Why do we treat adolescent idiopathic scoliosis? What we want to obtain and to avoid for our patients. SOSORT 2005 Consensus paper

BACKGROUND: Medicine is a scientific art: once science is not clear, choices are made according to individual and collective beliefs that should be better understood. This is particularly true in a field like adolescent idiopathic scoliosis, where currently does not exist definitive scientific evidence on the efficacy either of conservative or of surgical treatments. AIM OF THE STUDY: To verify the philosophical choices on the final outcome of a group of people believing and engaged in a conservative treatment of idiopathic scoliosis. METHODS: We performed a multifaceted study that included a bibliometric analysis, a questionnaire, and a careful Consensus reaching procedure between experts in the conservative treatment of scoliosis (SOSORT members). RESULTS: The Consensus reaching procedure has shown to be useful: answers changed in a statistically significant way, and 9 new outcome criteria were included. The most important final outcomes were considered Aesthetics (100%), Quality of life and Disability (more than 90%), while more than 80% of preferences went to Back Pain, Psychological well-being, Progression in adulthood, Breathing function, Scoliosis Cobb degrees (radiographic lateral flexion), Needs of further treatments in adulthood. DISCUSSION: In the literature prevail outcome criteria driven by the contingent treatment needs or the possibility to have measurement systems (even if it seems that usual clinical and radiographic methods are given much more importance than more complex Disability or Quality of Life instruments). SOSORT members give importance to a wide range of outcome criteria, in which clinical and radiographic issues have the lowest importance. CONCLUSION: We treat our patients for what they need for their future (Breathing function, Needs of further treatments in adulthood, Progression in adulthood), and their present too (Aesthetics, Disability, Quality of life). Technical matters, such as rib hump or radiographic lateral alignment and rotation, but not lateral flexion, are secondary outcomes and only instrumental to previously reported primary outcomes. We advocate a multidimensional, comprehensive evaluation of scoliosis patients, to gather all necessary data for a complete therapeutic approach, that goes beyond x-rays to reach the person and the family

Application of Microarray and Functional-Based Screening Methods for the Detection of Antimicrobial Resistance Genes in the Microbiomes of Healthy Humans

The aim of this study was to screen for the presence of antimicrobial resistance genes within the saliva and faecal microbiomes of healthy adult human volunteers from five European countries. Two non-culture based approaches were employed to obviate potential bias associated with difficult to culture members of the microbiota. In a gene target-based approach, a microarray was employed to screen for the presence of over 70 clinically important resistance genes in the saliva and faecal microbiomes. A total of 14 different resistance genes were detected encoding resistances to six antibiotic classes (aminoglycosides, β-lactams, macrolides, sulphonamides, tetracyclines and trimethoprim). The most commonly detected genes were erm(B), blaTEM, and sul2. In a functional-based approach, DNA prepared from pooled saliva samples was cloned into Escherichia coli and screened for expression of resistance to ampicillin or sulphonamide, two of the most common resistances found by array. The functional ampicillin resistance screen recovered genes encoding components of a predicted AcrRAB efflux pump. In the functional sulphonamide resistance screen, folP genes were recovered encoding mutant dihydropteroate synthase, the target of sulphonamide action. The genes recovered from the functional screens were from the chromosomes of commensal species that are opportunistically pathogenic and capable of exchanging DNA with related pathogenic species. Genes identified by microarray were not recovered in the activity-based screen, indicating that these two methods can be complementary in facilitating the identification of a range of resistance mechanisms present within the human microbiome. It also provides further evidence of the diverse reservoir of resistance mechanisms present in bacterial populations in the human gut and saliva. In future the methods described in this study can be used to monitor changes in the resistome in response to antibiotic therapy

The Notre Dame arc and the Taconic orogeny in Newfoundland

The Taconic orogeny in Newfoundland consisted of three accretionary events (Taconic 1, 2, and 3). Taconic 1 is represented by ca. 495 Ma, west-directed obduction of the infant-arc Lushs Bight oceanic tract (510–501 Ma) onto the peri-Laurentian Dashwoods microcontinent. Subduction is inferred to have initiated at a spreading center abandoned during an inboard ridge jump responsible for separation of Dash-woods from Laurentia and opening of the Humber seaway. Clogging of the subduction zone by Dashwoods forced subduction to step back into the Humber seaway. Inception of the new subduction zone led to formation of the ca. 490 Ma Baie Verte oceanic tract. Closure of the Humber seaway formed the Notre Dame arc (489–477 Ma) built on Dashwoods and the coeval Snooks Arm arc built on the Baie Verte oceanic tract. Sea-way closure led to collision (Taconic 2) between the arcs and Laurentia, which caused significant shortening of the Notre Dame arc. After a magmatic gap of 7–10 m.y., the Notre Dame arc records a voluminous flare-up of predominantly tonalite magmatism (464–459 Ma) during the waning stages of Taconic 2. Magmatism overlaps with deformation and includes both arc and non-arc-like tonalite. This flare-up was related to break-off of the oceanic lithosphere of the downgoing slab. The rapidly upwelling asthenosphere that replaced the broken-off slab induced melting in the subarc mantle and arc infrastructure. Taconic 3 is represented by 455–450 Ma accretion of a peri-Laurentian arc that had formed after the ca. 480 Ma initiation of west-directed subduction in the Iapetus Ocean outboard of the Dashwoods microcontinent