Lumbar ganglion cyst: Nosology, surgical management and proposal of a new classification based on 34 personal cases and literature review

AIM To analyze different terms used in literature to identify lumbar extradural cysts and propose a common scientific terminology; to elaborate a new morphological classification of this pathology, useful for clinical and surgical purposes; and to describe the best surgical approach to remove these cysts, in order to avoid iatrogenic instability or treat the pre-existing one. METHODS We retrospectively reviewed 34 patients with symptomatic lumbar ganglion cysts treated with spinal canal decompression with or without spinal fixation. Microsurgical approach was the main procedure and spinal instrumentation was required only in case of evident preoperative segmental instability. RESULTS The complete cystectomy with histological examination was performed in all cases. All patients presented an improvement of clinical conditions, evaluated by Visual Analogic Scale and Japanese Orthopaedic Association scoring. CONCLUSION Spinal ganglion cysts are generally found in the lumbar spine. The treatment of choice is the microsurgical cystectomy, which generally does not require stabilization. The need for fusion must be carefully evaluated: Preoperative spondylolisthesis or a wide joint resection, during the operation, are the main indications for spinal instrumentation. We propose the terms "ganglion cyst" to finally identify this spinal pathology and for the first time its morphological classification, clinically useful for all specialists

K -> pi vector form factor with N_f=2+1+1 Twisted Mass fermions

We present a lattice QCD determination of the vector form factor of the kaon semileptonic decay K -> pi l nu which is relevant for the extraction of the CKM matrix element |V_{us}| from experimental data. Our result is based on the gauge configurations produced by the European Twisted Mass Collaboration with N_f=2+1+1 dynamical fermions. We simulated at three different values of the lattice spacing and with pion masses as small as 210 MeV. Our preliminary estimate for the vector form factor at zero momentum transfer is f_+(0)=0.9683(65), where the uncertainty is both statistical and systematic. By combining our result with the experimental value of f_+(0)|V_{us}| we obtain |V_{us}|=0.2234(16), which satisfies the unitarity constraint of the Standard Model at the permille level

naked eye fingerprinting of single nucleotide polymorphisms on psoriasis patients

We report a low-cost test, based on gold nanoparticles, for the colorimetric (naked-eye) fingerprinting of a panel of single nucleotide polymorphisms (SNPs), relevant for the personalized therapy of psoriasis. Such pharmacogenomic tests are not routinely performed on psoriasis patients, due to the high cost of standard technologies. We demonstrated high sensitivity and specificity of our colorimetric test by validating it on a cohort of 30 patients, through a double-blind comparison with two state-of-the-art instrumental techniques, namely reverse dot blotting and sequencing, finding 100% agreement. This test offers high parallelization capabilities and can be easily generalized to other SNPs of clinical relevance, finding broad utility in diagnostics and pharmacogenomics

Young adult obese subjects with and without insulin resistance: what is the role of chronic inflammation and how to weigh it non-invasively?

<p>Abstract</p> <p>Background</p> <p>Obesity is a leading risk factor for metabolic syndrome whose further expression is non-alcoholic fatty liver disease. Metabolic syndrome is associated with a proinflammatory state that contributes to insulin resistance. Finally, a "metabolically benign obesity" that is not accompanied by insulin resistance has recently been postulated to exist.</p> <p>Aim</p> <p>To find whether any inflammation markers were independently associated with the presence of insulin resistance, evaluating specific anthropometric, ultrasonographic and laboratory parameters in a population of young adult obese subjects.</p> <p>Methods</p> <p>Of forty two young individuals, divided into two groups (with or without insulin resistance), were studied serum C-reactive protein and fibrinogen as indexes of chronic pro-inflammatory status. Body mass index, waist circumference and metabolic syndrome presence were assessed as part of the metabolic evaluation. Ultrasonography weighted visceral and subcutaneous abdominal fat thickness, spleen size as longitudinal diameter and liver hyperechogenicity.</p> <p>Results and Discussion</p> <p>Serum C-reactive protein and fibrinogen as well as spleen longitudinal diameter were significantly increased in the obese young with insulin resistance compared to non-insulin resistance group. Insulin resistance was significantly associated with hepatic steatosis score at sonography (r = 0.33, P = 0.03), spleen longitudinal diameter (r = 0.35, P = 0.02) and C-reactive protein (r = 0.38, P = 0.01), but not with body mass index, visceral or subcutaneous abdominal adipose tissue, waist circumference and fibrinogen (P = 0.18, 0.46, 0.33, 0.37 and 0.4, respectively). Steatosis score at sonography was well associated with spleen volume (rho = 0.40, P = 0.01) and C-reactive protein levels (rho = 0.49, P = 0.002). Metabolic syndrome was much more frequent in obese patients with insulin resistance. These findings show that in young adults the only abdominal adiposity without insulin resistance, plays a scarce role in determining hepatic steatosis as well as metabolic syndrome.</p> <p>Conclusion</p> <p>Increases in spleen size and CRP levels represent a reliable tool in diagnosing insulin resistance.</p

Extra-Anatomic Jump Graft from the Right Colic Vein: A Novel Technique to Manage Portal Vein Thrombosis in Liver Transplantation

In the context of cirrhosis, portal vein thrombosis (PVT) is present in 2.1% to 26% of patients. PVT is no longer considered an absolute contraindication for liver transplantation, and nowadays, surgical strategies depend on the extent of PVT. Complete PVT is associated with higher morbidity rates and poor prognosis, while comparable long-term outcomes can be achieved as long as physiological portal inflow is restored

Immunotherapy for early triple negative breast cancer: research agenda for the next decade

Breast cancer; Drug development; ImmunoeditingCàncer de mama; Desenvolupament de medicaments; ImmunoedicióCáncer de mama; Desarrollo de fármacos; InmunoediciónFor decades, the systemic treatment of localized triple negative breast cancer (TNBC) has exclusively relied on chemotherapy. Recent advancements, however, are rapidly reshaping the treatment algorithms for this disease. The addition of pembrolizumab to neoadjuvant chemotherapy has indeed shown to significantly improve event-free survival for stage II–III TNBC, leading to its establishment as new standard of care in this setting. This landmark advancement has however raised several important scientific questions. Indeed, we desperately need strategies to identify upfront patients deriving benefit from the addition of immunotherapy. Moreover, the best integration of pembrolizumab with further recent advancements (capecitabine, olaparib) is yet to be defined. Lastly, extensive efforts are needed to minimize the impact on patients of immune-related adverse events and financial toxicity. The next decade of clinical research will be key to overcome these challenges, and ultimately learn how to optimally integrate immunotherapy in the treatment landscape of TNBC.Supported by an American-Italian Cancer Foundation Post-Doctoral Research Fellowship

The Evolving Role of Local Treatments for HCC in the Third Millennium

Hepatocellular carcinoma (HCC) represents the fifth most common malignancy and the third cancer-related cause of death worldwide. The aim of this review was to clarify the role of local treatments for HCC, analyzing the indications and defining future perspectives

Sentinel-2 Remote Sensed Image Classification with Patchwise Trained ConvNets for Grassland Habitat Discrimination

The present study focuses on the use of Convolutional Neural Networks (CNN or ConvNet) to classify a multi-seasonal dataset of Sentinel-2 images to discriminate four grassland habitats in the “Murgia Alta” protected site. To this end, we compared two approaches differing only by the first layer machinery, which, in one case, is instantiated as a fully-connected layer and, in the other case, results in a ConvNet equipped with kernels covering the whole input (wide-kernel ConvNet). A patchwise approach, tessellating training reference data in square patches, was adopted. Besides assessing the effectiveness of ConvNets with patched multispectral data, we analyzed how the information needed for classification spreads to patterns over convex sets of pixels. Our results show that: (a) with an F1-score of around 97% (5 x 5 patch size), ConvNets provides an excellent tool for patch-based pattern recognition with multispectral input data without requiring special feature extraction; (b) the information spreads over the limit of a single pixel: the performance of the network increases until 5 x 5 patch sizes are used and then ConvNet performance starts decreasing