Lumbar total disc arthroplasty: outdated surgery or here to stay procedure? A systematic review of current literature

Background: The purpose of this study was to summarize the available evidence about total lumbar disc replacement (TDR), focusing our attention on four main topics: clinical and functional outcomes, comparison with fusion surgery results, rate of complications and influence on sagittal balance. Materials and methods: We systematically searched Pubmed, Embase, Medline, Medscape, Google Scholar and Cochrane library databases in order to answer our four main research questions. Effective data were extracted after the assessment of methodological quality of the trials. Results: Fifty-nine pertinent papers were included. Clinical and functional scores show statistically significant improvements, and they last at all time points compared to baseline. The majority of the articles show there is no significant difference between TDR groups and fusion groups. The literature shows similar rates of complications between the two surgical procedures. Conclusions: TDR showed significant safety and efficacy, comparable to lumbar fusion. The major advantages of a lumbar TDR over fusion include maintenance of segmental motion and the restoration of the disc height, allowing patients to find their own spinal balance. Disc arthroplasty could be a reliable option in the treatment of degenerative disc disease in years to come. Level of evidence: II

Vibration control in plates by uniformly distributed PZT actuators interconnected via electric networks

In this paper a novel device aimed at controlling the mechanical vibrations of plates by means of a set of electrically-interconnected piezoelectric actuators is described. The actuators are embedded uniformly in the plate wherein they connect every node of an electric network to ground, thus playing the two-fold role of capacitive element in the electric network and of couple suppliers. A mathematical model is introduced to describe the propagation of electro-mechanical waves in the device; its validity is restricted to the case of wave-forms with wave-length greater than the dimension of the piezoelectric actuators used. A self-resonance criterion is established which assures the possibility of electro-mechanical energy exchange. Finally the problem of vibration control in simply supported and clamped plates is addressed; the optimal net-impedance is determined. The results indicate that the proposed device can improve the performances of piezoelectric actuationComment: 22 page

What is the Current Evidence on Vertebral Body Osteonecrosis?: A Systematic Review of the Literature

Osteonecrosis (ON) is a clinical entity characterized by a pattern of cell death and complex process of bone resorption and formation. Studies related to ON have largely focused on certain anatomical sites; however, the evidence on vertebral body ON (VBON) is largely inconsistent and fragmented. The aim of this study was to clarify the pathophysiology, risk factors, imaging findings, and available treatment modalities for VBON. A systematic review of the relevant articles published in English was performed using PubMed, Embase, Medline, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases. A total of 81 articles were included in this study. Three main topics about VBON were identified: (1) pathophysiology and risk factors, (2) diagnosis, and (3) treatment. Forty-five studies were based on the pathophysiology, 52 on diagnosis, and 38 on the treatment options for VBON. The literature on VBON was limited and mainly focused on post-traumatic cases with a considerable overlap with nonunion and pseudoarthrosis

Arachnoiditis ossificans, isthmic spondylolisthesis and pseudomeningocele. A rare clinical scenario

The combination of arachnoiditis ossificans, isthmic spondylolisthesis and calcific pseudomeningocele is an extremely unusual condition. In the current literature, there is no previous report of this intricate clinical scenario, and therefore there are no clear indications on the best treatment. In the reported surgical case, the excision of calcific pseudomeningocele, L4 bilateral laminectomy and foraminotomy and posterolateral fusion were performed. L4L5 interbody fusion was aborted for impossibility of neural elements mobilization and a consequent intraoperative dural tear. The aims of the adopted surgical procedure are the decompression of neural elements and the stability due to bone fusion

Smart textile for respiratory monitoring and thoraco-abdominal motion pattern evaluation

The use of wearable systems for monitoring vital parameters has gained wide popularity in several medical fields. The focus of the present study is the experimental assessment of a smart textile based on 12 fiber Bragg grating sensors for breathing monitoring and thoraco‐abdominal motion pattern analysis. The feasibility of the smart textile for monitoring several temporal respiratory parameters (ie, breath‐by‐breath respiratory period, breathing frequency, duration of inspiratory and expiratory phases), volume variations of the whole chest wall and of its compartments is performed on 8 healthy male volunteers. Values gathered by the textile are compared to the data obtained by a motion analysis system, used as the reference instrument. Good agreement between the 2 systems on both respiratory period (bias of 0.01 seconds), breathing frequency (bias of −0.02 breaths/min) and tidal volume (bias of 0.09 L) values is demonstrated. Smart textile shows good performance in the monitoring of thoraco‐abdominal pattern and its variation, as well

Effectiveness of a Preventative Program for Groin Pain Syndrome in Elite Youth Soccer Players: A Prospective, Randomized, Controlled, Single-Blind Study

: Groin pain syndrome (GPS) is a prevalent issue in soccer. This study assessed the effectiveness of a new preventive protocol on GPS for youth soccer players. The protocol included targeted stretching and strengthening exercises for the adductor and core muscles from preseason to midseason. A questionnaire and two pain provocation tests were used for the evaluation. Mild GPS required positive results in at least two evaluations, while severe GPS was associated with pain incompatible with engagement in any activity confirmed by diagnostic ultrasound. Forty-two elite male athletes (aged 16.9 ± 0.7 years) participated in the study, with half of them assigned to the usual training (control group) and the remaining athletes undergoing the preventive protocol (treatment group) for 24 weeks. GPS rates were 14.3% (three diagnoses: two mild, one severe) in the treatment group and 28.6% (six diagnoses: three mild, three severe) in the control group. Toward the end of the season, three players, one from the treatment group and two from the control group had to stop playing due to severe GPS problems. In addition, one player in the control group stopped midseason. Even though the reduction in the risk of developing GPS was not significant (relative risk of 0.50 ([95%CI 0.14 to 1.74], p = 0.2759), the halved incidence of severe GPS and the increased muscle strength related to the treatment (p = 0.0277) are encouraging data for future studies

Roma: Oltre le baraccopoli: Agenda politica per ripartire dalle periferie dimenticate

Con il presente documento, presentato in vista delle elezioni comunali che si svolgeranno a Roma nel 2016, l’Associazione 21 luglio vuole proporre alle forze politiche e ai candidati a cariche elettive i principi essenziali per mutare radicalmente le politiche verso gli abitanti delle baraccopoli e dei micro insediamenti presenti nella Capitale. Le azioni previste nel documento hanno come obiettivo, nell’arco temporale di 5 anni: la chiusura graduale e progressiva delle baraccopoli e dei micro insediamenti della Capitale e il superamento dei centri di raccolta dove sono concentrate le famiglie vittime degli sgomberi che nel passato hanno coinvolto abitanti di numerose baraccopoli. “Roma: oltre le baraccopoli” si avvale degli studi condotti dall’Associazione 21 luglio e, nell’ultima parte, del prezioso apporto del prof. Tommaso Vitale, Sciences Po (Université Sorbonne Paris Cité)1. Il testo condivide medesimi principi e metodi riportati all’interno della “Delibera di iniziativa popolare per il superamento dei campi rom”, promossa da nove associazioni2 e sottoscritta da oltre 6.000 cittadini, depositata in Campidoglio l’11 settembre 2015

Consensus based recommendations for diagnosis and medical management of Poland syndrome (sequence)

Background Poland syndrome (OMIM: 173800) is a disorder in which affected individuals are born with missing or underdeveloped muscles on one side of the body, resulting in abnormalities that can affect the chest, breast, shoulder, arm, and hand. The extent and severity of the abnormalities vary among affected individuals. Main body The aim of this work is to provide recommendations for the diagnosis and management of people affected by Poland syndrome based on evidence from literature and experience of health professionals from different medical backgrounds who have followed for several years affected subjects. The literature search was performed in the second half of 2019. Original papers, meta-analyses, reviews, books and guidelines were reviewed and final recommendations were reached by consensus. Conclusion Being Poland syndrome a rare syndrome most recommendations here presented are good clinical practice based on the consensus of the participant experts

Extracorporeal life support in mitral papillary muscle rupture: Outcome of multicenter study

Background: Post-acute myocardial infarction papillary muscle rupture (post-AMI PMR) may present variable clinical scenarios and degree of emergency due to result of cardiogenic shock. Veno-arterial extracorporeal life support (V-A ECLS) has been proposed to improve extremely poor pre- or postoperative conditions. Information in this respect is scarce.Methods: From the CAUTION (meChanical complicAtion of acUte myocardial infarcTion: an InternatiOnal multiceNter cohort study) database (16 different Centers, data from 2001 to 2018), we extracted adult patients who were surgically treated for post-AMI PMR and underwent pre- or/and postoperative V-A ECLS support. The end-points of this study were in-hospital survival and ECLS complications.Results: From a total of 214 post-AMI PMR patients submitted to surgery, V-A ECLS was instituted in 23 (11%) patients. The median age was 61.7 years (range 46-81 years). Preoperatively, ECLS was commenced in 10 patients (43.5%), whereas intra/postoperative in the remaining 13. The most common V-A ECLS indication was post-cardiotomy shock, followed by preoperative cardiogenic shock and cardiac arrest. The median duration of V-A ECLS was 4 days. V-A ECLS complications occurred in more than half of the patients. Overall, in-hospital mortality was 39.2% (9/23), compared to 22% (42/219) for the non-ECLS group.Conclusions: In post-AMI PMR patients, V-A ECLS was used in almost 10% of the patients either to promote bridge to surgery or as postoperative support. Further investigations are required to better evaluate a potential for increased use and its effects of V-A ECLS in such a context based on the still high perioperative mortality

Septic AKI in ICU patients. diagnosis, pathophysiology, and treatment type, dosing, and timing: a comprehensive review of recent and future developments

Evidence is accumulating showing that septic acute kidney injury (AKI) is different from non-septic AKI. Specifically, a large body of research points to apoptotic processes underlying septic AKI. Unravelling the complex and intertwined apoptotic and immuno-inflammatory pathways at the cellular level will undoubtedly create new and exciting perspectives for the future development (e.g., caspase inhibition) or refinement (specific vasopressor use) of therapeutic strategies. Shock complicating sepsis may cause more AKI but also will render treatment of this condition in an hemodynamically unstable patient more difficult. Expert opinion, along with the aggregated results of two recent large randomized trials, favors continuous renal replacement therapy (CRRT) as preferential treatment for septic AKI (hemodynamically unstable). It is suggested that this approach might decrease the need for subsequent chronic dialysis. Large-scale introduction of citrate as an anticoagulant most likely will change CRRT management in intensive care units (ICU), because it not only significantly increases filter lifespan but also better preserves filter porosity. A possible role of citrate in reducing mortality and morbidity, mainly in surgical ICU patients, remains to be proven. Also, citrate administration in the predilution mode appears to be safe and exempt of relevant side effects, yet still requires rigorous monitoring. Current consensus exists about using a CRRT dose of 25 ml/kg/h in non-septic AKI. However, because patients should not be undertreated, this implies that doses as high as 30 to 35 ml/kg/h must be prescribed to account for eventual treatment interruptions. Awaiting results from large, ongoing trials, 35 ml/kg/h should remain the standard dose in septic AKI, particularly when shock is present. To date, exact timing of CRRT is not well defined. A widely accepted composite definition of timing is needed before an appropriate study challenging this major issue can be launched