Epidemiology, clinical presentation, diagnostic evaluation, and prognosis of spinal arteriovenous malformations

Spinal arteriovenous malformations (sAVM) are rare vascular pathologies whose natural history remains incompletely understood. Advances in diagnostic imaging, coupled with the evolution of endovascular and microsurgical techniques have led to the description of a number of classification schemes for these lesions. An updated method has changed AVM classification from five categories of lesion based on source and location of feeder vessels to three categories based on pathophysiology. These categories include extradural arteriovenous fistulae (AVFs), intradural AVFs, extradural-intradural AVFs, intramedullary AVMs, and conus medullaris AVM each with individual subclassifications. Treatment outcomes have been shown to differ based on classification criteria. The increased use of advanced imaging prior to surgical intervention has facilitated the treatment of AVFs. Definitive diagnosis and characterization have traditionally required digital subtraction angiography, which is now being supplemented with other forms of noninvasive imaging such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA). Epidemiologically, intradural dorsal AVFs account for 80% of all sAVMs, and are characterized by low-pressure shunts located in the sleeve of the dorsal nerve root. Microsurgical treatment has been shown to be highly effective in cases of intradural dorsal AVFs, although many cases are also amenable to durable occlusion using liquid embolics. Conus medullaris AVMs, which has only been recently characterized as a separate category of sAVM, is best treated using a combination of embolization and microsurgery. Successful treatment of sAVM mandates a thorough understanding of the anatomy and classification of these lesions. The purpose of this chapter is to review and summarize the classification, natural history, and prognosis of sAVMs

Effects of Vitamin E, Vitamin C and Mannanoligosaccharide (Bio-Mos (R)) Supplements on Performance and Immune System in Broiler Chicks

Maintaining gut health is important for the production of high quality and profitable poultry. The goal of this study was to examine the effects of supplemental mannan oligosaccharide (Bio-MOS (R)), Vitamin E (VE) and C (VC) on the growth performance and immune response of broilers given a corn based diet over a 6 weeks experimental period. About 1 day old male broilers (n=300) were randomly distributed to 4 groups (75 birds in each group and 15 birds in each subgroup for repetation 5 times) and reared under similar conditions. Standard husbandry and good management practices were followed that met or exceeded industry guideline. At each feeding, the following treatments were administered: control (no Bio-MOS (R), VE and VC), 1.5 g kg(-1) Bio-MOS (R), 500 mu g kg(-1) VE and 500 mu g kg(-1) VC. Body Weights (BW), Feed Intake (FI) and Feed Conversion Ratio (FCR) were measured on day 1, 21 and 42. Blood samples were taken from vena ulnaris every 7 days and were analyzed on IgG concentration. The results showed that there was no significant difference in BW, FI and FCR among the treatment groups. During the 6 weeks of trial period considering plasma IgG levels significant differences were only found as following: compared to control group it was significantly lower in VE group at week 1 and 2, higher in VC and Bip-MOS (R) groups at week 2 and lower in Bio-MOS (R) group at week 6. Additionally, at 4 week lowest (0.90+/-0.06 mg, n=15) and at 5 week highest (2.85+/-0.18 mg, n=15) plasma IgG levels was found after applying the dietary treatment in Bio-Mos (R) group. Consequently, this data suggest that supplementation of Bio-MOS (R), VE or VC may not improve either broiler performance or immune response in healthy broilers

Perioperative Complications and Long-Term Outcomes After Bypasses in Adults With Moyamoya Disease: A Systematic Review and Meta-Analysis

Background Surgical revascularization for adults with moyamoya disease (MD) includes direct, indirect, or combination bypasses. It is unclear which provides the best outcomes. We sought to determine the best surgical management for adults with MD by comparing perioperative complications and long-term outcomes among 3 bypass types. Methods Literature databases were searched for articles reporting revascularization bypass outcomes for adults with MD. A pooled analysis of all qualified studies and meta-analysis using only studies reporting direct comparisons of 2 bypass types were performed. Overall odds ratios (ORs) comparing 2 bypass types were computed and publication bias was assessed. Rates of perioperative and long-term hemorrhage and ischemia and favorable outcomes were compared. Results Forty-seven studies were analyzed; 8 had level 1 or 2 evidence. Pooled analyses showed that perioperative hemorrhage rates were significantly (P = 0.02) lower with indirect compared with direct (OR, 0.03; 95% confidence interval [CI], 0.002-0.55) or combined (OR, 0.03; 95% CI, 0.002-0.53) bypasses. Meta-analysis showed that direct bypass was better at preventing long-term hemorrhage than was indirect bypass (OR, 0.26; 95% CI, 0.09-0.79; P = 0.02). Pooled analyses showed that direct is significantly better (P \u3c 0.01) than indirect (OR, 0.51; 95% CI, 0.33-0.77) and combined (OR, 0.47; 95% CI, 0.31-0.72) bypasses in preventing long-term ischemia. Meta-analysis showed that direct was better than indirect bypass in producing long-term favorable outcomes (OR, 2.62; 95% CI, 1.19-5.79; P = 0.02), and the pooled analysis showed that combined bypass was better than indirect bypass in producing long-term favorable outcomes (OR, 1.26; 95% CI, 1.03-1.54; P = 0.02). Conclusions Overall, our analyses suggest that direct bypass with or without indirect augmentation provides the best outcomes for adults with MD