Lumbar facet joint stabilization for symptomatic spinal degenerative disease: A systematic review of the literature

Objective: Lumbar spinal degenerative disease (LSDD), unresponsive to conservative therapy, is commonly treated by surgical decompression and interbody fusion. Since facet joint incompetence has been suggested as responsible for the entire phenomenon of spinal degeneration, facet stabilization can be considered as an alternative technique to treat symptomatic spinal degenerative disease. The purpose of this study was to systematically review the literature for studies utilizing lumbar facet joint fixation techniques for LSDD to assess their safety and efficacy. Methods: A systematic literature review was performed following the preferred reporting items for systematic reviews and meta-analyses statement, with no limits in terms of date of publication. Demographic data, inclusion criteria, clinical and radiological outcome, frequency of adverse events (AEs), and follow-up time were evaluated. Results: A total of 19 studies were included with a total of 1577 patients. The techniques used for facet arthrodesis were Goel intra-articular spacers in 21 patients (5.3%), Facet Wedge in 198 patients (15.8%), facet screws fixation techniques in 1062 patients (52.6%), and facet joints arthroplasty in 296 patients (26.3%). Clinical outcomes were assessed through the evaluation of pain relief and improvement in functional outcome. Radiological outcomes were assessed by the evaluation of proper positioning of instrumentation, solid bony fusion rate, and preservation of disk height. AE's mainly observed were pseudoarthrosis, reoperation, instrumentation displacement/malpositioning/migration, neurological impairment, deep vein thrombosis, and infections. The mean follow-up time ranged from 6 months to 11.7 years. Conclusion: Our data demonstrate that facet joint arthrodesis appears to be effective in managing LSDD. These findings, however, are limited by the small sample size of patients. Accordingly, larger series are needed before formal recommendations can be made

Exosome biogenesis in the protozoa parasite Giardia lamblia: A model of reduced interorganellar crosstalk

Extracellular vesicles (EVs) facilitate intercellular communication and are considered a promising therapeutic tool for the treatment of infectious diseases. These vesicles involve microvesicles (MVs) and exosomes and selectively transfer proteins, lipids, mRNAs, and microRNAs from one cell to another. While MVs are formed by extrusion of the plasma membrane, exosomes are a population of vesicles of endosomal origin that are stored inside the multivesicular bodies (MVBs) as intraluminal vesicles (ILVs) and are released when the MVBs fuse with the plasma membrane. Biogenesis of exosomes may be driven by the endosomal sorting complex required for transport (ESCRT) machinery or may be ESCRT independent, and it is still debated whether these are entirely separate pathways. In this manuscript, we report that the protozoan parasite, Giardia lamblia, although lacking a classical endo-lysosomal pathway, is able to produce and release exosome-like vesicles (ElV). By using a combination of biochemical and cell biology analyses, we found that the ElVs have the same size, shape, and protein and lipid composition as exosomes described for other eukaryotic cells. Moreover, we established that some endosome/lysosome peripheral vacuoles (PVs) contain ILV during the stationary phase. Our results indicate that ILV formation and ElV release depend on the ESCRT-associated AAA+-ATPase Vps4a, Rab11, and ceramide in this parasite. Interestingly, EIV biogenesis and release seems to occur in Giardia despite the fact that this parasite has lost most of the ESCRT machinery components during evolution and is unable to produce ceramide de novo. The differences in protozoa parasite EV composition, origin, and release may reveal functional and structural properties of EVs and, thus, may provide information on cell-to-cell communication and on survival mechanisms.Fil: Moyano, Sofia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra. Universidad Nacional de Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra; ArgentinaFil: Musso, Juliana Rita. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra. Universidad Nacional de Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra; ArgentinaFil: Feliziani, Constanza. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra. Universidad Nacional de Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra; ArgentinaFil: Zamponi, Nahuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra. Universidad Nacional de Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra; ArgentinaFil: Frontera, Lorena Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra. Universidad Nacional de Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra; ArgentinaFil: Ropolo, Andrea Silvana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra. Universidad Nacional de Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra; ArgentinaFil: Lanfredi-Rangel, Adriana. Centro de Pesquizas Gonzalo Monis. Fiocruz; BrasilFil: Lalle, Marco. Department Of Infectious Diseases, Foodborne And Neglec; ItaliaFil: Touz, Maria Carolina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra. Universidad Nacional de Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra; Argentin

Cardiomegaly associated with clinical hypothyroidism

Introduction: Primary hypothyroidism corresponds to 95% of the total cases of hypothyroidism. Primary hypothyroidism is characterized as a clinical syndrome in which thyroid stimulating hormone (TSH) is above the reference values and free thyroxine (T4 L) below the limit of normality. These changes lead to a decrease in the basal metabolic rate that may affect the cardiovascular system. Severe cases can lead to a pericardial effusion and cardiomegaly. This case report describes an atypical manifestation hypothyroidism, the pericardial effusion, as an initial event of the disease, and aims to contribute to the medical literature, discussing a propaedeutic performed for diagnosis and describing a therapeutic response and clinical evolution. Case Report: A 44-year-old female patient; history of hypothyroidism undergoing irregular treatment. She was referred for elective computed tomography examination of the abdomen in nephrolithiasis investigation, but an important pericardial effusion was demonstrated without hemodynamic compromise. The chest X-ray showed an increase in the cardiac area and the echocardiogram showed a pericardial effusion (swinging heart aspect), paradoxical movement of the interventricular septum. The electrocardiogram showed no changes. During the investigation, T4 L was lower than 0.4 ng/dL, TSH: 319.9 uUI/mL, anti-hyroperoxidase: 142.3 IU/ml. Rheumatologic evaluation ruled out diseases. Faced with the hypothesis of pericardial effusion due to hypothyroidism, the patient then underwent levothyroxine treatment at a dose of 125mcg/day. Through 7 months of treatment there was a regression of cardiomegaly and pericardial effusion. The exams of January/2018 corroborate the hypothesis evidencing levels of T4 L: 1,2; TSH: 2.2 with normal imaging tests. Conclusion: In view of the rarity of the case, this work shows an oligosymptomatic patient, but with great repercussion in relation to the cardiological manifestation. The authors emphasize the importance of investigating thyroid function in patients with cardiac alterations.Introdução: O hipotireoidismo primário corresponde a 95% do total de casos de hipotireoidismo. Caracteriza-se como uma síndrome clínica onde o hormônio estimulante da tireoide (TSH) encontra-se acima dos valores de referência e a tiroxina livre (T4 L) abaixo do limite da normalidade. Essas alterações levam a uma diminuição da taxa metabólica basal o que pode acometer o aparelho cardiovascular. Casos severos podem levar a um derrame pericárdico e cardiomegalia. Este relato de caso descreve uma manifestação atípica do hipotireoidismo, o derrame pericárdio, como um evento inicial da doença, e visa contribuir para a literatura médica, discutindo a propedêutica realizada para diagnóstico e descrevendo a resposta terapêutica e evolução clínica. Relato de Caso: sexo feminino, 44 anos, parda, história de hipotireoidismo em tratamento irregular veio encaminhada para um exame eletivo de tomografia computadorizada do abdome em investigação de nefrolitíase, porém neste evidenciou-se um importante derrame pericárdico sem comprometimento hemodinâmico. À radiografia de tórax evidenciou aumento da área cardíaca e o ecocardiograma evidenciou uma efusão pericárdica (aspecto swinging heart), movimento paradoxal de septo interventricular. O eletrocardiograma não demonstrou alterações. Durante a investigação evidenciou T4 L inferior a 0,4 ng/dL, TSH: 319,9 uUI/mL, anticorpos anti-tireoperoxidase (anti-TPO):142,3UI/ml. Avaliação reumatológica descartou doenças. Diante da hipótese de derrame pericárdico devido ao hipotireoidismo realizou então o tratamento com levotiroxina chegando à dose de 125mcg/dia. Durante os 7 meses do tratamento houve uma regressão da cardiomegalia e do derrame pericárdico. Os exames de janeiro/2018 corroboram a hipótese evidenciando níveis de T4 L: 1,2; TSH: 2,2 com os exames de imagens normais. Conclusão: Diante da raridade do caso, este trabalho mostra uma paciente oligossintomática, mas com grande repercussão em relação à manifestação cardiológica. Com isso, os autores ressaltam a importância da investigação da função tireoidiana em pacientes com alteração cardíaca

Appetitive olfactory learning and memory in the honeybee depend on sugar reward identity

One of the most important tasks of the brain is to learn and remember information associated with food. Studies in mice and Drosophila have shown that sugar rewards must be metabolisable to form lasting memories, but few other animals have been studied. Here, we trained adult, worker honeybees (Apis mellifera) in two olfactory tasks (massed and spaced conditioning) known to affect memory formation to test how the schedule of reinforcement and the nature of a sugar reward affected learning and memory. The antennae and mouthparts of honeybees were most sensitive to sucrose but glucose and fructose were equally phagostimulatory. Whether or not bees could learn the tasks depended on sugar identity and concentration. However, only bees rewarded with glucose or sucrose formed robust long-term memory. This was true for bees trained in both the massed and spaced conditioning tasks. Honeybees fed with glucose or fructose exhibited a surge in haemolymph sugar of greater than 120. mM within 30. s that remained elevated for as long as 20. min after a single feeding event. For bees fed with sucrose, this change in haemolymph glucose and fructose occurred with a 30. s delay. Our data showed that olfactory learning in honeybees was affected by sugar identity and concentration, but that olfactory memory was most strongly affected by sugar identity. Taken together, these data suggest that the neural mechanisms involved in memory formation sense rapid changes in haemolymph glucose that occur during and after conditioning

in keeping with the spirit of the albertine statute constitutionalisation of the national unification

This chapter deals with the difficult process of constitutionalisation which characterised Italian Unification. Constitutionalisation is a long-term phenomenon which had the purpose of giving constitutional forms to the Nation. The promulgation of the Albertine Statute is more the start than the arrival of this phenomenon. The focus of this investigation is, therefore, to study the Constitution through its evolution paying particular attention to the process of legal integration within the structures of the Albertine Statute and to the amendment mechanisms of the constitutional text. The preamble of the Albertine Statute speaks of «perpetual and irrevocable fundamental law». The word «perpetual» meant the prohibition of revoking constitutional concession, while the word «irrevocable» was intended as a pact between the Sovereign and the Nation. Over the years, very few were the changes to the letter of the Albertine Statute. The interpretation and the practice represented the most important mechanisms of constitutional change (implicit constitutional changes). A primary role was acknowledged to non-written norms. In this perspective, it may well be said that the Italian Constitution consisted in something more than the written text and dwelt in the spirit and not in the letter of the Albertine Statute

A brief anatomo-surgical dissection guide to the human neck: results of a collaboration between the University of Palermo and the University of Malta.

The aim of this work was to offer a guide to young students and medical doctors that want to learn the bases of neck dissection. In the summer of 2017 a group of students from the University of Palermo that had already passed the Human Anatomy exams took a 4 weeks dissection course at the University of Malta Medicine is a science that requires both a practical and theoretical approach, and the last one, unfortunately, often is not valued by our University. Studying Human Anatomy, which is the basis for a doctor's education, exclusively through books and atlases, is indeed partially lacking. For this reason a group of students from the University of Palermo have been selected, based on their academic scores and English proficiency, to take part in an anatomic dissection course at the University of Malta. The course took place in the university's dissection hall. The students spent their time dissecting, analyzing and separating the various anatomical structures under the supervision of tutors from both universities. This experience has given excellent results and we hope to make further collaborations with the University of Malta in the future

A Spotlight on the Role of Radiomics and Machine-Learning Applications in the Management of Intracranial Meningiomas: A New Perspective in Neuro-Oncology: A Review

Background: In recent decades, the application of machine learning technologies to medical imaging has opened up new perspectives in neuro-oncology, in the so-called radiomics field. Radiomics offer new insight into glioma, aiding in clinical decision-making and patients’ prognosis evaluation. Although meningiomas represent the most common primary CNS tumor and the majority of them are benign and slow-growing tumors, a minor part of them show a more aggressive behavior with an increased proliferation rate and a tendency to recur. Therefore, their treatment may represent a challenge. Methods: According to PRISMA guidelines, a systematic literature review was performed. We included selected articles (meta-analysis, review, retrospective study, and case–control study) concerning the application of radiomics method in the preoperative diagnostic and prognostic algorithm, and planning for intracranial meningiomas. We also analyzed the contribution of radiomics in differentiating meningiomas from other CNS tumors with similar radiological features. Results: In the first research stage, 273 papers were identified. After a careful screening according to inclusion/exclusion criteria, 39 articles were included in this systematic review. Conclusions: Several preoperative features have been identified to increase preoperative intracranial meningioma assessment for guiding decision-making processes. The development of valid and reliable non-invasive diagnostic and prognostic modalities could have a significant clinical impact on meningioma treatment

Intraoperative Evaluation of Brain-Tumor Microvascularization through MicroV IOUS: A Protocol for Image Acquisition and Analysis of Radiomic Features

Microvascular Doppler (MicroV) is a new-generation Doppler technique developed by Esaote (Esaote s.p.a., Genova, Italy), which is able to visualize small and low-flow vessels through a suppression of interfering signals. MicroV uses advanced filters that are able to differentiate tissue artifacts from low-speed blood flows; by exploiting the space–time coherence information, these filters can selectively suppress tissue components, preserving the signal coming from the microvascular flow. This technique is clinically applied to the study of the vascularization of parenchymatous lesions, often with better diagnostic accuracy than color/power Doppler techniques. The aim of this paper is to develop a reproducible protocol for the recording and collection of MicroV intraoperative ultrasound images by the use of a capable intraoperative ultrasound machine and post-processing aimed at evaluation of brain-tumor microvascularization through the analysis of radiomic features. The proposed protocol has been internally validated on eight patients and will be firstly applied to patients affected by WHO grade IV astrocytoma (glioblastoma—GBM) candidates for craniotomy and lesion removal. In a further stage, it will be generally applied to patients with primary or metastatic brain tumors. IOUS is performed before durotomy. Tumor microvascularization is evaluated using the MicroV Doppler technique and IOUS images are recorded, stored, and post-processed. IOUS images are remotely stored on the BraTIoUS database, which will promote international cooperation and multicentric analysis. Processed images and texture radiomic features are analyzed post-operatively using ImageJ, a free scientific image-analysis software based on the Sun-Java platform. Post-processing protocol is further described in-depth. The study of tumor microvascularization through advanced IOUS techniques such as MicroV could represent, in the future, a non-invasive and real-time method for intraoperative predictive evaluation of the tumor features. This evaluation could finally result in a deeper knowledge of brain-tumor behavior and in the on-going adaptation of the surgery with the improvement of surgical outcomes

Liquid Biopsy in Diagnosis and Prognosis of High-Grade Gliomas; State-of-the-Art and Literature Review

Gliomas, particularly high-grade gliomas, represent the most common and aggressive tumors of the CNS and are still burdened by high mortality and a very poor prognosis, regardless of the type of therapy. Their diagnosis and monitoring rely on imaging techniques and direct biopsy of the pathological tissue; however, both procedures have inherent limitations. To address these limitations, liquid biopsies have been proposed in this field. They could represent an innovative tool that could help clinicians in the early diagnosis, monitoring, and prognosis of these tumors. Furthermore, the rapid development of next-generation sequencing (NGS) technologies has led to a significant reduction in sequencing cost, with improved accuracy, providing a molecular profile of cancer and leading to better survival results and less disease burden. This paper focuses on the current clinical application of liquid biopsy in the early diagnosis and prognosis of cancer, introduces NGS-related methods, reviews recent progress, and summarizes challenges and future perspectives