Cervical lordosis after subaxial spinal trauma surgery: relationship with neck pain and stiffness.

BACKGROUND: The objective of this retrospective study is to evaluate how neck pain is influenced by post-operative cervical alignment in patients operated for cervical spinal trauma. PATIENTS AND METHODS: From January 2013 to June 2017, at our department we operated 34 patients with cervical spinal trauma, 22 males and 12 females. Age, sex, level and type of fractures, surgical approach, fixation levels (cervical or cervico-dorsal), preoperative and postoperative CT scan, cervical (C2-C7) Cobb angle (lordotic > +10°, straight 0 /+10°, kyphotic < 0°) at X-rays on sitting position 3 months after surgery, postoperative self-reported neck stiffness scale, preoperative and follow-up ASIA score, pre and postoperative VAS value were evaluated for each patient. Statistical analysis was performed according to the Mann-Whitney and T-test. RESULTS: In this series, 22 patients were operated by anterior approach, 7 patients by posterior approach and 5 by combined approach. Postoperative chronic cervical pain was not correlated with cervical sagittal alignment after surgery, fracture type, surgical approach, fixation level and postoperative ASIA score but is correlated with the presence of neck stiffness (P=0,001). Patients treated with posterior approach (P=0,022) and fracture type C (P=0,026) had higher significantly neck stiffness compared to patients who underwent anterior approach for type B fractures. CONCLUSIONS: The presence of abnormal cervical lordosis after surgery for cervical spinal trauma does not correlate with neck pain. Patients treated with posterior fixation had higher neck stiffness and related chronic pain.

Deep spinal infection in instrumented spinal surgery: diagnostic factors and therapy.

AIM: Postoperative surgical site infections (SSI) are complication of spinal surgery. These complications may lead to a poor outcome with neurological deficits, spinal deformity and chronic pain. The purpose of this study is to explore the statistical value of diagnostic parameters and the proper therapy. METHOD: We retrospectively reviewed 550 patients who underwent spinal instrumentation at our department from January 2011 to December 2015. The SSI was present in 16 patients out of 550 operated. Diagnostic criteria of SSI were the positivity of the surgical wound swab or blood culture, the clinical findings, positivity of laboratory tests and radiological elements. All patients had peri-operative antibiotic prophylaxis. Diagnostic laboratory findings were compared with a homogeneous control group of 16 patients and analyzed by univariate statistical analysis with Chi-square test for the discrete variables. P<0,05 was considered statistically significant. RESULTS: Matching the SSI patients with a group of control, fever was not statistically significant for diagnosis as number of leukocytes, neutrophils and lymphocytes. On the contrary values of ESR and CRP were statistically significant with p <0, 01. The hardware was removed only in 3 patients (18%) out of 16 SSI patients. CONCLUSION: In this study the statistically significant parameters to diagnose SSI are ESR and CRP values. The leucocytes count, number of lymphocytes and presence of fever integrates the data of ESR and CRP with no statistical significance. Most patients with SSI reach clinical healing with favorable outcome by means of target antibiotic therapy without hardware removal.

Delayed diagnosed intermuscular lipoma causing a posterior interosseous nerve palsy in a patient with cervical spondylosis: the "priceless" value of the clinical examination in the technological era.

BACKGROUND: Posterior interosseous nerve (PIN) palsy may present with various symptoms, and may resemble cervical spondylosis. CASE REPORT: We report about a 59-year-old patient with cervical spondylosis which delayed the diagnosis of posterior interosseous nerve (PIN) palsy due to an intermuscular lipoma. Initial right hand paraesthesias and clumsiness, together with MR findings of right C5-C6 and C6-C7 foraminal stenosis, misled the diagnostic investigation. The progressive loss of extension of all right hand fingers brought to detect a painless mass compressing the PIN. Electrophysiological studies confirmed a right radial motor neuropathy at the level of the forearm. RESULTS: Surgical tumor removal and nerve decompression resulted in a gradual motor deficits recovery. CONCLUSIONS: A thorough clinical examination is paramount, and electrophysiology may differentiate between cervical and peripheral nerve lesions. Ultrasonography and MR offer an effective evaluation of lipomas, which represent a rare cause of PIN palsy. Surgical decompression and lipoma removal generally determine excellent prognoses, with very few recurrences.

A pilot study quantifying the shape of tidal breathing waveforms using centroids in health and COPD.

During resting tidal breathing the shape of the expiratory airflow waveform differs with age and respiratory disease. While most studies quantifying these changes report time or volume specific metrics, few have concentrated on waveform shape or area parameters. The aim of this study was to derive and compare the centroid co-ordinates (the geometric centre) of inspiratory and expiratory flow-time and flow-volume waveforms collected from participants with or without COPD. The study does not aim to test the diagnostic potential of these metrics as an age matched control group would be required. Twenty-four participants with COPD and thirteen healthy participants who underwent spirometry had their resting tidal breathing recorded. The flow-time data was analysed using a Monte Carlo simulation to derive the inspiratory and expiratory flow-time and flow-volume centroid for each breath. A comparison of airflow waveforms show that in COPD, the breathing rate is faster (17 ± 4 vs 14 ± 3 min(-1)) and the time to reach peak expiratory flow shorter (0.6 ± 0.2 and 1.0 ± 0.4 s). The expiratory flow-time and flow-volume centroid is left-shifted with the increasing asymmetry of the expired airflow pattern induced by airway obstruction. This study shows that the degree of skew in expiratory airflow waveforms can be quantified using centroids.

Self-assembling plants and integration across ecological scales.

BACKGROUND AND AIMS: Although individual plants exhibit much complex behaviour in response to environmental stimuli, they appear to do so without any identifiable centres of organization. We review a special class of model with the aim of testing whether plants can effectively be self-assembling, modular-driven organisms, in the sense that whole-plant organization and behaviour emerges solely from the interactions of much smaller structural elements. We also review evidence that still higher-level behaviour, at the population and community levels of organization, can emerge from this same source. METHODS: In previous work we devised a special cellular automaton (CA) model of plant growth. This comprises a section depicting a two-dimensional plant in its above- and below-ground environments. The whole plant is represented by branching structures made up from identical 'modules'. The activity of these modules is driven by morphological, physiological and reproductive rulesets derived from comparative plant ecology, a feature which lends itself to experimentation at several ecological scales. KEY RESULTS: From real experiments using virtual plants we show that the model can reproduce a very wide range of whole-plant-, population- and community-level behaviour. All of these properties emerge successfully from a ruleset acting only at the level of the CA module. CONCLUSIONS: The CA model can, with advantage, be driven by C-S-R plant strategy theory. As this theory can ascribe a functional classification to any temperate angiosperm on the basis of a few simple tests, any community of such plants can be redescribed in terms of its 'functional signature' and the net environment that it experiences. To a valuable first approximation, therefore, a C-S-R version of the CA model can simulate the most essential properties both of natural vegetation and of its environment. We have thus achieved a position from which we can test a plethora of high-level community processes, such as diversity, vulnerability, resistance, resilience, stability, and habitat-community heterogeneity--processes which, if investigated on the scales truly required for a full understanding, would fall beyond the practical scope of even the largest real-life investigation.

[Angiotensin II stimulates endothelin-1 release from human endothelial cells]. / L'angiotensina II stimola il rilascio di endotelina-1 da cellule endoteliali umane.

Endothelin-1 (ET-1) is an endothelium-derived vasoconstrictor peptide isolated from the culture supernatant of porcine aortic endothelial cells. This 21 amino-acid residue peptide has potent vasoconstrictive properties in vitro and in vivo. ET-1 action involves phosphatidylinositol turnover, calcium mobilization and protein kinase C activation. Endothelial cells have distinct receptors for different operating through hydrosoluble hormones. The aim of this study was to investigate on a possible role of angiotensin II (ANG II) to modulate the release ET-1 from human endothelial cells in vitro. These data revealed a time- and a dose-dependent increase of ET-1 production in response to ANG II. This mechanism may have important pathophysiological implications in vivo. In fact, a double-mechanism of secretion of ET-1 from endothelial cells could exist: one active in a physiological condition and an other in response to a vasoconstrictor stimuli (as well as ANG II). Furthermore, these results may suggest an additional favourable effect of ACE-inhibition in human hypertension therapy.

[The proteolytic etiopathogenesis of pulmonary emphysema]. / L'etiopatogenesi proteolitica dell'enfisema polmonare.

Laennec and later workers attributed the aetiopathogenesis of emphysema to mechanical causes. This view has been superseded by the current proteolytic theory. It is now believed that the destruction of the pulmonary parenchyma in emphysema occurs when the homeostatic equilibrium between cellular proteases (polymorphonucleates and macrophages) and serum antiproteases (primarily alpha-1-antitrypsin) which protects the respiratory ways, is disturbed. This imbalance not only produces idiopathic emphysema due to alpha-1-antitrypsin but also post-bronchitic forms due to increased protease release.