After the Knife: A detailed Roadmap for Vestibular Schwannoma Resection in the Semi-sitting Position - How I do It

After the discussion of a straightforward narrative description of the pre-surgical steps required before actual incision in the semi-sitting position¹, using vestibular schwannoma surgery as an example, the authors intend likewise to provide a narrative description of the steps following incision, for safe resection of vestibular schwannomas, again attempting to simplify a complex procedure into a more reproducible one. Vestibular schwannoma surgeries are known to be intrinsically related to complications due to their intimate relationship to cranial nerves and vessels as well as brainstem structures in the posterior fossa. It is therefore paramount not only to be familiar with the anatomical and surgical nuances of the procedure, but having an easy-to-follow strategy to significantly reduce complications rate to a minimum. The authors have therefore divided the surgical steps into five major momentums of the procedure, from skin disruption and subcutaneous tissue dissection and retraction, through craniotomy, dural opening, tumor resection with internal acoustic meatus opening, and final closure. Enumeration of the steps, therefore, serve as a facilitated guide for the surgical steps that can be reproduced time and again for better surgical outcomes and the video supplement serves as a useful visual guide for improved understanding of the distinct phases of the surgical intervention.

Comparison Between Sagittal Balance Outcomes After Corpectomy, Laminectomy, and Fusion for Cervical Spondylotic Myelopathy: A Matched Cohort Study

Cervical spondylotic myelopathy (CSM) can be successfully decompressed via either anterior cervical corpectomy and fusion (ACCF) or posterior laminectomy with fusion (LMF). However, few studies have compared the isolated effect of both techniques on cervical sagittal balance, a surrogate end point for clinical outcomes.We aimed to compare the sagittal balance radiological outcomes of ACCF against LMF. A case-matched controlled study of radiological cervical alignment parameters (C0-2, C2-3, index angles, T1 slope, and sagittal vertical axis (SVA)) in two groups of patients was performed by using pre- and postoperative neutral cervical X-rays.In total, 34 patients were enrolled (ACCF n = 17; LMF n = 17). The mean preoperative C2-7 angle was similar (11.58 ± 16.00° for ACCF; 13.36 ± 12.21° for LMF) in both cohorts. Both led to a loss of lordosis (-2.68 ± 13.8°, p = 0.43; -2.94 ± 11.5°, p = 0.31, respectively). At the C0-2, the two operations induced opposite variations (-0.9 ± 8.0°, p = 0.709 for ACCF; 3.5 ± 15.4°, p = 0.357 for LMF). ACCF led to a significant increase in SVA (7.1 ± 11.9 mm, p = 0.002). The C2-3 disk angle more pronouncedly increased with LMF.Both techniques show an equivalent kyphotic effect, with a greater disadvantage for ACCF. The negative impact on SVA changes is greater with ACCF. Both affect the C0-2 unit, with a tendency for kyphosis with ACCF and one for lordosis with LMF. When choosing the appropriate decompression and fusion technique, preoperative sagittal balance parameters should be included in the decision-making process.

Minimally Invasive Posterior Cervical Fusion: A Handsome Option

Cervical spondylosis is the leading cause of cervical myelopathy. When surgery is indicated, it is commonly addressed through an anterior or posterior cervical approach, such as cervical discectomy and fusion (ACDF) or laminectomy and fusion (LMF). Besides their own merits, each one has specific approach- or device-related complications, such as dysphagia, significant postoperative pain, wound infection, adjacent segment degeneration (ASD), and pseudoarthrosis. Through a tissue-sparing minimally invasive technique, posterior cervical fusion (PCF) has shown unfolding compelling evidence of biomechanical stability, good clinical outcomes, and high fusion rates, with fewer complications and better econometrics. On the basis of our own experience, we discuss here the indications, advantages, and drawbacks of minimally invasive PCF.

Long-Term Clinical and Radiological Evaluation of Low-Grade Lumbar Spondylolisthesis Stabilization with Rigid Percutaneous Pedicle Screws

The armamentarium of surgical treatment options for lumbar spondylolisthesis (LS) includes decompression alone, stabilization with interlaminar devices, or instrumented fusion, through open or minimally invasive approaches. Despite its safe profuse use in distinctive lumbar spine disorders, using percutaneous pedicle screws (PPSs) alone to stabilize LS has never been described before. We performed a retrospective study of prospectively collected data, enrolling 24 patients with LS and scrutinizing clinical and radiological outcomes. A statistically significant decrease in visual analog scale (VAS) scores (p < 0.001) and Oswestry Disability Index (ODI) scores (p < 0.001) was observed, as was a reduction in the intake of acetaminophen after surgery (p = 0.022). In the long-term, PPS effectively reduced the index-level range of motion (p < 0.001), reduced preoperative slippage (p = 0.03), and maintained foraminal height, thus accounting for the positive clinical outcomes. It induced a significant segmental kyphotic effect (p < 0.001) that was compensated for by a favorable increase in the pelvic incidence minus lumbar lordosis (PI-LL) index (0.028).

Spinal Intradural Extramedullary Tumors: A Retrospective Analysis on Ten-Years' Experience of Minimally Invasive Surgery and a Comparison with the Open Approach

Spinal intradural extramedullary (ID-EM) tumors are pathologies widely treated through a classical open approach. However, minimally invasive surgery is gaining traction as a comparable treatment option because it carries less morbidity and may reduce healthcare costs.This study aimed to compare the clinical and functional outcomes of open versus minimally invasive approaches for patients with ID-EM tumors. We performed a retrospective analysis on prospectively collected data from patients with ID-EM tumors submitted to surgery. Baseline features and operative variables were compared, including surgery duration and estimated blood loss (EBL). Postoperative data covered tumor histology, length of stay (LOS), complication(s), and neurological status (Medical Research Council (MRC) scale) at the last follow-up.In total, 46 patients were included: 30 (65.2%) operated through an open approach and 16 (34.8%) through a minimally invasive surgical (MIS) approach. The predominant histology type was schwannomas (43.5%). Lesions more frequently affected the lumbar spine (34.8%). The tumor dimensions were similar in both cohorts. The minimally invasive approach was on average 76.7 min faster and correlated positively with less EBL (140 mL less than that of the open approach). Patients in the MIS group had shorter LOSs (5.63 days vs. 17.27 days) and had fewer postoperative complications. No significant difference in functional outcome was found.MIS is as effective as the traditional approach in achieving comparable functional outcomes, with advantages such as shorter surgery durations, less blood loss, and shorter hospital LOSs.

Role of methyl jasmonate and salicylic acid in kiwifruit plants further subjected to Psa infection: biochemical and genetic responses

The use of plant elicitors for controlling Pseudomonas syringae pv. actinidiae (Psa), the etiological agent of the kiwifruit bacterial canker (KBC), has been analysed in the past and, while salicylic acid (SA) seems to decrease disease susceptibility, methyl jasmonate (MJ) shows an opposite effect. However, the metabolic and genomic responses of Psa-infected plants following elicitation with these two compounds, as compared with non-elicited Psa-inoculated plants, are poorly understood, being the focus of this study. Micropropagated A. chinensis 'Hayward' plants were elicited with MJ or SA, and further inoculated with Psa. Fifteen days post-inoculation, Psa population in MJ-treated plants was increased by 7.4-fold, whereas SA elicitation led to decreased Psa colonization (0.5-fold), as compared with non-elicited inoculated plants. Additionally, elicitation with MJ or SA generally decreased polyphenols and lignin concentrations (by at least 20%) and increased total proteins (by at least 50%). MJ led to the upregulation of SOD, involved in plant antioxidant system, and reporter genes for the jasmonic acid (JA) (JIH and LOX1), abscisic acid (SnRK), SA (ICS1), and ethylene (ACAS1, ETR1 and SAM) pathways. Moreover, it increased ABA (40%) and decreased carotenoids (30%) concentrations. Contrastingly, comparing with non-elicited Psa-inoculated plants, SA application resulted in the downregulation of antioxidant system-related genes (SOD and APX) and of reporter genes for ethylene (ETR1) and JA (JIH and ETR1). This study contributes to the understanding of potential mechanisms involved in kiwifruit plant defences against Psa, highlighting the role of the JA, ABA and ethylene in plant susceptibility to the pathogen.

Phospholipase D1 Ablation Disrupts Mouse Longitudinal Hippocampal Axis Organization and Functioning

Phosphatidic acid (PA) is a signaling lipid involved in the modulation of synaptic structure and functioning. Based on previous work showing a decreasing PA gradient along the longitudinal axis of the rodent hippocampus, we asked whether the dorsal hippocampus (DH) and the ventral hippocampus (VH) are differentially affected by PA modulation. Here, we show that phospholipase D1 (PLD1) is a major hippocampal PA source, compared to PLD2, and that PLD1 ablation affects predominantly the lipidome of the DH. Moreover, Pld1 knockout (KO) mice show specific deficits in novel object recognition and social interaction and disruption in the DH-VH dendritic arborization differentiation in CA1/CA3 pyramidal neurons. Also, Pld1 KO animals present reduced long-term depression (LTD) induction and reduced GluN2A and SNAP-25 protein levels in the DH. Overall, we observe that PLD1-derived PA reduction leads to differential lipid signatures along the longitudinal hippocampal axis, predominantly affecting DH organization and functioning.

Podocyte GSK3 is an evolutionarily conserved critical regulator of kidney function

Albuminuria affects millions of people, and is an independent risk factor for kidney failure, cardiovascular morbidity and death. The key cell that prevents albuminuria is the terminally differentiated glomerular podocyte. Here we report the evolutionary importance of the enzyme Glycogen Synthase Kinase 3 (GSK3) for maintaining podocyte function in mice and the equivalent nephrocyte cell in Drosophila. Developmental deletion of both GSK3 isoforms (α and β) in murine podocytes causes late neonatal death associated with massive albuminuria and renal failure. Similarly, silencing GSK3 in nephrocytes is developmentally lethal for this cell. Mature genetic or pharmacological podocyte/nephrocyte GSK3 inhibition is also detrimental; producing albuminuric kidney disease in mice and nephrocyte depletion in Drosophila. Mechanistically, GSK3 loss causes differentiated podocytes to re-enter the cell cycle and undergo mitotic catastrophe, modulated via the Hippo pathway but independent of Wnt-β-catenin. This work clearly identifies GSK3 as a critical regulator of podocyte and hence kidney function.

Preoperative Evaluation of Ferritinemia in Primary Epithelial Ovarian Cancer

Aims and background

High ferritin serum levels have been reported in patients suffering from various malignancies. The aim of this study was to evaluate the role of ferritinemia in the preoperative diagnosis of ovarian carcinoma.

Methods

Between March 1993 and September 1996, 60 patients suffering from ovarian carcinoma were surgically treated at our Department. Their ferritin serum levels were measured preoperatively by a solid-phase, two-site chemiluminescent immunometric assay and compared with those of a group of 60 healthy, age-matched, non pregnant controls.

Results

The mean serum concentration of ferritin was 54.7 ± 7.8 ng/ml (range, 14–135) in healthy controls and 112.3 ± 21.2 ng/ml (range, 9–947) in patients with ovarian carcinoma. The difference was statistically significant (P = 0.005, X2 test = 7.951). Serum ferritin was elevated preoperatively (cutoff ≥ 120 ng/ml) in 18/60 patients with malignancy (sensitivity 30%), whereas the CA 125 levels were above the cutoff in 53/60 patients (sensitivity 88.3%). Only 2/60 women of the control group had ferritin titers > 120 ng/ml (specificity 96.7%). The ferritin levels increased with advancing disease stage; no significant correlation was found between ferritin concentration and neoplastic histology and grading. The mean serum iron levels were also measured preoperatively in patients with ovarian carcinoma and healthy controls. They were 57.2 ± 3.8 and 66.3 ± 2.61 μg/dl, respectively, and the difference was not significant (P = 0.655, X2 test= 0.200).

Conclusions

The present study underlines that although ferritin shows an elevated specificity, its low sensitivity does not suggest any true usefulness as a tumor marker in epithelial ovarian cancer.

Microfluidic immunosensor for rapid and highly-sensitive salivary cortisol quantification

This paper presents a novel poly(dimethylsiloxane) (PDMS) microfluidic immunosensor that integrates a complementary metal-oxide-semiconductor (CMOS) optical detection system for a rapid and highly-sensitive quantification of salivary cortisol. The simple and non-invasive method of saliva sampling provides an interesting alternative to the blood, allowing a fast sampling at short intervals, relevant for many clinical diagnostic applications. The developed approach is based on the covalent immobilization of a coating antibody (Ab), a polyclonal anti-IgG, onto a treated PDMS surface. The coating Ab binds the capture Ab, an IgG specific for cortisol, allowing its correct orientation. Horseradish peroxidase (HRP)-labelled cortisol is added to compete with the cortisol in the sample, for the capture Ab binding sites. The HRP-labelled cortisol, bonded to the capture Ab, is measured through the HRP enzyme and the tetramethylbenzidine (TMB) substrate reaction. The cortisol quantification is performed by colorimetric detection of HRP-labelled cortisol, through optical absorption at 450nm, using a CMOS silicon photodiode as the photodetector. Under the developed optimized conditions presented here, e.g., microfluidic channels geometry, immobilization method and immunoassay conditions, the immunosensor shows a linear range of detection between 0.01-20ng/mL, a limit of detection (LOD) of 18pg/mL and an analysis time of 35min, featuring a great potential for point-of-care applications requiring continuous monitoring of the salivary cortisol levels during a circadian cycle.

Absence of Tau triggers age-dependent sciatic nerve morphofunctional deficits and motor impairment

Dementia is the cardinal feature of Alzheimer's disease (AD), yet the clinical symptoms of this disorder also include a marked loss of motor function. Tau abnormal hyperphosphorylation and malfunction are well‐established key events in AD neuropathology but the impact of the loss of normal Tau function in neuronal degeneration and subsequent behavioral deficits is still debated. While Tau reduction has been increasingly suggested as therapeutic strategy against neurodegeneration, particularly in AD, there is controversial evidence about whether loss of Tau progressively impacts on motor function arguing about damage of CNS motor components. Using a variety of motor‐related tests, we herein provide evidence of an age‐dependent motor impairment in Tau−/− animals that is accompanied by ultrastructural and functional impairments of the efferent fibers that convey motor‐related information. Specifically, we show that the sciatic nerve of old (17–22‐months) Tau−/− mice displays increased degenerating myelinated fibers and diminished conduction properties, as compared to age‐matched wild‐type (Tau+/+) littermates and younger (4–6 months) Tau−/− and Tau+/+ mice. In addition, the sciatic nerves of Tau−/− mice exhibit a progressive hypomyelination (assessed by g‐ratio) specifically affecting large‐diameter, motor‐related axons in old animals. These findings suggest that loss of Tau protein may progressively impact on peripheral motor system.

Absence of IFNγ promotes hippocampal plasticity and enhances cognitive performance

Cognitive functioning can be differentially modulated by components of the immune system. Interferon-γ (IFNγ) is a pro-inflammatory cytokine whose production is altered in many conditions displaying some degree of cognitive deficits, although its role in cognitive functioning is still unclear. Here we show that the absence of IFNγ selectively enhances cognitive behaviours in tasks in which the hippocampus is implicated. Moreover, the absence of IFNγ leads to volumetric and cell density changes that are restricted to the dorsal part of the hippocampus. In the dorsal hippocampus, the absence of this pro-inflammatory cytokine leads to an increase in the numbers of newly born neurons in the subgranular zone of the dentate gyrus (DG), an adult neurogenic niche known to support learning and memory, and to an enlargement of the dendritic arborization of DG granule and cornu ammonis (CA)1 pyramidal neurons. Moreover, it also modestly impacts synaptic plasticity, by decreasing the paired-pulse facilitation in the Schaffer collateral to CA1 pyramidal cell synapses. Taken together, our results provide evidence that IFNγ is a negative regulator of hippocampal functioning, as its absence positively impacts on dorsal hippocampus structure, cell density, neuronal morphology and synaptic plasticity. Importantly, these neuroplastic changes are associated with improved performance in learning and memory tasks. Therefore, blockage of the IFNγ signalling may present as promising therapeutic targets for the treatment of inflammation-associated cognitive dysfunction.

Tau Mislocation in Glucocorticoid-Triggered Hippocampal Pathology

The exposure to high glucocorticoids (GC) triggers neuronal atrophy and cognitive deficits, but the exact cellular mechanisms underlying the GC-associated dendritic remodeling and spine loss are still poorly understood. Previous studies have implicated sustained GC elevations in neurodegenerative mechanisms through GC-evoked hyperphosphorylation of the cytoskeletal protein Tau while Tau mislocation has recently been proposed as relevant in Alzheimer's disease (AD) pathology. In light of the dual cytoplasmic and synaptic role of Tau, this study monitored the impact of prolonged GC treatment on Tau intracellular localization and its phosphorylation status in different cellular compartments. We demonstrate, both by biochemical and ultrastructural analysis, that GC administration led to cytosolic and dendritic Tau accumulation in rat hippocampus, and triggered Tau hyperphosphorylation in epitopes related to its malfunction (Ser396/404) and cytoskeletal pathology (e.g., Thr231 and Ser262). In addition, we show, for the first time, that chronic GC administration also increased Tau levels in synaptic compartment; however, at the synapse, there was an increase in phosphorylation of Ser396/404, but a decrease of Thr231. These GC-triggered Tau changes were paralleled by reduced levels of synaptic scaffolding proteins such as PSD-95 and Shank proteins as well as reduced dendritic branching and spine loss. These in vivo findings add to our limited knowledge about the underlying mechanisms of GC-evoked synaptic atrophy and neuronal disconnection implicating Tau missorting in mechanism(s) of synaptic damage, beyond AD pathology.

Plant growth promotion by inoculation with selected bacterial strains versus mineral soil supplements

In the process of remediation of mine sites, the establishment of a vegetation cover is one of the most important tasks. This study tests two different approaches to manipulate soil properties in order to facilitate plant growth. Mine waste from Ingurtosu, Sardinia, Italy rich in silt, clay, and heavy metals like Cd, Cu, and Zn was used in a series of greenhouse experiments. Bacteria with putative beneficial properties for plant growth were isolated from this substrate, propagated and consortia of ten strains were used to inoculate the substrate. Alternatively, sand and volcanic clay were added. On these treated and untreated soils, seeds of Helianthus annuus, of the native Euphorbia pithyusa, and of the grasses Agrostis capillaris, Deschampsia flexuosa and Festuca rubra were germinated, and the growth of the seedlings was monitored. The added bacteria established well under all experimental conditions and reduced the extractability of most metals. In association with H. annuus, E. pithyusa and D. flexuosa bacteria improved microbial activity and functional diversity of the original soil. Their effect on plant growth, however, was ambiguous and usually negative. The addition of sand and volcanic clay, on the other hand, had a positive effect on all plant species except E. pithyusa. Especially the grasses experienced a significant benefit. The effects of a double treatment with both bacteria and sand and volcanic clay were rather negative. It is concluded that the addition of mechanical support has great potential to boost revegetation of mining sites though it is comparatively expensive. The possibilities offered by the inoculation of bacteria, on the other hand, appear rather limited.

Lipocalin-2 is involved in emotional behaviors and cognitive function

Lipocalin-2 (LCN2), an iron-related protein well described to participate in the innate immune response, has been shown to modulate spine morphology and to regulate neuronal excitability. In accordance, LCN2-null mice are reported to have stress-induced anxiety. Here we show that, under standard housing conditions, LCN2-null mice display anxious and depressive-like behaviors, as well as cognitive impairment in spatial learning tasks. These behavioral alterations were associated with a hyperactivation of the hypothalamic-pituitary-adrenal axis and with an altered brain cytoarchitecture in the hippocampus. More specifically, we found that the granular and pyramidal neurons of the ventral hippocampus, a region described to be associated with emotion, were hypertrophic, while neurons from the dorsal hippocampus, a region implicated in memory and cognition, were atrophic. In addition, LCN2-null mice presented synaptic impairment in hippocampal long-term potentiation. Whether the LCN2 effects are mediated through modulation of the level of corticosteroids or through a novel mechanism, the present observations bring further into light this immune-related protein as a player in the fine-tuning of behavior and of synaptic activity.

A scalable method for O-antigen purification applied to various Salmonella serovars

The surface lipopolysaccharide of gram-negative bacteria is both a virulence factor and a B cell antigen. Antibodies against O-antigen of lipopolysaccharide may confer protection against infection, and O-antigen conjugates have been designed against multiple pathogens. Here, we describe a simplified methodology for extraction and purification of the O-antigen core portion of Salmonella lipopolysaccharide, suitable for large-scale production. Lipopolysaccharide extraction and delipidation are performed by acetic acid hydrolysis of whole bacterial culture and can take place directly in a bioreactor, without previous isolation and inactivation of bacteria. Further O-antigen core purification consists of rapid filtration and precipitation steps, without using enzymes or hazardous chemicals. The process was successfully applied to various Salmonella enterica serovars (Paratyphi A, Typhimurium, and Enteritidis), obtaining good yields of high-quality material, suitable for conjugate vaccine preparations.

Relative stability of meningococcal serogroup A and X polysaccharides

Prior to the introduction of the MenAfriVac™ serogroup A glycoconjugate vaccine in September 2010, serogroup A was the major epidemic disease-causing meningococcal serogroup in the African meningitis belt. However, recently serogroup X meningococcal (MenX) disease has received increased attention because of outbreaks recorded in this region, with increased endemic levels of MenX disease over the past 2 years. Whereas polysaccharide-protein conjugate vaccines against meningococcal serogroups A, C, W and Y (MenA, MenC, MenW, MenY) are on the market, a vaccine able to protect against MenX has never been achieved. The structure of serogroup A, C, W and Y meningococcal polysaccharides has been already fully elucidated by NMR. MenX capsular polysaccharide (MenX CPS) structure is also documented but fewer characterization data have been published. We have applied here (1)H NMR, (31)P NMR and HPLC to evaluate the stability of MenX CPS in aqueous solution as compared to MenA capsular polysaccharide (MenA CPS). The stability study demonstrated that MenA CPS is more susceptible to hydrolytic degradation than MenX CPS. The different stereochemistry of the N-acetyl group at position C(2) of mannosamine (MenA CPS) and glucosamine (MenX CPS) respectively might play a fundamental role in this susceptibility to polysaccharide chain degradation. The satisfactory stability of MenX CPS predicts the possibility that a stable fully-liquid MenX polysaccharide or glycoconjugate vaccine could be developed.

AlphaScope vs lens-based hysteroscope for office polypectomy without anesthesia: randomized controlled study

In this randomized controlled study, effectiveness, operative time, and acceptability of endometrial polypectomy were compared using an AlphaScope vs an office operative lens-based hysteroscope (LBH). One hundred fifty women with a diagnosis of endometrial polyp were operated on using an AlphaScope or LBH in the office setting. In 73 procedures using the AlphaScope (97.3%) and 68 using the LBH (90.7%), the polyp was successfully removed completely. In the AlphaScope group, 2 procedures were incomplete because of excessive endometrial mucosa thickness. In the LBH group, 3 procedures were incomplete because of difficulty in management of a large polyp, and 4 procedures were stopped because of patient pain and low compliance. Time to completion of the procedure and complete removal of the polyp was significantly shorter in the AlphaScope group than in the LBH group (p < .05). Similarly, the pain score at the end of the procedure was significantly lower in the AlphaScope group than in the LBH group (p < .05). The AlphaScope is an effective operative hysteroscope that increases the possibility of performing endometrial polypectomy in the office setting without anesthesia and improves the indications for and acceptability of office hysteroscopy.

Generation of cnoidal waves by a laser system with a controllable saturable absorber

We demonstrate the cnoidal wave formation in a two-laser system with a saturable absorber in the cavity of one of the lasers. Another laser is used to activate the saturable absorber in order to control the pulse shape, width, intensity and frequency. Using the three-level laser model based on the Statz--De Mars equations, we show that for any value of the saturable absorber parameter there exists a certain modulation frequency for which the pulse shape is very close to a soliton shape with less than 5% error at the pulse base. Such a device may be prominent for optical communication and laser engineering applications.

Frequency of human papillomavirus infection and genotype distribution among women with known cytological diagnosis in a Southern Italian region

INTRODUCTION

In the Puglia region (South Italy) about 200 new hospitalizations for cervical cancer are registered every year. The study investigated the frequency of Human Papillomavirus (HPV) infection and the genotype distribution of HPV in a sample of women with known cytology attending the outpatient clinics of four Gynecological Departments of the University of Bari over a four-year period (2005-2008).

METHODS

Cervical samples from 1,168 women were analyzed for the presence of HPV-DNA through Polymerase Chain Reaction (PCR) in L1 region and reverse hybridization. The cytological results were associated with HPV positivity and type-specific prevalence.

RESULTS

Overall, HPV infection was found in 355 (30.4%) women. HPV-DNA was found in 34.4% of women with a cytological diagnosis of ASCUS, in 46.8% of women with Low-grade Squamous Intraepithelial Lesion (LSIL) and in 87.0% of women with High-grade Squamous Intraepithelial Lesion (HSIL)/carcinoma. Also 16.0% of women with normal Pap smear were found to be HPV-DNA positive. The most common HPVgenotype was type 16 found in 27.3% of positives, followed by type 53 (11.5%), type 66 (9.2%) and type 31 (9.0%). HPV genotype 18 was found in 6.4% of positives. Types 16 or 18 were detected in about 34% (120/355) of all infected women, in about 33% of LSIL and in 60% of HSIL/ carcinoma HPV-positive women. Among low risk (LR) genotypes, type 61 was found in 10.7% of HPV positive women, type 62 in 8.4%, type 42 in 8.1% and type CP6108 in 7.8%.

DISCUSSION AND CONCLUSIONS

The findings of the study give evidence that HPV infection is frequent in the studied cohort of women. The most widespread genotypes found were 16 and 53. These data may represent a benchmark for future evaluation after the recent introduction of vaccination against HPV in 12-year-old girls.

[Reliability of the diagnostic fluid mini-hysteroscopy in the diagnosis of intrauterine pathologies]

AIM

The aim of this study was to determine the diagnostic accuracy of minihysteroscopy with fluid distention and vaginoscopic approach for the diagnosis of endometrial pathologies.

METHODS

This controlled clinical study was conducted on 930 women with endometrial abnormalities who referred to our Department of Obstetrics and Gynecology, University Medical School of Bari, to perform hysterectomy. One week before hysterectomy all the patients underwent minihysteroscopy with fluid distention. Histological diagnoses were compared with the hysteroscopic findings, and the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were determined.

RESULTS

Hysteroscopy was technically successful in all women and revealed sensitivity of 98%, specificity of 99%, a positive predictive value of 92%, a negative predictive value of 99%, and diagnostic accuracy of 99% for the diagnosis of endometrial carcinoma.

CONCLUSIONS

Size reduction of the hysteroscope is of greatest importance for reducing pain and risk of vasovagal reaction. In conclusion, the best approach in terms of ease, reliability, acceptability, and safety to patients in whom intrauterine exploration is indicated should be simple diagnostic mini-hysteroscopy using a small-diameter, rod lens hysteroscope with a single-flow diagnostic sheath, vaginoscopic approach, and fluid distention. In this way in about 90% of patients, a correct diagnosis and proper choice for eventual subsequent operative strategy can be obtained, without discomfort and risk.

Cavum veli interpositi cyst: prenatal diagnosis and postnatal outcome

OBJECTIVE

The cavum veli interpositi (CVI) is a space within the double-layered tela choroidea of the third ventricle. Occasionally, this space is fluid-filled and sonographically visible as an interhemispheric anechoic cyst. Because of its rarity, the incidence of CVI cyst is undetermined and the outcome of affected individuals has been found to be variable. The aim of this study was to report our experience of the sonographic findings and outcome of fetuses affected by CVI cysts.

METHODS

In five fetuses with a CVI cyst, we performed targeted prenatal ultrasound scans of intracranial structures and a detailed anatomical survey to rule out associated malformations. Follow-up consisted of neurological examination and neurosonography.

RESULTS

The CVI cyst appeared as a well-defined anechoic lesion without adjacent mass effect. In all fetuses the cyst was single and in two cases it enlarged slightly during pregnancy. The cyst was isolated in three fetuses and associated with borderline ventriculomegaly in two. A single umbilical artery was the only associated extracranial anomaly and this was detected in only one fetus. Neurosonography confirmed the presence of CVI cysts in all cases after delivery. During postnatal follow-up (range 10-48 months), the cyst regressed in one case within 1 month after delivery while the size of the others remained stable. No infant developed psychomotor disorders.

CONCLUSIONS

Prenatal sonographic diagnosis of CVI cysts is feasible. Its finding in isolation is consistent with favorable postnatal outcome.

Paclitaxel, ifosfamide, and cisplatin regimen as neoadjuvant chemotherapy in young women with locally advanced squamous cervical cancer

5587

Background: Chemoradiotherapy is the standard treatment of advanced cervical cancer. Neoadjuvant chemotherapy (NAC) may represent an alternative for locally advanced cervical cancer (LACC).This study was undertaken to evaluate the efficacy of NAC in young patients with squamous LACC. Methods: Since 2000 to 2008, 61 pts (mean age 43 yrs) with squamous LACC were treated with NAC and afterwards evaluated for radical surgery. Eligibility included proven histologically diagnosis of squamous cervical carcinoma, FIGO stage IB2/IIA>4cm/IIB, measurable disease, ECOG PS 0–2, no prior therapy and age under 49 years. All patients received TIP regimen (cisplatin 50 mg/m2 i.v. day 1, paclitaxel 175 mg/m2 over 3 hrs i.v.day1, ifosfamide 5,000 mg/m2 plus mesna 6,000 mg/m2 over 24 hrs i.v. day 1–2). Each cycle was repeated every 21 days. Patients were evaluated 4–6 weeks after the completion of the third cycle with the purpose to perform radical surgery according to clinical response. Results: 35pts (57.4%) were stage IB2; 9 (14.7%) were IIA >4cm; and 17 (27.9%) were IIB. After restaging the clinical results were: CR = 4/61 (6.6%), PR = 51/61 (83.6%); no response = 5/61 (8.2%); progression = 1/61 (1.6%). A total of 55 pts (90.1%) were eligible for surgery; 6/61 pts (9.8%) were submitted to curative radiotherapy (until 2004) or chemoradiotherapy. Pathological responses after surgery were: 4 pCR (7.3%); 46 pPR (83.6%); and 5 (9.1%) pPR with presence of positive surgical margins or metastatic lymph nodes. Out of 55 pts, 50 received 2 cycles of TIP regimen as a consolidation therapy before follow-up; 5 pts with incomplete pPR underwent radio/chemoradiotherapy. After NAC an overall downstaging of LACC was obtained in 50/61 pts (82.0%). In this group of pts at the median follow-up of 42 months (range 4–98) updated as of December 2008, the 3-years progression-free survival and overall survival are 85.9% and 82.0%, respectively. Conclusions: Our results indicate that TIP regimen-based NAC is an attractive option in young women with squamous LACC (IB2,IIA >4cm, IIB) that strongly desire surgery.The rate of patients with a prolonged remission of disease (82.0%) suggests that the clinical benefit of TIP regimen-based NAC followed by surgery may be comparable to chemoradiotherapy.

No significant financial relationships to disclose.

Ovário-histerectomia laparoscópica em felinos hígidos: estudo comparativo de três métodos de hemostasia

Foram avaliadas 24 gatas, hígidas, sem raça definida, distribuídas em três grupos de oito animais. Descreveu-se o acesso laparoscópico para ovariossalpingo-histerectomia (OSH) e comparou-se o uso do eletrocautério bipolar (grupo I), do clipe de titânio (grupo II) e da ligadura com fio de sutura (grupo III) para a oclusão dos vasos ovarianos e uterinos. Hemorragia e enfisema subcutâneo foram as principais complicações observadas no transoperatório e hematoma subcutâneo e deiscência de sutura, as do pós-operatório. O procedimento cirúrgico e a técnica operatória mostraram-se viáveis nos três grupos. O uso do eletrocautério bipolar apresentou vantagens na comparação com os outros métodos de hemostasia.

One century sedimentary record of Hg and Pb pollution in the Sagua estuary (Cuba) derived from 210Pb and 137Cs chronology

The vertical distribution of Hg and Pb were determined in a sediment core collected from the Sagua estuary (North Cuba) that receives input from the Sagua river, one of the most polluted rivers discharging into the Cuban coastal environment. Depth profiles of metal concentrations were converted to time-based profiles using the (210)Pb dating method and confirmed with the (137)Cs fallout peak. The mean mass accumulation rate was estimated to be 0.17+/-0.04 g cm(-2)y(-1) (mean sediment accumulation rate 0.52+/-0.13 cm y(-1)) and the core bottom was estimated to date back about 130 years. The historical sedimentary record showed a strong enrichment of mercury concentrations in the past decades, caused by the incomplete treatment of industrial wastes from a chlor-alkali plant with mercury-cell technology in the Sagua river basin. Lead fluxes to sediments showed a gradual increase from the 1920s to present, which agrees with a population increase in Sagua la Grande City. Fluxes of both metals have increased the past 25 years, with values reaching a maximum of 0.5 and 3.9 microg cm(-2)y(-1) for Hg and Pb, respectively.

Gastrointestinal stromal tumors mimicking gynecological masses on ultrasound: a report of two cases

Gastrointestinal stromal tumors (GISTs) are among the most common mesenchymal tumors of the gastrointestinal tract. Diagnosis of GIST on ultrasound examination can be difficult because of their similarity in appearance to gynecological neoplasms. We present two cases of GIST originating from the small bowel and the stomach, which were preoperatively misdiagnosed as a uterine leiomyoma and an ovarian tumor, respectively. The ultrasonographic differential diagnosis of these pelvic masses is discussed.

Adverse events after infusions of cryopreserved hematopoietic stem cells depend on non-mononuclear cells in the infused suspension and patient age

BACKGROUND

Adverse events (AE) represent a significant clinical problem after infusion of cryopreserved HPC. However, the factors playing a role in the pathogenesis have not yet been fully established.

METHODS

We prospectively collected data on AE that occurred with 179 HPC infusions performed on patients affected with hematologic neoplasm after high-dose chemotherapy. The stem cell source was hemopoietic progenitor cells aphaeresis (HPC-A) in 157 cases and hemopoietic progenitor cell BM (HPC-BM) in 22 cases. In all cases, an endotoxin-free DMSO was used.

RESULTS

One or more AE were registered in 51/179 infusions (28.6%). The frequency of AE was higher after HPC-A than after HPC-BM (31.3% vs. 4.5%; chi(2) test, P =0.008). With univariate logistic regression, other factors found important for AE were age (P =0.028), number of total nucleated cells infused per kilogram (P =0.002), volume per kilogram infused (P =0.057), volume of packed RBC (P =0.019), a content of non-mononuclear cells >0.5 x 10(8)/kg (<P =0.0001) and actual time of infusion (P =0.058). When all aforementioned factors were evaluated with a multivariate logistic regression, only age of patient (P =0.024) and a content of non-mononuclear cells >0.5 x 10(8)/kg (P =0.0003) remained significant. A significant correlation existed between reduction of cardiac frequency both with volume per kilogram infused (r =0.221, P =0.02) and actual time of infusion (r =0.269, P =0.005).

DISCUSSION

Cardiovascular changes are influenced by volume per kilogram infused and by actual time of infusion, while non-cardiovascular AE are dependent on patient age and contamination by non-mononuclear cells in apheretic harvests.

[Sonoembryological criteria in the evaluation of gestational age]

AIM

The progressive appearance of specific embryological structures has been successfully used to define the ultrasonographic gestational age (GA). In our study we have revised this technique by comparing our results with the ones from Warren et al. obtained in 1989. Aim of the study is to evaluate the accuracy of this technique when applied working with new instrumentations and average skilled sonographers.

METHODS

Sixty-five pregnant women with correct GA ranging between 4 and 12 weeks have been observed between April 2003 and March 2004. We exposed them to an ultrasound examination looking for these structures in terms of presence/absence: gestational sac, yolk sac, embryo pole with cardiac activity, thromboencephalic cavity, falx cerebri and physiologic midgut herniation. We used transvaginal sonography (TVS) until 11 weeks of GA, from 11 weeks + 1 day we switched to transabdominal sonography (TAS). We have compared our results with the ones published by Warren et al.

RESULTS

Gestational sac's visualization has been possible between 4 weeks+3 days/5 weeks of GA. Yolk sac has been visualized between 5 weeks+4 days/6 weeks of GA, embryo with cardiac activity has been observed between 5 weeks+6 days/6 weeks+2 days of GA, romboencephalic cavity has been visualized between 7 weeks and 7 weeks+5 days, falx cerebri has been detected between 9 weeks+1 day/10 weeks+3 days. Visualization of physiologic midgut herniation has been possible between 8 weeks+3 days/8 weeks+6 days; it disappeared between 10 weeks+3 days/11 weeks +1 day.

CONCLUSIONS

Although the technological improvement in the US equipment in the last 15 years and the combination of TVS with TAS, there has been no advanced visualization of those single embryological structures. Indeed there has been a reduction of the time range during which those structures have been visualized. This improvement might have important practical implications in the ultrasonographic assessment of GA.

Pediatric Renal Transplantation: 13 Years of Experience—Report From The Chilean Cooperative Multicenter Group

Between 1989 and 2002, 178 renal transplants were performed in 168 pediatric patients in Chile. The mean age was 10.9 +/- 3.7 years (range 1 to 17.9). End-state renal disease etiologies were: congenital renal hypoplasia/dysplasia, chronic glomerulonephritis, and reflux nephropathy. Seventy received a graft from a living donor (LD), and 108 from a cadaveric donor (CD). Only 9% received antibody induction. Acute rejection episodes were reported in 76 patients: 38% in LD recipients and 48% in CD recipients (P = NS). One-, 3-, and 5-year graft survivals were 88%, 84%, and 76%, respectively, for LD and 86%, 79%, and 68% for CD recipients. Actuarial graft survival was significantly better among those patients with serum creatinine < 1 mg/dL at 1 year posttransplant compared with those with creatinine > 1 mg/dL (P < .05). The graft survival rate has improved from the first period (1989 to 1996) to the second period (1997 to 2002); (P = .05). Patient survival rates at 1, 3, and 5 years were 98%, 98%, and 98%, respectively, for LD, and 95%, 94%, and 94% for CD. Global height/age Z-score decreased from -0.7 at birth to -1.5 when dialysis started, and to -2.4 at the time of transplantation. The Z-score height/age at 1, 3, and 5 years posttransplantation was -2.25, -2.24, and -2.5. No significant differences were observed in transplant outcomes comparing patients younger than 7 years with those older ones. In conclusion, pediatric renal transplant has been performed in Chile with acceptable morbidity. The patient and graft survivals are similar to the reported international experience. In the last period there was a significant improvement in graft survival.

A kinetic study of trace element leachability from abandoned-mine-polluted soil treated with SS-MSW compost and red mud. Comparison with results from sequential extraction

The effect of adding treated red mud, a by-product of alumina production, to soil polluted by an abandoned mine and characterised by high concentrations of heavy metals, relatively low reaction grade, and low organic carbon content, was investigated. Also studied was addition of both red mud and compost (produced from source-separated municipal solid waste)--the synergistic action of red mud and compost could be exploited to achieve both metal trapping and an increase in organic carbon content. Leaching batch tests were performed on four different systems: soil, soil and treated red mud, soil and compost, soil and compost plus treated red mud. Dilute sulfuric acid and EDTA solution (liquid/solid ratio 10:1) were used in the tests--sulfuric acid to "mimic" acid rain and EDTA in accordance with general methods for estimating "plant-available" metals. Sequential extraction was also applied to the same samples. The use of relatively non-specific extractant reagents in the leaching tests led to a kinetic approach (already proposed in literature), because measurements of trace elements extracted at equilibrium cannot be related to their speciation. Comparison of information obtainable by the kinetic approach to evaluation of data from leaching tests with results from sequential extraction enabled evaluation whether the "kinetic fractionation method", a relatively rapid and simple procedure, furnishes adequate information about the mobility and bioavailability of trace elements. Especially interesting results were obtained for Mn, Zn, and Ni, present in large amounts in the soil studied--their leachability was significantly reduced by addition of red mud and compost, suggesting interesting perspectives in soil-remediation activity.

Basiliximab: efficacy and tolerability in adults and children

An open, single arm, prospective clinical trial to assess the efficacy and safety of basiliximab (Simulect) combined with cyclosporine microemulsion (Neoral), steroids, and azathioprine was performed in four centers in Chile, two adult and two pediatric. The 23 patients who were enrolled were followed for 12 months. There were four acute rejection episodes (three adults and one child) and three graft losses (two adults and one child) during the study. Renal function in both adult and pediatric patients at 6 and 12 months was good. Basiliximab was well tolerated. The incidence of infections was low, with only one CMV infection. There were no deaths.

CONCLUSIONS

The incidence of acute rejection episodes among renal allograft recipients treated with basiliximab is low, showing that the drug is well tolerated. In particular the number of CMV infections is extremely low.

Uranium daily intake and urinary excretion: a preliminary study in Italy

An estimate was made of daily uranium intake in Italy through human diet and drinking water. The uranium concentration was determined in food, drinking water, and other beverages. Uranium concentration was also determined in a "total diet" sampled in 1999. The total daily dietary intake was estimated to be in the range 2.9-4.8 microg d(-1). The contribution of drinking water to the total uranium intake is sometimes significant as the uranium concentration range in 29 analyzed tap and bottled "mineral" waters is 0.04-5.86 microg L(-1) and the drinking water consumption about 1 L d(-1) or more. Data obtained in this study were compared with data from literature on the uranium daily intake in other countries. Urine samples were collected from 24 male and 14 female occupationally unexposed subjects, 20-50 y of age, living and working in the district of Rome (Italy). The mean concentration found was 10 +/- 7.0 ng L(-1); the inter-subject variability and the daily variability was evaluated. Analyses were performed using ICP-MS.