Small Case Research Articles

Seagrass-Associated Biodiversity Influences Organic Carbon in a Temperate Meadow

There is increasing interest in the role that seagrasses play in storing carbon in the context of climate mitigation, but many knowledge gaps in the factors controlling this storage exist. Here, we provide a small case study that examines the role of infaunal biodiversity in influencing seagrass and the carbon stored in its sediments. A total of 25 species of invertebrate were recorded in an intertidal Zostera marina meadow, where these species were dominated by polychaete worms with no bivalves present. We find organic carbon storage (within the top 20 cm) measured by AFDW to be highly variable within a small area of seagrass meadow ranging from 2961 gC.m−2 to 11,620 gC.m−2 with an average (±sd) of 64602 ± 3274 gC.m−2. Our analysis indicates that infaunal communities are significantly and negatively correlated with this sediment organic carbon. However, this effect is not as influential as hypothesised, and the relatively small sample size of the present study limits its ability to provide strong causality. Other factors, such as algal abundance, curiously had a potentially stronger influence on the carbon in the upper sediments. The increasing richness of infauna is likely reducing the build-up of organic carbon, reducing its ecosystem service role. We believe this to likely be the result of bioturbation by specific species such as Arenicola marina and Ampharete acutifrons. A change in sediment organic carbon suggests that these species could be key drivers of bioturbator-initiated redox-driven organic matter turnovers, influencing the microbial processes and remobilizing sediment compounds. Bioturbators should be considered as a limitation to Corg storage when managing seagrass Corg stocks; however, bioturbation is a natural process that can be moderated when an ecosystem is less influenced by anthropogenic change. The present study only provides small-scale correlative evidence with a range of surprising results; confirming these results within temperate seagrasses requires examining this process at large spatial scales or with targeted experiments.

Clinical and Dermoscopic Characteristics of Cutaneous Chondroid Syringoma: A Systematic Review

Introduction: Cutaneous chondroid syringoma (CS) is a rare benign mixed skin tumor originating from sweat glands. Despite its rarity, accurate diagnosis and management are crucial due to its potential for malignant transformation. Objective: This study aims to provide comprehensive insights into the main features of cutaneous CS, encompassing its epidemiology, clinical presentation, and particularly, dermoscopic findings. Methods: A systematic review was conducted to identify relevant literature on CS up to November 2023. Data extraction included clinical and histopathological characteristics from case reports and small case series. Results: The systematic review identified 347 unique CS cases, predominantly benign. Clinical features included a predilection for the head and neck region, with variations in morphology observed. Dermoscopic patterns, although limited, revealed recurrent features aiding diagnosis. Malignant CS cases constituted a notable subset, exhibiting distinct clinical and histopathological features. Conclusion: Cutaneous chondroid syringoma presents with characteristic clinical and histopathological features, necessitating comprehensive diagnostic approaches. Dermoscopy emerges as a valuable tool, although further research is needed to establish definitive patterns. Treatment primarily involves wide local excision, with collaboration among clinicians essential for optimal management. Future studies are warranted to address existing knowledge gaps and enhance understanding of this rare skin neoplasm.

Intramyocardial fatty infiltration lesion in sporadic inclusion body myositis: a case report.

Sporadic inclusion body myositis (sIBM), the most common inflammatory muscle disorder in adults over 50 years, is often misdiagnosed due to its gradual onset and its common but unspecific muscle weakness in older adults. Diagnosis relies on clinical, radiological, and pathological features. Cardiac involvement is rare, prompting this case description and a comprehensive literature analysis. A 73-year-old woman diagnosed with sIBM in 2021 through muscle biopsy had been experiencing muscular symptoms since 2015. Her condition progressively worsened, affecting daily activities. Annual follow-ups revealed a moderate obstructive syndrome on respiratory testing, prompting a cardiac evaluation. Cardiac magnetic resonance (CMR) imaging identified intramyocardial lesions consistent with fatty infiltration, highlighting the interest of advanced imaging in sIBM management. Cardiac involvement in sIBM is presumed rare compared to other idiopathic inflammatory myopathies, though the exact frequency remains unclear. Early identification of heart alterations by CMR in sIBM can be prognostically valuable, guiding follow-up and interventions. However, literature on this subject is limited to small cohort studies and case reports describing complications. Given the slow progression of sIBM and the limited efficacy of current treatments, the discovery of myocardial lesions could warrant closer cardiological monitoring. Larger cohort studies are needed to explore potential new therapeutic approaches. Our case underscores the importance of CMR in detecting subtle cardiac manifestations in sIBM and illustrates the potential prognostic value of cardiac assessment in the management of sIBM.

Appendectomy for suspected appendicitis during pregnancy– a retrospective comparative study of 99 pregnant and 1796 non-pregnant women

IntroductionSuspected appendicitis is the most common indication for non-obstetric surgery during pregnancy. Diagnosis and management of these patients can be challenging. Atypical clinical presentation has been described before, but the current literature consists mostly of small case series. Therefore, we conducted a large retrospective study to analyze the frequency and diagnostic accuracy of clinical signs, laboratory findings and imaging modalities in pregnant woman undergoing surgery for suspected appendicitis compared to a control group of non-pregnant women of childbearing age. We further describe intra- and postoperative findings in both groups.MethodsData from consecutive patients who underwent appendectomy for suspected appendicitis during pregnancy were retrieved from the electronic patient database and analyzed. Preoperative clinical, laboratory and imaging findings as well as intra- and postoperative characteristics were compared between pregnant and non-pregnant women.ResultsBetween January 2008 and June 2023, 99 pregnant woman and 1796 non-pregnant woman between the ages of 16 and 49 underwent emergency surgery for suspected appendicitis. Pregnant women were less likely to have right lower quadrant tenderness (p = 0.002), guarding (p = 0.011) and rebound tenderness (p = 0.097). A greater percentage of pregnant women had a symptom duration of more than 24 h before presentation (p = 0.003) Abdominal ultrasound showed a reduced diagnostic accuracy in pregnant women (p = 0.004). MRI was used in eight pregnant women and showed a diagnostic accuracy of 100%. Pregnant women had a longer operating time (p = 0.006), a higher rate of open appendectomies or conversion (p < 0.001) and a longer postoperative hospital stay (3.2 days vs. 2.2 days, p < 0.001). The perforation rate was also higher in pregnant women at 16% vs. 10% (p = 0.048).ConclusionThe diagnosis of acute appendicitis during pregnancy presents a challenge for the clinician. Our data confirm the paradigm of “atypical presentation” which should lead to an extended diagnostic workup. Ultrasound showed less diagnostic accuracy in pregnant women in our study. MRI is a useful tool to reduce uncertainty and the rate of negative appendectomies.

Our Experience with the Low-Profile Braided Occluder: A Case Series of Splenic Artery Embolization in Three Trauma Patients

AbstractThe spleen is the most injured intra-abdominal organ, with splenic injuries constituting 42 to 49% of all abdominal injuries. Due to this vulnerability and the fact that splenic ruptures can potentially result in life-threatening hemorrhage, finding quick and efficient ways to control splenic bleeding in a trauma setting can improve patient outcomes. Recently, the U.S. Food and Drug Administration cleared the low-profile braided occluder (LOBO; Okami Medical, Aliso Viejo, California, United States), a vascular occlusion system designed to rapidly occlude vessels by using a high-density, uniform small pore structure. We present a small case series describing the use of the LOBO device for proximal splenic embolization in three trauma patients. Our report suggests that the LOBO device is safe and efficient for proximal splenic artery embolization as all three of our patients had a successful outcome with no complications; furthermore, we believe using the LOBO device may enhance patient and provider safety by decreasing fluoroscopic time and radiation dose, though further studies are needed to support this.

Awake Supraglottic Airway Placement in Pediatric Patients for Airway Obstruction or Difficult Intubation: Insights From an International Airway Registry (PeDI).

Small case series have described awake supraglottic airway placement in infants with significant airway obstruction and difficult intubations. We conducted this study to determine outcomes when supraglottic airways were placed in awake children enrolled in the international Pediatric Difficult Intubation Registry including success of ventilation, success of tracheal intubation, and complications. We reviewed the Pediatric Difficult Intubation Registry to identify all cases of awake supraglottic airway placement before planned tracheal intubation from August 2012 to September 2023 with subsequent review of details of awake supraglottic airway placement in the medical record. We present descriptive statistics of patient demographics, ventilation and intubation outcomes, and complications. A supraglottic airway was placed in an awake child in 95 of 8061 (1.2%) cases in the Pediatric Difficult Intubation Registry. Median age was 37 days (range 0-17.6 years) and median weight was 3.7 kg (1.6-46.7 kg). Sixteen (17%) cases were in patients older than 2 years and 7 (7%) were in adolescents. Adequate ventilation via a supraglottic airway was achieved in 81/95 (85%, 95% confidence interval [CI], 77%-93%) encounters. Inadequate (n = 13) or impossible (n = 1) ventilation occurred in 14/95 (15%). No complications were reported with supraglottic airway placement. For subsequent intubation, there was a 35% (33/95) first-attempt success rate and 99% (94/95) eventual success, with 1 patient awakened after failed attempts at tracheal intubation. Hypoxia occurred during the first intubation attempt in 9/95 (9%) encounters. The incidence of hypoxia was lower in encounters in which ventilation via the supraglottic airway was adequate (4/81, 5%) than in encounters in which ventilation via the supraglottic airway was inadequate or impossible (5/14, 36%). Although infrequently attempted, awake placement of a supraglottic airway in children with difficult airways achieved adequate ventilation and provided a conduit for oxygenation and ventilation after induction of anesthesia across a spectrum of ages.

Safety of Kidney Transplantation from Donors with HIV

BackgroundKidney transplantation from donors with human immunodeficiency virus (HIV) to recipients with HIV is an emerging practice. It has been performed since 2016 under the U.S. congressional HIV Organ Policy Equity Act and is currently approved for research only. The Department of Health and Human Services is considering expanding the procedure to clinical practice, but data are limited to small case series that did not include donors without HIV as controls.MethodsIn an observational study conducted at 26 U.S. centers, we compared transplantation of kidneys from deceased donors with HIV and donors without HIV to recipients with HIV. The primary outcome was a safety event (a composite of death from any cause, graft loss, serious adverse event, HIV breakthrough infection, persistent failure of HIV treatment, or opportunistic infection), assessed for noninferiority (margin for the upper bound of the 95% confidence interval, 3.00). Secondary outcomes included overall survival, survival without graft loss, rejection, infection, cancer, and HIV superinfection.ResultsWe enrolled 408 transplantation candidates, of whom 198 received a kidney from a deceased donor; 99 received a kidney from a donor with HIV and 99 from a donor without HIV. The adjusted hazard ratio for the composite primary outcome was 1.00 (95% confidence interval [CI], 0.73 to 1.38), which showed noninferiority. The following secondary outcomes were similar whether the donor had HIV or not: overall survival at 1 year (94% vs. 95%) and 3 years (85% vs. 87%), survival without graft loss at 1 year (93% vs. 90%) and 3 years (84% vs. 81%), and rejection at 1 year (13% vs. 21%) and 3 years (21% vs. 24%). The incidence of serious adverse events, infections, surgical or vascular complications, and cancer was similar in the groups. The incidence of HIV breakthrough infection was higher among recipients of kidneys from donors with HIV (incidence rate ratio, 3.14; 95%, CI, 1.02 to 9.63), with one potential HIV superinfection among the 58 recipients in this group with sequence data and no persistent failures of HIV treatment.ConclusionsIn this observational study of kidney transplantation in persons with HIV, transplantation from donors with HIV appeared to be noninferior to that from donors without HIV. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT03500315.)

Impact of autologous mitochondrial transfer on obstetric and neonatal health of offspring: A small single-center case series

IntroductionA pilot study was carried out to test the efficacy of the autologous mitochondrial transfer therapy (AUGMENT) technique. No improvements in pregnancy rate, development, or embryo quality were observed in the AUGMENT-treated group versus the Control group in this study. The main objective of this research is to analyze whether AUGMENT technology did have any impact on the obstetric and perinatal outcomes of pregnancies and children resulting from treated oocytes. MethodsFollow up study of women with a livebirth who participated in a pilot randomized controlled trial in which sibling MII oocytes were randomly allocated to AUGMENT + intracytoplasmic sperm injection (ICSI) (AUGMENT group) or ICSI alone (control group). Preimplantation genetic testing for aneuploidy was performed in both groups. Pregnancy and neonatal outcomes of 14 women (15 pregnancies) and their 18 children were analyzed. The information was retrieved by reviewing the medical records or through questionnaires sent to the patients. ResultsNo differences were found in this small case series between the AUGMENT and control groups regarding the rate of gestational complications, birth defects, gestational age at delivery (271.4 ± 12.56 vs 278 ± 10.4 days), birthweight (3.1 ± 0.6 kg vs. 3.1 ± 0.4 kg) and neonatal outcome. DiscussionThe few pregnancies achieved using AUGMENT oocyte therapy had similar outcomes than controls in this very small series. Our very preliminary data need to be confirmed in larger samples. The long term follow up of these children also needs to be analyzed.

Behçet's syndrome: one year in review 2024.

The aim of this review is to provide a critical summary of studies published during 2023 that contribute to our understanding of Behçet's syndrome. An increase in the incidence of BS was reported in Northern Spain after 2014.Studies on patient perspectives showed the impact of Behçet's syndrome on quality of life, daily activities, education, work, and relationships. Differences in genetics among Behçet's syndrome patients with different types of organ involvement were reported and an association between HLA-B/MICA and SLCO4A1 polymorphisms and eye involvement and between DDX60L polymorphisms and nervous system involvement were observed. It was suggested that Integrin α9β1 plays a crucial role in the neutrophil-mediated inflammatory pathways underlying this syndrome and the dysfunction of the PDL1/PD-1 pathway may be associated with the hyperactivity of the Th-1/Th-17 axis. Vein wall thickness seems to be increased in patients with Behçet's syndrome, but its pathogenetic and clinical implications are not clear. There is growing evidence regarding the efficacy of TNF inhibitors in different types of organ involvement. A number of small case series point out to the potential role of TCZ and JAK inhibitors.

Hand Surgical Operating Room Size Allocation: A Comparative Space Utilisation Study.

Background: This study evaluated operating room (OR) space required for various hand surgical procedures. We analysed the size requirements for hand surgical cases divided into four settings: (1) large OR setting requiring fluoroscopy and microsurgical equipment, (2) medium-sized OR setting for cases requiring fluoroscopy, (3) smaller OR setting and (4) minor procedural room without anaesthesia with the aim to describe room size requirements for hand surgery practices. Methods: A variety of hand surgical cases were selected: large cases (microvascular digit replantation), medium-sized cases (closed reduction percutaneous pinning [CRPP] of phalangeal fractures) and smaller cases (carpal tunnel release [CTR]) with and without anaesthesia. Space requirements were compared to general surgery cases (laparoscopic appendectomy) and general orthopaedic surgery cases (cephalomedullary nail [CMN]). Necessary operative equipment was measured (ft2) to calculate requirements for each procedure. Results: Large hand cases such as digit replantation necessitated the most OR space (125 ft2), followed by general orthopaedic cases (CMN; 118 ft2), medium-sized hand cases (CRPP phalanx; 107 ft2), general surgery laparoscopic appendectomy (68 ft2), small hand cases (CTR; 85 ft2) and minor procedures (49 ft2). Conclusions: Hand procedures can be divided into major procedures requiring significant OR space (125 ft2), medium procedures in standard OR suites (107 ft2), procedures in small ORs with anaesthesia (81 ft2) or office-based setting without anaesthesia (49 ft2). These findings help define space utilisation for hand procedures and may have practical implications related to efficiency, cost and patient safety in the hospital and outpatient setting. Level of Evidence: Level IV (Economic and Decision Analyses).

The novel balloon-expandable Myval transcatheter heart valve: systematic review of aortic, mitral, tricuspid and pulmonary indications

Introduction and objectivesMyval technology represents the first balloon-expandable alternative since the Edwards system became commercially available. Despite certain controversies, its use has rapidly expanded. We aimed to gather all the available literature regarding its indications and outcomes. MethodsA comprehensive search of articles published between December 2016 and May 2024 was conducted using BioMedCentral, Google Scholar, and PubMed to evaluate the main outcomes of Myval for native aortic stenosis (AS) (meta-analysis) and off-label uses (systematic review). ResultsA total of 151 studies were identified, and 74 were included in the analysis, covering aortic (n=51), mitral (n=9), tricuspid (n=6), and pulmonary (n=8) valve positions. A meta-analysis of studies on native AS demonstrated that Myval is safe and effective, with a 30-day mortality rate of 1.3%, good hemodynamic performance, low rates of pacemaker implantation (8.8%), and ≥ moderate paravalvular regurgitation (1.3%). Compared with other contemporary devices, Myval was competitive and associated with lower rates of pacemaker implantation. In a systematic review of off-label indications, Myval was also found to be safe and effective. In bicuspid AS, pure regurgitation, and aortic valve-in-valve procedures, success rates were 100%, 92%, and 100%, respectively, with pacemaker rates of 9.9%, 22.2%, and 3%, respectively. For mitral valve-in-valve/in-ring procedures, the success rate was 96.9%, while in tricuspid and pulmonary positions, small case series reported 100% success rates for both, with minimal procedural complications. ConclusionsMyval technology is safe and effective for the treatment of native valvular disease and dysfunctional prostheses or rings in all heart valve positions, although larger scale studies are warranted.

Discrete Logarithm Factory

The Number Field Sieve and its variants are the best algorithms to solve the discrete logarithm problem in finite fields (except for the weak small characteristic case). The Factory variant accelerates the computation when several prime fields are targeted. This article adapts the Factory variant to non-prime finite fields of medium and large characteristic. A precomputation, solely dependent on an approximate finite field size and an extension degree, allows to efficiently compute discrete logarithms in a constant proportion of the finite fields of the given approximate size and extension degree. We combine this idea with two other variants of NFS, namely the tower and special variant. This combination improves the asymptotic complexity. We also notice that combining our approach with the MNFS variant would be an unnecessary complication as all the potential gain of MNFS is subsumed by our Factory variant anyway. Furthermore, we demonstrate how Chebotarev's density theorem allows to compute the density of finite fields that can be solved with a given precomputation. Finally, we provide experimental data in order to assess the practical reach of our approach.

Beyond the Digital: Analogue Games´ Creative Potential in Deepening Data Literacy

: In an era where digital technology often dominates the educational landscape, the enduring appeal and educational potential of analogue learning games remain significant. These traditional, non-digital games, offer a tactile and interactive approach to learning that is both unique and impactful. Unlike their digital counterparts, analogue games require physical presence and direct interaction, which bring benefits to the educational process (Ribeiro, 2019; Medeisiene et al., 2021). This small case study explores, through a sociocultural lens, how analogue learning games influence creative learning processes in Continuing Education students. The results of a questionnaire to 43 participants enrolled in a course on Data Literacy in Norway, show that analogue learning games promote active engagement, foster social interaction, and stimulate innovative thinking connected to the course content when the setting around the activity feels safe for the participants. Participants also expressed that the tactile and social nature of analogue games encouraged more profound group discussions, leading to diverse perspectives and novel ideas. This resonates with findings from Medeisiene et al. (2021) who highlight the pedagogical value of game-based learning in enhancing engagement. These interactions not only bolstered creativity but also enhanced and deepened understanding and retention of knowledge from the Data Literacy course content. Moreover, the study highlights the importance of context and facilitation in maximising the benefits of analogue games for Continuing Education students. The findings suggest a promising avenue for further exploration into using analogue games in educational contexts. The study concludes with advocating conducting more research on the integration of learning games into continuing education curricula as a strategy to leverage the benefits of social interaction and active engagement, and to enhance creative learning that can deepen learning of course content.

7958 Organ Of Zuckerkandl Paragangliomas

Abstract Disclosure: L. McVicker: None. S. Egan: None. K.C. Conlon: None. J. Gibney: None. J. Feeney: None. M. Whelan: None. A. Garrahy: None. Background: The Organ of Zuckerkandl (OoZ) was first described in 1901 by an Austrian anatomist Emile Zuckerkandl as a para-aortic paraganglia located laterally to the abdominal aorta at the level of the inferior mesenteric artery. It represents the largest accumulation of extra-adrenal chromaffin cells in mammals. Paragangliomas (PGL) of the OoZ are rare entities with prior retrospective study of 371 patients with phaeochromocytoma or sympathetic PGL revealing only 21 cases of OoZ PGLs of which 14 of which (66%) had metastases at diagnosis (1). 70% of cases are in association with SDHB or less commonly, SDHD mutations (2). Clinical Case: A 48-year-old female presented with a year long history of palpitations and headache. Plasma normetanephrine level was 6340 pmol/L (lab reference 0-1180), plasma metanephrine 412 pmol/L (lab reference 0-510) and plasma 3-methoxytyramine &amp;lt;100 pmol/L (lab reference 0-180). CT adrenals showed normal adrenal glands. A 4.5 cm x 2.1 cm hyper-vascular retroperitoneal mass was visualised. A 68Ga-DOTATOC PET/CT showed no abnormal uptake in the area of the mass. [1]23I-MIBG scan showed increased uptake within the mass compatible with a PGL of the OoZ. Following surgery, histology confirmed PGL of the OoZ and plasma metanephrines normalised following. Genetic testing for predisposing mutation was negative. A 38-year-old male presented with sweating episodes, palpitations, and hypertension. Plasma normetanephrine level was 2,230 pmol/L (lab reference 0-1180) and plasma metanephrines 223 pmol/L (lab reference 0-520). CT adrenals showed normal adrenal glands with no other abnormalities noted. [1]23I-MIBG showed increased uptake in the region of the origin of the inferior mesenteric artery from the aorta consistent with PGL of the OoZ. The patient underwent laparoscopic resection with resultant normalisation of metanephrine levels. Histology showed a 21 mm encapsulated tumour in keeping with PGL with a PASS Score of 7. As with the first case, genetic testing for predisposing mutations returned negative. Conclusion: OoZ PGLs represent rare presentations of phaeochromocytoma-paraganglioma disease. This small case series is notable as neither case was associated with a predisposing genetic mutation, which has previously been shown to be more common in OoZ PGLs. There was also no evidence of metastasis in either case which is more commonly associated with this OoZ disease. The first case is also remarkable in terms of the tumour’s imaging characteristics. Previous studies have shown greater sensitivity using 68Ga-DOTA-Somatostatin Analogue PET/CT in comparison to [1]23I-MIBG in the detection of PGLs (3). In the first case, the tumour did not show any significant avidity on 68Ga-DOTATOC PET/CT but was avid on [1]23I-MIBG. Reference: 1. Ayala-Ramirez et al. J Clin Endocrinol Metab. 2011 2. Lodish et al. Endocr Relat Cancer. 2010 3. Carrasquillo et al. J Nuclear Medicine. 2021 Presentation: 6/2/2024

Fatal road traffic accidents and injuries: a preliminary study.

Road traffic accidents (RTAs) are a major public health problem globally and cause deaths, disability, and significant economic costs. In Italy, there was an increased number of road accidents, deaths, and injuries in 2022 compared to 2021, although still below pre-pandemic levels. A retrospective observational study was performed on a case series of 53 consecutive fatal RTAs examined by the Section of Forensic Medicine of Verona. The case series was divided, according to the type of victims involved, into pedestrians, car drivers, car passengers, and motorcyclists. For each, the times and causes of death, the distribution of external and internal injuries, and toxicological data were analysed, and the results were compared with those in the literature. Although this is a preliminary study on a small case series and lacks statistical validation, so more cases are needed, the preliminary results seem to provide a useful tool for assessing injuries in complex fatal road accidents.

Steroid-Responsive Meningitis-Arteritis in a Small Breed Dog Case Report and Literature Review

Steroid-Responsive Meningitis-Arteritis in a Small Breed Dog Case Report and Literature Review

Complications in Minimally Invasive Spine Surgery in the Last 10 Years: A Narrative Review.

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

Posterior Cranial Vault Distractor Osteogenesis for the Treatment of Chiari Malformation Type 1: A Systematic Review of the Literature.

Although posterior cranial vault distraction osteogenesis (PVDO) is utilized routinely now for the treatment of craniosynostosis, its use as a treatment option for Chiari type 1 malformation (CM1) is limited to case reports and small retrospective case series. The authors conducted a systematic review of the published literature for PVDO as a treatment for CM1. The primary outcomes were reported complications, symptom improvement, and reoperation rates in patients that had PVDO surgery for CM1. The authors further investigated differences between patients with CM1 with an associated genetic syndrome and craniosynostosis. In total, 42 patients with an average age of 41.1 months were used in our analysis. A total of 38.1% of the patients had a diagnosed syndrome, 78.6% of patients had associated craniosynostosis, and 26/42 (61.9%) total patients-reported symptom improvement. Of 26 patients that reported symptom improvement, 20 (76.9%) had associated syndromes and 6 (23.1%) did not (P=0.011). In addition, of these 26 symptom improved patients, 17 (65.4%) were associated with craniosynostosis while 9 (36.4%) did not have craniosynostosis (P=0.008). Posterior cranial vault distraction osteogenesis seems to be a promising new surgical intervention for treatment of CM1. Most patients saw symptom improvement after treatment (61.9%). There was a clinically and statistically significant difference in symptom improvement for patients with syndromic CM1 when compared with nonsyndromic CM1 patients.

Beyond the WHO 2020 Classification of Female Genital Tumors: Types of Endometrial Cancer: A Pathological and Molecular Focus on Challenging Rare Variants.

Endometrial carcinoma is a heterogeneous group of malignancies characterized by distinct histopathological features and genetic underpinnings. The 2020 WHO classification has provided a comprehensive framework for the categorization of endometrial carcinoma. However, it has not fully addressed the spectrum of uncommon entities that are currently not recognized by the 2020 WHO and have only been described in the form of small case series and case reports. These neoplasms represent a real diagnostic challenge for pathologists; furthermore, their therapeutic management still remains controversial and information regarding tumor prognosis is very limited. This review aims to elucidate these lesser-known variants of endometrial carcinoma. We discuss the challenges of identifying these rare subtypes and the molecular alterations associated with them. Furthermore, we propose the need for expanded classification systems that include these variants to enhance clinical outcomes and research efforts. We believe that a better histological typing characterization of these entities may lead to more reproducible and accurate diagnoses and more personalized treatments. By raising awareness of these rare entities, we also hope to encourage further investigation and integration into clinical practice to improve patient care in endometrial carcinoma.

Procedural interventions for erythromelalgia: A narrative review.

Erythromelalgia is a rare disorder characterized by episodic burning pain with redness and warmth of the extremities. Topical and systemic medications are the mainstay of management. We reviewed the published evidence for using procedural interventions to manage erythromelalgia, including their proposed mechanism of action and possible adverse effects, and included information in this review on epidural infusion, sympathetic ganglion block, sympathectomy, pulsed radiofrequency, spinal cord stimulation, dorsal root ganglion stimulation, brain stimulation, transcranial magnetic stimulation, and botulinum toxin injections. Both successful and unsuccessful outcomes have been reported. Although these procedural interventions extend the therapeutic options for erythromelalgia, the evidence for their use is limited. Case reports and small case series comprise most of the evidence. Based on our review, a multidisciplinary approach to management may be needed for patients with erythromelalgia.