Plasticity of the bony carotid canal and its clinical use for assessing negative remodeling of the internal carotid artery

Background and objective It has long been believed that the bony carotid canal has no plasticity and that a small canal represents a hypoplastic internal carotid artery. We aimed to show whether the carotid canal can narrow according to morphological changes in the internal carotid artery. Materials and methods The carotid canal diameter was longitudinally measured in seven individuals who underwent carotid artery ligation. As moyamoya disease is known to be associated with negative remodeling of the internal carotid artery, the carotid canal diameter was measured in 106 patients with moyamoya disease, and an association with the outer diameter of the internal carotid artery or a correlation with the disease stage was investigated. The carotid canal was measured by computed tomography (106 patients), and the outer diameter of the artery was measured by high-resolution magnetic resonance imaging (63 patients). The carotid canal area was calculated by the product of the maximum axial diameter and its perpendicular diameter. Results All seven patients who underwent carotid artery ligation showed narrowing of the carotid canal, and the carotid canal area decreased by 12.2%–28.9% during a mean follow-up period of 4.2 years. In patients with moyamoya disease, the carotid canal area showed a linear correlation with the outer area of the internal carotid artery (r = 0.657, p < 0.001), and a negative correlation with the disease stage (ρ = −0.283, p < 0.001). Conclusion The bony carotid canal has plasticity, and its area reflects the outer area of the internal carotid artery, therefore, it can be used to assess the remodeling of the carotid artery. A narrow carotid canal may not necessarily indicate hypoplastic internal carotid artery.

Panama’s economy is poised for dramatic rebound

Significance Mining and quarrying activities (728%), construction (489%), hotels and restaurants (92%), transport and communications (29.8%) and trade (23.9%) were the main drivers of growth, boosted by an easing of mobility restrictions and stronger global trade flows. Impacts The 'Pandora Papers' investigation will cast further doubt on Panama’s anti-money laundering efforts. Large social and economic disparity between the Panama Canal area and the rest of the country will continue to hinder development. The Darien Gap is increasingly becoming a migration bottleneck which will necessitate international cooperation, especially with Colombia. Service activities related to the expansion of the Panama Canal will support growth in the coming years. Higher import demand boosted by economic recovery will weigh on external accounts this year.

Multivariate analysis of factors associated with spinal cord area in single-door cervical laminoplasty with miniplate fixation

Objectives To explore the factors associated with the increased spinal cord area in single-door cervical laminoplasty (SDCL) with miniplate fixation. Methods A retrospective study enrolled 83 patients underwent SDCL with miniplate fixation and the patient characteristics such as age, gender, tobacco use, alcohol use, diabetes mellitus, hypertension, diagnosis, operative level, etc., were obtained. The opening angle, door shaft position and spinal canal area of the patients were measured after surgery. The sagittal canal diameter (SCD), the C2–7 Cobb angle, the cervical curvature index (CCI), the range of motion (ROM) and the spinal canal area were measured before and after operation. The increased cervical spinal cord area was also measured before and after surgery, and the correlation between the above indicators and the increased cervical spinal cord area was studied through Pearson’s correlation analysis and multivariate logistic regression analysis. Results There were 34 patients in small spinal cord area increment group (SAI group), 29 patients in middle spinal cord area increment group (MAI group) and 20 patients in large spinal cord area increment group (LAI group). The preoperative diagnosis(P = 0.001), door shaft position (P = 0.008), preoperative spinal canal area (P = 0.004) and postoperative spinal canal area (P = 0.015) were significant different among the 3 groups. The multivariate analysis showed that the preoperative diagnosis (OR = 2.076, P = 0.035), door shaft position (OR = 3.425, P = 0.020) and preoperative spinal canal area (OR = 10.217, P = 0.009) were related to increased spinal cord area. Conclusions The preoperative diagnosis, door shaft position and preoperative spinal canal area might be associated with increased spinal cord area after cervical laminoplasty with miniplate fixation. Preoperative symptoms are mostly caused by compression of the spinal cord, so spinal cord area enlargement can bring a better recovery in patients alongside long-term. Spine surgeons should pay more attention to the accuracy of the preoperative diagnosis, the preoperative measurement of spinal canal area and the door shaft position during the operation.

Mechanical Changes of the Lumbar Intervertebral Space and Lordotic Angle Caused by Posterior-to-Anterior Traction Using a Spinal Thermal Massage Device in Healthy People

Background: The axial (horizontal) traction approach has been traditionally used for treatment of low back pain-related spinal disorders such as nuclear protrusion, primary posterolateral root pain, and lower thoracic disc herniation; however, it is known to have some technical limitations due to reductions of the spinal curve. Lumbar lordosis plays a pivotal function in maintaining sagittal balance. Recently, vertical traction and combination traction have been attracting attention due to improving therapeutic outcomes, although evidence of their clinical application is rare; therefore, this study was conducted to investigate the mechanical changes of lumbar intervertebral space, lordotic angle, and the central spinal canal area through vertical traction treatment using a spinal massage device in healthy participants. Methods: In total, 10 healthy subjects with no musculoskeletal disorders and no physical activity restrictions participated. The participants lay on the experimental device (CGM MB-1901) in supine extended posture and vertical traction force was applied in a posterior-to-anterior direction on the L3–4 and L4–5 lumbar sections at level 1 (baseline) and level 9 (traction mode). Magnetic resonance (MR) images were recorded directly under traction mode using the MRI scanner. The height values of the intervertebral space (anterior, center, and posterior parts) and lordosis angle of the L3–4 and L4–5 sections were measured using Image J software and the central spinal canal area (L4–5) was observed through superimposition method using the MR images. All measurement and image analyses were conducted by 2 experienced radiologists under a single-blinded method. Results: The average height values of the intervertebral space under traction mode were significantly increased in both L3–4 and L4–5 sections compared to baseline, particularly in the anterior and central parts but not in the posterior part. Cobb’s angle also showed significant increases in both L3–4 and L4–5 sections compared to baseline (p < 0.001). The central spinal canal area showed a slightly expanded feature in traction mode. Conclusions: In this pilot experiment, posterior-to-anterior vertical traction on L3–4 and L4–5 sections using a spinal massage device caused positive and significant changes based on increases of the intervertebral space height, lumbar lordosis angle, and central spinal canal area compared to the baseline condition. Our results are expected to be useful as underlying data for the clinical application of vertical traction.

ANALISIS PENYEBAB BANJIR KELURAHAN JATAKE - TANGERANG

A flood is a natural disaster that occurs due to various factors, and there are lots of losses caused by flooding. In the Jatake-Tangerang district, floods were recorded as high as 30-50 cm during February 2020. This study aims to determine the factors that cause flooding in the area to find solutions. In this study, several things need to be analyzed: rainfall, channel capacity, and existing channel conditions. Rainfall was analyzed using the Chi-Square and Kolmogorov-Smirnov methods to determine the type of distribution to be used. The existing plan's capacity is analyzed using the Manning method to determine the discharge, which will be compared with the discharge due to rainfall that occurs using the rational method. Based on the results of the calculation of 6 of the 73 channels reviewed, it cannot accommodate the discharge due to the rainfall that occurs. It is necessary to plan a new channel to change the channel's dimensions that do not meet. After the analysis was carried out, it could be concluded that the flooding in the Jatake-Tangerang area was caused by a lack of capacity of the existing canal, area contours, garbage, and sediment at the bottom of the channel. ABSTRAKBanjir merupakan salah satu bencana alam yang terjadi karena berbagai faktor dan banyak sekali kerugian yang ditimbulkan akibat banjir. Di wilayah Kelurahan Jatake-Tangerang tercatat mengalami banjir setinggi 30-50 cm selama bulan Februari 2020. Penelitian ini bertujuan untuk mengetahui faktor penyebab terjadinya banjir di daerah tersebut sehingga bisa dicari solusinya. Dalam penelitian ini ada beberapa hal yang perlu dianalisis yaitu curah hujan, kapasitas saluran dan kondisi saluran eksisting. Curah hujan dianalisis dengan metode Chi-Square dan Kolmogorov-Smirnov untuk menentukan jenis distribusi yang akan digunakan. Kapasitas rencana eksisting dianalisis dengan metode Manning untuk mengetahui debitnya yang akan dibandingkan dengan debit akibat curah hujan yang terjadi menggunakan metode rasional. Berdasarkan hasil perhitungan 6 dari 73 saluran yang ditinjau tidak mampu menampung debit akibat curah hujan yang terjadi, maka perlu dilakukan perencanaan saluran baru untuk mengubah dimensi saluran yang tidak memenuhi. Setelah analisis dilakukan dapat disimpulkan bahwa banjir di kawasan Jatake-Tangerang disebabkan oleh kurangnya kapasitas saluran eksisting, kontur wilayah, sampah dan sedimen di dasar saluran.

Interplay between intraocular and intracranial pressure effects on the optic nerve head in vivo

Intracranial pressure (ICP) has been proposed to play an important role in the sensitivity to intraocular pressure (IOP) and susceptibility to glaucoma. However, the in vivo effects of simultaneous, controlled, acute variations in ICP and IOP have not been directly measured. We quantified the deformations of the anterior lamina cribrosa (ALC) and scleral canal at Bruch's membrane opening (BMO) under acute elevation of IOP and/or ICP. Four monkey eyes were imaged in vivo with OCT under four pressure conditions: IOP and ICP either at baseline or elevated. The BMO and ALC were reconstructed from manual delineations. From these, we determined BMO area, aspect ratio and planarity, and ALC median depth relative to the BMO plane. To better account for the pressure effects on the imaging, we also measured ALC visibility as a percent of the BMO area. Further, ALC depths were analyzed only in regions where the ALC was visible in all pressure conditions. Bootstrap sampling was used to obtain mean estimates and confidence intervals, which were then used to test for significant effects of IOP and ICP, independently and in interaction. Response to pressure manipulation was highly individualized between eyes, with significant changes detected in a majority of the parameters. Significant interactions between ICP and IOP occurred in all measures, except ALC visibility. On average, ICP elevation expanded canal area by 0.17mm2 at baseline IOP, and contracted canal area by 0.02 mm2 at high IOP. ICP elevation decreased ALC depth by 10 μm at baseline IOP, but increased depth by 7 μm at high IOP. ALC visibility decreased as ICP increased, both at baseline (-10%) and high IOP (-17%). IOP elevation expanded canal area by 0.04 mm2 at baseline ICP, and contracted canal area by 0.09 mm2 at high ICP. On average, IOP elevation caused the ALC to displace 3.3 μm anteriorly at baseline ICP, and 22 μm posteriorly at high ICP. ALC visibility improved as IOP increased, both at baseline (5%) and high ICP (8%). In summary, changing IOP or ICP significantly deformed both the scleral canal and the lamina of the monkey ONH, regardless of the other pressure level. There were significant interactions between the effects of IOP and those of ICP on LC depth, canal area, aspect ratio and planarity. On most eyes, elevating both pressures by the same amount did not cancel out the effects. Altogether our results show that ICP affects sensitivity to IOP, and thus that it can potentially also affect susceptibility to glaucoma.