Short Necks Research Articles

Membrane nanotubes transform into double-membrane sheets at condensate droplets

Cellular membranes exhibit a multitude of highly curved morphologies such as buds, nanotubes, cisterna-like sheets defining the outlines of organelles. Here, we mimic cell compartmentation using an aqueous two-phase system of dextran and poly(ethylene glycol) encapsulated in giant vesicles. Upon osmotic deflation, the vesicle membrane forms nanotubes, which undergo surprising morphological transformations at the liquid-liquid interfaces inside the vesicles. At these interfaces, the nanotubes transform into cisterna-like double-membrane sheets (DMS) connected to the mother vesicle via short membrane necks. Using super-resolution (stimulated emission depletion) microscopy and theoretical considerations, we construct a morphology diagram predicting the tube-to-sheet transformation, which is driven by a decrease in the free energy. Nanotube knots can prohibit the tube-to-sheet transformation by blocking water influx into the tubes. Because both nanotubes and DMSs are frequently formed by cellular membranes, understanding the formation and transformation between these membrane morphologies provides insight into the origin and evolution of cellular organelles.

Are very short necks ESAR patients safe from type 1A endoleak risk?

Are very short necks ESAR patients safe from type 1A endoleak risk?

Endosutured Aneurysm Repair of Abdominal Aortic Aneurysms with Short Necks Achieves Acceptable Midterm Outcomes—Results from the Peru Registry

IntroductionThe study aims to describe midterm outcomes following treatment of infrarenal abdominal aortic aneurysms (AAAs) with short necks by endosutured aneurysm repair (ESAR) using the Heli-FX EndoAnchor system. MethodsThis is a retrospective study of prospectively collected data from nine vascular surgery departments between June 2010 - December 2019, including treated AAAs with neck lengths ≤ 10mm. The decision for the use of EndoAnchors was made by the treating surgeon or multidisciplinary aortic committee according to each centre’s practice. There were two subgroups further assessed according to neck length, A (≥4 and < 7mm) and B (≥7 and ≤10mm). The main outcomes analysed were technical success, freedom from type Ia endoleaks (TIaEL), sac size increase, all-cause (ACM) and aneurysm related mortality (ARM). Results76 patients were included in the study, 17 fell into Subgroup A and 59 into subgroup B. Median follow-up for the cohort was 40.5 (IQR 12-61) months. A median of 6 (IQR 3) EndoAnchors were deployed in each subject. Technical success was 86.8% for the total group, 82.4% and 88.1% (p=0.534) for subgroups A and B respectively. Six out of ten (60%) of TIaELs at the completion angiographies showed spontaneous resolution. Cumulative freedom from TIaEL at 3 and 5 years for the total group was 89% and 84% respectively; this was 93% and 74% for subgroup A and 88% at both intervals in subgroup B (p=0.545). In total, there were 7 (9.2%) patients presenting with type Ia endoleaks over the entire study period. Two (11.8%) in subgroup A and 5 (8.5%) in subgroup B (p=0.679). There were more patients with sac regression in subgroup B (subgroup A=6 - 35.3% versus subgroup B=34 - 57.6%, p=0.230) with no statistical significance. ACM was 19 (25%) patients, with no difference (4 – 23.5% versus 15 – 25.4%, p=0.874) between subgroups; whereas ARM occurred in one patient from subgroup A and 3 from subgroup B. ConclusionsThis study demonstrates reasonable outcomes for patients with short-necked AAAs treated by ESAR in terms of type Ia endoleaks up to 5 year follow up. EndoAnchor use should be judiciously evaluated in short necks and may be a reasonable option when anatomical constraints are encountered, mainly for those with 7-10mm neck lengths. Shorter neck length aspects, as indicated by the results from Group A, may be an alternative when no other options are available or feasible.

Five-year outcomes of endosuture aneurysm repair in patients with short neck abdominal aortic aneurysm from the ANCHOR registry

ObjectiveHostile aortic neck anatomies such as proximal short necks are known to put patients at an increased risk for type IA endoleaks, migration, and need for reinterventions. The Heli-FX EndoAnchor System was designed to improve seal of aortic stent grafts. Endosuture aneurysm repair (ESAR) using EndoAnchors with the Endurant stent graft has been shown to be safe and effective for the treatment of patients with short necks through one year. This study reports the 5-year patient outcomes of the Aneurysm Treatment using the Heli-FX EndoAnchor System Global Registry (ANCHOR) short neck regulatory cohort. MethodsThe 70 patients from the ANCHOR Registry were cohort submitted to regulators for approval of the Endurant short neck indication. Patients had an infrarenal neck length of ≥ 4 mm and <10 mm. At 5 years, this short neck cohort had clinical and imaging follow-up compliance rates of 85% (28/33) and 70% (23/33), respectively. ResultsThe short neck cohort had a mean age of 71.3±8.1 years and was 27.1% (19/70) female. Kaplan Meier freedom from all-cause mortality was 68.5 ± 6.2%, freedom from aneurysm-related mortality was 90.1 ± 4.5%, freedom from any endovascular or surgical secondary procedure was 76.9 ± 7.2%, and freedom from rupture was 95.6 ± 3.2%. Eight patients had a total of nine type IA endoleaks detected through 5 years, of which three resolved spontaneously by the next follow-up visit. There were two patients with renal complications who did not undergo reintervention and there were no device migrations reported through 5 years. After 5 years, 68.2% of patients (15/22) had sac regression, 13.6% (3/22) had stable sacs, and 18.2% (4/22) had increased sac diameter as compared with their 1-month measurements. ConclusionsAfter ESAR treatment using Heli-FX EndoAnchors with Endurant, the 5-year outcomes of the short neck cohort from the ANCHOR registry had encouraging results with regards to proximal neck-related complications, secondary procedures, and sac regression. This review of ESAR in patients with short proximal necks showed positive outcomes through 5 years although follow-up of a larger cohort is necessary.

Changes of Adenoid and Pharyngeal Airway Space Following Orthognathic Surgery in Class III Patients with Mandibular Prognathism: A Retrospective Analysis

Aim and Background: This retrospective study evaluated the changes in adenoid and pharyngeal airway spaces associated with surgical mandibular setback in skeletal Class III patients. Patients and Methods: Pre- and one- year-post-operative lateral cephalograms of 25 adult patients with mandibular prognathism who had bilateral sagittal split osteotomy (BSSO) were traced. Cephalometric parameters including SNA, SNB, GoGn to SN, y-axis, SPPS, MPS, IPS, PNS-Eb, at-atp, ppw-Ba were calculated, compared, and then data were analyzed using Paired t-test or Sign test. The role of growth pattern and gender factor was analyzed with Fisher exact test. MannWhitney test was utilized to compare between the groups of male/female as well as the groups of vertical/horizontal grower. The results were considered at a maximum level of significance of 5% (P &lt; 0.05). Results: At long-term follow-up, 25 patients (m:8, f:17) with the mean age of 25±4; there was a decrease in MPS value (3.8±6.7) that statistically significant (P=0.001). Although an increase was found in PNS-Eb index (3.1±4.4), the changes were not significant (P=0.03). No significant change was observed in other parameters. Also, growth pattern and gender didn’t affect the mentioned parameters. Conclusion: Mandibular setback surgery causes a long-term effect in some parameters of pharyngeal airway space area. In patients suffering from obstructive sleep apnea or in case of some other risk factors including overweight, short necks, and small pharyngeal airway space, a mandibular setback surgery could possibly predispose to the development of sleep apnea syndrome.

TECHNICAL CHARACTERISTICS OF THE OVATION ALTO FOR THE TREATMENT OF ABDOMINAL AORTIC ANEURYSMS: APPLICATION TO CHALLENGING ANATOMIES.

The Ovation Alto design repositions the maximum diameter of the proximal sealing ring at 7 mm below the lowermost renal artery. Although it has been introduced to address abdominal aortic aneurysms with short necks ≥7 mm, we present further applications of Alto in other neck irregularities, presenting four representative challenging cases with a short, wide and conical neck as well a juxtarenal aneurysm. At one month follow up, there was 100% technical and clinical success.

Tracheal injury from dog bite in a child

BackgroundDog bites associated with the head and neck area in children are a common problem. Most of the lacerations are found in the upper lip and the nose region, and tracheal injury is rare [1]. Tracheal injury requires prompt and accurate diagnosis and treatment to rescue the patient. Especially in children, securing the airway is often more difficult than in adults because of their short neck and narrow trachea. In this report, we experienced a pediatric case of multiple dog bites with tracheal injuries in the neck.Case presentationWe report the case of a 3-year-old girl who presented with multiple dog bites. There were multiple wounds on the head, face, neck, and anterior chest, and air leakage was observed from the cervical wound at the time of transfer. It was difficult to perform oral endotracheal intubation, therefore, we extended the neck wound, probed the trachea with finger, and inserted a tracheal tube directly from the cervical wound in the emergency room. Tracheoplasty and another wound cleansing were performed in the operating room. The patient was discharged on the 18th day after surgery, without further complications.ConclusionTracheal injury from a dog bite is rare. It is important to prompt and accurate diagnosis and treatment. Children should be especially careful because of their short necks and narrow tracheas.

A long-snouted and long-necked polycotylid plesiosaur from the Late Cretaceous of North America

SummaryPlesiosaurs are a group of Mesozoic marine diapsids. Most derived plesiosaurs fall into one of two typical body forms: those with proportionately small heads, short snouts, and elongated necks, and those with large heads, elongated snouts, and short necks. Serpentisuchops pfisterae is a polycotylid plesiosaur from the Upper Cretaceous Pierre Shale that presents the trait combination of both an elongate snout and elongate neck (consisting of 32 vertebrae). Phylogenetic analysis places Serpentisuchops within the Polycotylinae, indicating that its long snout is an ancestral trait, while its long neck is secondarily derived and convergent with that of ancestral plesiosaurs, contemporaneous elasmosaurids, and some more basal members of the Polycotylidae. The conical, recurved, and narrow teeth are consistent with a piscivorous diet. The tall and anteroposteriorly broad cervical neural spines indicate large epaxial muscles, suggesting that Serpentisuchops used both its neck and snout in fast lateral strikes aimed at proportionately small prey.

Minimally Invasive Full-endoscopic Posterior Cervical Foraminotomy and Discectomy: Introducing a Simple and Useful Localization Technique of the "V" Point.

ObjectiveConventional localization technique of V point for full‐endoscopic posterior cervical foraminotomy and discectomy (FPCD) required repeated fluoroscopies, especially in patients with short and thick necks. To address this issue, the present study aimed to introduce a new localization technique of V point, and further evaluate its efficacy.MethodsA K‐wire was inserted and fixed at the pedicle eye under A/P fluoroscopy, then a working channel was established quickly along with it. Thirty‐four patients who underwent minimally invasive FPCD assisted by the new technique were included in this study. The clinical and radiological data were collected and analyzed, including radiation dose, operative time, positioning time, visual analog scale (VAS) for neck and arm pain, neck disability index (NDI) scores, Cobb angle of operative level and range of motion of the cervical spine.ResultsAll operations were performed successfully, and no iatrogenic nerve or vascular injury occurred. None of the patients needed to be transferred to open surgery or revision surgery. The mean radiation dose was found to be1.68 ± 0.36 mSv. The mean positioning time observed was 10.68 ± 5.42 min and the average operation time was 81.18 ± 10.87 min. The operation time significantly declined as the number of patients increased. A significant difference in operation time between the first (96.22 ± 10.36 min) and last quartile (75.00 ± 3.84 min) of cases was observed (t = 4.82, P < 0.001). The VAS scores for neck and arm pain, and NDI scores were significantly improved after surgery (P VAS−Neck<0.0001, P VAS−Arm<0.0001, P NDI<0.0001). Based on MacNab criteria, the excellent plus good rate was 91.17%. The Cobb angle of operative level and range of motion of the cervical spine were significantly improved postoperatively (t = 2.846, P OA = 0.015; t = 2.232, P ROM−CA = 0.026).ConclusionThe new image‐assisted V point localization technique is simple and useful with little radiation exposure and short positioning time. FPCD assisted by the new technique could be a safe and effective alternative on properly selected patients.

A new discosorid and some other nautiloids from the Givetian of the Rhenish Massif, Germany

Nautiloids were subordinate inhabitants of Middle Devonian Rhenish reefs and in surrounding neritic carbonate facies. However, a literature review shows the presence of more than 45 orthoconic, cyrtobreviconic, and gyroconic taxa, which are mostly insufficiently known. We report the first discovery of an orthobreviconic representative of the order Discosorida from the initial phase (Binolen Member) of the thick Hagen-Balve Reef Complex in the Hönne Valley (northern Sauerland). It belongs to a new genus and species (Binoleniceras stichlingi n. gen. n. sp.) that is characterised by fast conch expansion, fine longitudinal ribbing, and a marginal siphuncle with short, recumbent cyrtochoanitic (dorsally) and suborthochoanitic (ventrally) septal necks, rounded adapical thickenings (bulletes), strongly thickened connecting rings, and irregular lamellae in the septal opening. It has no described relative in the Middle Devonian of Central or Southern Europe. Other taxa discussed are the oncoceratoid Cranoceras Hyatt, 1884, with the first Rhenish record of Cranoceras subdepressum (Roemer, 1850), and the archiacoceratid Cyrtoceratites, with a possibly new species with very large-sized siphuncle.

COVID–19によるARDSを来した短頚の高度肥満女性に対し両側大腿静脈カニュレーションによるECMOを用いて救命した1例(A case of extracorporeal membrane oxygenation with bilateral femoral vein cannulation in a morbidly obese woman with a short neck who had acute respiratory distress syndrome due to coronavirus disease 2019)

ABSTRACTWe present a case of a morbidly obese 44–year–old woman with a short neck who had nasal discharge 3 days prior to admission. She was diagnosed with acute respiratory distress syndrome due to coronavirus disease 2019 (COVID–19) using severe acute respiratory syndrome–coronavirus–2 polymerase chain reaction test and was admitted to our hospital the following day. Her respiratory condition gradually worsened. On day 9 of hospitalization, she was intubated and transferred to our department. On day 4 after admission to the intensive care unit (ICU), her P/F ratio was 82.6. Therefore, extracorporeal membrane oxygenation (ECMO) was warranted. Since she had a short neck, the cannula could not be inserted through the jugular vein. Therefore, veno–venous ECMO was initiated through the left and right femoral veins. On day 30, the patient was weaned off ECMO. On day 36, she was extubated, and on day 47, she was discharged from the ICU. Finally, on day 55, she was discharged from the hospital. In morbidly obese patients with short necks, VV–ECMO with bilateral femoral venipuncture may be a treatment option. Thus, it is important to understand its advantages and disadvantages to ensure proper management.

Endovascular aortic repair of endoleaks : Diagnosis, treatment, and outcomes

Sämtliche Patienten nach endovaskulärer Versorgung eines Aortenaneurysmas bedürfen einer regelmäßigen Nachkontrolle, zumeist in jährlichem Abstand. Der kontrastmittelverstärkte Ultraschall und die Computertomographie-Angiographie (CTA) sind die wichtigsten diagnostischen Modalitäten für die Erkennung von Endoleaks. Die (CTA) erlaubt eine bessere Unterscheidung der verschiedenen Endoleak-Typen. Sogenannte Hochdruck-Endoleaks (Typ I und Typ III) stellen, wenn sich nicht kurzzeitig ein Spontanverschluss zeigt, eine absolute Indikation zur Nachbehandlung dar. Typ-II-Endoleaks weisen in der Mehrzahl einen benignen Verlauf auf. Wenn kein Wachstum des Aneurysmasacks erfolgt, kann eine Nachkontrolle im gewohnten Intervall durchgeführt werden. Typ-II-Endoleaks mit assoziiertem Wachstum des Aneurysmasacks können durch Embolisation der verantwortlichen Gefäße behandelt werden. Ob eine Behandlung immer durchgeführt werden muss, ist umstritten. Eine Behandlungsindikation von einem Typ-II-Endoleak mit wachsendem Aneurysmasack ist jedoch gegeben, wenn durch eine Verkürzung des Aneurysmahalses ein sekundäres Typ-I-Endoleak droht. Typ-I-Endoleaks stellen die Hauptlimitation der Stentgraft-Therapie dar. Die beste Prävention eines Typ-I-Endoleaks ist die Bereitstellung einer adäquaten proximalen Landezone. Dies kann durchaus bedeuten, dass fenestrierte Stentgrafts verwendet werden müssen. Die Verwendung von Schrauben oder anderen Fixationsinstrumenten zur sicheren Behandlung auch kurzer Hälse ist derzeit noch in der Studienphase.

Traditional Husbandry Practices and Selection Criteria of Goats in Selected Districts of Sidama Zone, Southern Ethiopia

Before implementing any development plan, it is critical to understand traditional goat management practices, which allow breeders to create long-term genetic improvement, while preserving indigenous goat production. This study aimed to describe the goat husbandry system in two districts of Sidama zone of southern Ethiopia using two production systems. A semi-structured questionnaire was employed to gather information regarding the management activities, purpose of keeping goats, and farmer’s selection criteria for breeding animals. A total of 240 households were interviewed to collect relevant information for the study. Data collected was statistically analyzed and summarized into descriptive statistics. Indexes were calculated to clarify rankings by using indexes formula. The number goat population was more in Loka Abaya than Aroresa. The primary purpose of keeping goats in the study area is mainly for their milk, meat and income generation. Broad shoulders, compact frame, and short and thick necks of the bucks were considered as the most important characteristics for selection. Communal grazing and crop aftermath were the most common feed sources reported by farmers in the study area. River was the major water source for goats in the study districts. The major factors limiting the productivity of goats are feed shortage, diseases, and labour shortage. The management and husbandry practices are nearly equivalent to the rest of the country with the same agroecology. Planning and implementing of goat development and extension services on management, improvement, disease control, and suitable forage production strategies helps farmers in increasing goat production and therefore improving their livelihood.

The correlation of aortic neck length to late outcomes following EVAR with the Ovation stent graft

ObjectiveEndovascular aneurysm repair (EVAR) performed outside manufacturers’ instructions for use due to short aortic neck for the treatment of abdominal aortic aneurysm (AAA) is associated with unfavorable outcomes. Newer endografts now have an indication for shorter neck aneurysms that previous endografts do not, but this cohort has yet to be evaluated individually. The aim of this study is to evaluate 5-year outcomes after EVAR in patients with short aortic necks (<10 mm) using the Ovation stent graft. MethodsThe study comprised 238 patients who underwent EVAR as part of the prospective international multicenter Ovation stent graft trials. The main inclusion criteria were AAA diameter ≥ 5 cm, proximal parallel neck length ≥7 mm, neck angulation ≤60°, and bilateral iliac fixation length ≥10 mm. A clinical events committee adjudicated adverse events through 1 year, an independent imaging core laboratory analyzed imaging through 5 years, and a data safety and monitoring board provided study oversight. Patients were divided into short neck (<10 mm) and standard neck (≥10 mm) groups. End points included long-term survival, freedom from aneurysm-related mortality (ARM), freedom from type Ia endoleak, and freedom from reintervention. ResultsPatients were predominantly male (81%) with a mean age of 73 ± 8 years. Median follow-up time was 58 months (interquartile range, 36-60 months). Of 238 patients, 41 (17.2%) had a proximal neck length <10 mm and would be considered outside the instructions for use with other stent grafts. Baseline characteristics were relatively similar between the two groups. The 5-year overall survival estimates were 77.8% for the standard neck group compared with 59.5% for the short neck group (P = .03). There were no differences in the 5-year freedom from ARM (99.2% vs 100%; P = .7), freedom from type Ia endoleak (96.3% vs 96.3%; P = .8), and freedom from reintervention (77.9% vs 79.7%; P = .7) between the standard and short neck groups, respectively. After adjusting for age and other potential confounders, short proximal neck was associated with a two-fold increase in 5-year all-cause mortality (adjusted hazard ratio, 2; 95% confidence interval, 1.02-3.8; P = .04]. ConclusionsThe Ovation endograft performed well in short AAA neck with no difference in 5-year type Ia endoleak, reintervention, and ARM rates. However, short proximal neck was independently associated with a two-fold increase in the risk of all-cause mortality at 5 years. These findings confirm the prior literature on the association of hostile neck anatomy with late mortality following EVAR.

The Management of Down Syndrome

Down syndrome occurs when individuals experience abnormal cell division, resulting in a partial or complete copy of chromosome 21. Persons with Down syndrome have short necks, protruding tongues, poor muscle tones, flattened faces, and excessive flexibility. The genetic disorder affects approximately 400,000 adults and children in the United States. Unmanaged Down syndrome leads to serious health complications like ear infections, eye diseases, heart defects, hearing loss, seizures, gastrointestinal disorders, obesity, and obstructive sleep apnea. The literature review completes a comprehensive analysis of pharmacological and non-pharmacological methods for managing Down syndrome to protect individuals from adverse complications. Specifically, the report examines the benefits of medications, such as donepezil, rivastigmine, memantine, and galantamine, in managing Down syndrome associated with dementia. They review the impact of non-pharmacological methods, including speech therapy, occupational therapy, physical therapy, assistive technologies, and surgeries, on managing Down syndrome. The collection of data for the literature review is based on secondary research. Particularly, the researcher collected and applied data from peer-reviewed journals, e-books, or agencies reports published between 2011 and 2021. The literature review has specific gaps as the peer-reviewed articles did not provide information on particular surgeries for managing complications of Down syndrome, the accurate dosage of medications for adults and children, and the side effects of pharmacological methods. Although the literature has gaps, patients and clinicians should apply the discussed pharmacological and non-pharmacological strategies for managing Down syndrome. The clinical significance of the literature review is to: • Facilitate the early intervention and management of Down syndrome. • Reduce the adverse complications of Down syndrome in children and adults. • Enhance knowledge and awareness of Down syndrome and its evidence-based management approaches among clinicians, vulnerable persons, and community members. • Increase the safety and clinical outcomes of individuals with Down syndrome.

Fenestrated EVAR Promotes Positive Infrarenal Neck Remodeling Leading to Greater Sac Shrinkage Compared With EVAR

The standard of care treatment for abdominal aortic aneurysms (AAAs) in the modern era is endovascular aneurysm repair (EVAR). Numerous devices exist for standard infrarenal AAA repair, but in patients with short infrarenal necks, fenestrated endovascular aneurysm repair (fEVAR) offers a minimally invasive alternative to traditional open repair. Over time, aortic neck dilation can occur in the segment used as a seal zone, leading to loss of seal, endoleaks, and AAA sac growth. This study compares aortic remodeling post EVAR vs fEVAR and evaluates if fEVAR confers a benefit in terms of sac shrinkage.

Favorable Outcomes in Octogenarians With Hostile Neck Undergoing Endovascular Repair Using EndoAnchors

ObjectivesStandard endovascular repair (EVAR) is not suitable in patients with hostile aortic anatomy. Open aneurysm repair (OAR) has been the gold-standard approach in managing these patients. EndoAnchors have been introduced as a technique to make EVAR in patients with short and angulated necks possible. The use of EndoAnchors in managing hostile aneurysms in octogenarians has not been studied before. Thus, the purpose of this study is to evaluate both short and long-term outcomes in octogenarians versus nonoctogenarians patients with hostile aortic anatomy undergoing EVAR using EndoAnchors. MethodsOnly patients enrolled in the primary arm of the ANCHOR registry were included and stratified into octogenarians (80–89 years) and nonoctogenarians (<80 years). Standard univariate (chi-square, fisher's exact, student's t-tests) and multivariable (logistic, cox-regression) analysis was used to evaluate patients’ characteristics and outcomes between octogenarians versus nonoctogenarians as appropriate. ResultsOf 461 patients, 21% (N = 97) were octogenarians. Compared to nonoctogenarians, octogenarians were more likely to have a history of renal (32.0% vs. 18.4%) and genitourinary (30.9% vs. 21.2%) disease (both P < 0.05). They were also more likely to have an AAA diameter greater than 55 mm compared to nonoctogenarians (59% vs. 46%), had increased neck tortuosity index (mean [S.D.] 1.07 [0.08] vs. 1.05 [0.05]), greater proximal neck angulation (mean [S.D.]: 28.2 [17.3] vs. 23.7 [16] degrees) and were more likely to have localized (29.3% vs. 18.7%) and diffuse (25.6% vs. 20.7%) neck calcification (All P < 0.05). The overall procedural success was similar between both groups. However, octogenarians had higher rates of endoleaks at completion (32.0% vs. 21.2%, P = 0.03) and 30-day bleeding (12.4% vs. 5.8%) and cardiac (13.4% vs. 5.2%) complications (All P < 0.05). Additionally, compared to nonoctogenarians, octogenarians had lower freedom from all-cause mortality (87.90% vs. 96.50%) and type II endoleak (73.30% vs. 88.60%) based on Kaplan Meier estimates through one year (Both P < 0.05). In multivariable cox-regression analysis, octogenarians demonstrated a 5-fold increase in all cause mortality (HR [95% CI]: 5.19 [1.92–14], P = 0.001) and a 3-fold increase in type II endoleak (HR [95% CI]: 2.99 [1.54–5.81], P = 0.001) at 1-year. However, no significant difference was seen in aneurysm/device related mortality (HR [95% CI]: 1.42 [0.14–14.7], P = 0.77) and type I endoleak (HR [95% CI]: 1.71 [0.31–9.55], P = 0.54) at 1-year. ConclusionsDespite a worse aortic neck anatomy, octogenarians undergoing EVAR using EndoAnchors showed acceptable short and long-term outcomes. The results of our study could expand the utilization of EVAR in octogenarians with hostile neck.

Surgical Techniques Ensuring Success in Posterior Endoscopic Cervical Foraminotomy and Discectomy at C6-7 in Patients with Prominent Shoulders and Short Necks

Introduction: There is a steep learning curve for a successful posterior endoscopic cervical foraminotomy and discectomy (PECFD), an important surgery for cervical foraminal or lateral disc herniation, and cervical radiculopathy due to a small operation field. PECFD becomes even more challenging in patients who have prominent shoulders and/or short necks with C6–7-disc herniation, because of the difficulty to localize C6–7 vertebral structure under fluoroscopy. The study objective is to prove that the PECFD can be performed safely and successfully to C6–7-disc herniation on patients with prominent shoulders and/or short necks following our novel surgical techniques under fluoroscopic guidance. Materials and Methods: PECFD was performed on a patient who had an extruded foraminal disc herniation at C6–7 on the left with left arm pain and weakness. Due to his prominent shoulders and a short neck, the C6–7 anatomic site was not visible under traditional anterior-posterior (AP) and lateral fluoroscopic views. The authors inserted a reference needle to C4–5 facets between C4 and C5 pedicles under AP and lateral fluoroscopic views. Following the reference needle, the C6–7 facets were easily located with an oblique fluoroscopic view. A large endoscopic cannula was used initially for adequate resection of C6–7 facets, followed by a small cannula for nerve root handling with minimal pressure and discectomy. Results: The novel surgical techniques resulted in a complete resection of the C6–7-disc herniation and resolution of the patient’s radiculopathy with no postoperative complications. Conclusion: PECFD can be safely and successfully applied for C6–7-disc herniation in patients with prominent shoulders and/or short necks using our novel surgical techniques.

Hip hemiarthroplasty with modular neck: is it useful in residents' learning curve? A prospective clinical trial.

The number of femoral neck fractures (FNFs) worldwide will drastically increase in the next few decades, reaching 6.3 million by 2050. In the future, therefore, newly-qualified orthopaedic surgeons will treat this kind of injury more frequently than in past decades. This prospective observational study aims to assess whether hip hemiarthroplasty with modular neck, performed via the Hardinge approach, can be safely carried out by orthopaedic residents. Patients referred to our Level I trauma centre, between January 2016 and June 2017, with displaced intra-articular femoral fractures, were prospectively recruited. All patients underwent cemented modular bipolar hip hemiarthroplasty (Profemur Z, MicroPort Orthopedics Inc., Arlington, TN, USA) via the Hardinge approach, with the patient positioned in lateral decubitus. The surgical procedures were performed by the same surgical and anesthesiology team, under spinal anaesthesia. All patients underwent clinical and radiographic follow-up up to 24 months. Complications and re-operations were recorded. Clinical evaluation was performed using the Harris Hip Score (HHS), Osteoporosis Quality of Life Questionnaire QUALEFFO-41 and EuroQol-5D (EQ-5D) questionnaire. Anteroposterior pelvis x-rays were performed preoperatively, postoperatively and at 1, 3, 6, 12 and 24 months follow-up. 118 patients met the inclusion criteria (male: 50; female: 68; mean age: 74.3 years; range 65-88 years) and were included in the current study. 67 patients out of 118 (56.8%) were managed by senior orthopaedic surgeons (Group A), whereas the remaining 51 patients out of 118 (43.2%) were treated by orthopaedic residents (Group B). Hip hemiarthroplasties performed by senior surgeons showed the prevalent use of straight (short or long) necks, whereas, in surgical procedures performed by residents, there was a significantly higher use of varus/valgus, anteverted or retroverted necks. The overall complication rate was significantly higher in Group-B patients, compared with Group-A patients (p = 0.002). The length of hospital stay and the mean clinical scores at 24 months follow-up showed no significant differences. Hip hemiarthroplasty with modular neck can be safely employed during the learning curve of orthopaedic residents. Great efforts, however, should be made in future to improve residents' training in the management of FNFs.

Tracing the Paleobiology of Paedotherium and Tremacyllus (Pachyrukhinae, Notoungulata), the Latest Sciuromorph South American Native Ungulates – Part II: Orbital, Auditory, and Occipito-Cervical Regions

The caudal cranium and occipito-cervical region, although usually overlooked, are informative about the paleobiology of fossil mammals, allowing inquiry into vision and hearing abilities, as well as head and neck postures. Particularly for Pachyrukhinae, some related features remain unexplored. In this contribution, 22 specimens of Paedotherium and Tremacyllus were analyzed in a mainly qualitative and comparative framework. Pachyrukhines are characterized by having large orbits and hearing cavities, moderate to short necks with generalized morphologies, and S-shape postures. These features allow rejecting some types of specialized digging habits, and support the preference of open or low-humidity environments. Paedotherium typicum is distinguished by the presence of laterally oriented eyes, marked vaulted cranium and predominant short extensor and stabilizing neck muscles, and cervico-occipital-hyoid configurations suitable for ventro-flexed resting posture. These features indicate accentuated frontation and panoramic-vision, upward head postures enhancing substrate perception, and the resistance of impacts during leaping-cursorial locomotion. Conversely, P. bonaerense, and to lesser degree Tremacyllus spp., show less frontation and probably adopted more horizontal head postures. More particularly, stronger ventral and lateral neck and head flexors and extrinsic arm musculature are reconstructed for P. bonaerense, compatible with generalist or scratch-digging habits. Its smaller auditory cavities and stronger ear musculature, compared to the contemporary P. typicum and especially Tremacyllus spp., would indicate larger ears and microhabitat segregation. The integrative analysis proposed here and in the accompanying contribution aims to shed light on convergences with extant models, paleobiology, niche partitioning, and external appearance of the latest rodent-like ungulates.