Although the supraclavicular approach has been widely adopted for cervical rib resection, a transaxillary approach has been favored by many. We have reviewed more than two decades of experience with ...decompression of the thoracic outlet to treat thoracic outlet syndrome (TOS) in patients with complete cervical ribs using a novel transaxillary approach.
A prospectively maintained database of patients undergoing surgery for TOS was searched for patients with complete (class 3 and 4) cervical ribs from 1997 to 2019. All these patients had undergone transaxillary resection using a technique in which the cervical and first ribs were separated and then individually resected. The data abstracted included patient demographics, symptoms, surgical details, and complications. The outcomes were contemporaneously assessed clinically and using standardized functional tools: somatic pain scale (SPS) and Quick Disabilities of the Arm, Hand, and Shoulder questionnaire (QuickDASH). The cervical rib data were organized and reported in accordance with the Society for Vascular Surgery reporting standards.
During the study period, 1506 patients had undergone surgery for TOS at our institution. Of these 1506 patients, 38 had undergone complete transaxillary resection of 40 fully formed cervical ribs (10 class 3 and 30 class 4). Of these 38 patients, 74% were women. The presentations had been neurogenic (65%), arterial (31%), and venous (5%). The average initial SPS and QuickDASH score was 6.4 and 50, respectively. The duration of surgery averaged 141 minutes, blood loss was 65 mL, and length of stay was 2.1 days. None of the patients had experienced brachial plexus, phrenic, or long thoracic nerve injury. The average follow-up period was 65 months. The final mean postoperative SPS and QuickDASH scores were lower than the scores at presentation (SPS score, 6.4 vs 1.2; P < .001; QuickDASH score, 50 vs 17; P < .001).
To the best of our knowledge, the present study is the largest reported experience of resection of fully formed cervical ribs using a transaxillary approach that allowed for individual dissection and removal of cervical and first rib segments. This technique has proved to be successful, with low morbidity and reliable improvement in patient symptom and disability scores. Based on these reported outcomes, this novel approach to transaxillary resection of fully formed cervical ribs should be considered a safe and effective operation.
β-Catenin, the core element of the Wnt/β-catenin pathway, is a multifunctional and evolutionarily conserved protein which performs essential roles in a variety of developmental and homeostatic ...processes. Despite its crucial roles, the mechanisms that control its context-specific functions in time and space remain largely unknown. The Wnt/β-catenin pathway has been extensively studied in planarians, flatworms with the ability to regenerate and remodel the whole body, providing a 'whole animal' developmental framework to approach this question. Here we identify a C-terminally truncated β-catenin (β-catenin4), generated by gene duplication, that is required for planarian photoreceptor cell specification. Our results indicate that the role of β-catenin4 is to modulate the activity of β-catenin1, the planarian β-catenin involved in Wnt signal transduction in the nucleus, mediated by the transcription factor TCF-2. This inhibitory form of β-catenin, expressed in specific cell types, would provide a novel mechanism to modulate nuclear β-catenin signaling levels. Genomic searches and in vitro analysis suggest that the existence of a C-terminally truncated form of β-catenin could be an evolutionarily conserved mechanism to achieve a fine-tuned regulation of Wnt/β-catenin signaling in specific cellular contexts.
An organizer is defined as a group of cells that secrete extracellular proteins that specify the fate of surrounding cells according to their concentration. Their function during embryogenesis is key ...in patterning new growing tissues. Although organizers should also participate in adult development when new structures are regenerated, their presence in adults has only been identified in a few species with striking regenerative abilities, such as planarians. Planarians provide a unique model to understand the function of adult organizers, since the presence of adult pluripotent stem cells provides them with the ability to regenerate any body part. Previous studies have shown that the differential activation of the WNT/β-catenin signal in each wound is fundamental to establish an anterior or a posterior organizer in the corresponding wound. Here, we identify the receptors that mediate the WNT/β-catenin signal in posterior-facing wounds. We found that Wnt1-Fzd1-LRP5/6 signaling is evolutionarily conserved in executing a WNT/β-catenin signal to specify cell fate and to trigger a proliferative response. Our data allow a better understanding of the mechanism through which organizers signal to a "competent" field of cells and integrate the patterning and growth required during de novo formation of organs and tissues.
A laboratory course on the science of color, incorporating several related disciplines, was developed for a nonscience majors ' lecture course. Besides physical sciences, the experiments span the ...disciplines of art, computer graphics, psychology, and theatre. Assessment data collected from lecture-only and lecture/lab students revealed that laboratory significantly improved student perception of their own abilities with regard to data analysis, conceptualizing science, and using laboratory instrumentation. Comparison of final exam grades revealed no statistical differences between lecture-only and lecture/lab groups. This report includes descriptions of lab experiments, information on assessment measures, and a discussion of best practices for projects of this nature, in which several disciplinary representatives work together to create a course taught by a single faculty member.
Considering the high impact that severe Coronavirus disease 2019 (COVID-19) cases still pose on public health and their complex pharmacological management, the search for new therapeutic alternatives ...is essential. Mesenchymal stromal cells (MSCs) could be promising candidates as they present important immunomodulatory and anti-inflammatory properties that can combat the acute severe respiratory distress syndrome (ARDS) and the cytokine storm occurring in COVID-19, two processes that are mainly driven by an immunological misbalance. In this review, we provide a comprehensive overview of the intricate inflammatory process derived from the immune dysregulation that occurs in COVID-19, discussing the potential that the cytokines and growth factors that constitute the MSC-derived secretome present to treat the disease. Moreover, we revise the latest clinical progress made in the field, discussing the most important findings of the clinical trials conducted to date, which follow 2 different approaches: MSC-based cell therapy or the administration of the secretome by itself, as a cell-free therapy.
La excavación en curso de un monumento escalonado en el yacimiento de Mestre Ramon en la isla de Mallorca ha aportado nueva información cronológica y arquitectónica que ha motivado una revisión ...analítica de las estructuras conocidas como monumentos escalonados en Mallorca. La combinación de la información cronológica existente con nuevas dataciones radiocarbónicas relacionadas con el yacimiento de Mestre Ramon ha permitido situar el momento de construcción de los monumentos escalonados en el período Prototalayótico (ca. 1100/1000-850 cal a.n.e.). Este encuadre cronológico ha sido la base del análisis de las características arquitectónicas de dichos monumentos y su relación con otras estructuras. El trabajo que se presenta ofrece una caracterización preliminar, pero detallada, de las peculiaridades materiales de los monumentos escalonados y de su dimensión social dentro de los procesos de transformación social que se desarrollaron durante el final de la Edad de Bronce en Mallorca.
In the extended structure of the title compound, Zn2(C10H12N2O8)(H2O), prepared under hydrothermal conditions, there are two distinct ZnII sites. The first, with octahedral geometry, bonds to two N ...and three O atoms from one ethylenediaminetetraacetate tetraanion (EDTA) and one water molecule. The second, with tetrahedral geometry, coordinates to O atoms from four different EDTA ligands. The EDTA ligand almost encapsulates the octahedral ZnII ion and binds to four symmetry‐related tetrahedral ZnII ions, hence generating the extended structure. One noncoordinated O‐atom site on the EDTA ligand connects to the water molecule by hydrogen bonding. Structural comparisons are made with other compounds containing zinc, EDTA and water.
In this study, three multidentate ligands—diethylenetriaminepentaacetate (DTPA), ethylenediaminetetraacetate (EDTA) and tetraethylenepentamine (tetren)—were investigated in the hydrothermal growth of ...crystals of zinc oxide (ZnO). Aqueous solutions containing zinc-ligand complexes and KOH were hydrothermally reacted and the products examined. Reactants were placed in teflon-lined stainless steel autoclaves and heated to a temperature of 200°C, generating pressures of approximately 15 atm. Optical microscopy and scanning electron microscopy on the resulting products revealed crystals with needle and plate habits, with needle lengths up to approximately 1mm for EDTA and plate dimensions up to 100μm for DTPA. When only complexing agent was varied at high pH, needles were observed for all samples, with EDTA yielding the longest (300μm) and tetren yielding the shortest (20μm); results were analyzed by considering complex formation constants, qualitative ligand polarity and complex strain. A variable pH study with 2 aminocarboxylic ligands, EDTA and DTPA, yielded mostly needles and dendritic formations for EDTA over the studied pH range (6–14), and plates or needles for DTPA. Results of variable pH products were analyzed by considering concentrations of all zinc-ligand and zinc-hydroxy species as a function of pH.
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