Diagnosis and management of sacral Tarlov cysts

Journal ArticlePerineurial (Tarlov) cysts are meningeal dilations of the posterior spinal nerve root sheath that most often affect sacral roots and can cause a progressive painful radiculopathy. Tarlov cysts are most commonly diagnosed by lumbosacral magnetic resonance imaging and can often be demonstrated by computerized tomography myelography to communicate with the spinal subarachnoid space. The cyst can enlarge via a net inflow of cerebrospinal fluid, eventually causing symptoms by distorting, compressing, or stretching adjacent nerve roots. It is generally agreed that asymptomatic Tarlov cysts do not require treatment. When symptomatic, the potential surgery-related benefit and the specific surgical intervention remain controversial. The authors describe the clinical presentation, treatment, and results of surgical cyst fenestration, partial cyst wall resection, and myofascial flap repair and closure in a case of a symptomatic sacral Tarlov cyst. They review the medical literature, describe various theories on the origin and pathogenesis of Tarlov cysts, and assess alternative treatment strategies

Frameless stereotactic image-guided C1-C2 transarticular screw fixation for atlantoaxial instability: review of 20 patients

Journal ArticleAtlantoaxial instability can result from trauma, rheumatoid arthritis, congenital malformation, or tumor invasion. The goal of treatment is stabilization of the C1-C2 complex to prevent neurologic and neurovascular compromise. First described in 1987 by Magerl and Seemann, C1-C2 transarticular screw fixation has been shown to yield excellent fusion rates.1-4 Several authors have reported that this technique offers the best biomechanical stability and allows the least amount of rotation.5-8 However, placement of transarticular screws (TASs) is technically challenging and incurs significant risk of neural and vascular injury. Previous clinical studies of C1-C2 TAS fixation have reported screw misplacement in up to 15% of patients, with an 8% rate of vertebral artery (VA) injury.9,10 Safe and accurate screw placement requires thorough radiologic assessment of the cervical spine with careful preoperative planning of screw trajectory

Dorsal root ganglion axon bifurcation tolerates increased cyclic GMP levels: the role of phosphodiesterase 2A and scavenger receptor Npr3

A cyclic GMP (cGMP) signaling pathway, comprising C-type natriuretic peptide (CNP), its guanylate cyclase receptor Npr2, and cGMP-dependent protein kinase I, is critical for the bifurcation of dorsal root ganglion (DRG) and cranial sensory ganglion axons when entering the mouse spinal cord and the hindbrain respectively. However, the identity and functional relevance of phosphodiesterases (PDEs) that degrade cGMP in DRG neurons are not completely understood. Here, we asked whether regulation of the intracellular cGMP concentration by PDEs modulates the branching of sensory axons. Real-time imaging of cGMP with a genetically encoded fluorescent cGMP sensor, RT-PCR screens, in situ hybridization, and immunohistology combined with the analysis of mutant mice identified PDE2A as the major enzyme for the degradation of CNP-induced cGMP in embryonic DRG neurons. Tracking of PDE2A-deficient DRG sensory axons in conjunction with cGMP measurements indicated that axon bifurcation tolerates increased cGMP concentrations. As we found that the natriuretic peptide scavenger receptor Npr3 is expressed by cells associated with dorsal roots but not in DRG neurons itself at early developmental stages, we analyzed axonal branching in the absence of Npr3. In Npr3-deficient mice, the majority of sensory axons showed normal bifurcation, but a small population of axons (13%) was unable to form T-like branches and generated turns in rostral or caudal directions only. Taken together, this study shows that sensory axon bifurcation is insensitive to increases of CNP-induced cGMP levels and Npr3 does not have an important scavenging function in this axonal system

A Textured Silicon Calorimetric Light Detector

We apply the standard photovoltaic technique of texturing to reduce the reflectivity of silicon cryogenic calorimetric light detectors. In the case of photons with random incidence angles, absorption is compatible with the increase in surface area. For the geometrically thin detectors studied, energy resolution from athermal phonons, dominated by position dependence, is proportional to the surface-to-volume ratio. With the CaWO4 scintillating crystal used as light source, the time constants of the calorimeter should be adapted to the relatively slow light-emission times.Comment: Submitted to Journal of Applied Physic

Attosecond dispersive soft X-ray absorption fine structure spectroscopy in graphite

Phase transitions of solids and structural transformations of molecules are canonical examples of important photo-induced processes, whose underlying mechanisms largely elude our comprehension due to our inability to correlate electronic excitation with atomic position in real time. Here, we present a decisive step towards such new methodology based on water-window-covering (284 eV to 543 eV) attosecond soft X-ray pulses that can simultaneously access electronic and lattice parameters via dispersive X-ray absorption fine-structure (XAFS) spectroscopy. We validate attoXAFS with an identification of the {\sigma}* and {\pi}* orbital contributions to the density of states in graphite simultaneously with its lattice's four characteristic bonding distances. This work demonstrates the concept of attoXAFS as a powerful real-time investigative tool which is equally applicable to gas-, liquid- and condensed phase

Reconstruction of the wavefunctions of coupled nanoscopic emitters using a coherent optical technique

We show that using coherent, spatially resolved spectroscopy, complex hybrid wave functions can be disentangled into the individual wave functions of the individual emitters. This way, detailed information on the coupling of the individual emitters, not available in far-field spectroscopy can be obtained. The proposed quantum state tomography relies on the ability to selectively excite each emitter individually by spatially localized pulses. Simulations of coupled semiconductor Ga/InAs quantum dots, using light fields available in current nanoplasmonics, show that even undesired resonances can be removed from measured spectra. The method can also be applied to study the internal coupling of pigments in photosythesis and artificial light harvesting.Comment: 20 pages, 5 figure

Slow group velocity and Cherenkov radiation

We theoretically study the effect of ultraslow group velocities on the emission of Vavilov-Cherenkov radiation in a coherently driven medium. We show that in this case the aperture of the group cone on which the intensity of the radiation peaks is much smaller than that of the usual wave cone associated with the Cherenkov coherence condition. We show that such a singular behaviour may be observed in a coherently driven ultracold atomic gas.Comment: 4 pages, 4 figure

Gammaretrovirus-mediated correction of SCID-X1 is associated with skewed vector integration site distribution in vivo

We treated 10 children with X-linked SCID (SCID-X1) using gammaretrovirus-mediated gene transfer. Those with sufficient follow-up were found to have recovered substantial immunity in the absence of any serious adverse events up to 5 years after treatment. To determine the influence of vector integration on lymphoid reconstitution, we compared retroviral integration sites (RISs) from peripheral blood CD3(+) T lymphocytes of 5 patients taken between 9 and 30 months after transplantation with transduced CD34(+) progenitor cells derived from 1 further patient and I healthy donor. Integration occurred preferentially in gene regions on either side of transcription start sites, was clustered, and correlated with the expression level in CD34(+) progenitors during transduction. In contrast to those in CD34(+) cells, RISs recovered from engrafted CD3(+)T cells were significantly overrepresented within or near genes encoding proteins with kinase or transferase activity or involved in phosphorus metabolism. Although gross patterns of gene expression were unchanged in transduced cells, the divergence of RIS target frequency between transduced progenitor cells and post-thymic T lymphocytes indicates that vector integration influences cell survival, engraftment, or proliferation