Surgical Strategies and Perioperative Considerations for Cervical Deformity With Cerebral Palsy: A Comprehensive Review of the Literature

The complex nature of the cervical spine makes surgical intervention challenging when treating cervical deformity in patients with cerebral palsy (CDCP). However, few studies have investigated the unique characteristics of cerebral palsy that create the need for surgery, the most effective surgical strategies, and the possible perioperative complications. The intended benefit and the potential risk of postoperative complications must be considered when deciding to operate for CDCP. Because the approach and correction strategy depend on the type of cervical deformity, as well as the patient’s comorbidities and functional status, a customized strategy is needed. Perioperatively, botulinum toxin injections and muscle division techniques can help control excessive involuntary movements and improve the spinal fusion success rate. Surgical intervention for CDCP requires a multidisciplinary approach, and the information presented in this article is intended to help in the perioperative management and surgical treatment of CDCP

Light-Responsive Polymeric Micellar Nanoparticles with Enhanced Formulation Stability.

Light-sensitive polymeric micelles have recently emerged as promising drug delivery systems for spatiotemporally controlled release of payload at target sites. Here, we developed diazonaphthoquinone (DNQ)-conjugated micellar nanoparticles that showed a change in polarity of the micellar core from hydrophobic to hydrophilic under UV light, releasing the encapsulated anti-cancer drug, doxetaxel (DTX). The micelles exhibited a low critical micelle concentration and high stability in the presence of bovine serum albumin (BSA) solution due to the hydrophobic and π-π stacking interactions in the micellar core. Cell studies showed enhanced cytotoxicity of DTX-loaded micellar nanoparticles upon irradiation. The enhanced stability would increase the circulation time of the micellar nanoparticles in blood, and enhance the therapeutic effectiveness for cancer therapy

A High-Yield Fabrication Process for Silicon Neural Probes

There is a great need for silicon microelectrodes that can simultaneously monitor the activity of many neurons in the brain. However, one of the existing processes for fabricating silicon microelectrodes—reactive- ion etching in combination with anisotropic KOH etching—breaks down at the wet-etching step for device release. Here we describe amodified wet-etching sidewall-protection technique for the high-yield fabrication of well-defined silicon probe structures, using a Teflon® shield and low-pressure chemical vapor deposition (LPCVD) silicon nitride. In the proposed method, a micro-tab holds each individual probe to the central scaffold, allowing uniform anisotropicKOHetching. Using this approach, we obtained a well-defined probe structure without device loss during the wet-etching process. This simple method yielded more accurate fabrication and an improved mechanical profile.This work was supported in part by the Korean Science and Foundation (KOSEF) through the Nano-Bioelectronics and Systems Research Center, Seoul National Universit

Radiographic comparison between cervical spine lateral and whole-spine lateral standing radiographs

Study Design Retrospective radiologic study. Objective The sagittal alignment of the cervical spine can be evaluated using either a lateral cervical radiograph or a whole-spine lateral view on which the cervical spine is included. To our knowledge, however, no report has compared the two. The purpose of this work is to identify the difference in radiographic parameters between the cervical spine lateral view and the whole-spine lateral view. Methods We retrospectively analyzed 59 adult patients suffering from neck pain with cervical spine lateral radiographs and whole-spine lateral radiographs from November 2007 to December 2011. The radiographs were measured using standard techniques to obtain the following parameters from the two different radiographs: occipital–C2 angle, C2–C7 angle, C7–sternal angle, sternal slope, T1 slope, C2 central offset distance, the distance between C2 and C7 plumb lines, C4 anteroposterior (AP) diameter, the ratio of C2 central off distance to C4 AP diameter, the ratio of plumb lines' distance to C4 AP diameter. Results We found that the occipital–C2 angle, sternal slope, and C4 AP diameter were similar, but the C2–C7 angle, C7–sternal angle, T1 slope, C2 central offset distance, distance between C2 and C7 plumb lines, ratio of C2 central off distance to C4 AP diameter, and ratio of plumb lines' distance to C4 AP diameter were different. However, the error of measurement was greater than the small angular and linear differences between the two views. Conclusions Most numerical values of the measured radiographic parameters appear to be different between the two views. However, the two views are comparable because the numerical differences were smaller than the errors of measurement

Airborne Measurements of High Pollutant Concentration Events in the Free Troposphere over the West Coast of South Korea between 1997 and 2011

Aircrafts enable the direct measurement of chemical components in the free troposphere (FT). This study employed airborne measurements to examine the occurrences of high concentrations of SO2 and NOx in the FT over the coastal region west of the Seoul metropolitan area, South Korea. The data from a long-term (1997-2011) airborne measurement campaign were used to determine the meteorological conditions favorable for carrying these pollutants into the Seoul area. The back trajectory analyses of 21 instances of high FT pollutant concentration events showed ascending patterns from the major pollutant sources, mainly the industrial complexes in eastern China, in 9 instances and passing patterns in 12 instances. In the ascending instances, developing low-pressure systems over the source regions provide favorable conditions to uplift air pollutants from the surface into the FT. In the passing instances, an anomalous low-pressure system near the surface prevented airflows from descending into the boundary layer and upper-level anticyclonic systems helped to keep the ascending airflows in the FT. This study proposes the basic mechanisms for predicting air quality in the Seoul area, considering that air pollutants in the FT often entrain into the boundary layer to increase local concentrationsopen0

Cyclooxygenase-2 and p53 Expression as Prognostic Indicators in Conventional Renal Cell Carcinoma

The aim of this study was to investigate the relationship of cyclooxygenase (COX)-2 and p53 expression with prognosis in patients with conventional renal cell carcinoma (RCC). Formalin-fixed, paraffin-embedded tissue sections of conventional RCC from 92 patients, who had undergone radical nephrectomy, were examined for COX-2 and p53 expression by immunohistochemistry and compared with clinicopathological variables. The COX-2 expression significantly correlated only with tumor size (p=0.049), whereas the p53 expression profoundly correlated with the TNM stage (p=0.024), M stage (p=0.001), and metastasis (synchronous or metachronous; p=0.004). The COX-2 overexpression did not significantly associate with p53 positivity (p=0.821). The survival rate of patients correlated with the p53 expression (p<0.0001) but not with the COX-2 expression (p=0.7506). Multivariate analyses indicated that tumor size, M stage, and p53 expression were independent prognostic factors for cancer-specific survival. The COX-2 expression was not an independent factor. These results show that the increased expression of p53 was associated with metastasis and a worse prognosis in conventional RCC, which suggests that p53 might have played an important role in the progression of conventional RCC. The increased expression of COX-2 was associated only with tumor size, but may not be an important prognostic factor in conventional RCC. No association was observed between COX-2 overexpression and p53 positivity in conventional RCC

Lumbar Stenosis: A Recent Update by Review of Literature

Degeneration of the intervertebral disc results in initial relative instability, hypermobility, and hypertrophy of the facet joints, particularly at the superior articular process. This finally leads to a reduction of the spinal canal dimensions and compression of the neural elements, which can result in neurogenic intermittent claudication caused by venous congestion and arterial hypertension around nerve roots. Most patients with symptomatic lumbar stenosis had neurogenic intermittent claudication with the risk of a fall. However, although the physical findings and clinical symptoms in lumbar stenosis are not acute, the radiographic findings are comparatively severe. Magnetic resonance imaging is a noninvasive and good method for evaluation of lumbar stenosis. Though there are very few studies pertaining to the natural progression of lumbar spinal stenosis, symptoms of spinal stenosis usually respond favorably to non-operative management. In patients who fail to respond to non-operative management, surgical treatments such as decompression or decompression with spinal fusion are required. Restoration of a normal pelvic tilt after lumbar fusion correlates to a good clinical outcome

New Radiographic Index for Occipito-Cervical Instability

Study DesignRetrospective study.PurposeTo propose a new radiographic index for occipito-cervical instability.Overview of LiteratureSymptomatic atlanto-occipital instability requires the fusion of the atlanto-occipital joint. However, measurements of occipito-cervical translation using the Wiesel-Rothman technique, Power's ratio, and basion-axial interval are unreliable because the radiologic landmarks in the occipito-cervical junction lack clarity in radiography.MethodsOne hundred four asymptomatic subjects were evaluated with lateral cervical radiographs in neutral, flexion and extension. They were stratified by age and included 52 young (20–29 years) and 52 middle-aged adults (50–59 years). The four radiographic reference points were posterior edge of hard palate (hard palate), posteroinferior corner of the most posterior upper molar tooth (molar), posteroinferior corner of the C1 anterior ring (posterior C1), and posteroinferior corner of the C2 vertebral body (posterior C2). The distance from posterior C1 and posterior C2 to the above anatomical landmarks was measured to calculate the range of motion (ROM) on dynamic radiographs. To determine the difference between the two age groups, unpaired t-tests were used. The statistical significance level was set at p<0.05.ResultsThe ROM was 4.8±7.3 mm between the hard palate and the posterior C1, 9.9±10.2 mm between the hard palate and the posterior C2, 1.7±7.2 mm between the molar to the posterior C1, and 10.4±12.1 mm between the molar to the posterior C2. There was no statistically significant difference for the ROM between the young- and the middle-aged groups. The intra-observer reliability for new radiographic index was good. The inter-observer reliability for the ROM measured by the hard palate was low, but was better than that by the molar.ConclusionsROM measured by the hard palate might be a useful new radiographic index in cases of occipito-cervical instability

Enhancing deep learning classification performance of tongue lesions in imbalanced data: mosaic-based soft labeling with curriculum learning

Background Oral potentially malignant disorders (OPMDs) are associated with an increased risk of cancer of the oral cavity including the tongue. The early detection of oral cavity cancers and OPMDs is critical for reducing cancer-specific morbidity and mortality. Recently, there have been studies to apply the rapidly advancing technology of deep learning for diagnosing oral cavity cancer and OPMDs. However, several challenging issues such as class imbalance must be resolved to effectively train a deep learning model for medical imaging classification tasks. The aim of this study is to evaluate a new technique of artificial intelligence to improve the classification performance in an imbalanced tongue lesion dataset. Methods A total of 1,810 tongue images were used for the classification. The class-imbalanced dataset consisted of 372 instances of cancer, 141 instances of OPMDs, and 1,297 instances of noncancerous lesions. The EfficientNet model was used as the feature extraction model for classification. Mosaic data augmentation, soft labeling, and curriculum learning (CL) were employed to improve the classification performance of the convolutional neural network. Results Utilizing a mosaic-augmented dataset in conjunction with CL, the final model achieved an accuracy rate of 0.9444, surpassing conventional oversampling and weight balancing methods. The relative precision improvement rate for the minority class OPMD was 21.2%, while the relative score improvement rate of OPMD was 4.9%. Conclusions The present study demonstrates that the integration of mosaic-based soft labeling and curriculum learning improves the classification performance of tongue lesions compared to previous methods, establishing a foundation for future research on effectively learning from imbalanced data.This research was supported by grants from the Technology Innovation Program (20006105), funded by the Ministry of Trade, Industry & Energy, Republic of Korea, and the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (Grant number: HI20C2114)