Lumbar total disc arthroplasty: outdated surgery or here to stay procedure?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

Nephrology@Point of Care: A New Journal for Hands-On Clinicians

Stenosis and thrombosis are common causes of prosthetic vascular access (pVA) failure. The role of arteriovenous fistula (AVF) surveillance is widely debated. The aim of this paper is to present a new real-time application designed for AVF surveillance called SPIDER. Surgical staff and hemodialysis nurses are responsible for data entry. SPIDER automatically analyses data and generates alerts in case of abnormal trends. Surgical evaluation and duplex Doppler ultrasonography are then immediately performed to confirm presence of stenosis or other possible pVA defects. Surgery can be performed if required. A preliminary analysis of results will be completed at 12 months after the program begins and subsequently after 24 months. Primary assisted patency will be compared with historical using multivariate analysis. Expected results are an improvement in primary assisted pVA patency and reduction of hospitalizations. Simultaneous management of a high number of patients can become difficult due to the large amount of data required for surveillance. We want to demonstrate whether a real-time automated system could help to prevent thrombosis and graft loss

Simultaneous management of renal carcinoma with caval vein thrombosis and double coronary artery disease

Introduction: Recent advances in surgical and anesthesiology techniques allow simultaneous thoracic and abdominal operations to be performed for severe heart disease and benignant or malignant abdominal diseases. Case report: The simultaneous surgical management in a 75-year-old patient suffering from severe double coronary artery disease and a renal cell carcinoma with extended intravascular growth into the inferior vena cava is reported. Conclusion: The postoperative course was uneventful. Simultaneous surgery proved to be beneficial and safe, showing optimal results in our patient

A mechatronic platform for behavioral studies on infants

In this article the design and fabrication of a new mechatronic platform (called "Mechatronic Board") for behavioral analysis of children are presented and discussed. The platform is the result of a multidisciplinary design approach which merges input coming from neuroscientists, psychologists, roboticians and bioengineers, with the main goal of studying learning mechanisms driven by intrinsic motivations and curiosity. A detailed analysis of the main features of the mechatronic board is provided, focusing on the key aspects which allow studying intrinsically motivated learning in children. Finally preliminary results on curiosity-driven learning, coming from a pilot study on children are reporte

Experiencing an elongated limb in virtual reality modifies the tactile distance perception of the corresponding real limb

In measurement, a reference frame is needed to compare the measured object to something already known. This raises the neuroscientific question of which reference frame is used by humans when exploring the environment. Previous studies suggested that, in touch, the body employed as measuring tool also serves as reference frame. Indeed, an artificial modification of the perceived dimensions of the body changes the tactile perception of external object dimensions. However, it is unknown if such a change in tactile perception would occur when the body schema is modified through the illusion of owning an limb altered in size. Therefore, employing a virtual hand illusion paradigm with an elongated forearm of different lengths, we systematically tested the subjective perception of distance between two points (tactile distance perception task, TDP task) on the corresponding real forearm following the illusion. Thus, TDP task is used as a proxy to gauge changes in the body schema. Embodiment of the virtual arm was found significantly greater after the synchronous visuo-tactile stimulation condition compared to the asynchronous one, and the forearm elongation significantly increased the TDP. However, we did not find any link between the visuo-tactile induced ownership over the elongated arm and TDP variation, suggesting that vision plays the main role in the modification of the body schema. Additionally, significant effect of elongation found on TDP but not on proprioception suggests that these are affected differently by body schema modifications. These findings confirm the body schema malleability and its role as reference frame in touch

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

Development of goal-directed action selection guided by intrinsic motivations: an experiment with children

Action selection is extremely important, particularly when the accomplishment of competitive tasks may require access to limited motor resources. the spontaneous exploration of the world plays a fundamental role in the development of this capacity, providing subjects with an increasingly diverse set of opportunities to acquire, practice and refine the understanding of action-outcome connection. the computational modeling literature proposed a number of specific mechanisms for autonomous agents to discover and target interesting outcomes: intrinsic motivations hold a central importance among those mechanisms. Unfortunately, the study of the acquisition of action-outcome relation was mostly carried out with experiments involving extrinsic tasks, either based on rewards or on predefined task goals. this work presents a new experimental paradigm to study the effect of intrinsic motivation on action-outcome relation learning and action selection during free exploration of the world. three- and four-year-old children were observed during the free exploration of a new toy: half of them were allowed to develop the knowledge concerning its functioning; the other half were not allowed to learn anything. the knowledge acquired during the free exploration of the toy was subsequently assessed and compared

Exploring Online Community College Course Completion and a Sense of School Community

Researchers have found low online course completion rates to be a complex problem in higher education. Meanwhile, theory on adult learners\u27 online persistence highlights the importance of a sense of school community. At the small, rural focus community college (FCC) for this study, general education online course completion rates are lower than the national average. FCC has not addressed the low online course completion rates. Using Rovais\u27 composite persistence model as the conceptual framework, this instrumental case study examined how students\u27 experiences and perceptions of a sense of school community contribute to their ability to complete online general education courses. Semistructured interview data were gathered with a purposeful, criterion-based, sample of 9 adult online students taking online general education courses. The inductive data analysis utilized case and cross-case analysis, marking, cutting, and sorting of text until 4 themes emerged: interaction, sense of belonging, support, and educational values. The results led to a white paper recommending an orientation and community space, asynchronous video technology, and an online curriculum instructional designer. This study contributes to positive social change by providing FCC with program and policy change recommendations that support the colleges\u27 goals of increasing access and success. Increased educational access and success for the local adult population creates informed citizens, contributes to economic growth, and provides a higher quality of life for the community

Exploration and learning in capuchin monkeys (Sapajus spp.): the role of action-outcome contingencies

Animals have a strong propensity to explore the environment. Spontaneous exploration has a great biological significance since it allows animals to discover and learn the relation between specific behaviours and their consequences. The role of the contingency between action and outcome for learning has been mainly investigated in instrumental learning settings and much less in free exploration contexts. We tested 16 capuchin monkeys (Sapajus spp.) with a mechatronic platform that allowed complex modules to be manipulated and to produce different outcomes. Experimental subjects could manipulate the modules and discover the contingencies between their own specific actions and the outcomes produced (i.e., the opening and lighting of a box). By contrast, Control subjects could operate on the modules, but the outcomes experienced were those performed by their paired Experimental subjects (\u27\u27yoked-control\u27\u27 paradigm). In the exploration phase, in which no food reward was present, Experimental subjects spent more time on the board and manipulated the modules more than Yoked subjects. Experimental subjects outperformed Yoked subjects in the following test phase, where success required recalling the effective action so to open the box, now baited with food. These findings demonstrate that the opportunity to experience action-outcome contingencies in the absence of extrinsic rewards promotes capuchins\u27 exploration and facilitates learning processes. Thus, this intrinsically motivated learning represents a powerful mechanism allowing the acquisition of skills and cognitive competence that the individual can later exploit for adaptive purposes

Intermittent Theta Burst Stimulation Over Ventral Premotor Cortex or Inferior Parietal Lobule Does Not Enhance the Rubber Hand Illusion

An enhanced sense of prosthesis ownership may be the key for higher amputees’ quality of life. In this study in 28 healthy subjects, neuronavigated intermittent Theta Burst Stimulation (iTBS) delivered over the right ventral premotor cortex or inferior parietal lobule has been tested, compared to sham stimulation, to enhance embodiment in the rubber hand illusion paradigm. Neuromodulation of both areas did not result in an enhancement of embodiment, as assessed by the results collected from a self-evaluation questionnaire for the extent of self-attribution of the rubber hand and proprioceptive drift. In all cases, the difference between synchronous and asynchronous stroking confirms the successful induction of the illusion. It may be speculated that the low consistency of iTBS over brain regions other than primary motor cortex may account for the absence of effect, suggesting to test other neuromodulating techniques, acting on cortical networks different from the ones sensitive to iTBS to enhance artificial hand embodiment