The intriguing history of the human calvaria: sinister and religious

Introduction A review of the ancient world finds multiple documentations describing the use of the human calvaria as a drinking implement. Terminology This term, which is frequently and incorrectly called the “calvarium,” has a unique history among multiple cultures of the world. For example, the purported site of Jesus’ crucifixion “Calvary” is derived from this term calvaria. The present report explores the derivation, misuse, and history of the human calvaria.     

Clinical evaluation of an HIV-1 and HCV assay and demonstration of significant reduction of the HCV detection window before seroconversion

BACKGROUND: One HIV-1 and HCV assay simultaneously detects HIV-1 and HCV RNA (Procleix, Chiron Corp.). The main intended use of the assay is the testing of blood and blood products in blood banking. STUDY DESIGN AND METHODS: To evaluate the clinical sensitivity of the assay, 164 anti-HIV-1+ and 160 anti-HCV+ patients of different viral load were tested. The assay specificity was determined in 1000 HIV-1- and HCV-seronegative blood donors. The ability of the assay to detect different HCV genotypes was investigated in a total of 40 patients of different genotypes (1-4). Furthermore, to investigate the reduction of the HCV window phase before seroconversion, serial samples of 25 hemodialysis patients who seroconverted to anti-HCV were also tested. RESULTS: The assay detected all 60 HIV-1-infected patients with a viral load of greater than 50 copies per mL and 48 of 104 patients with a viral load of less than 50 copies per mL. Moreover, all 60 patients with an HCV RNA load of greater than 521 IU per mL and 7 of 100 patients with a viral load of less than 50 IU per mL tested positive. The assay specificity was found to be 100 percent. In addition, all 40 patients of different HCV genotypes were successfully detected. Finally, the median time that the assay detected HCV infection before second- and third-generation anti-HCV assay was found to be 183 and 91 days, respectively. CONCLUSION: The assay sensitivity and specificity, its ability to detect different HCV genotypes, and the significant reduction of window period of HCV infection further support its use for improving the safety of blood and blood products.     

Migraine With Aura: Segregation Analysis and Heritability Estimation

A genetic study was performed in a group of 60 migraine patients and their first-degree relatives as well as in a group of sex- and age-matched controls. Segregation analysis showed that multifactorial inheritance seems to be the most probable mode of genetic transmission. Heritabilities were estimated according to the sex of probands and relatives.
Our findings favor multifactorial inheritance, but the contribution of a major gene can not be excluded.     

Surgical relevance of the lateral costotransverse ligament in relation to the dorsal root ganglion

The lateral costotransverse ligament, a short band that stabilizes the costovertebral joint, is found in close proximity to the dorsal root ganglion. This ligament is an important surgical landmark during tumor resections or nerve blocks in the paravertebral space. The purpose of this study was to quantitatively and qualitatively describe the morphology of the lateral costotransverse ligament and its relation to the dorsal root ganglion at all levels of the thoracic spine. The thoracic spines of eight embalmed cadavers were dissected bilaterally. The length, width, and thickness of the ligament were measured. The distance from the inferolateral aspect of the ligament to the lateral aspect of the dorsal root ganglion was also measured. Three bilateral groups of lateral costotransverse ligaments, top (on ribs 1–2), middle (on ribs 3–10), and bottom (on ribs 11–12), were compared based on anatomic distinctions between the costotransverse joints, which can influence ligament morphology. Among the three groups, the differences between the length, width, and thickness were not statistically significant. However, the distance from the lateral costotransverse ligament to the dorsal root ganglion differed significantly (P = 0.000), with the middle group having the longest distance, and the bottom group having the shortest distance. This finding can help clinicians and surgeons avoid iatrogenic injuries of neural structures during thoracic spine surgery, or when performing nerve blocks in the paravertebral space.     

Consensus Paper: Neuroimmune Mechanisms of Cerebellar Ataxias

In the last few years, a lot of publications suggested that disabling cerebellar ataxias may develop through immune-mediated mechanisms. In this consensus paper, we discuss the clinical features of the main described immune-mediated cerebellar ataxias and address their presumed pathogenesis. Immune-mediated cerebellar ataxias include cerebellar ataxia associated with anti-GAD antibodies, the cerebellar type of Hashimoto’s encephalopathy, primary autoimmune cerebellar ataxia, gluten ataxia, Miller Fisher syndrome, ataxia associated with systemic lupus erythematosus, and paraneoplastic cerebellar degeneration. Humoral mechanisms, cell-mediated immunity, inflammation, and vascular injuries contribute to the cerebellar deficits in immune-mediated cerebellar ataxias.     

Arterial variations around the atlas: a comprehensive review for avoiding neurosurgical complications

Introduction

Neurosurgical approaches often involve the atlas. Therefore, the arterial relationships and anatomical variations are of paramount importance to the neurosurgeon.

Methods

Using standard search engines, a literature review of arterial variants near the first cervical vertebra was performed.

Conclusions

Arterial variations around the atlas are surgically significant. Awareness of their existence and course may provide better pre-operative planning and surgical intervention, potentially leading to better clinical outcomes. Three-dimensional computed tomography angiography (3D CTA) is an important tool for identifying and diagnosing such abnormalities and should be used when such vascular anomalies are suspected.

     

FoSTeS, MMBIR and NAHR at the human proximal Xp region and the mechanisms of human Xq isochromosome formation

The recently described DNA replication-based mechanisms of fork stalling and template switching (FoSTeS) and microhomology-mediated break-induced replication (MMBIR) were previously shown to catalyze complex exonic, genic and genomic rearrangements. By analyzing a large number of isochromosomes of the long arm of chromosome X (i(Xq)), using whole-genome tiling path array comparative genomic hybridization (aCGH), ultra-high resolution targeted aCGH and sequencing, we provide evidence that the FoSTeS and MMBIR mechanisms can generate large-scale gross chromosomal rearrangements leading to the deletion and duplication of entire chromosome arms, thus suggesting an important role for DNA replication-based mechanisms in both the development of genomic disorders and cancer. Furthermore, we elucidate the mechanisms of dicentric i(Xq) (idic(Xq)) formation and show that most idic(Xq) chromosomes result from non-allelic homologous recombination between palindromic low copy repeats and highly homologous palindromic LINE elements. We also show that non-recurrent-breakpoint idic(Xq) chromosomes have microhomology-associated breakpoint junctions and are likely catalyzed by microhomology-mediated replication-dependent recombination mechanisms such as FoSTeS and MMBIR. Finally, we stress the role of the proximal Xp region as a chromosomal rearrangement hotspot.     

Peripheral facial nerve communications and their clinical implications

The facial nerve (CN VII) nerve follows a torturous and complex path from its emergence at the pontomedullary junction to its various destinations. It exhibits a highly variable and complicated branching pattern and forms communications with several other cranial nerves. The facial nerve forms most of these neural intercommunications with branches of all three divisions of the trigeminal nerve (CN V), including branches of the auriculotemporal, buccal, mental, lingual, infraorbital, zygomatic, and ophthalmic nerves. Furthermore, CN VII also communicates with branches of the vestibulocochlear nerve (CN VIII), glossopharyngeal nerve (CN IX), and vagus nerve (CN X) as well as with branches of the cervical plexus such as the great auricular, greater, and lesser occipital, and transverse cervical nerves. This review intends to explore the many communications between the facial nerve and other nerves along its course from the brainstem to its peripheral branches on the human face. Such connections may have importance during clinical examination and surgical procedures of the facial nerve. Knowledge of the anatomy of these neural connections may be particularly important in facial reconstructive surgery, neck dissection, and various nerve transfer procedures as well as for understanding the pathophysiology of various cranial, skull base, and neck disorders.