Mesenchymal Stem Cell for Prevention and Management of Intervertebral Disc Degeneration

Intervertebral disc degeneration (IVD) is a frequent pathological condition. Conservative management often fails, and patients with IVD degeneration may require surgical intervention. Several treatment strategies have been proposed, although only surgical discectomy and arthrodesis have been proved to be predictably effective. The aim of biological strategies is to prevent and manage IVD degeneration, improve the function, the anabolic and reparative capabilities of the nucleus pulposus and annulus fibrosus cells, and inhibit matrix degradation. At present, clinical applications are still in their infancy. Further studies are required to clarify the role of mesenchymal stem cells and gene therapy for the prevention and treatment of IVD degeneration

Surgical management of spinal fractures and neurological involvement in patients with myeloma

none6noIntroduction: Multiple Myeloma (MM) typically involves the spine and causes bone pain, pathological fractures and spinal cord compression with possible consequent neurological deficits. This retrospective study reports the results of surgery on a selected population of patients who underwent surgery for symptomatic spinal myeloma.Materials and methods: A total of 26 patients who underwent surgery for spinal myeloma with neurological involvement were studied retrospectively. Neurological evaluation was performed according to the Frankel grade. Characteristics of this population, reconstructive techniques and surgery-related complications were reviewed.Results: The tumours involved the thoracic spine in 13 patients, the lumbar spine in 10 patients, and the cervical spine in three patients. The most common approach was a posterior-only approach (70%), followed by a staged, combined approach (20%), and an anterior-only approach (10%). The mean postoperative survival time was 43 months (range: 8-60 months). A significant improvement in neurological function was observed in the study population after surgery (p = 0.001). There were seven early postoperative complications, two late complications and five surgery-related complications.Discussion: Surgery in selected patients affected by spinal myeloma with neurological involvement is associated with good clinical outcomes and neurological recovery and an acceptable rate of complications. Neurological deficit and segmental instability can be treated sufficiently in most cases by the implementation of a posterior-only approach; however, the final treatment should, when possible, include adjuvant chemotherapy and radiotherapy and rigorous bracing. (C) 2016 Elsevier Ltd. All rights reserved.mixedDenaro, Vincenzo; Denaro, Luca; Albo, Erika; Papapietro, Nicola; Piccioli, Andrea; Di Martino, AlbertoDenaro, Vincenzo; Denaro, Luca; Albo, Erika; Papapietro, Nicola; Piccioli, Andrea; Di Martino, Albert

Extrinsic compression of the inferior vena cava by a lumbar osteophyte: A rare cause of pulmonary embolism

Introduction: Pulmonary embolism results from thrombus migration into the pulmonary artery, with the most common cause being deep vein thrombosis. However, pulmonary embolism might not necessarily originate in the lower extremities, which necessitates specific diagnostic and therapeutic choices. Case Presentation: An 84-year-old man presented with acute pulmonary embolism, but with no sign of deep vein thrombosis or a thrombophilic state. He experienced complete resolution with medical therapy involving parenteral and oral anticoagulants. During the patient's hospital stay, an abdominal CT scan revealed a 23 mm lumbar osteophyte compressing and displacing the inferior vena cava. The turbulent blood flow through the stenotic area might have caused a thrombus and the consequent pulmonary embolism. Conclusions: This is the first report of pulmonary embolism caused by inferior vena cava extrinsic compression due to an osteophyte. Such a diagnosis should be suspected if the patient lacks deep vein thrombosisandhypercoagulative states. Acutepulmonary embolism could be a rare consequence of osteoarthritis in the spine, although correct assessment is crucial to initiating lifelong oral anticoagulant therapy following the first episode of pulmonary embolism. Indeed, spinal surgery is generally avoided due to the high risks and the fact that extrinsic compression of the inferior vena cava cannot be radically resolved

Cabozantinib targets bone microenvironment modulating human osteoclast and osteoblast functions

Cabozantinib, a c-MET and vascular endothelial growth factor receptor 2 inhibitor, demonstrated to prolong progression free survival and improve skeletal diseaserelated endpoints in castration-resistant prostate cancer and in metastatic renal carcinoma. Our purpose is to investigate the direct effect of cabozantinib on bone microenvironment using a total human model of primary osteoclasts and osteoblasts. Osteoclasts were differentiated from monocytes isolated from healthy donors; osteoblasts were derived from human mesenchymal stem cells obtained from bone fragments of orthopedic surgery patients. Osteoclast activity was evaluated by tartrate resistant acid phosphatase (TRAP) staining and bone resorption assays and osteoblast differentiation was detected by alkaline phosphatase and alizarin red staining. Our results show that non-cytotoxic doses of cabozantinib significantly inhibit osteoclast differentiation (p=0.0145) and bone resorption activity (p=0.0252). Moreover, cabozantinib down-modulates the expression of osteoclast marker genes, TRAP (p=0.006), CATHEPSIN K (p=0.004) and Receptor Activator of Nuclear Factor k B (RANK) (p=0.001). Cabozantinib treatment has no effect on osteoblast viability or differentiation, but increases osteoprotegerin mRNA (p=0.015) and protein levels (p=0.004) and down-modulates Receptor Activator of Nuclear Factor k B Ligand (RANKL) at both mRNA (p < 0.001) and protein levels (p=0.043). Direct cell-to-cell contact between cabozantinib pre-treated osteoblasts and untreated osteoclasts confirmed the indirect anti-resorptive effect of cabozantinib. We demonstrate that cabozantinib inhibits osteoclast functions "directly" and "indirectly" reducing the RANKL/osteoprotegerin ratio in osteoblasts

Imaging and surgical approach for a schwannoma of the hand

Schwannomas are benign encapsulated neoplasms of the peripheral nerve sheath. Clinical diagnosis is often difficult, and final diagnosis is usually based on histopathological findings. Imaging techniques, such as magnetic resonance imaging and ultrasonography, can be optimized to improve assessment prior to surgical treatment. The present case demonstrates that high-resolution sonography can be useful in assessing the underlying cause of median nerve pathology

Estimating the risk for symptomatic adjacent segment degeneration after lumbar fusion: analysis from a cohort of patients undergoing revision surgery

Purpose Aim of this study is to estimate the risk for symptomatic adjacent segment degeneration (ASD) and examine the association between spino-pelvic parameters and ASD.Methods 22 patients operated upon by instrumented lumbar or lumbosacral spinal fusion and re-operated upon for ASD were enrolled in the study. 83 consecutive patients with the same surgery and never re-operated upon were the controls. Pelvic incidence, sacral slope (SS), pelvic tilt (PT), and lumbar lordosis were calculated.Results Patients with ASD had significantly lower SS (p = 0.005) and higher PT values (p 21 degrees, were at higher risk for symptomatic ASD (relative risk 1.73 for SS and 3.663 for PT).Conclusions In patients re-operated upon for ASD, pelvic retroversion and hyperlordosis are the main mechanisms of compensation for the unbalanced spine. Patients with PT above 21 degrees and SS below 39 degrees are at higher risk for symptomatic ASD

Estimating the risk for symptomatic adjacent segment degeneration after lumbar fusion: analysis from a cohort of patients undergoing revision surgery

Models have been developed to calculate the impact of different policy scenarios on nature in agricultural areas. These models treat abiotic/landscape factors and management regimes separately. First, separate maps are made of the quality of separate abiotic factors. These maps are then integrated into a single map, describing the ‘potential quality’ of the landscape. Management is considered as a factor that determines the degree in which this potential quality is realised, resulting in a ‘realised quality’ map. The potential and realised habitats are differentiated into reproduction habitats and foraging habitats. The final suitability of these habitats is determined by their magnitude and spatial distribution. A brief description is given of how the model can be used to calculate different scenarios. This may be done by making changes in the factor maps (e.g. changes in landscape structure or drainage) or in the management map (e.g. intensification of the management regime)