Elderly patients are at increased risk for mortality undergoing surgical repair of dens fractures

Objective

Dens fractures are common cervical injuries in advanced aged patients. The presented study was undertaken to analyze the clinical results and risks of surgically treated patients with dens fractures over 70 years.

Methods

Data of 28 patients (17 female, 11 male) over 70 years treated from September 2004 to October 2009 were recorded. Clinical and radiological parameters were obtained including type of fracture, associated cervical and/or other injuries, comorbidities, symptoms, neurological condition, surgical strategy, postoperative course and complications.

Results

89% were in a good neurological condition before surgery (ASIA E or D). In most cases, surgery was performed at an early stage after trauma (21 patients within 5 days). Ventral screw fixation was the preferred surgical strategy (64%). A slight worsening of neurological functions immediately after operation was only seen in one patient. Five patients died in the early and 2 in the late postoperative course which means a treatment mortality of 25%. Among the surviving patients two had general medical complications.

Conclusion

Type II dens fractures are a common fracture of elderly patients. Our results are good concerning the neurological functions. Surgical and general medical complications were acceptable. However, the study also underlines that mortality rate is high and therefore treatment options should be well-considered in this high risk group.     

Emotional face expressions are differentiated with brain oscillations.

The differentiation of "facial expressions" is a process of higher mental activity, which has considerable applications in "psychology of moods and emotions". We applied the approach of event-related oscillations (EROs) to investigate the modulation of electrical manifestations related to emotional expression in EEG recordings of 20 healthy subjects. EROs of "neutral, angry and happy" faces in 13 electrical recordings sites (F(3), F(4), C(z), C(3), C(4), T(3), T(4), T(5), T(6), P(3), P(4), O(1), O(2)) were analyzed. Following the recording session, the subjects were asked to express the degree of their emotional involvement (valence and arousal) using the Self-Assessment Manikin ratings. Amplitude frequency characteristics (AFCs) were used to determine the frequencies of interest and the ranges for digital pass-band filtering applied accordingly. Consecutively, peak to peak amplitude measures of oscillatory responses were computed for the selected frequency bands and for the differentiation of the different stimuli. A differentiation between angry and happy facial expressions was observed especially in the alpha (9-13 Hz) and beta (15-24 Hz) frequencies, however, only when selecting stimuli with high mood involvement. Therefore, these frequency bands are the main focus of this report. The amplitudes of the alpha responses upon angry face stimulation were significantly higher than upon presentation of the happy faces at posterior locations. At F(3), C(z) and C(3), beta responses upon angry face stimulation were significantly higher in amplitude compared with the happy face stimulation. It is discussed that the frontal theta response is highly increased in comparison to all theta responses also encountered in studies of face recognition: During observation of facial expression, the occipital theta is much higher. We conclude and emphasize that the analysis of brain oscillatory responses distributed over the scalp in combination with subjective ratings of emotional impact of stimuli provide a good basis for analysing the influence of emotional information processing in the brain. In congruence with others, the results support the phylogenetical viewpoint suggesting that angry face stimulations are faster and more ample in responding. Furthermore, frontal, temporal, parietal and occipital lobes seem to be involved in processing of facial expressions, as reflected in an ensemble of different frequency brain oscillatory responses distributed over the scalp.     

The Abbé island flap for the reconstruction of severe secondary cleft lip deformities

Primary repair of the cleft lip is often associated with secondary deformities, which require revision and secondary reconstruction. Patients with one or all of the following, a tight lip restricting use of orthodontic appliances, absence of a Cupid's bow, or absence of vermilion tubercle, were treated with the Abbé island flap. A triangular muco-musculo-cutaneous island flap was designed in the central segment of the lower lip. A full-thickness incision of skin, muscle, and mucosa was made in the midline of the upper lip, dividing the lip into two segments, and the island Abbé flap was inserted. One week after surgery, the pedicle of the island flap was divided and the inset of the flap completed. Sixty patients with severe secondary cleft lip deformities (36 males and 24 females) were treated. Good aesthetic and functional results were achieved during 1 to 17 years of follow-up. Insertion of the Abbé flap resulted in release of the tight upper lip and a new, inconspicuous scar. Use of orthodontic appliances was facilitated, and tightness of the tissue, which restricted the expansion of the alveolar process, was eliminated. Adequate tissue was transferred to the upper lip, which improved the bulk of the lip and vermilion tubercle. The retrusion of the midface and the projection of the upper lip were also improved, and the upper and lower lips became better balanced. Donor site morbidities were insignificant. Use of the Abbé flap in selected patients resulted in successful reconstruction of secondary cleft lip deformities.     

Detection of metabolites of the new synthetic cannabinoid CUMYL‐4CN‐BINACA in authentic urine samples and human liver microsomes using high‐resolution mass spectrometry

CUMYL‐4CN‐BINACA(1‐(4‐cyanobutyl)‐N‐(2‐phenylpropan‐2‐yl)‐1H–indazole‐3‐carboxamide) is a recently introduced indazole‐3‐carboxamide‐type synthetic cannabinoid (SC) that was detected in herbal incense seized by of the Council of Forensic Medicine, Istanbul Narcotics Department, in May 2016 in Turkey. Recently introduced SCs are not detected in routine toxicological analysis; therefore, analytical methods to measure these compounds are in demand. The present study aims to identify urinary marker metabolites of CUMYL‐4CN‐BINACA by investigating its metabolism in human liver microsomes and to confirm the results in authentic urine samples (n = 80). In this study, 5 μM CUMYL‐4CN‐BINACA was incubated with human liver microsomes (HLMs) for up to 3 hours, and metabolites were identified using liquid chromatography–high‐resolution mass spectrometry (LC–HRMS). Less than 21% of the CUMYL‐4CN‐BINACA parent compound remained after 3 hours of incubation. We identified 18 metabolites that were formed via monohydroxylation, dealkylation, oxidative decyanation to aldehyde, alcohol, and carboxylic acid formation, glucuronidation or reaction combinations. CUMYL‐4CN‐BINACA N‐butanoic acid (M16) was found to be major metabolite in HLMs. In urine samples CUMYL‐4CN‐BINACA was not detected; CUMYL‐4CN‐BINACA N‐butanoic acid (M16) was major metabolite after β‐glucuronidase hydrolysis. Based on these findings, we recommend using M16 (CUMYL‐4CN‐BINACA N‐butanoic acid), M8 and M11 (hydroxylcumyl CUMYL‐4CN‐BINACA) as urinary marker metabolites to confirm CUMYL‐4CN‐BINACA intake.