Articles: cations.
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Observational Study
The Extent of Tissue Damage in the Epidural Space by Ho / YAG Laser During Epiduroscopic Laser Neural Decompression.
Lasers have recently become very useful for epiduroscopy. As the use of lasers increases, the potential for unwanted complications with direct application of laser energy to nerve tissue has also increased. Even using the lowest laser power to test for nerve stimulation, there are still risks of laser ablation. However, there are no studies investigating tissue damage from laser procedures in the epidural space. ⋯ Even with low power and short duration, a laser can destroy tissue if the laser beam makes direct contact with the tissue.
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Efforts to implement quality improvements in surgery are notoriously problematic. One needs to look no farther than recent attempts to implement checklists, team training, and surgical briefings. These interventions have been empirically shown to improve team communication and performance. ⋯ The model highlights important variables associated with implementation success. It also provides a tool for diagnosing why certain interventions may not have worked as intended so that improvements in the implementation process can be made. Finally, the model offers a general framework for guiding future implementation or "how to" research.
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The lipopolysaccharide (LPS) molecule is composed of a hydrophobic lipid region (Lipid A), an oligosaccharide core, and an O-Antigen chain. Lipid A has been described as the molecular region responsible for inducing activation of immune cells. We hypothesize that the O-Antigen plays a critical role in the activation and responsiveness of mononuclear cell immune function. ⋯ Structural variants of LPS activate monocytes differentially. The complete O-Antigen is important for maximal activation of MAPK, cytokine synthesis, and cytokine secretion. LPS with attenuated O-Antigen and Lipid A activate only certain components of these pathways. LPS with a complete O-Antigen stimulates cytokine secretion that is partially independent of CD14, but shortening or removal of the O-Antigen inhibits this secretion.
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Unplanned readmission after surgical procedures is an important quality metric. Yet, readmission rates and causes have not been evaluated for patients after transsphenoidal surgery for pituitary tumors. ⋯ CMS, Centers for Medicare and Medicaid ServicesDI, diabetes insipidusSIADH, syndrome of inappropriate antidiuretic hormone.
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: Neurosurgeons encounter a number of pigmented tumors of the central nervous system in a variety of locations, including primary central nervous system melanoma, blue nevus of the spinal cord, and melanotic schwannoma. When examined through the lens of embryology, pigmented lesions share a unifying connection: They occur in structures that are neural crest cell derivatives. Here, we review the important progress made in the embryology of neural crest cells, present 3 cases of pigmented tumors of the nervous system, and discuss these clinical entities in the context of the development of melanoblasts. Pigmented lesions of the nervous system arise along neural crest cell migration routes and from neural crest-derived precursors. Awareness of the evolutionary clues of vertebrate pigmentation by the neurosurgical and neuro-oncological community at large is valuable for identifying pathogenic or therapeutic targets and for designing future research on nervous system pigmented lesions. When encountering such a lesion, clinicians should be aware of the embryological basis to direct additional evaluation, including genetic testing, and to work with the scientific community in better understanding these lesions and their relationship to neural crest developmental biology. ⋯ DRG, dorsal root gangliaEMT, epithelium-to-mesenchyme transitionNC, neural crestNCM, neurocutaneous melanosisSCP, Schwann cell precursor.