72 months, from January 2016 to December 2021, we analyzed 49 patients treated with SACE because of internal carotid artery (ICA) aneurysms (C6 ophthalmic segment or C7 communicating segment). DSA was performed in all patients at 24-months and TCD was examined preoperatively and at 3, 6, 12, and 24-months postoperatively. The degree of stenosis found on TCD was compared with the results of DSA. Preoperative and postoperative blood flow velocities, including peak systolic blood flow velocity (Vs), end diastolic velocity (Vd), and mean velocity (Vm), were compared and the optimal cutoff velocities for detecting stenosis were calculated. ResultsPre-embolization middle cerebral artery (MCA) and intracranial terminal internal cerebral arteries (TICA) velocities and pulsatility index (PI) did not significantly differ between the ipsilateral and contralateral sides. The blood flow velocities, Vs, Vd, and Vm, on the operation side significantly increased after SACE (P < 0.05). Over the 24-month study period, 7 of the 49 patients (14.3%) exhibited angiographic ISS. ISS of TCD and DSA results at 24-months were compared and found to correlate well; the Cohen’s κ coefficient was 0.851 (95% CI 0.651–1.051). The optimal cutoff velocity for detecting ISS was MCA Vs = 173.5 cm/s. ConclusionsTCD is a potentially useful adjunct for evaluating ISS after SACE.

Intercostobrachial neuralgia—a case of bizzare diagnosis?

BackgroundIntercostobrachial neuralgia is a rare and bizarre diagnosis usually missed by many clinicians. The rare occurrence and absence of clear diagnostic criteria could be a result of this missed diagnosis. The symptoms could range from debilitating pain in the axilla, medial arm, and forearm at rest and with specific shoulder movements. The symptoms are very distinct from axillary web syndrome in which the patient could have thickening of subcutaneous tissue of axilla with affected shoulder mobility but absence of neural symptoms. The diagnostic and treatment procedure involving breast cancer may cause injury or lesion of the intercostobrachial nerve and is of particular interest to the surgeons, pain physicians, and physical therapists. The diagnosis is reached after excluding all the other possible diagnoses. The treatment of this post-surgical intercostobrachial neuralgia can range from cryoneurolysis, ultrasound-guided nerve block, steroid injection, and paravertebral nerve block. Lidocaine injection and avoiding certain positions like flexion and abduction are helpful in certain patients. Unfortunately, there is not much literature available on possible manual therapy treatments of this diagnosis. Therefore, this case report focuses on potential manual therapies to address this intricate diagnosis.Case presentationThe patient is a 38-year-old Asian female reported to an outpatient orthopedic physical therapy clinic with left medial arm and forearm pain for the past 5 years. Medical history included left breast lump removal surgery 9 years ago and cervical laminectomy C6–C7 with little success. The quick disability arm and hand scale showed a 36% disability score of function. The manual therapy approach targeted the cervicothoracic junction, second and third costovertebral joint, thoracic spine (T1–T8), and atlantooccipital joint (C0–C1). The patient showed significant improvement in function with a DASH score falling to 0% disability with a hands-on approach.ConclusionThe intercostobrachial neuralgia is usually undiagnosed by various practitioners, physicians, and surgeons. The clinicians must consider manual treatments to the second and third rib and soft tissue mobilizations around the axillary region. The patient demonstrated significant improvement in symptoms with this approach.