Navigated Brain Stimulation (NBS) for Pre-Surgical Planning of Brain Lesion in Critical Areas: Basic Principles and Early Experience

none3noModern neurosurgery attempts to get the difficult goal of combining an "aggressive" resection of brain tumors with the fundamental purpose of preserving brain functions and best possible quality of life. One of the most important evolutions of neurosurgical therapies is the opportunity to provide a customized surgical intervention by using modern methods to "map" the eloquent areas of the brain. This allows the identification of brain functional areas to be preserved from possible inadvertent intraoperative damage. Direct cortical stimulation (DCS) is an intraoperative technique that uses electrodes placed directly on the exposed cortical surface of the brain to stimulate activity of functional areas by simultaneously recording the evoked responses peripherally. DCS is very precise and reliable and can be considered the gold standard in brain mapping and intraoperative functional monitoring. Nevertheless, the neurosurgeon discovers the spatial relationship between the disease and eloquent cortical surfaces only after having completed a craniotomy and dural opening. A pre-surgical mapping method would give the opportunity to plan the treatment of brain diseases optimizing many aspects of the surgical treatment, including patient positioning, type of anesthesia, size of craniotomy, and extent of resection. Moreover, pre-surgical mapping would allow more precise prediction of the efficacy and risks of treatments that can be discussed with the patient and influence the therapeutic strategy. New techniques have been proposed in an attempt to provide a reliable method for the functional study that can be, however, exploited pre-operatively. The most recent of these methods of mapping cortical activities is navigated brain stimulation (NBS), which is based on the neurophysiological technique of transcranial magnetic stimulation (TMS) of the cerebral cortex combined with the conventional neuronavigation. Basic principles of NBS will be here discussed together with our preliminary experience using this technique in different neurosurgical diseases.mixedDr. Terry Lichtor; Alafaci C; Conti A; Tomasello F.Dr. Terry Lichtor; Alafaci C; Conti A; Tomasello F

LA FORNACE DA VASAIO TM IB DI HAGHIA TRIADA. L’IMPIANTO

The aim of this paper is to deepen the investigation of the kiln published in 1975 by D. Levi and C. Laviosa, with commendable zeal and documentation. Construction details are now comparable with those of other kilns excavated in Late Minoan Crete

The dietary inclusion of Portulaca oleracea to the diet of laying hens increases the n-3 fatty acids content and reduces the cholesterol content in the egg yolk

The effect of n-3 polyunsaturated fatty acids (PUFA)-enriched diet on yolk fatty acid profile and cholesterol content was evaluated. Dried Poutulaca oleracea (purslane: PO diet) was added to a commercial diet (C diet) at 20% of inclusion level. The effect of the supplemented diet was compared to that of C diet. Twenty-six laying hens were fed ad libitum for 21 days with the 2 diets, supplemented also with 300 mg α-tocopherol acetate/kg. Eggs were collected and then the fatty acids (FA) profile and the cholesterol content were analysed. The PO diet significantly reduced the saturated FA content (P<0.05) and increased that of the polyunsaturated FA (PUFA): 18:2 n-6 (P<0.001), 18:3 n-3 (P<0.001) and 22:6 n-3 (DHA; P<0.01). Both n-6 and n-3 PUFA significantly increased with the PO diet and the n-6/n-3 ratio was improved (10.4 vs 11.3; P<0.05)

Impressive late stent recoil of a drug-eluting resorbable magnesium coronary stent

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Role of Stress Myocardial Scintigraphy in the Evaluation of Incompletely Revascularized Post-PCI Patients

Percutaneous coronary intervention (PCI) is actually the most used method of revascularization. Although complete revascularization remains a desirable goal, it may not be possible or not easy to plan in many patients. Thus, incomplete revascularization might be a preferred treatment strategy in selected patient categories. Stress myocardial scintigraphy, because of its high diagnostic accuracy and prognostic value and its ability to assess location and extent of myocardial ischemia regardless of symptoms as well as to evaluate patients who are unable to exercise or who have uninterpretable electrocardiogram, is of paramount importance for clinical decision making in patients with multivessel disease and incomplete revascularization

Survival benefit with adjuvant chemotherapy in stage III microsatellite-high/deficient mismatch repair colon cancer: a systematic review and meta-analysis

Clinical observations have demonstrated that microsatellite instability-high (MSI-H) and/or deficient MMR (dMMR) status are associated with favorable prognosis and no benefit from 5-Fluorouracil (5-FU)-based adjuvant chemotherapy in patients with resected stage II colorectal cancer (CRC). This study represents a systematic review and meta-analysis exploring the predictive role of MSI-H status in stage III CRC undergoing or not adjuvant chemotherapy. Published articles that evaluated the role of adjuvant chemotherapy in resected stage III CRC from inception to September 2020 were identified by searching the PubMed, EMBASE, and Cochrane Library databases. The random-effects model was conducted to estimate the pooled effect size of OS and DFS. The primary outcome of interest was OS. 21,590 patients with MSI-H/dMMR stage III CRC, from n = 17 retrospective studies, were analyzed. Overall, OS was improved with any adjuvant chemotherapy vs. any control arm (single-agent 5-FU or surgery alone): HR 0.42, 95% CI 0.26-0.66; P &lt; 0.01. Conversely, DFS was not significantly improved (HR 0.7, 95% CI 0.45-1.09; P = 0.11). In patients with stage III MSI-H/dMMR CRC, adjuvant chemotherapy is associated with a significant OS improvement. Thus, MSI-H/dMMR status does represent a predictive factor for postoperative chemotherapy benefit in stage III CRC beyond its prognostic role

ROLE OF CHAPERONES IN HEALTHY BOWEL AND IBD.

The chaperoning system is the wole complement of chaperones, co-chaperones and chaperone cofactors of the body that preserves cell and tissue homeostasis. Its structural and/or functional defects can cause pathologic conditions, nemed chaperonopathies. Large bowel homeostasis includes a healthy status of the mucosal tissues and the microbiota. An alteration of one of them may determine, in turn, modifications of the other. Molecular chaperones of bacteria and human origin have been implicated in inflammatory bowel disease (IBD). In IBD chaperone levels usually increase and their cellular and subcellular loclization change. This is considered a physiological stress-response of mucosal cells to inflammation. However, chaperones also play active roles in IBD pathogenesis, e.g. perpetuate inflammation. Therefore, IBD can be classified among the chaperonopathies. This classification opens the door to the design and application of new forms of treatment targeting the chaperones, namely chaperonopathy

INFLAMMATORY BOWEL DISEASE AND EXTRAINTESTINAL MANIFESTATIONS

Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, are chronic and recurrent inflammatory diseases. Although the typical symptoms are localized in the gastrointestinal tract, there are also extraintestinal manifestations (EIMs) associated with IBD, probably caused by immune reactions secondary to the pathology of origin. Anybody can be affected by EIMs, which can be dermatological, pulmonary, ocular, musculoskeletal, hepatobiliary and neurological, et al. This represents a therapeutic challenge for clinicians, who must first establish a diagnostic and then a multidisciplinary therapeutic path, in order to guarantee an optimal quality of life for the patient