Multilevel non-contiguous thoracic pedicle subtraction osteotomy for fixed rounded hyperkyphotic deformity of the thoraco-lumbar junction with anterior bony fusion: technical note

Background: Fixed severe hyperkyphotic deformities spread over more than five vertebral levels represent a therapeutic challenge, especially when the deformity apex is located at the thoraco-lumbar junction, thus requiring a huge amount of correction. The aim of this article is to describe an innovative all-posterior corrective technique based on multilevel non-contiguous thoracic pedicle subtraction ostoeotomy (PSO). Materials and methods: A retrospective review of three patients with fixed severe thoracic hyperkyphosis (a deformity angle of over 70°) with a thoraco-lumbar apex (between T11 and L1) treated by simultaneous two-level thoracic PSO and thoraco-lumbar posterior fusion was performed. Radiographic and clinical records were evaluated pre-operatively, post-operatively and at last follow-up (after a minimum of 2 years). Each variable was presented as mean ± SD (standard deviation). Statistical analyses were performed using paired t-tests (P value < 0.05 was considered significant). Results: The mean local deformity angle decreased by 75% (from 81.3° ± 2.1° to 20.7° ± 1.4°, p < 0.001), the post-operative thoracic kyphosis decreased by 46% (from 61.4° ± 2.4° to 33.2° ± 0.9°, p < 0.001) and the sagittal vertical axis decreased by 73% (from 14.7 cm ± 0.8 cm to 3.9 cm ± 0.3 cm, p < 0.001). No differences were observed in the radiological results between post-operative values and those at the final follow-up. The average Oswestry Disability Index (ODI) score reduced from 65.7 ± 1.8 pre-operatively to 17.3 ± 1.7 at last follow-up (p < 0.001). No neurological, mechanical nor infective complication occurred. Conclusions: The presented technique, although technically demanding, proved to be a safe and effective alternative for the management of fixed severe thoraco-lumbar junction hyperkyphotic deformities. Level of evidence: IV TRIAL REGISTRATION Retrospectively registered

Surgical treatment of severe adolescent idiopathic scoliosis through one-stage posterior-only approach: A systematic review and meta-analysis

: The aim of this meta-analysis was to analyze the results of one-stage all-posterior spinal fusion for severe adolescent idiopathic scoliosis (AIS). A systematic search of articles about one-stage posterior spinal fusion for severe AIS was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data about population, pre-and postoperative radiographical data, surgical procedure details, and complications were extracted. Meta-analyses were performed when possible. Fourteen studies (640 patients) were included. The mean Cobb angle of the major curve varied from 80.0 ± 7.3 to 110.8 ± 12.1. The meta analysis showed a comprehensive coronal correction rate of the major curve of 58.6%, a comprehensive operative time of 274.5 min, and a comprehensive estimated intraoperative blood loss of 866.5 mL (95% confidence interval: 659.3-1073.6, I 2 ≈ 0%). A total of 48 complications (5.4%) were reported. Overall, the meta-analysis showed a major complication rate of 4%. In seven cases, revision surgery was needed. Posterior-only approach is effective enough to correct severe curves and can spare the patient possible adverse events due to anterior approach. However, when choosing this approach for severe AIS, screw density needs to be high and posterior column osteotomies may need to be planned to mobilize the spine and maximize correction

Sharing Circulating Micro-RNAs between Osteoporosis and Sarcopenia: A Systematic Review

Background: Osteosarcopenia, a combination of osteopenia/osteoporosis and sarcopenia,is a common condition among older adults. While numerous studies and meta-analyses have beenconducted on osteoporosis biomarkers, biomarker utility in osteosarcopenia still lacks evidence. Here,we carried out a systematic review to explore and analyze the potential clinical of circulating microR-NAs (miRs) shared between osteoporosis/osteopenia and sarcopenia. Methods: We performed asystematic review on PubMed, Scopus, and Embase for differentially expressed miRs (p-value < 0.05)in (i) osteoporosis and (ii) sarcopenia. Following screening for title and abstract and deduplication,83 studies on osteoporosis and 11 on sarcopenia were identified for full-text screening. Full-textscreening identified 54 studies on osteoporosis, 4 on sarcopenia, and 1 on both osteoporosis andsarcopenia. Results: A total of 69 miRs were identified for osteoporosis and 14 for sarcopenia. Therewere 9 shared miRs, with evidence of dysregulation (up- or down-regulation), in both osteoporo-sis and sarcopenia: miR-23a-3p, miR-29a, miR-93, miR-133a and b, miR-155, miR-206, miR-208,miR-222, and miR-328, with functions and targets implicated in the pathogenesis of osteosarcopenia.However, there was little agreement in the results across studies and insufficient data for miRsin sarcopenia, and only three miRs, miR-155, miR-206, and miR-328, showed the same directionof dysregulation (down-regulation) in both osteoporosis and sarcopenia. Additionally, for mostidentified miRs there has been no replication by more than one study, and this is particularly true forall miRs analyzed in sarcopenia. The study quality was typically rated intermediate/high risk of bias.The large heterogeneity of the studies made it impossible to perform a meta-analysis. Conclusions:The findings of this review are particularly novel, as miRs have not yet been explored in the context ofosteosarcopenia. The dysregulation of miRs identified in this review may provide important clues tobetter understand the pathogenesis of osteosarcopenia, while also laying the foundations for furtherstudies to lead to effective screening, monitoring, or treatment strategies (PDF) Sharing Circulating Micro-RNAs between Osteoporosis and Sarcopenia: A Systematic Review. Available from: https://www.researchgate.net/publication/368667300_Sharing_Circulating_Micro-RNAs_between_Osteoporosis_and_Sarcopenia_A_Systematic_Review [accessed Feb 26 2023]

One stage correction via the Hi-PoAD technique for the management of severe, stiff, adolescent idiopathic scoliosis curves > 90°

Study design: Retrospective cohort study. Purpose: to assess the efficacy and safety of Hi-PoAD technique in patients with a major thoracic curve > 90°, < 25% of flexibility and deformity spread over more than five vertebral levels. Methods: retrospective review of AIS patients with a major thoracic curve (Lenke 1-2-3) > 90°, with < 25% of flexibility and deformity spread over more than five vertebral levels. All were treated via the Hi-PoAD technique. Radiographic and clinical score data were collected pre-operatively, operatively, at 1 year, 2 years and at last follow-up (2 years minimum). Results: 19 patients were enrolled. A 65.0% correction rate of the main curve was achieved, from 101.9° to 35.7° (p < 0.001). The AVR reduced from 3.3 to 1.3. The C7PL/CSVL reduced from 1.5 to 0.9 cm (p = 0.013). Trunk Height increased from 31.1 to 37.0 cm (p < 0.001). At the final follow-up no significant changes, except from an improvement in C7PL/CSVL (from 0.9 cm to 0.6 cm; p = 0.017). SRS-22 increased in all patients, from 2.1 to 3.9 at 1 year of follow-up (p < 0.001). 3 patients had a transient drop of MEP and SEP during maneuver and were managed with temporary rods and a second surgery after 5 days. 2 of these 3 cases (66.7%) had a Total-Deformity Angular Ratio (T-DAR) > 25; conversely, among patients who had a one-stage procedure, only 1 (6.2%) had a T-DAR > 25 (p = 0.008). Conclusions: The Hi-PoAD technique proved to be a valid alternative for the treatment of severe, rigid AIS involving more than 5 vertebral bodies. Study design: Retrospective comparative cohort study. Level of evidence: III

Return to sport after posterior spinal fusion for adolescent idiopathic scoliosis: what variables actually have an influence? A retrospective study

Purpose To retrospectively evaluate a cohort of athletically active patients who underwent surgery for adolescent idiopathic scoliosis (AIS), and to determine which clinical, surgical and anthropometric variables influenced their return to sport after surgery. Methods 112 adolescents who underwent high-density posterior fusion for AIS by a single surgeon were analyzed for clinical, surgical and demographic predictors of return to presurgical physical activity levels. Data were retrospectively collected by charts and X-rays analysis and patients interviews. Results Preoperative main curve Cobb was 64.4 +/- 14.12 degrees and obtained correction was 70.0 +/- 12.5%. Included patients played many different sports (Table 4), most of all ballet (44/112, 39.2%), swimming (40/112, 35.7%) and gymnastics (32/112, 28.6%). At an average of 50.3 months follow-up, 76 (67.8%) patients returned to sports (RTS) at an equal or higher level than preoperatively. Younger age, lower Lenke curve type and lower main curve Cobb were significantly associated with RTS. As for RTS timing, patients who returned within the first 6 months were younger, with a higher Lenke and a less severe main curve, a more distal UIV and a more proximal LIV. No complications related to RTS were registered. Conclusion In conclusion, patients with adolescent idiopathic scoliosis safely returned to physical activity after surgery. Younger age, higher Lenke type and lower main curve severity predicted a quicker return to sport. However, prospective studies are needed to confirm these findings

Epigenetic Factors Related to Low Back Pain: A Systematic Review of the Current Literature

: Low back pain (LBP) is one of the most common causes of pain and disability. At present, treatment and interventions for acute and chronic low back pain often fail to provide sufficient levels of pain relief, and full functional restoration can be challenging. Considering the significant socio-economic burden and risk-to-benefit ratio of medical and surgical intervention in low back pain patients, the identification of reliable biomarkers such as epigenetic factors associated with low back pain could be useful in clinical practice. The aim of this study was to review the available literature regarding the epigenetic factors associated with low back pain. This review was carried out in accordance with Preferential Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was carried out in October 2022. Only peer-reviewed articles were considered for inclusion. Fourteen studies were included and showed promising results in terms of reliable markers. Epigenetic markers for LBP have the potential to significantly modify disease management. Most recent evidence suggests that epigenetics is a more promising field for the identification of factors associated with LBP, offering a rationale for further investigation in this field with the long-term goal of finding epigenetic biomarkers that could constitute biological targets for disease management and treatment

Mechanobiology of the Human Intervertebral Disc: Systematic Review of the Literature and Future Perspectives

: Low back pain is an extremely common condition with severe consequences. Among its potential specific causes, degenerative disc disease (DDD) is one of the most frequently observed. Mechanobiology is an emerging science studying the interplay between mechanical stimuli and the biological behavior of cells and tissues. The aim of the presented study is to review, with a systematic approach, the existing literature regarding the mechanobiology of the human intervertebral disc (IVD), define the main pathways involved in DDD and identify novel potential therapeutic targets. The review was carried out in accordance with the Preferential Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were included if they described biological responses of human IVD cells under mechanical stimulation or alterations of mechanical properties of the IVD determined by different gene expression. Fifteen studies were included and showed promising results confirming the mechanobiology of the human IVD as a key element in DDD. The technical advances of the last decade have allowed us to increase our understanding of this topic, enabling us to identify possible therapeutic targets to treat and to prevent DDD. Further research and technological innovations will shed light on the interactions between the mechanics and biology of the human IVD

Simultaneous Selective Thoracic Fusion of Lenke-1C Scoliosis and Reduction of Symptomatic Spondylolisthesis: A Case Report

The combined treatment of unrelated Lenke-1C curves and spondylolisthesis represents a challenge: The two arthrodesis areas must achieve corrections while preserving mobility as much as possible. We reported a case of 20-year-old girl with Lenke-1C scoliosis and Meyerding grade-2 symptomatic L5-S1 isthmic spondylolisthesis. She was treated with one-stage correction with T3-T12 posterior selective thoracic fusion (STF) associated to reduction and fusion of the spondylolisthesis. Pre-op Cobb angle of the main thoracic (MT) curve was 62°. The non-structural lumbar (L) curve was 52°. Coronal imbalance was 39 mm. 1-month post-op X-ray showed a reduction of MT-curve to 32° and L-curve to 24°. The coronal imbalance was 13 mm. A satisfactory sagittal alignment and olisthesis reduction were achieved. At 24-months follow-up, L-curve increased to 30°. Coronal imbalance was 24 mm. Loss of correction appeared stable at 36-months final follow-up. Although the evidence cautiously suggests STF to treat also Lenke-1C scoliosis, this case confirmed that the risk of worsening coronal decompensation exists, and it is possibly increased by a distal lumbar arthrodesis to treat spondylolisthesis. However, we believe that STF is justified as worsening L-curve does not balance the possibility of preserving motility of the lumbar tract, also because the need for revision is an uncommon event

Underground Measurements of Nuclear Reaction Cross-Sections Relevant to AGB Stars

none14noneAnanna, Chemseddine; Barile, Francesco; Boeltzig, Axel; Bruno, Carlo Giulio; Cavanna, Francesca; Ciani, Giovanni Francesco; Compagnucci, Alessandro; Csedreki, Laszlo; Depalo, Rosanna; Ferraro, Federico; Masha, Eliana; Piatti, Denise; Rapagnani, David; Skowronski, JakubAnanna, Chemseddine; Barile, Francesco; Boeltzig, Axel; Bruno, Carlo Giulio; Cavanna, Francesca; Ciani, Giovanni Francesco; Compagnucci, Alessandro; Csedreki, Laszlo; Depalo, Rosanna; Ferraro, Federico; Masha, Eliana; Piatti, Denise; Rapagnani, David; Skowronski, Jaku

Targeted quantitative metabolic profiling of brain-derived cell cultures by semi-automated MEPS and LC-MS/MS

The accurate characterisation of metabolic profiles is an important prerequisite to determine the rate and the efficiency of the metabolic pathways taking place in the cells. Changes in the balance of metabolites involved in vital processes such as glycolysis, tricarboxylic acid (TCA) cycle, oxidative phosphorylation (OXPHOS), as well as in the biochemical pathways related to amino acids, lipids, nucleotides, and their precursors reflect the physiological condition of the cells and may contribute to the development of various human diseases. The feasible and reliable measurement of a wide array of metabolites and biomarkers possesses great potential to elucidate physiological and pathological mechanisms, aid preclinical drug development and highlight potential therapeutic targets. An effective, straightforward, sensitive, and selective liquid chromatography-tandem mass spectrometry (LC-MS/MS) approach was developed for the simultaneous quali-quantitative analysis of 41 compounds in both cell pellet and cell growth medium obtained from brain-derived cell cultures. Sample pretreatment miniaturisation was achieved thanks to the development and optimisation of an original extraction/purification approach based on digitally programmed microextraction by packed sorbent (eVol®-MEPS). MEPS allows satisfactory and reproducible clean-up and preconcentration of both low-volume homogenate cell pellet lysate and cell growth medium with advantages including, but not limited to, minimal sample handling and method sustainability in terms of sample, solvents, and energy consumption. The MEPS-LC-MS/MS method showed good sensitivity, selectivity, linearity, and precision. As a proof of concept, the developed method was successfully applied to the analysis of both cell pellet and cell growth medium obtained from a line of mouse immortalised oligodendrocyte precursor cells (OPCs; Oli-neu cell line), leading to the unambiguous determination of all the considered target analytes. This method is thus expected to be suitable for targeted, quantitative metabolic profiling in most brain cell models, thus allowing accurate investigations on the biochemical pathways that can be altered in central nervous system (CNS) neuropathologies, including e.g., mitochondrial respiration and glycolysis, or use of specific nutrients for growth and proliferation, or lipid, amino acid and nucleotide metabolism