SHARC: Space Habitat, Assembly and Repair Center

Integrated Space Systems (ISS) has taken on the task of designing a Space Habitat, Assembly and Repair Center (SHARC) in Low Earth Orbit to meet the future needs of the space program. Our goal is to meet the general requirements given by the 1991/1992 AIAA/LORAL Team Space Design competition with an emphasis on minimizing the costs of such a design. A baseline structural configuration along with preliminary designs of the major subsystems was created. Our initial mission requirements, which were set by AIAA, were that the facility be able to: support simultaneous assembly of three major vehicles; conduct assembly operations and minimal extra vehicular activity (EVA); maintain orbit indefinitely; and assemble components 30 feet long with a 10 foot diameter in a shirtsleeve environment

New classification for the treatment of pyogenic spondylodiscitis: validation study on a population of 250 patients with a follow-up of 2 years

Purpose: Pyogenic spondylodiscitis (PS) is still burdened by a high rate of orthopedic and neurological complications. Despite the rising incidence, the choice of a proper orthopedic treatment is often delayed by the lack of clinical data. The aim of this study was to propose a clinical-radiological classification of pyogenic spondylodiscitis to define a standard treatment algorithm. Methods: Based on data from 250 patients treated from 2008 to 2015, a clinical-radiological classification of pyogenic spondylodiscitis was developed. According to primary classification criteria (bone destruction or segmental instability, epidural abscesses and neurological impairment), three main classes were identified. Subclasses were defined according to secondary criteria. PS without segmental instability or neurological impairment was treated conservatively. When significant bone loss or neurological impairment occurred, surgical stabilization and/or decompression were performed. All patients underwent clinical and radiological 2-year follow-up. Results: Type A PS occurred in 84 patients, while 46 cases were classified as type B and 120 as type C. Average time of hospitalization was 51.94 days and overall healing rate was 92.80%. 140 patients (56.00%) were treated conservatively with average time of immobilization of 218.17 ± 9.89 days. Both VAS and SF-12 scores improved across time points in all classes. Residual chronic back pain occurred in 27 patients (10.80%). Overall observed mortality was 4.80%. Conclusions: Standardized treatment of PS is highly recommended to ensure patients a good quality of life. The proposed scheme includes all available orthopedic treatments and helps spine surgeons to significantly reduce complications and costs and to avoid overtreatment

Space Habitat, assembly and repair facility

Integrated Space Systems (ISS) has designed a Low Earth Orbit Assembly Facility for submission in the 1992 AIAA/LORAL Team Space Design Competition. This facility, the Space Habitat, Assembly, and Repair Center (SHARC), will be used to construct, assemble, and service space vehicles. SHARC's primary mission will be the construction of interplanetary vehicles, but it will also be able to perform repair and refueling operations of craft which are in an Earth orbit. This facility has been designed using only present and near-present technology. The emphasis is on minimizing cost

Constrained Spherical Deconvolution Tractography reveals a direct cerebello-ventro tegmental pathway in humans

Introduction. In addition to its role in motor control, reflex adaption and motor learning in the past years numerous studies demonstrated the role of the cerebellum in non-motor functions. Furthermore, lesional animal and neuroimaging in vivo human studies demonstrated connections of the cerebellum with brain regions involved in cognitive, emotional, motivation linguistic processing [1, 2]. Although, studies suggest the role of the cerebellum in neuropsychiatric disorders of the mesocorticolimbic structure (i.e. schizophrenia), at the present time the existence cerebello-ventro tegmental pathway has been demonstrated in only in rodents and only hypothesized in humans. Aim. The goal of this in vivo constrained spherical deconvolution (CSD) tractography study is the investigation on the presence of a direct cerebello-ventro tegmental pathway in the human brain. Material and Methods. We recruited 15 human subjects with no previous history of neurological or psychiatric disorders. The entire study was performed using a 3T Achieva Philips scanner; a SENSE 8 channels head coil, acquiring T1 weighted 3D TFE, DTI sequence; data were analyzed by using constrained spherical deconvolution techniques (CDS). Results. We demonstrated with CSD dentate-ventral midbrain connections. In particular, we found a direct route linking between the dentate nucleus and the ventro tegmental area. Conclusions. This study provides for the first time the existence of a human dentate nucleus connections with the ventro tegmental area, moreover the existence of this cerebello-midbrain pathway suggest that the cerebellum may be involved in the modulation of the mesocorticolimbic system and in related neuropsychiatric disorders such as the schizophrenia

Kyphoplasty vs conservative treatment: a case-control study in 110 post-menopausal women population. Is kyphoplasty better than conservative treatment?

Abstract. – OBJECTIVE: Osteoporosis is a highly prevalent disease worldwide. Consequences of vertebral osteoporotic fractures include pain and progressive vertebral collapse resulting in spinal kyphosis, decreased quality of life, disability and mortality. Minimally invasive procedures represent an advance to the treatment of osteoporotic VCFs. Despite encouraging results reported by many authors, surgical intervention in an osteoporotic spine is fraught with difficulties. Advanced patients age and comorbidities are of great concern. PATIENTS AND METHODS: We designed a retrospective case-control study on 110 postmenopausal women consecutively visited at our institution. Study population was split in a surgical and a conservative cohort, according to the provided treatment. RESULTS: Kyphoplasty treated patients had lower back pain VAS scores at 1 month as compared with conservatively treated patients (p < 0.05). EQ5D validated questionnaire also showed a better quality of life at 1 month for surgically treated patients (p < 0.05). SF-12 scores showed greater improvements at 1 month and 3 months with statistically significant difference between the two groups just at 3 months (p < 0.05). At 12 months, scores from all scales were not statistically different between the two cohorts, although surgically treated patients showed better trends than conservatively treated patients in pain and quality of life. Kyphoplasty was able to restore more than 54.55% of the original segmental kyphosis, whereas patients in conservative cohort lost 6.67% of the original segmental kyphosis on average. CONCLUSIONS: Kyphoplasty is a modern minimal invasive surgery, allowing faster recovery than bracing treatment. It can avoid the deformity in kyphosis due to VCF. In fact, the risk to develop a new vertebral fracture after the first one is very high

10-Year Clinical, Functional, and X-ray Follow-Up Evaluation of a Novel Posterior Percutaneous Screw-Rod Instrumentation Technique for Single-Level Pyogenic Spondylodiscitis

Medical treatment with antibiotic therapy remains the mainstay of treatment for pyogenic spondylodiscitis (PS). Nevertheless, orthopaedic treatment is also very important in relieving pain, preventing neurological damage, and avoiding development of spinal deformities (e.g., scoliosis, kyphosis) due to spinal instability. Rigid thoracolumbosacral orthosis (TLSO) bracing is often needed in patients with PS, and average duration of treatment of 3 to 4 months. However, TLSO bracing can be poorly tolerated and limit ability of the patient to go back to a normal life. In 2004 our group developed an alternative surgical treatment to TLSO bracing by percutaneous posterior screw-rod bridge instrumentation of the infected level. This treatment allows early and free mobilization of the patients and is associated with faster recovery, lower pain scores and improved quality of life as previously reported. Herein, we report the clinical outcome of the first 3 patients who have completed the 10 years follow-up mark after the procedure. A case report is also described and details of the procedure are provided

Surgical treatment of tuberculous spondylodiscitis.

BACKGROUND: Most patients affected by spinal tuberculosis can be successfully treated conservatively with chemotherapy, external bracing and prolonged rest. Nevertheless, kyphotic deformity, spinal instability and neurological deficit remain a common complication associated with conservative approach. AIM: To illustrate different indications and treatment modalities for tuberculous spondylodiscitis, focusing on the role of surgery as an adjuvant of effective chemotherapy in the management of selected patients. MATERIALS AND METHODS: Various early and late surgical procedures are recommended to treat spinal tuberculosis. The Authors analyzed surgical indications, approaches, complications and outcomes comparing their experience with available Literature. RESULTS: Conservative management is preferable in patients without vertebral instability and deformity; in presence of abscesses, invasive radiological techniques in combination with abscess drainage and chemotherapy are recommended. In patients with vertebral collapse, kyphotic deformity or abscess formation, vertebral instability or neurological deficits, anterior radical debridement, anterior strut grafting and anterior instrumentation is an optimal standardized procedure. In patients with involvement of more than two vertebral levels or lumbosacral junction and in those whose sagittal alignment is markedly deformed with segmental kyphosis, and in patients who have difficulty in undergoing anterior instrumentation, posterior instrumentation is recommended in combination with anterior radical debridement and anterior strut grafting in one or two staged procedures. CONCLUSIONS: Since surgery for spinal tuberculosis is demanding, it should be performed only after taking into account the risks and benefits in operable patients. Various surgical procedures are recommended to treat spinal tuberculosis but the common goals are to eradicate the infection and to prevent or to treat neurologic deficits or spinal deformity

A particular case of pyogenic spondylodiscitis misdiagnosed as a vertebral fragility fracture and erroneously treated with balloon kyphoplasty

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Teriparatide anabolic therapy as potential treatment of type II dens non-union fractures

Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type II fractures are the most common fracture pattern in elderly patients. Treatment (rigid and non-rigid immobilization, anterior screw fixation of the odontoid and posterior C1-C2 fusion) remains controversial and represents a unique challenge for the treating surgeon. The aims of treatment in the elderly is to quickly restore pre-injury function while decreasing morbidity and mortality associated with inactivity, immobilization with rigid collar and prolonged hospitalization. Conservative treatment of type II odontoid fractures is associated with relatively high rates of non-union and in a few cases delayed instability. Options for treatment of symptomatic non-unions include surgical fixation or prolonged rigid immobilization. In this report we present the case of a 73-year-old woman with post-traumatic odontoid nonunion successfully treated with Teriparatide systemic anabolic therapy. Complete fusion and resolution of the symptoms was achieved 12 wk after the onset of the treatment. Several animal and clinical studies have confirmed the potential role of Teriparatide in enhancing fracture healing. Our case suggests that Teriparatide may have a role in improving fusion rates of C2 fractures in elderly patients