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In the last decades, bio-based active food packaging materials have received much attention. It is known that the utilization of traditional materials for food packaging applications lack some critical characteristics such as resistance to the harmful microbes that cause a damage to the preserved foods. Therefore, the current study aimed to find an alternative packaging films comprises an efficient biopolymers. This research work was designed to prepare film mats using hydroxypropyl starch (HPS), polyvinyl alcohol (PVA), palmitic acid (PA) and biosynthesized zinc oxide nanoparticles (ZnONPs). The fabricated films were coded as 1H, 2H, 3H and 4H based on the utilized concentration of ZnONPs. The biosynthesized ZnONPs and the bio-based films loaded with ZnONPs were characterized. The results revealed that ZnONPs exhibited nearly spherical shape and size ∼40 nm. The surface structure of the produced bioactive packaging films exhibited smooth with homogeneous features, excellent mechanical and thermal stability properties. The prepared bioactive packaging film loaded with ZnONPs (4H) exhibited superior antibacterial activity among other films against Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 25923 with inhibition zones 15.1 ± 0.76 and 12.1 ± 0.71 mm respectively. Correspondingly, packing film 4H exhibited potential antifungal activity toward Aspergillus niger RCMB 02724, A. flavus RCMB 02782, Penicillium expansum IMI 89372 and Fusarium oxysporum RCMB 001004 with inhibition zones (16 ± 1.0, 22 ± 0.90, 18.0 ± 1.1 and12.3 ± 0.57 mm respectively). Moreover, all prepared films did not show cytotoxicity on the normal cell line (Wi38) and recorded biodegradability properties that reached around 85 % after four weeks in soil. Based on these results, the antimicrobial films comprising HPS/PVA and loaded with the biosynthesized ZnONPs can be considered as a suitable film for food packaging purposes.

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Fluorescence is well-known nowadays as one of the most efficient anti-counterfeiting techniques. Zinc oxide quantum dots (ZnOQds) are exceptionally fluorescence when exposed to ultraviolet (UV) light, which makes them a candidate for anti-counterfeiting printing. The resulting anti-counterfeiting papers are sustainable and resistance against organic dyes. In this work, ZnOQds were prepared via a green method and characterized under UV-visible spectroscopy, along with microscopic observations by transmission electron microscopy (TEM) and crystallography by X-ray diffraction (XRD). Formation of ZnOQds nanocrystals with an average partials size of 7.3 nm was approved. Additionally, double-layers sheets were prepared at two loading concentrations of ZnOQds, namely 0.5 and 1 (wt./v) and underwent characterization using a topographical surface study via field emission scanning electron microscopy (FE-SEM). Hybrid sheets were mechanically more stable compared to single-layer paper and likewise polymer film. Moreover, aging simulation approved a high stability for hybrid sheets. Particularly, the photoluminescence emission affirmed anti-aging character of hybrid paper for more than 25 years. The hybrid sheets also showed a broad range of antimicrobial activity.

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This study deals with the production of natural fiber plastic composites (NFPCs) to reduce environmental pollution with agricultural and plastic waste. Where the NFPCs were prepared from waste/pure polyethylene (WPE) (pure polyethylene (50%)/recycled polyethylene (50%)) and modified sunflower waste via an eco-friendly and economic biological process. The sunflower fibers (SF) were treated via whole selective fungal isolate, namely, Rhizopus oryzae (acc no. OM912662) using two different incubation conditions; submerged (Sub), and solid-state fermentation (SSF) to enhance the fibers' compatibility with WPE. The treated and untreated fibers were added to WPE with various concentrations (10 and 20 wt%). The morphology and structure of fibers were characterised by a scanning electron microscope (SEM) and attenuated total reflection-Fourier transform infrared (ATR-FTIR). Furthermore, the mechanical properties, morphology, biodegradation and water vapour transmission rate (WVTR) for the prepared NFPCs were investigated. The results showed that compatibility, mechanical properties and biodegradation of NFPCs were improved by the addition of sunflower fibers treated by SSF conditions.

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Cytomegalovirus (CMV) retinitisis a vision-threatening disease that principally afflicts immunosuppressed patients. For the management of the disease, Ganciclovir (GCV) is usually administered systemically, where patients may suffer severe untoward effects. The ocularly-applied alternatives are either the intravitreal injections, which are frequently administered due to GCV short half-life, or the sustained-release implants, which require surgical removal upon drug depletion. Both therapies are invasive and should be completed by a medical expert. The objective of this research was to formulate a non-invasive alternative represented in GCV loaded ultra-fluidic glycerosomes (UFGs), which are glycerosomes containing sodium taurocholate as an edge activator (EA), then incorporating the optimal UFGs in polylactic acid (PLA)-based 3D printed ocusert to prolong the release of GCV. The experimental design, the statistical analysis, and the optimization were performed via Design-Expert® software. The optimal formulation (UFGs 6; composed of 600 mg Phosphatidylcholine (PC), 20 mg cholesterol, 0.1:1 weight molar ratio of EA: PC and 1 gm glycerol) possessed nanovesicles (441.70 ± 1.13 nm) that entrapped 69.33 ± 0.28 % of GCV, with zeta potential value of -37.00 ± 0.42 mV and deformability index value of 74.68 ± 0.71. The confocal microscopy results showed the supreme penetration power of UFGs through the rabbit's cornea, compared to edge-activated vesicles and conventional glycerosomes from the laden ocusert. Moreover, the topical application of the ocusert laden with the optimal GCV loaded UFGs to the rabbits' eyes evidenced their safety as per the histopathological findings. Furthermore, a pharmacokinetic study in the rabbit's aqueous humor demonstrated the sustained release of GCV from the ocusert laden with the optimal GCV loaded UFGs over 5 days. Inclusively, the ocusert laden with UFGs could be considered as a non-invasive sustaining drug delivery system of GCV for the management of CMV retinitis.

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INTRODUCTION: Knowing patients' smoking history helps guide who may benefit from preventive services such as lung cancer screening. The accuracy of smoking history electronic health records remains unclear. METHODS: This was a secondary analysis of data collected from a portal-based lung cancer screening decision aid. Participants of an academically affiliated health system, aged 55-76 years, completed an online survey that collected a detailed smoking history including years of smoking, years since quitting, and smoking intensity. Eligibility for lung cancer screening was defined using the Centers for Medicare and Medicaid Services criteria. Data analysis was performed May-December 2018, and data collection occurred between November 2016 and February 2017. RESULTS: A total of 336 participants completed the survey and were included in the analysis. Of 175 participants with self-reported smoking intensity, 72% had packs per day and 62% had pack-years recorded in the electronic health record. When present, smoking history in the electronic health records correlated well with self-reported years of smoking (r =0.78, p≤0.0001) and years since quitting (r =0.94, p≤0.0001). Self-reported smoking intensity, including pack-years (r =0.62, p<0.0001) and packs per day (r =0.65, p≤0.0001), was less correlated. Of those participants eligible for lung cancer screening by self-report, only 35% met criteria for screening by electronic health records data alone. Others were either incorrectly classified as ineligible (23%) or had incomplete data (41%). CONCLUSIONS: The electronic health records frequently misses critical elements of a smoking history, and when present, it often underestimates smoking intensity, which may impact who receives lung cancer screening.

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BACKGROUND: Patients with lateral elbow pain are often diagnosed with lateral epicondylalgia. Lateral elbow pain is often associated with dysfunction of the wrist extensor muscles; however, in some cases, it can also mimic signs and symptoms of radial nerve dysfunction. CASE DESCRIPTION: In this case report, a 43-year-old man, who was originally referred with a diagnosis of lateral epicondylalgia as a result of playing table tennis and who previously responded favorably to manual therapy and exercise, presented to the clinic for treatment. An exacerbation while participating in a table tennis match resulted in a return of his lateral epicondylalgia symptoms, which did not respond favorably to the same interventions used in his prior course of therapy. Further examination revealed sensitization of the radial nerve, which was treated with 2 sessions of ultrasound-guided percutaneous electrical nerve stimulation and 4 weeks of a low-load, concentric/eccentric exercise program for the wrist extensors. OUTCOMES: Following this intervention, the patient experienced clinically meaningful improvement in pain intensity (numeric pain-rating scale), function (Patient-Rated Tennis Elbow Evaluation), and related disability (Disabilities of the Arm, Shoulder and Hand questionnaire). The patient progressively exhibited complete resolution of pain and function, which was maintained at 2 years. DISCUSSION: This case report demonstrates the outcomes of a patient with lateral elbow pain who did not respond to manual therapy and exercise. Once radial nerve trunk sensitivity was identified and the intervention, consisting of ultrasound-guided percutaneous electrical nerve stimulation targeting the radial nerve combined with a low-load exercise program, was applied, a full resolution of pain and function occurred rapidly. Future clinical trials should examine the effect of percutaneous electrical nerve stimulation in the management of nerve-related symptoms associated with musculoskeletal pain conditions. LEVEL OF EVIDENCE: Therapy, level 5. J Orthop Sports Phys Ther 2019;49(5):347-354. Epub 18 Jan 2019. doi:10.2519/jospt.2019.8570.

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Bladder cancer is the most prevalent malignancy of the urinary tract and is associated with significant morbidity and mortality. Preventative efforts to reduce the medical and financial burdens of bladder cancer are highly desirable. However, the utilization of natural and pharmaceutical products for the prevention and treatment of bladder cancer remains largely controversial. Herein, we review the current body of evidence surrounding a number of natural dietary substances and their roles in chemoprevention of bladder cancer. Possible chemopreventative properties of several pharmaceutical agents are also reviewed. Overall, the current body of evidence is insufficient to establish a clear link between these proposed chemopreventive agents and risk of bladder cancer.

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Routine HIV testing of all pregnant women in Oman has been introduced without prior knowledge of women's attitudes towards testing or their behaviour in the event of a positive test. This study recruited 1000 Omani pregnant women from antenatal clinics to explore their knowledge of HIV/AIDS, attitudes towards HIV testing and intended behaviours in the event of a positive test. Mother-to-child transmission was recognized by 86.6% of the women but only 21.0% knew that it was preventable and a few acknowledged the important role of antiviral drugs. Half of the women (51.9%) reported having been tested for HIV and 75.8% agreed about routine HIV testing for all pregnant women. A higher level of knowledge was significantly associated with a favourable intended behaviour related to voluntary testing, disclosure and seeking professional assistance in the event of a positive HIV test. The results are discussed in relation to opt-in and opt-out approaches to voluntary testing during pregnancy.

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This study determined the rates and correlates of depression among community-dwelling elderly people, based on data from the comprehensive health assessment conducted in Al-Dakhiliyah governorate in Oman in 2008-2010. Data covered sociodemographic characteristics, medical and nutrition status, functional abilities, depression and dementia. The rate of depression was 16.9%, higher among women than men (19.3% versus 14.3%). Depression was independently predicted by the presence of social risk (OR = 3.44), dementia (OR = 3.17), impairment in activities of daily living (OR = 2.19), joint problems (OR = 1.52) and mobility restriction (OR = 1.43). If dementia was excluded from the model, depression was additionally predicted by poor perception of health (OR = 2.09), impairment in instrumental activities of daily living (OR = 1.47) and older ages of 70-< 80 years (OR = 1.63) and ≥ 80 years (OR = 1.75). Although not presenting as a complaint, depression in not uncommon among elderly people.

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BACKGROUND: Squamous cell carcinoma (SCC) and transitional carcinoma with squamous differentiation (SCC/TCC) are rare in western countries. Chronic inflammation and irritation of the urothelium are common risk factors for the development of SCC and TCC/SCC. Tumour biology of squamous cell cancer and precancerous squamous lesions is different from transitional cell cancer (TCC). Recent advances in molecular analysis of benign and malignant squamous cell lesions indicate that they are closely associated and might lead to improved bladder cancer subclassification in the future. AIM: At present, the clinical management and therapy of SCC remains challenging, as scientific evidence based on prospective clinical trials is not available. We performed an analysis of available literature on natural history, treatment, and prognosis of SCC, SCC/TCC and metaplastic lesions. Furthermore, recent findings in molecular cancer biology are discussed with a focus on their relevance for SCC carcinogenesis.

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This study determined the rates and correlates of depression among community-dwelling elderly people, based on data from the comprehensive health assessment conducted in Al-Dakhiliyah governorate in Oman in 2008-2010.Data covered sociodemographic characteristics, medical and nutrition status, functional abilities, depression and dementia.The rate of depression was 16.9%, higher among women than men [19.3% versus 14.3%]. Depression was independently predicted by the presence of social risk [OR = 3.44], dementia [OR = 3.17], impairment in activities of daily living [OR - 2.19], joint problems [OR -1.52]and mobility restriction [OR = 1.43]. If dementia was excluded from the model, depression was additionally predicted by poor perception of health [OR = 2.09], impairment in instrumental activities of daily living [OR -1.47]and older ages of 70-< 80 years [OR -1.63]and > 80 years [OR -1.75]. Although not presenting as a complaint, depression in not uncommon among elderly people

تهدف هذه الدراسة إلى التعرف على معدلات الاكتئاب والعوامل المصاحبة له لدى المسنين في المجتمع استنادا إلى البيانات المستمدة من تقييم صحي شامل أجري في محافظة الداخلية في سلطنة عمان في الفترة 2008 - 2010 . وتغطي تلك البيانات السمات الديموغرافية، والأحوال الطبية والتغذوية، والقدرات الوطيفية، والاكتئاب، والخرف. واتضح أن معدل حدوث الاكتئاب 16.9% وهو أعلى لدى النساء [19.3]مما هو لدى الرجال [14.3 %]وأنه مما يرجح حدوث الاكتئاب:وجود عوامل اختطار اجتماعية مستقلة [معدل الأرجحية 3.44]، والخرف [معدل الأرجحية 3.17]، واختال أنشطة الحياة اليومية [معدل الأرجحية 2.19]، ومشكلات في المفاصل [معدل الأرجحية 1.52]، وتقييد في الحركة [معدل الأرجحية 1.43]. وإذا ما استبعد الباحثون الخرف من النموذج فإن الاكتئاب يمكن توقعه أيضا من خلال ضعف الإدراك للصحة [معدل الأرجحية 2.09]، وخلل الأنشطة الأساسية للحياة اليومية [معدل الأرجحية 1.47]، والأعمار المتقدمة التي تزيد على 70 عاما وتقل عن 80 عاما [معدل الأرجحية 1.63]، والأعمار التي تبلغ أو تزيد على ثمانين عاما [معدل الأرجحية 1.75]، واستنتج الباحثون من الدراسة أن الاكتئاب شائع بين المسنين، رغم أنه ليس من الشكاوى الرئيسية لديهم

La présente étude visait à déterminer les pourcentages et les corrélats de la dépression chez des personnes âgées vivant dans la communauté, à partir des données extraites de l'évaluation de santé globale menée dans la région d'Al-Dakhliyah [Oman]de 2008 à 2010.Les données recueillies couvraient les caractéristiques sociodémographiques, l'état de santé et nutritionnel, les capacités fonctionnelles, la dépression et la démence.Le taux de dépression était de 16, 9 %; il était plus élevé chez les femmes [19, 3 %]que chez les hommes [14, 3 %]. Le risque social [OR = 3, 44], la démence [OR = 3, 17], des difficultés à accomplir les activités de la vie quotidienne [OR = 2, 19], des douleurs articulaires [OR = 1, 52]et une restriction de la mobilité [OR = 1, 43]étaient les facteurs prédictifs indépendants de la mauvaise perception de sa santé [OR=2, 09], les difficultés à accomplir les activités importantes de la vie quotidienne [OR = 1, 47]ainsi que les tranches d'âge plus avancées - 70 a moins de 80 ans [OR = 1, 63]et 80 ans et plus [OR = 1, 75]. La dépression n'était pas rare chez les personnes âgées, même si elle ne motivait pas une consultation

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A cross-sectional survey was conducted in March 2011 to study the patterns and determinants of physical activity among 439 secondary-school students in Muscat governorate based on a self-administered questionnaire. Half of the students (52.9%) were enrolled in physical education classes and 95.9% reported after-school physical activities. The recommended level of physical activity (> or = 1680 MET minutes/week) was met by 23.9% of students, being significantly lower among girls (9.8%) than boys (38.8%). More girls were in the stages of pre-contemplation (5.8%) and contemplation (26.7%) of adopting exercise while more boys were in the action (15.4%) and maintenance stages (36.0%). Girls reported significantly more barriers to exercise, related to lack of energy, interest in other activities, lack of encouragement, worries about looks, and time constraints from academic responsibilities and family obligations. The full model logistic regression revealed that boys, 11th-grade students and attempts to regulate weight significantly predicted physical activity meeting the recommended levels.

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This cross-sectional study aimed to assess knowledge of routes of transmission, awareness of MRSA control guidelines and reasons for non-adherence to guidelines among medical staff at Alexandria University hospitals. A random sample of 158 physicians and 47 nurses answered a self-administered questionnaire. Overall awareness of MRSA control guidelines was 67.3%, and nurses were significantly more aware than physicians (91.5% versus 60.1%). The lowest awareness level was among anaesthesiologists; only 54.4% knew the correct transmission routes. Among medical staff overall, 70.0% accepted the necessity of screening measures for high-risk patients and 35.8% of doctors accepted the use of the same pair of gloves when caring for different body sites on an individual patient. Lack of resources was the most common justification for suboptimum adherence. The study showed low awareness levels of MRSA-related guidelines.

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This cross-sectional study aimed to assess knowledge of routes of transmission, awareness of MRSA control guidelines and reasons for non-adherence to guidelines among medical staff at Alexandria University hospitals. A random sample of 158 physicians and 47 nurses answered a self-administered questionnaire. Overall awareness of MRSA control guidelines was 67.3%, and nurses were significantly more aware than physicians [91.5% versus 60.1%]. The lowest awareness level was among anaesthesiologists; only 54.4% knew the correct transmission routes. Among medical staff overall, 70.0% accepted the necessity of screening measures for high-risk patients and 35.8% of doctors accepted the use of the same pair of gloves when caring for different body sites on an individual patient. Lack of resources was the most common justification for suboptimum adherence. The study showed low awareness levels of MRSA-related guidelines

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BACKGROUND: It still remains debatable whether peroxisome proliferator-activated receptor gamma (PPARγ) is pro- or antineoplastic, and its exact role in mycosis fungoides (MF) remains unclear. OBJECTIVE: This prospective comparative study aimed to investigate the expression of PPARγ in MF and compare it with psoriatics and controls in a trial to deduce its possible role in MF. Also, we tried to clarify the relation between PPARγ and Bcl-2 in MF. METHODS: Twenty MF patients, 20 psoriatic patients and 20 controls were included. All participants underwent a skin biopsy, and immunohistochemical staining for both PPARγ and Bcl-2 were performed. Western blot analysis was performed for detection of both PPARγ and Bcl-2. RESULTS: The mean area per cent of PPARγ measured in the MF patients (57.1217±9.502417) was significantly higher (P<0.001) when compared with that of both the psoriatics (2.989±1.723) and controls (35.9357±8.1789). The mean area per cent of Bcl-2 in MF patients (9.3763±6.6328) was significantly higher (P<0.001) than that of both the psoriatics (2.35±1.35) and the controls (0.73105±0.5302)]. Our results were confirmed using the western blot analysis. We detected a highly significant positive correlation between the PPARγ and Bcl-2 mean area per cents in all patients. In our MF patients, both parameters were also positively correlated with the age of the patient, duration and stage of MF (P<0.05). CONCLUSION: Our data suggest a possible role for PPARγ in the pathogenesis of MF possibly through several mechanisms, one of which might be conferring upon the lymphoma cells, a survival advantage at least partially through up regulating Bcl-2.

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OBJECTIVE: To compare the effect of two different types of short text message service (SMS-text) reminders on the uptake of screening mammogram. METHODS: A randomized controlled trial was conducted in 2010 among females aged between 40 and 75, benefiting from the Health Insurance Plan at the American University of Beirut, whose cell phone numbers were available in their electronic medical records, and who did not do a mammogram in the past 2 years. The sample (n=385) was randomly divided into two subgroups. The first subgroup (n1=192) received a general SMS-text inviting its members to do a mammogram while the second subgroup (n2=193) received an additional informative SMS-text informing them about the benefits of mammogram screening. RESULTS: 30.7% (59) of subgroup 1 and 31.6% (61) of subgroup 2 underwent a mammogram screening test during the 6 months follow up interval post-intervention (Chi-square test, p-value ≥ 0.05). There was no difference between the response rates in the two subgroups. CONCLUSION: A brief invitation SMS-text message for screening mammogram was found to be as effective as a detailed informative one.

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STUDY DESIGN: In vitro biomechanical study of cadaveric cervical spine. OBJECTIVE: To compare the rigidity of the cervical spine after anterior, posterior, and circumferential fixation after 1-level corpectomy, and evaluate the effects of the integrity of the facet capsules and posterior ligaments (PL). SUMMARY OF BACKGROUND DATA: Anterior cervical corpectomy is commonly used for decompression of the spinal canal in the treatment of different pathologic conditions. The effect of the integrity of the facet capsules and PLs on the biomechanical stability provided by anterior, posterior, or circumferential fixation following 1-level corpectomy has not been investigated. METHODS: Nine cadaveric cervical spines were potted rostrally at C2, and caudally at T1-T2, and were tested in 6 directions with pure moment application, in 5 conditions: In the intact spine, after a C5 corpectomy and anterior fixation, after anterior fixation and disruption of the C4-C5 and C5-C6 facet capsules and PL, after circumferential fixation, and after posterior fixation alone without anterior cage. Angular motion of C4 relative to C6 was measured. RESULTS: Despite C5 corpectomy, anterior grafting and plate fixation was more rigid than the intact spine with all loads in flexion, at loads of 0.5 Nm and 1.0 Nm in right axial rotation and right lateral bending, and at all loads in left lateral bending. Posterior ligamentous disruption increased motion in the coronal and axial planes, but not in the sagittal plane. Circumferential instrumentation resulted in a significant reduction in motion of the spine compared with anterior instrumentation in both the coronal and axial planes but not in the sagittal plane. Posterior fixation without anterior cage failed to limit cervical spine motion in the sagittal plane, but was restrictive in axial rotation and lateral bending when compared with circumferential fixation. CONCLUSION: After C5 corpectomy, with intact PLs and facet capsules, anterior instrumentation is sufficient for spinal stabilization as the resultant construct is more rigid than the intact state. In the presence of C5 corpectomy with PL and bilateral facet capsule disruption, anterior plus posterior instrumentation is more rigid than anterior instrumentation alone in the axial and coronal planes and more rigid than posterior instrumentation without anterior cage in the sagittal plane.

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Between March and August 2008 we undertook 2 cross-sectional surveys among 1375 residents of 3 randomly selected villages in the district of Gebiley in the North-West Zone, Somalia. We investigated for the presence of malaria infection and the period prevalence of self-reported fever 14 days prior to both surveys. All blood samples examined were negative for both species of Plasmodium. The period prevalence of 14-day fevers was 4.8% in March and 0.6% in August; the majority of fevers (84.4%) were associated with other symptoms including cough, running nose and sore throat; 48/64 cases had resolved by the day of interview (mean duration 5.4 days). Only 18 (37.5%) fever cases were managed at a formal health care facility: 7 within 24 hours and 10 within 24-72 hours of onset. None of the fevers were investigated for malaria; they were treated with antibiotics, antipyretics and vitamins.

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Psoriasis, vitiligo, and mycosis fungoides (MF) are among the most frequently treated dermatological diseases by photo(chemo)therapy. The objectives are to determine which photo (chemo) therapeutic modality could achieve the best response in the treatment of psoriasis, vitiligo, and MF. The design used in this study is retrospective analytical study. The study included 745 patients' records; 293 with psoriasis, 309 with vitiligo, and 143 with early MF, treated in the Phototherapy Unit, Dermatology Department, Kasr El-Aini Hospital, Cairo University by either psoralen and ultraviolet A (PUVA), narrow band ultraviolet B (NB-UVB), psoralen and narrow band UVB (P-NBUVB), broad band UVB (BB-UVB), or broad band UVA (BetaBeta-UVA). Data were retrieved from the computer database of the unit and statistically analyzed. In psoriasis, oral and topical PUVA and NB-UVB were found to be equally effective, whereas oral PUVA had significantly better results than both UVA and BB-UVB at the end of therapy. In generalized vitiligo, PUVA and P-NBUVB had significantly better results than NB-UVB alone. In early MF, there was no statistically significant difference between the response to oral PUVA and NB-UVB. PUVA and NB-UVB are good choices in patients with psoriasis and early stage MF, whereas PUVA appears the best choice in the treatment of vitiligo.

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OBJECTIVE: The indications and operative technique for a number of posterolateral approaches to the craniovertebral junction (CVJ) are reviewed. METHODS: The literature addressing posterolateral approaches to the CVJ is reviewed, and illustrative cases are presented. RESULTS: The far lateral approach and its variants, including the transcondylar, supracondylar, and paracondylar approaches, are an effective means of addressing intradural anterior and anterolateral CVJ lesions. These approaches provide exposure of the lower third of the clivus, the foramen magnum, and the upper cervical spine; do not cross contaminated regions; and enable a watertight dural closure to be performed. They are associated with minimal morbidity and usually do not significantly decrease the stability of the CVJ. CONCLUSION: All surgeons treating lesions of the CVJ should be familiar with the posterolateral approach and its modifications.

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