Minimally Invasive Stent Screw-Assisted Internal Fixation Technique Corrects Kyphosis in Osteoporotic Vertebral Fractures with Severe Collapse: A Pilot "Vertebra Plana" Series.

BACKGROUND AND PURPOSE: Fractures with "vertebra plana" morphology are characterized by severe vertebral body collapse and segmental kyphosis; there is no established treatment standard for these fractures. Vertebroplasty and balloon kyphoplasty might represent an undertreatment, but surgical stabilization is challenging in an often elderly osteoporotic population. This study assessed the feasibility, clinical outcome, and radiologic outcome of the stent screw-assisted internal fixation technique using a percutaneous implant of vertebral body stents and cement-augmented pedicle screws in patients with non-neoplastic vertebra plana fractures. MATERIALS AND METHODS: Thirty-seven consecutive patients with vertebra plana fractures were treated with the stent screw-assisted internal fixation technique. Vertebral body height, local and vertebral kyphotic angles, outcome scales (numeric rating scale and the Patient's Global Impression of Change), and complications were assessed. Imaging and clinical follow-up were obtained at 1 and 6 months postprocedure. RESULTS: Median vertebral body height restoration was 7 mm (+74%), 9 mm (+150%), and 3 mm (+17%) at the anterior wall, middle body, and posterior wall, respectively. Median local and vertebral kyphotic angles correction was 8° and 10° and was maintained through the 6-month follow-up. The median numeric rating scale score improved from 8/10 preprocedure to 3/10 at 1 and 6 months (P < .001). No procedural complications occurred. CONCLUSIONS: The stent screw-assisted internal fixation technique was effective in obtaining height restoration, kyphosis correction, and pain relief in patients with severe vertebral collapse.

Baseline radionuclide and heavy metal concentrations in sediments of Sabaki River estuary (Kenya, Indian Ocean).

Baseline study of natural (7Be, 210Pb, 226Ra, 234Th, 228Ra, 40K) and anthropogenic (137Cs) radionuclides was carried out in two cores collected from Sabaki River estuary (Kenya, Indian Ocean). There was no exponential decrease of excess 210Pb down the cores, which did not allow dating and determination of heavy metal pollution history. The use of 137Cs as a time marker was not possible due to its low fallout rates in East Africa. The short-lived radioisotope 7Be, a tracer of river floods, confirmed 2018 flood in Sabaki River estuary. Heavy metal concentration in the two cores showed nonsystematic trends with depth. Only Pb concentration in Sabaki River estuary was higher than the background levels. Application of the "Environmental Risk from Ionising Contaminants Assessment and management" (ERICA) tool confirmed that the potential dose rates to biota from the sediment radioactivity concentrations are unlikely to pose appreciable ecological risks.

Edge Contrast of the FLAIR Hyperintense Region Predicts Survival in Patients with High-Grade Gliomas following Treatment with Bevacizumab.

BACKGROUND AND PURPOSE: Treatment with bevacizumab is standard of care for recurrent high-grade gliomas; however, monitoring response to treatment following bevacizumab remains a challenge. The purpose of this study was to determine whether quantifying the sharpness of the fluid-attenuated inversion recovery hyperintense border using a measure derived from texture analysis-edge contrast-improves the evaluation of response to bevacizumab in patients with high-grade gliomas. MATERIALS AND METHODS: MRIs were evaluated in 33 patients with high-grade gliomas before and after the initiation of bevacizumab. Volumes of interest within the FLAIR hyperintense region were segmented. Edge contrast magnitude for each VOI was extracted using gradients of the 3D FLAIR images. Cox proportional hazards models were generated to determine the relationship between edge contrast and progression-free survival/overall survival using age and the extent of surgical resection as covariates. RESULTS: After bevacizumab, lower edge contrast of the FLAIR hyperintense region was associated with poorer progression-free survival (P = .009) and overall survival (P = .022) among patients with high-grade gliomas. Kaplan-Meier curves revealed that edge contrast cutoff significantly stratified patients for both progression-free survival (log-rank χ2 = 8.3, P = .003) and overall survival (log-rank χ2 = 5.5, P = .019). CONCLUSIONS: Texture analysis using edge contrast of the FLAIR hyperintense region may be an important predictive indicator in patients with high-grade gliomas following treatment with bevacizumab. Specifically, low FLAIR edge contrast may partially reflect areas of early tumor infiltration. This study adds to a growing body of literature proposing that quantifying features may be important for determining outcomes in patients with high-grade gliomas.

Restriction Spectrum Imaging Improves Risk Stratification in Patients with Glioblastoma.

BACKGROUND AND PURPOSE: ADC as a marker of tumor cellularity has been promising for evaluating the response to therapy in patients with glioblastoma but does not successfully stratify patients according to outcomes, especially in the upfront setting. Here we investigate whether restriction spectrum imaging, an advanced diffusion imaging model, performed after an operation but before radiation therapy, could improve risk stratification in patients with newly diagnosed glioblastoma relative to ADC. MATERIALS AND METHODS: Pre-radiation therapy diffusion-weighted and structural imaging of 40 patients with glioblastoma were examined retrospectively. Restriction spectrum imaging and ADC-based hypercellularity volume fraction (restriction spectrum imaging-FLAIR volume fraction, restriction spectrum imaging-contrast-enhanced volume fraction, ADC-FLAIR volume fraction, ADC-contrast-enhanced volume fraction) and intensities (restriction spectrum imaging-FLAIR 90th percentile, restriction spectrum imaging-contrast-enhanced 90th percentile, ADC-FLAIR 10th percentile, ADC-contrast-enhanced 10th percentile) within the contrast-enhanced and FLAIR hyperintensity VOIs were calculated. The association of diffusion imaging metrics, contrast-enhanced volume, and FLAIR hyperintensity volume with progression-free survival and overall survival was evaluated by using Cox proportional hazards models. RESULTS: Among the diffusion metrics, restriction spectrum imaging-FLAIR volume fraction was the strongest prognostic metric of progression-free survival (P = .036) and overall survival (P = .007) in a multivariate Cox proportional hazards analysis, with higher values indicating earlier progression and shorter survival. Restriction spectrum imaging-FLAIR 90th percentile was also associated with overall survival (P = .043), with higher intensities, indicating shorter survival. None of the ADC metrics were associated with progression-free survival/overall survival. Contrast-enhanced volume exhibited a trend toward significance for overall survival (P = .063). CONCLUSIONS: Restriction spectrum imaging-derived cellularity in FLAIR hyperintensity regions may be a more robust prognostic marker than ADC and conventional imaging for early progression and poorer survival in patients with glioblastoma. However, future studies with larger samples are needed to explore its predictive ability.

(137)Cs vertical distribution at the deep basins of the North and Central Aegean Sea, Greece.

Large volume seawater samples were collected for the determination of (137)Cs concentration along with depth in the deep basins of North and Central Aegean Sea. The vertical (137)Cs distribution showed maximum concentration at the bottom of the basins, while the minimum values corresponded to the intermediate layer, where Levantine water exists. The surface (137)Cs activity is found to lie between the two limits and is originated from the Black Sea waters. The typical oceanographic advection-diffusion balance model is modified to a diffusion-settling-decay balance model to better understand the vertical distribution and variation of the (137)Cs concentration in the deep basins. In addition, the diffusivity of each basin, as well as the settling speed of particulate (137)Cs is also estimated. The results are compared with theoretical approach as well as with previous data.

Environmental radioactivity analyses in Italy following the Fukushima Dai-ichi nuclear accident.

Following the Fukushima power plants accident on the 11th March 2011, the radioactivity monitoring programme at the Italian ENEA research centres was activated in order to detect the possible new input of radionuclides through atmospheric transport and precipitation. Measurements of (131)I and (134,137)Cs were carried out on atmospheric particulate, atmospheric deposition, seawater and mussels and sheep milk. In the daily samples of air particulate, (131)I was detectable between March 28 and April 12, with extremely low concentrations (<1 mBq m(-3); the detection limit for (131)I was ~0.2 mBq m(-3)) while Cs isotopes were always below the detection limit (<0.2 mBq m(-3)). The two main episodes of (131)I atmospheric deposition were registered in La Spezia research centre, around March 28 and April 15, reaching values of 17.8 ± 1.1 and 8.0 ± 2.5 Bq m(-2) respectively; maximum values of (134)Cs and (137)Cs were 0.11 ± 0.03 and 0.17 ± 0.02 Bq m(-2), respectively, detected in Brasimone research centre in April (reference date April 15). Mussels and seawater were collected in the Gulf of La Spezia: only mussels after the main (131)I deposition, on March 28, contained a measurable, although very small, amount of (131)I (0.18 ± 0.05 Bq kg(-1), detection limit (131)I = 0.03 Bq kg(-1) wet weight - soft parts). The (131)I was also detected in sheep milk in Rome (Casaccia research centre) until May 5, showing a maximum concentration of 4.9 ± 0.4 Bq L(-1). As for other European Countries for which data are available, activity levels remain of no concern for public health.

Sediment reworking rates in deep sediments of the Mediterranean Sea.

Different pelagic areas of the Mediterranean Sea have been investigated in order to quantify physical and biological mixing processes in deep sea sediments. Herein, results of eleven sediment cores sampled at different deep areas (> 2000 m) of the Western and Eastern Mediterranean Sea are presented. ²¹°Pb(xs) and ¹³7Cs vertical profiles, together with ¹4C dating, are used to identify the main processes characterising the different areas and, finally, controlling mixing depths (SML) and bioturbation coefficients (D(b)). Radionuclide vertical profiles and inventories indicate that bioturbation processes are the dominant processes responsible for sediment reworking in deep sea environments. Results show significant differences in sediment mixing depths and bioturbation coefficients among areas of the Mediterranean Sea characterised by different trophic regimes. In particular, in the Oran Rise area, where the Almeria-Oran Front induces frequent phytoplankton blooms, we calculate the highest values of sediment mixing layers (13 cm) and bioturbation coefficients (0.187 cm² yr⁻¹), and the highest values of ²¹°Pb(xs) and ¹³7Cs inventories. Intermediate values of SML and D(b) (~6 cm and ~0.040 cm² yr⁻¹, respectively) characterise the mesothrophic Algero-Balearic basin, while in the Southern Tyrrhenian Sea mixing parameters (SML of 3 cm and D(b) of 0.011 cm² yr⁻¹ are similar to those calculated for the oligotrophic Eastern Mediterranean (SML of 2 cm and D(b) of ~0.005 cm² yr⁻¹).

Variation of the activity concentrations and fluxes of natural (210Po, 210Pb) and anthropogenic (239,240Pu, 137Cs) radionuclides in the Strait of Gibraltar (Spain).

The activity concentrations and fluxes of natural (210Pb, 210Po) and anthropogenic (239,240Pu, 137Cs) radionuclides have been determined in the different water masses crossing the Strait of Gibraltar. New data have been gathered during four multidisciplinary and multinational sampling campaigns, performed between 1997 and 1999 within the framework of the CANIGO-FLUGIST Project. Mean activity concentrations of 210Po (1.53+/-0.34 Bq m(-3), n = 30) and 210Pb (1.16+/-0.50 Bq m(-3), n = 31) in the Atlantic water entering the Mediterranean basin are about double those measured in the Mediterranean outflow, namely 0.84+/-0.34 Bq m(-3) (n = 22) for 210Po and 0.66+/-0.34 Bq m(-3) (n = 22) for 210Pb. The opposite trend is observed for 231,240Pu, with average concentrations of 9.9+/-3.0 mBq m(-3) (n = 29) in the incoming Atlantic flow and 22.0+/-3.0 mBq m(-3) (n = 22) in the outpouring Mediterranean water. In the case of 137Cs, the same concentrations were quantified in the waters moving inwards (2.52+/-0.28 Bq m(-3), n = 27) and outwards (2.14+/-0.52 Bq m(-3), n = 21) from the Mediterranean Sea. On this basis, the Mediterranean basin experiences a net annual input flux of 14 TBq of 210Pb and 19 TBq of 210Po, and a net annual loss of 0.34 TBq of 239,240Pu, while--at present--137Cs input and output fluxes appear to be balanced.

Distributions of Pu, Am and Cs in margin sediments from the western Mediterranean (Spanish coast).

Continental margins are important areas to be considered when studying the distributions and depositions of pollutants, both conventional and radioactive. Coastal sediments accumulate most of those contaminants which can be introduced following atmospheric and/or fluvial pathways. Moreover, their residence times within the water column are usually shortened due to their affinity to associate with the downward falling particulate matter, more abundant at shallower depths. In this paper the distribution profiles and inventories of plutonium, americium and cesium are detailed, providing useful information about recent sedimentation phenomena such as sediment mixing, slumping processes and bioturbation. Unsupported 210Pb data are used as reliable indicators of enhanced/reduced deposition events. Also, the calculated inventories have enabled the estimation of the radiological contribution of the Spanish Mediterranean margin to the total radioactivity deposited onto the Mediterranean sea floor.

137Caesium distribution in the eastern Mediterranean Sea: recent changes and future trends.

A series of sampling campaigns were carried out in the eastern Mediterranean in the period 1995-1997, to examine the relationship between the distribution of 137Cs in the water column and water mass circulation. 137Cs concentration in the surface water ranges between 3.3 and 4.0 mBq/l all over the area, indicating that the input due to the Chernobyl accident has been transferred to deep water layers by convection processes. In fact, in the vertical profiles, relative maxima are observed in the intermediate (4 mBq/l) and deep waters (approximately 2.5 mBq/l) formed after the Chernobyl accident. A clear Chernobyl signal also traces the new deep waters formed in the Aegean Sea that, exiting from the Cretan Arc Straits, since 1991 are spreading in the bottom layer of the eastern Mediterranean. The changes in 137Cs vertical profiles related to the new thermohaline circulation of the intermediate and deep waters of the eastern Mediterranean are being monitored at a deep station in the western Ionian Sea. The 1997 profile shows a decrease in 137Cs concentration both in the Levantine intermediate water and in the eastern Mediterranean deep water with respect to 1996. The decrease in Levantine intermediate water is likely due to seasonal/interannual variability, while the changes in the deep layer are related to the spreading westward into the Ionian of the new Aegean dense water. Along the path towards the western Mediterranean, 137Cs content in the Levantine intermediate water decreases from approximately 4 mBq/l in the W-Ionian Sea to approximately 2 mBq/l at the western sill of the Sicily Straits, due to mixing with underlying water, with lower caesium content, near the Malta Sill. Time-series measurements at the western sill of the Sicily Straits show that, while 137Cs concentration in the surface water entering the eastern Mediterranean remained constant (approximately 3.5 mBq/l) in the period 1993-1997, its level in the Levantine intermediate water leaving the basin decreased from 3.5 to 2.0 mBq/l.

Vertical and horizontal fluxes of plutonium and americium in the western Mediterranean and the Strait of Gibraltar.

New data on the vertical distributions of plutonium and americium in the waters of the western Mediterranean and the Strait of Gibraltar are examined in terms of the processes governing their delivery to, transport in and removal from the water column within the basin. Residence times for plutonium and americium in surface waters of approximately 15 and approximately 3 years, respectively, are deduced, and it is shown that by the mid 1990s only approximately 35% of the 239,240Pu and approximately 5% of the 241Am deposited as weapons fallout still resided in the water column. Present 239,240Pu inventories in the water column and the underlying sediments are estimated to be approximately 25 TBq and approximately 40 TBq, respectively, which reconcile well with the time-integrated fallout deposition in this zone, taken to be approximately 69 TBq. The data show that there are significant net outward fluxes of plutonium and americium from the basin through the Strait of Gibraltar at the present time. These appear to be compensated by net inward fluxes of similar magnitude through the Strait of Sicily. Thus, the time-integrated fallout deposition in the western basin can be accounted for satisfactorily in terms of present water column and sediment inventories. Enhanced scavenging on the continental shelves, as evidenced by the appreciably higher transuranic concentrations in shelf sediments, supports this contention.