STUDY DESIGN: Prospective case series study. PURPOSE: Description of the outcome of stand-alone cervical cages for single and multilevel cervical degenerative spine disease. OVERVIEW OF LITERATURE: The aim of anterior cervical discectomy and fusion (ACDF) for cervical spine disease is to improve patient symptoms and spine stability and restore lordosis. Locking stand-alone cages were developed with the goal of minimizing soft tissue disruption anterior to the vertebrae and reducing the profile of the construct by avoiding an anterior plate, thereby maximizing ACDF benefits. METHODS: This study comprises a case series of patients surgically treated between July 2015 and February 2018 who received single or multilevel ACDF with a zero-profile stand-alone cervical cage. Surgical and clinical preoperative evaluation and surgical outcomes were evaluated using pre- and postoperative Nurick, Visual Analog Scale (VAS), Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) score for myelopathy scales, cervical Cobb angles, postoperative surgical complications, and fusion and subsidence rates. RESULTS: Fifty-three patients underwent ACDF; the mean age of these patients was 58.8 years, and their preoperative VAS, NDI, and JOA scores were 8.1, 31.6, and 15.3, respectively. The preoperative Cobb angle was 30.7°. Forty-five percent of patients had one-level, 54.7% had two-level, and 13.2% had three-level procedures. On preoperative magnetic resonance imaging, foraminal stenosis was present in 94.3% of patients, whereas medullar stenosis was present in 41.5%. The rate of complications was 5.7%: two patients had postoperative dysphagia (3.7%), and one patient had a surgical site hematoma. Mean postoperative follow-up time was 6.7 months; postoperative VAS, NDI, and JOA scores were 2.4, 15.9, and 15.8, respectively. Postoperative Cobb angle was 35.9°, fusion rate was 84.9%, and subsidence rate was 11.3%. CONCLUSIONS: ACDF with zero-profile stand-alone cervical devices is an excellent option for cervical degenerative disc disease of one, two, and three levels, with similar results reported when using ACDF with either cage or plate.
Animals ; Asian Continental Ancestry Group ; Constriction, Pathologic ; Deglutition Disorders ; Diskectomy ; Follow-Up Studies ; Hematoma ; Humans ; Lordosis ; Magnetic Resonance Imaging ; Neck ; Orthopedics ; Prospective Studies ; Spinal Cord Compression ; Spinal Cord Diseases ; Spine ; Spondylosis ; Visual Analog Scale ; Weights and Measures

BACKGROUND: The prevalence of flap necrosis after palatoplasty in patients with cleft palate. The prevalence of mucoperiosteal flap necrosis after palatoplasty remains unknown, and this complication is rare. This event is highly undesirable for both the patient and the surgeon. We present here a new scale to evaluate the degree of hypoplasia of the palate and identify patients with cleft palate at high risk for the development of this complication. METHODS: In this case series, a 20-year retrospective analysis (1994–2014) identified patients from our records (medical records and screening day registries) with nonsyndromic cleft palate who underwent operations at 3 centers. All of these patients underwent operations using 2-flap palatoplasty and also underwent a physical examination with photographs and documentation of the presence of palatal flap necrosis after primary palatoplasty. RESULTS: Palatal flap necrosis was observed in 4 cases out of 1,174 palatoplasties performed at these centers. The observed prevalence of palatal flap necrosis in these groups was 0.34%. CONCLUSIONS: The prevalence of flap necrosis can be reduced by careful preoperative planning, and prevention is possible. The scale proposed here may help to prevent this complication; however, further studies are necessary to validate its utility.
Cleft Palate* ; Craniofacial Abnormalities ; Humans ; Mass Screening ; Necrosis* ; Palate ; Physical Examination ; Prevalence ; Retrospective Studies

Background: Currently, Mexico ranks third worldwide in mortality due to coronavirus disease pandemic 2019 (COVID-19) and reliable information is scarce, with the available data focused on epidemiological characteristics. This study aimed to identify the risk factors associated with mortality and outcomes in hospitalized Mexican patients with COVID-19. Methods: We prospectively assessed patients admitted to a COVID-19 reference center in southeast Mexico between March 28 and June 30, 2020. Mortality was defined as survivors or non-survivors and univariate and multivariate logistic regression analyses were performed to explore the association of the clinical characteristics and laboratory parameters with mortality. Results: We included 200 patients with a mean age of 55 years, 69% were men and 72% had at least one chronic comorbidity. Eighty-six patients required invasive mechanical ventilation (IMV) with an overall mortality rate of 82.5%. Only 51% of the patients with IMV were admitted to the intensive care unit (ICU), with a survival rate of 27.3%, but only 7.2% for patients without ICU admissions (p=0.014). The multivariate analysis found that a neutrophil-to-lymphocyte ratio ≥9 (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.05–10.53) albumin <3.5 g/dL (OR, 3.76; 95% CI, 1.56–9.07), lactate dehydrogenase (LDH) level ≥725 U/L (OR, 5.45; 95% CI, 2.36–12.57), and IMV (OR, 64.7; 95% CI, 15.20–275.39) were independent risk factors associated with mortality. Conclusion Neutrophil-to-lymphocyte ratio, LDH, albumin, and IMV were independent risk factors for mortality in Mexican patients with COVID-19. Also, the availability of ICU resources is invaluable for better outcomes in critically ill patients. Our results could provide clinical information for timely decision-making in low-and-middle income countries to overcome the pandemic.

Background: Currently, Mexico ranks third worldwide in mortality due to coronavirus disease pandemic 2019 (COVID-19) and reliable information is scarce, with the available data focused on epidemiological characteristics. This study aimed to identify the risk factors associated with mortality and outcomes in hospitalized Mexican patients with COVID-19. Methods: We prospectively assessed patients admitted to a COVID-19 reference center in southeast Mexico between March 28 and June 30, 2020. Mortality was defined as survivors or non-survivors and univariate and multivariate logistic regression analyses were performed to explore the association of the clinical characteristics and laboratory parameters with mortality. Results: We included 200 patients with a mean age of 55 years, 69% were men and 72% had at least one chronic comorbidity. Eighty-six patients required invasive mechanical ventilation (IMV) with an overall mortality rate of 82.5%. Only 51% of the patients with IMV were admitted to the intensive care unit (ICU), with a survival rate of 27.3%, but only 7.2% for patients without ICU admissions (p=0.014). The multivariate analysis found that a neutrophil-to-lymphocyte ratio ≥9 (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.05–10.53) albumin <3.5 g/dL (OR, 3.76; 95% CI, 1.56–9.07), lactate dehydrogenase (LDH) level ≥725 U/L (OR, 5.45; 95% CI, 2.36–12.57), and IMV (OR, 64.7; 95% CI, 15.20–275.39) were independent risk factors associated with mortality. Conclusion Neutrophil-to-lymphocyte ratio, LDH, albumin, and IMV were independent risk factors for mortality in Mexican patients with COVID-19. Also, the availability of ICU resources is invaluable for better outcomes in critically ill patients. Our results could provide clinical information for timely decision-making in low-and-middle income countries to overcome the pandemic.

Galectins are an evolutionarily ancient and widely expressed family of lectins that have unique glycan-binding characteristics. They are pleiotropic regulators of key biological processes, such as cell growth, proliferation, differentiation, apoptosis, signal transduction, and pre-mRNA splicing, as well as homo- and heterotypic cell-cell and cell-extracellular matrix interactions. Galectins are also pivotal in immune responses since they regulate host-pathogen interactions, innate and adaptive immune responses, acute and chronic inflammation, and immune tolerance. Some galectins are also central to the regulation of angiogenesis, cell migration and invasion. Expression and functional data provide convincing evidence that, due to these functions, galectins play key roles in shared and unique pathways of normal embryonic and placental development as well as oncodevelopmental processes in tumorigenesis. Therefore, galectins may sometimes act as double-edged swords since they have beneficial but also harmful effects for the organism. Recent advances facilitate the use of galectins as biomarkers in obstetrical syndromes and in various malignancies, and their therapeutic applications are also under investigation. This review provides a general overview of galectins and a focused review of this lectin subfamily in the context of inflammation, infection and tumors of the female reproductive tract as well as in normal pregnancies and those complicated by the great obstetrical syndromes.
Apoptosis ; Biomarkers ; Biological Processes ; Carcinogenesis ; Cell Movement ; Epigenomics ; Female ; Galectins* ; Host-Pathogen Interactions ; Humans ; Immune Tolerance ; Inflammation* ; Lectins ; Placentation ; Pregnancy ; Pregnancy Complications* ; RNA Precursors ; Signal Transduction

BACKGROUND: The decidua has been implicated in the “terminal pathway” of human term parturition, which is characterized by the activation of pro-inflammatory pathways in gestational tissues. However, the transcriptomic changes in the decidua leading to terminal pathway activation have not been systematically explored. This study aimed to compare the decidual expression of developmental signaling and inflammation-related genes before and after spontaneous term labor in order to reveal their involvement in this process. METHODS: Chorioamniotic membranes were obtained from normal pregnant women who delivered at term with spontaneous labor (TIL, n = 14) or without labor (TNL, n = 15). Decidual cells were isolated from snap-frozen chorioamniotic membranes with laser microdissection. The expression of 46 genes involved in decidual development, sex steroid and prostaglandin signaling, as well as pro- and anti-inflammatory pathways, was analyzed using high-throughput quantitative real-time polymerase chain reaction (qRT-PCR). Chorioamniotic membrane sections were immunostained and then semi-quantified for five proteins, and immunoassays for three chemokines were performed on maternal plasma samples. RESULTS: The genes with the highest expression in the decidua at term gestation included insulin-like growth factor-binding protein 1 (IGFBP1), galectin-1 (LGALS1), and progestogen-associated endometrial protein (PAEP); the expression of estrogen receptor 1 (ESR1), homeobox A11 (HOXA11), interleukin 1β (IL1B), IL8, progesterone receptor membrane component 2 (PGRMC2), and prostaglandin E synthase (PTGES) was higher in TIL than in TNL cases; the expression of chemokine C-C motif ligand 2 (CCL2), CCL5, LGALS1, LGALS3, and PAEP was lower in TIL than in TNL cases; immunostaining confirmed qRT-PCR data for IL-8, CCL2, galectin-1, galectin-3, and PAEP; and no correlations between the decidual gene expression and the maternal plasma protein concentrations of CCL2, CCL5, and IL-8 were found. CONCLUSIONS: Our data suggests that with the initiation of parturition, the decidual expression of anti-inflammatory mediators decreases, while the expression of pro-inflammatory mediators and steroid receptors increases. This shift may affect downstream signaling pathways that can lead to parturition.
Chemokines ; Cytokines ; Decidua ; Estrogen Receptor alpha ; Estrogens ; Female ; Galectin 1 ; Galectin 3 ; Galectins ; Gene Expression* ; Genes, Homeobox ; Humans ; Immunoassay ; Interleukin-8 ; Interleukins ; Leukocytes ; Membranes ; Microdissection ; Parturition* ; Plasma ; Pregnancy ; Pregnant Women ; Progesterone ; Real-Time Polymerase Chain Reaction ; Receptors, Progesterone ; Receptors, Steroid ; Sexual Development ; Transcriptome*