The value of fusion imaging (PET – CT) in the diagnosis of vertebral and spinal tumors

Fusion imaging (PET/CT), widely used in the developed countries, allows the identification of different lesions at the molecular level, enabling the emergence of a new field of advanced medicine - "molecular imaging". For example, marking with a radiotrasor of a nucleic acid chain component allows the identification of the cancer at the molecular level and its treatment by radioimuno - scintigraphic techniques. Having a great sensitivity in the early detection of some lesions in a wide spectrum of pathology, Nuclear Medicine procedures are much sought by the clinicians

Role of Nutraceuticals in Modulation of Gut-Brain Axis in Elderly Persons

A rather new and somewhat unusual concept connects brain functions to gut microbiota. It is called “gut-brain axis” (or “microbiota-gut-brain axis”) and states that probiotics consumption and a healthy gut microbiota positively influence brain functions related to behavior and cognition. Synergistic with a low chronic grade peripheral inflammation, this faulty barrier exposes the aged brain to negative extra-cerebral signals. Given the quasi-constant failure of pharmacological treatments in neurodegenerative diseases, increased interest is directed toward allopathic medicine, including dietary supplements. Interplay between gut microbiota and central nervous system by immune, neural and metabolic pathways is being explored as a possible modulator of cognitive impairment and behavior disorders. In elderly persons, this axis has been reported to be altered, contributing to systemic inflammation and was also indicated as a possible marker for early frailty in younger population. Currently, there are several clinical trials addressing the relationship between gut microbiota and central nervous system psychiatric disorders and at least one directly investigating whether there is a correlation between composition of gut microbiome, permeability of intestinal barrier and systemic inflammation in patients with dementia. This chapter discusses evidence-based data on positive modulation of gut-brain axis to alleviate behavior and cognition alterations in the elderly

The sub-seasonal to seasonal prediction (S2S) project database

A database containing sub-seasonal to seasonal forecasts from 11 operational centres is available to the research community and will help advance our understanding of the sub-seasonal to seasonal time range. Demands are growing rapidly in the operational prediction and applications communities for forecasts that fill the gap between medium-range weather and long-range or seasonal forecasts. Based on the potential for improved forecast skill at the sub-seasonal to seasonal time range, a sub-seasonal prediction (S2S) research project has been established by the World Weather Research Program/World Climate Research Program. A main deliverable of this project is the establishment of an extensive database, containing sub-seasonal (up to 60 days) forecasts, 3-weeks behind real-time, and reforecasts from 11 operational centers, modelled in part on the THORPEX Interactive Grand Global Ensemble (TIGGE) database for medium range forecasts (up to 15 days). The S2S database, available to the research community since May 2015, represents an important tool to advance our understanding of the sub-seasonal to seasonal time range that has been considered for a long time as a “desert of predictability”. In particular, this database will help identify common successes and shortcomings in the model simulation and prediction of sources of sub-seasonal to seasonal predictability. For instance, a preliminary study suggests that the S2S models underestimate significantly the amplitude of the Madden Julian Oscillation (MJO) teleconnections over the Euro-Atlantic sector. The S2S database represents also an important tool for case studies of extreme events. For instance, a multi-model combination of S2S models displays higher probability of a landfall over Vanuatu islands 2 to 3 weeks before tropical cyclone Pam devastated the islands in March 2015

Patient Specific Instruments for Complex Tumor Resection-Reconstruction Surgery within the Pelvis: A Series of 4 Cases.

The pelvis bone resection-reconstruction surgery is one of the most challenging fields in orthopedics. Being applied for tumors, as for other complex reconstruction cases, this type of surgery needs careful planning and is time consuming, in order to obtain proper accuracy. Unfortunately not all the time the expected accuracy is met, with consequences for the patients. PSI proved to provide good cutting accuracy during simulated tumor surgery within the pelvis. This article present a series of 4 patients operated in our department between June 2014 and Mars 2015 for tumors resectionreconstructions. The patients were imaged using a CT and an MRI scan and the images were reconstructed in 3D. According to the bone bank stock, the most similar allograft was chosen and the stored CT scan was reconstructed in 3D. Patient specific instruments (PSI) were designed and manufactured using rapid-prototyping technology for the resection of the native tissues as for the resection of the careful selected hemipelvic allografts. Allografts fitting to the pelvis of the patients was excellent and allowed stable osteosynthesis.Instrumente specifice utilizate în chirurgia complexã a tumorilor (rezecåia – reconstrucåia) situate în pelvis: o serie de 4 cazuri Chirurgia de rezecåie-reconstrucåie la nivelul pelvisului este una dintre cele mai dificile ramuri ale ortopediei. Aplicatã pentru rezecåiile tumorale, cât æi pentru cazurile complexe de reconstrucåie, acest tip de chirurgie necesitã planificare atentã æi este de lungã duratã, totul pentru a obåine acurateåe maximã. Când rezecåia nu este precisã consecinåele pentru pacient sunt grave. Tehnologia PSI (patient specific instrument) s-a dovedit a fi precisã în timpul rezecåiilor tumorale simulate, de la nivelul pelvisului. Acest articol prezintã o serie de 4 pacienåi operaåi la Cliniques Universitaires St. Luc între Iunie 2014 æi Martie 2015 pentru rezecåii-reconstrucåii tumorale. Pacienåii au fost investigaåi cu Ct æi RMN, iar imaginile au fost reconstruite 3D. Din stocul bãncii de os a fost aleasã cea mai apropiatã allogrefã ca formã æi dimensiune, iar imaginile CT stocate au fost reconstruite 3D. S-au conceput æi imprimat ghiduri de taiere specifice pacientului folosind tehnologia Rapid-Prototyping, pentru rezecåia åesutului nativ cât æi pentru rezecåia allogrefei de hemipelvis atent selectatã. Implantarea alogrefelor s-a fãcut cu potrivire exactã æi a permis osteosinteza stabil

The ACL Fixation

ACL rupture frequently occurs due to a pivotal movement between the tibia and femur. In lack of reconstruction surgery of the ligament, osteoarthritis appears. The ACL graft can be fitted through different systems: compression, expansion and suspension. Although different in technique, the clinical end-results show little differences

Anterolateral Ligament (ALL) — Myth or Reality?

Although the anterolateral ligament (ALL) was described a long time ago, recent research shows a lot of interest regarding this structure. There is a high variability concerning its anatomy, especially its capsular/extracapsular situation and insertion sites. There is also some controversy about its ligamentous structure. It seems that it has a biomechanical role in restricting anterior tibial translation and internal rotation. The ALL complex seems to have a clinical significance, and a relationship with the pivot shift has been described. Although there are promising results recently, the surgical techniques of ALL reconstruction, in addition to anterior cruciate ligament reconstruction, have to be further investigated. A precise indication algorithm and patient selection criteria need to be established

Primary Anterior Cruciate Ligament Reconstruction. How Do We Do It?

Anterior cruciate ligament (ACL) tears are frequently seen in current practice mostly affecting the young, active subjects, and usually require ligament reconstruction in order to restore normal knee kinematics. As worldwide interest in anatomic reconstruction grew over the last decade, we have also refined our technique in order to restore the anatomical function as near to the normal as possible. This anatomical restoration concept is believed to prevent the onset of osteoarthritis, which the non-anatomic reconstructions fail to attain. The knowledge gained from the ACL anatomy, function and kinematics has helped in developing the current anatomic methods of reconstruction, which take into account patient anatomy, the rupture pattern, as well as the comorbidities. We present our approach to anatomical single- and double-bundle ACL reconstruction

ACL Surgical Technique — Staying Out of Trouble

The incidence of ACL tear and reconstruction has increased over time, and failure of ACL reconstruction is not perfectly defined among surgeons. Atraumatic failure of ACL surgery represents approximately 70% of causes, and occurs in diagnostic errors, technical errors and problems of ACL graft integrations. Regarding surgical technique, we should answer certain questions about our choice of surgery, tunnel position, graft type, graft suture, tensioning the graft, and how we deal with certain incidents or intraoperative accidents. The purpose of this article is to review the current information and trends of ACL reconstruction, and presents some tips and tricks we use in our current practice

Novel Surgical Technique for Bone Marrow Lesion — Case Report

Introduction: Bone marrow lesions (BMLs) are commonly described as magnetic resonance imaging (MRI) findings associated with stress injuries or trauma. The presence of BMLs closely correlates with pain and rapid joint deterioration. Case presentation: A 51-year-old healthy man presented to our clinic with severe knee pain due to BMLs. After 3 months of conservative treatment, arthroscopy and subchondroplasty (SCP) of the medial femoral condyle was performed. The IKDC (International Knee Documentation Committee) score improved from 39.9 to 66.7 at 6 months, and to 87.4 at 1 year after surgery. The KOOS (Knee Injury and Osteoarthritis Outcome) score improved from 38.5 to 77.7 at 6 months, and to 92.6 at 1 year after surgery. The Tegner Lysholm score improved from 23 to 80 at 6 months, and to 95 at 1 year after surgery. Conclusion: SCP may provide a viable approach to reduce pain associated with BML, with minimal risk of significant complications

ACL Surgical Technique — Staying Out of Trouble

The incidence of ACL tear and reconstruction has increased over time, and failure of ACL reconstruction is not perfectly defined among surgeons. Atraumatic failure of ACL surgery represents approximately 70% of causes, and occurs in diagnostic errors, technical errors and problems of ACL graft integrations. Regarding surgical technique, we should answer certain questions about our choice of surgery, tunnel position, graft type, graft suture, tensioning the graft, and how we deal with certain incidents or intraoperative accidents. The purpose of this article is to review the current information and trends of ACL reconstruction, and presents some tips and tricks we use in our current practice