Two-level corpectomy and fusion vs. three-level anterior cervical discectomy and fusion without plating: long-term clinical and radiological outcomes in a multicentric retrospective analysis

Background: Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) represent effective alternatives in the management of multilevel cervical spondylotic myelopathy (CSM). A consensus on which of these techniques should be used is still missing. Methods: The databases of three centers were reviewed (January 2011-December 2018) for patients with three-level CSM, who underwent three-level ACDF without plating or two-level ACCF with expandable cage (VBRC) or mesh (VBRM). Demographic data, surgical strategy, complications, and implant failure were analyzed. The Neck Disability Index (NDI), the Visual Analog Scale (VAS), and the cervical lordosis were compared between the two techniques at 3 and 12 months. Logistic regression analyses investigated independent factors influencing clinical and radiological outcomes. Results: Twenty-one and twenty-two patients were included in the ACDF and ACCF groups, respectively. The median follow-up was 18 months. ACDFs were associated with better clinical outcomes at 12 months (NDI: 8.3% vs. 19.3%, p < 0.001; VAS: 1.3 vs. 2.6, p = 0.004), but with an increased risk of loss of lordosis correction & GE; 1 & DEG; (OR = 4.5; p = 0.05). A higher complication rate in the ACDF group (33.3% vs. 9.1%; p = 0.05) was recorded, but it negatively influenced only short-term clinical outcomes. ACCFs with VBRC were associated with a higher risk of major complications but ensured better 12-month lordosis correction (p = 0.002). No significant differences in intraoperative blood loss were noted. Conclusions: Three-level ACDF without plating was associated with better clinical outcomes than two-level ACCF despite worse losses in lordosis correction, which is ideal for fragile patients without retrovertebral compressions. In multilevel CSM, the relationship between the degree of lordosis correction and clinical outcome advantages still needs to be investigated

Two-Level Corpectomy and Fusion vs. Three-Level Anterior Cervical Discectomy and Fusion without Plating: Long-Term Clinical and Radiological Outcomes in a Multicentric Retrospective Analysis

Background: Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) represent effective alternatives in the management of multilevel cervical spondylotic myelopathy (CSM). A consensus on which of these techniques should be used is still missing. Methods: The databases of three centers were reviewed (January 2011-December 2018) for patients with three-level CSM, who underwent three-level ACDF without plating or two-level ACCF with expandable cage (VBRC) or mesh (VBRM). Demographic data, surgical strategy, complications, and implant failure were analyzed. The Neck Disability Index (NDI), the Visual Analog Scale (VAS), and the cervical lordosis were compared between the two techniques at 3 and 12 months. Logistic regression analyses investigated independent factors influencing clinical and radiological outcomes. Results: Twenty-one and twenty-two patients were included in the ACDF and ACCF groups, respectively. The median follow-up was 18 months. ACDFs were associated with better clinical outcomes at 12 months (NDI: 8.3% vs. 19.3%, p < 0.001; VAS: 1.3 vs. 2.6, p = 0.004), but with an increased risk of loss of lordosis correction & GE; 1 & DEG; (OR = 4.5; p = 0.05). A higher complication rate in the ACDF group (33.3% vs. 9.1%; p = 0.05) was recorded, but it negatively influenced only short-term clinical outcomes. ACCFs with VBRC were associated with a higher risk of major complications but ensured better 12-month lordosis correction (p = 0.002). No significant differences in intraoperative blood loss were noted. Conclusions: Three-level ACDF without plating was associated with better clinical outcomes than two-level ACCF despite worse losses in lordosis correction, which is ideal for fragile patients without retrovertebral compressions. In multilevel CSM, the relationship between the degree of lordosis correction and clinical outcome advantages still needs to be investigated

F9 Missense mutations impairing factor ix activation are associated with pleiotropic plasma phenotypes

Background: Circulating dysfunctional factor IX (FIX) might modulate distribution of infused FIX in haemophilia B (HB) patients. Recurrent substitutions at FIX activation sites (R191-R226, >300 patients) are associated with variable FIX activity and antigen (FIXag) levels. Objectives: To investigate i) expression of a complete panel of missense mutations at FIX activation sites and ii) contribution of F9 genotypes on the FIX pharmacokinetics (PK). Methods: FIXag and activity assays in plasma and after recombinant expression of FIX variants. Analysis of infused FIX PK parameters in patients (n=30), mostly enrolled in the F9 Genotype and PK HB Italian Study (GePKHIS; EudraCT ID2017-003902-42). Results: The variable FIXag amounts and good relation between biosynthesis and activity of multiple R191 variants result in graded moderate-to-mild severity of the R191C>L>P>H substitutions. Recombinant expression may predict the absence in the HB mutation database of the benign R191Q/W/K and R226K substitutions. Equivalent changes at R191/R226 produced higher FIXag levels for R226Q/W/P substitutions, as also observed in p.R226W female carrier plasma. PK analysis in patients suggested that infused FIX Alpha distribution and Beta elimination phases positively correlated with endogenous FIXag levels. Mean residence time was particularly prolonged (79.4 hrs, 95% CI 44.3-114.5) in patients (n=7) with the R191/R226 substitutions, which in regression analysis were independent predictors (β coefficient 0.699, p=0.004) of Beta half-life, potentially prolonged by the increasing over time ratio between endogenous and infused FIX. Conclusions: FIXag levels and specific features of the dysfunctional R191/R226 variants may exert pleiotropic effects both on HB patients’ phenotypes and substitutive treatment

Into the Un(Known). Unveiling Science's intrinsic Art

Entrerete in un mondo nuovo e quasi astratto, apparentemente innaturale. Sarete circondati da suoni e immagini familiari e allo stesso tempo distanti dalla vostra quotidianità. Gli eventi in cui vi troverete immersi sono comuni nella vita di tutti i giorni, anche se non li riconoscete perché “silenziati”. Sono, infatti, fenomeni che acquistano importanza su scale molto grandi, cosmiche potremmo dire, e in condizioni fisiche incompatibili con la vita umana. A raccontarvi questo meraviglioso mondo sarà la “voce” familiare della luce, la radiazione elettromagnetica prodotta dalle varie sorgenti astrofisiche sparse nell’Universo, il principale canale di comunicazione a disposizione degli astronomi per indagare i più reconditi segreti del Cosmo. La luce, esploratrice instancabile, ci racconta gli scenari in cui è stata generata: esplosioni di Supernovae, materia che cade in un buco nero, brillamenti solari, e molto altro. Fenomeni lontani e misteriosi che sfuggono alla nostra esperienza diretta, ma che da anni sono al centro delle ricerche scientifiche più avanzate. Preparatevi ad entrare nell'ignoto, lasciate che la luce vi mostri l'invisibile

Ramucirumab plus docetaxel versus placebo plus docetaxel in patients with locally advanced or metastatic urothelial carcinoma after platinum-based therapy (RANGE): a randomised, double-blind, phase 3 trial

Few treatments with a distinct mechanism of action are available for patients with platinum-refractory advanced or metastatic urothelial carcinoma. We assessed the efficacy and safety of treatment with docetaxel plus either ramucirumab-a human IgG1 VEGFR-2 antagonist-or placebo in this patient population

A performance analysis of mesh models for cloud-based workflows

Nell'ambito della loro trasformazione digitale, molte organizzazioni stanno adottando nuove tecnologie per supportare lo sviluppo, l'implementazione e la gestione delle proprie architetture basate su microservizi negli ambienti cloud e tra i fornitori di cloud. In questo scenario, le service ed event mesh stanno emergendo come livelli infrastrutturali dinamici e configurabili che facilitano interazioni complesse e la gestione di applicazioni basate su microservizi e servizi cloud. L’obiettivo di questo lavoro è quello di analizzare soluzioni mesh open-source (istio, Linkerd, Apache EventMesh) dal punto di vista delle prestazioni, quando usate per gestire la comunicazione tra applicazioni a workflow basate su microservizi all’interno dell’ambiente cloud. A questo scopo è stato realizzato un sistema per eseguire il dislocamento di ognuno dei componenti all’interno di un cluster singolo e in un ambiente multi-cluster. La raccolta delle metriche e la loro sintesi è stata realizzata con un sistema personalizzato, compatibile con il formato dei dati di Prometheus. I test ci hanno permesso di valutare le prestazioni di ogni componente insieme alla sua efficacia. In generale, mentre si è potuta accertare la maturità delle implementazioni di service mesh testate, la soluzione di event mesh da noi usata è apparsa come una tecnologia ancora non matura, a causa di numerosi problemi di funzionamento

La grotta. Lo spazio sacro. Il rito. Nuove evidenze dai livelli neolitici di Grotta San Biagio

Tra i materiali provenienti dai livelli di Grotta San Biagio (Ostuni-BR), indicatori di varia natura avvalorano l\u2019ipotesi che il sito fosse frequentato per scopi cultuali e rituali in un periodo compreso tra la met\ue0 del VI e la met\ue0 del III millennio. In questa comunicazione si presentano alcuni dati riferibili alla frequentazione neolitica della grotta acquisiti durante i recenti scavi condotti dall\u2019universit\ue0 di Bologna. Le ricerche hanno consentito di individuare, oltre alla presenza di focolari e buche, un grande recinto di pietra -sulla scorta dei noti esempi di Cala Scizzo e Grotta Pacelli. La presenza della raffinata ceramica di facies serra d\u2019Alto, in associazione con i gi\ue0 noti oggetti estranei alla sfera del quotidiano come la pintadera, l\u2019idoletto a testa di papero e le accettine in pietra verde, insieme al nuovo rinvenimento di un pozzetto di carattere rituale, costituiscono una chiara testimonianza dell\u2019utilizzo della cavit\ue0 a scopi cultuali.Among the artifacts found in San Biagio\u2019s Cave (Ostuni - Brindisi - Italy), specific indicators are supporting the hypothesis of a ritual and cultic use of the cave between the half of the VI millennium BC and the half of the III millennium BC. This paper will show and discuss the data coming from the most recent excavations season, leaded by the University of Bologna. Beyond a series of hearths and pits, a huge stone fence has been found, showing a possible connection with Cala scizzo and Cave Pacelli in Apulia sites. Other than that, the presence of serra d\u2019Alto fine pottery, together with other unusual objects such as a pintadera, a zoomorphic idol interpreted as a \u201cbird head\u201d, several green stone-hatchets and the new ritual pit, are supporting again the cultic use hypothesis for this cave

Surgical treatment of metastatic pheochromocytomas of the spine: a systematic review

Metastatic pheochromocytoma of the spine (MPS) represents an extremely rare and challenging entity. While retrospective studies and case series make the body of the current literature and case reports, no systematic reviews have been conducted so far. This systematic review aims to perform a systematic review of the literature on this topic to clarify the status of the art regarding the surgical management of MPS. A systematic review according to PRISMA criteria has been performed, including all studies written in English and involving human participants. 15 papers for a total of 44 patients were finally included in the analysis. The median follow-up was 26.6 months. The most common localization was the thoracic spine (54%). In 30 out of 44 patients (68%), preoperative medications were administered. Open surgery was performed as the first step in 37 cases (84%). Neoadjuvant treatments, including preoperative embolization were reported in 18 (41%) cases, while adjuvant treatments were administered in 23 (52%) patients. Among those patients who underwent primary aggressive tumor removal and instrumentation, 16 out of 25 patients (64%) showed stable disease with no progression at the final follow-up. However, the outcome was not reported in 14 patients. Gross total resection of the tumor and spinal reconstruction appear to offer good long-term outcomes in selected patients. Preoperative alpha-blockers and embolization appear to be useful to enhance hemodynamic stability, avoiding potential detrimental complications

Epiretinal membrane in a 12-year-old immunocompetent girl with cytomegalovirus infection

PURPOSE. To report the case of a 12-year-old immunocompetent girl presenting bilateral epiretinal membrane formation in conjunction with systemic human cytomegalovirus (HCMV) infection. METHODS. The patient had a sudden onset of blurred vision and floaters in both eyes. Her medical history was unremarkable, except for allergic asthma that she had had for several years and that she was treating with inhaler corticosteroids prescribed by her pediatrician. The patient underwent a complete ophthalmic examination and serologic blood test. RESULTS. The ocular examination revealed an epiretinal membrane confirmed by optical coherence tomography, which showed a band of high optical reflectivity compatible with a proliferation of abnormal tissue on the surface of the retina. The patient had serologic evidence of exposure to HCMV which was verified by a strongly positive HCMV IgM antibody test result (320 IU), with detectable IgG antibodies against HCMV, which significantly rose further in consecutive blood samples, due to IgG antibody seroconversion. CONCLUSIONS. Our patient had allergic asthma that she was treating with inhaled corticosteroids. The immunosuppressive properties of corticosteroids could induce endogenous reactivation of latent HCMV (Eur J Ophthalmol 2009; 19: 1098-101