Background: Cranioplasty in pediatrics is quite challenging and intricated. The ideal material for it is still debatable until now due to the limited study comparing autologous and implant grafts. This meta-analytic study was conducted to evaluate the risk of infection and revision in pediatric patients after autograft and implant cranioplasty. Methods: A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A thorough literature search was conducted on PubMed, Cochrane, Scopus, and ScienceDirect database. Articles published from 2000 to 2021 were selected systematically using PRISMA based on the predetermined eligibility criteria. The relevant data were, then, analyzed and discussed. Results: A total of four publications investigating the outcome of autograft and implant cranioplasty were included and reviewed. Postoperative infection and revision rate after 126 cranioplasty procedures (both autograft or implant) from 119 patients below 21 years during time frame of study were analyzed. This meta-analysis study showed that the rate of infection and revision after cranioplasty were not different between the autograft and implant groups. Conclusion: Autograft and implant cranioplasty have no significant difference in postoperatively infection and revision rate. This study showed that cranioplasty using implant is a plausible option in pediatric patients with cranial defects, depending on the patients’ condition due to similar outcome with autograft cranioplasty. Further studies with larger population and more specific details are necessary to determine the comparison of autograft and implant material in cranioplasty procedure.

Background Spinal cord injury (SCI) is a significant cause of morbidity since it results in the inflammation process which leads to necrosis or apoptosis. Inflammatory response to the tissue damage increases IL-6 and IL-8 levels. ACTH4–10Pro8-Gly9-Pro10 is a peptide community that has been shown to have a beneficial effect on minimizing the morbidity and increasing the recovery time. Methods This study is a true experimental laboratory research with a totally randomized method. The subjects were animal models with light and extreme compression of spinal cord, respectively. Results The administration of ACTH 4–10 in mild SCI in the 3-hour observation group did not show a significant difference in IL-6 expression compared with the 6-hour observation group. The administration of ACTH 4–10 in severe SCI showed a significantly lower expression level of IL-6 in the 3-hour observation group compared with the 6-hour one. The administration of ACTH 4–10 in severe SCI led to a significantly lower IL-8 expression in the 3-hour observation group compared with the 6-hour one. However, there was no significant difference in IL-8 expression in the group receiving ACTH 4–10 in 3 hours observation compared with that in 6 hours observation. Conclusion The administration of ACTH4–10Pro8-Gly9-Pro10 can reduce the expression of IL-6 and IL-8 at 3-hour and 6-hour observation after mild and severe SCI in animal models. Future research works are recommended.

Rheumatoid arthritis (RA), a chronic inflammatory disease primarily affecting synovial joints and tendons, can potentially impact various organs within the body. One notable complication associated with RA is upper cervical spine instability, medically termed atlantoaxial subluxation (AAS). This condition can lead to adverse consequences, including chronic myelopathy and acute mechanical compression of the medulla oblongata, with the potential for sudden death. While AAS may often remain asymptomatic, some nonspecific symptoms, such as neck pain, have been documented. Severe atlantoaxial subluxation can trigger more distinct symptoms, including delayed occipital pain attributed to the compression of the exiting C2 nerve root. Recent studies have elucidated a spectrum of symptoms preceding sudden death, encompassing vertigo, dizziness, convulsions, dysphagia, disorientation, and seizures. Remarkably, some cases have reported sudden death occurring during sleep. Historical data reveal a fluctuating incidence of this phenomenon, with eleven cases reported between 1969 and 1975 and six cases documented between 1990 and 2010. Notably, one of the most prevalent causes of sudden mortality in individuals with RA is the acute mechanical damage inflicted upon the medulla oblongata due to atlantoaxial subluxation.

The best artificial disc material must closely resemble the viscoelasticity, biomechanics and bioavailability of a natural human intervertebral disc. Currently, there is a lack of reviews discussing the characterization of polyvinyl alcohol (PVA) hydrogel as a nucleus pulposus (NP) replacement in intervertebral disc herniation. The present study systematically reviewed the biomechanical characterization of PVA hydrogel as a potential ideal candidate for the replacement of NP. The PubMed, Google Scholar, Science Direct, and Cochrane Database of Systematic Reviews databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses guideline. Data from the literature regarding study design, sample size, materials and biomechanical properties were collected. The literature search identified seven publications, which were read to obtain information about the biomechanical characteristics of PVA hydrogel material used with different compounds. Stress, strain and Young's modulus testing outcomes were all evaluated. The biomechanical characteristics of the materials were evaluated to determine how closely they resemble those of the NP. The results revealed that the PVA hydrogel and NP share similar biomechanical characteristics. In order to enhance its biomechanical capabilities, the PVA hydrogel may be combined with other materials.

Background: The purpose of this study was to analyze the response of inflammatory cytokines interleukin-8 (IL-8) and NF-κB to the closure of skull defect with periosteum as a scaffolding material in bone healing used after surgery. Methods: Thirty Oryctolagus cuniculus rabbits underwent a craniotomy to create a 20 mm diameter round defect in the parietal bones. The parietal bones were returned to its place and stabilized by an internal plate fixation. The defects were either left empty or implanted with periosteum. At 6 weeks, the specimens were euthanized and examined. Results: Histological examination showed a more well-developed formation of woven bone in the periosteum group. Immunohistochemical examinations showed that the use of periosteum in the closure of skull defects reduced the NF-κB and IL-8 response which affected the ossification process. Conclusion: The experiment showed that the use of periosteum was linked with IL-8 and NF-κB downregulation toward ossification effects at any point throughout the trial. Periosteum usage might be beneficial as a scaffolding material in bone healing for autograft cranioplasty in animal model and could be applied to clinical practice.

Background: Juvenile xanthogranuloma (JXG) is a proliferative disorder of non-Langerhans histiocytes. The lesions typically occur in children as solitary cutaneous lesions, but are only rarely found in adults in their late twenties to thirties. Approximately 5–10% of JXG are extracutaneous in location, with spinal JXG being only rarely encountered. Here, we described a 28-year-old male with an extradural spinal JXG resulting in severe C6– T1 spinal cord compression and a progressive quadriparesis that warranted a decompressive laminectomy/C6–T2 fusion. Case Description: A 28-year-old male presented with a progressive quadriparesis of 12 months’ duration that rapidly worsened over the last 3 months. When the MRI revealed severe cord epidural C6–T1 cord compression, the patient successfully underwent a C6–T1 laminectomy for gross total tumor excision followed by a C6–T2 instrumented fusion. The histopathology confirmed the diagnosis of a spinal JXG. Conclusion: Spinal JXGs in adults are only rarely encountered and should be treated with gross total tumor excision with/without fusion to achieve the best long-term outcomes.