The value of intraoperative neurophysiological monitoring during positioning in pediatric scoliosis correction: A case report.

Introduction: Prone position during posterior spine surgery can represent a potentially risky procedure for the nervous system. Infrequent injuries due to prone positioning consist of subtle spinal cord infarction or myelopathy that can be promptly detected by intraoperative neurophysiological monitoring (IONM), if applied in this phase of surgery. Here, we report a case that stresses the value of IONM even in detecting spinal positioning-related neurological complications during kyphoscoliosis correction. Case presentation: A 3-year-old child with a severe thoracic kyphoscoliosis with the angle in the tract T5-T6 underwent an early treatment of scoliosis with growing rods. Before instrumentation or the reduction maneuver, lower limb somatosensory and motor responses disappeared. The patient was repositioned with neck and chest in a more protective position and neuromonitoring signals returned to baseline. The surgery could be completed and the patient had no postoperative neurologic or vascular deficits. Conclusion: Our findings suggest the importance of extending neuromonitoring in the early phases of anesthesia induction and patient positioning during corrective spinal deformity surgery.

Magnetoencephalography reveals differences in brain activations for fast and slow responses to simple multiplications.

Despite decades of studies, it is still an open question on how and where simple multiplications are solved by the brain. This fragmented picture is mostly related to the different tasks employed. While in neuropsychological studies patients are asked to perform and report simple oral calculations, neuroimaging and neurophysiological studies often use verification tasks, in which the result is shown, and the participant must verify the correctness. This MEG study aims to unify the sources of evidence, investigating how brain activation unfolds in time using a single-digit multiplication production task. We compared the participants' brain activity-focusing on the parietal lobes-based on response efficiency, dividing their responses in fast and slow. Results showed higher activation for fast, as compared to slow, responses in the left angular gyrus starting after the first operand, and in the right supramarginal gyrus only after the second operand. A whole-brain analysis showed that fast responses had higher activation in the right dorsolateral prefrontal cortex. We show a timing difference of both hemispheres during simple multiplications. Results suggest that while the left parietal lobe may allow an initial retrieval of several possible solutions, the right one may be engaged later, helping to identify the solution based on magnitude checking.

Doppler-Guided Transanal Hemorrhoidal Dearterialization (DG-THD) Versus Stapled Hemorrhoidopexy (SH) in the Treatment of Third-Degree Hemorrhoids: Clinical Results at Short and Long-Term Follow-Up.

INTRODUCTION: The stapled hemorrhoidopexy (SH) and the Doppler-guided transanal hemorrhoidal dearterialization (DG-THD) are minimally invasive procedures for the surgical treatment of hemorrhoids. This study aims to verify the efficacy of the DG-THD versus the SH in the treatment of third-degree hemorrhoids. METHOD: One hundred consecutive patients were causally allocated to either procedure, obtaining two groups of 50 pts. A clinical examination was performed at 3, 7, 15, and 30 days after the operation. Quality of life, anal symptoms, recurrence of hemorrhoids, and reoperation were assessed by means of a questionnaire and of a clinical examination at long-term follow-up (7.0 year average). RESULTS: At short-term follow-up, the median postoperative pain score was significantly lower in DG-THD group compared to SH group, (V.A.S 2 vs 6; t = 2.65, p < 0.01). The morbidity rate and the return to normal life and work were similar after the two procedures. At long-term follow-up, the incidence of piles was not statistically different between the two groups (DG-THD 10.0 %; SH 14.0 %). No differences were reported by patients in terms of satisfaction for surgery. CONCLUSION: SH and DG-THD procedures do not show significantly different results with regard to the patients outcome. However, considering the lower p. o. pain, the DG-THD might be proposed as the first line treatment in third-degree hemorrhoids.

Modulation of affective symptoms and resting state activity by brain stimulation in a treatment-resistant case of obsessive-compulsive disorder.

The effect of transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) on psychopathological symptoms and resting state brain activity was assessed in a patient with obsessive-compulsive disorder (OCD). tDCS and rTMS had no effect on OC symptoms. tDCS, however, improved depression and anxiety. Functional magnetic resonance imaging at baseline showed an interhemispheric asymmetry with hyperactivation of the left and hypoactivation of the right anterior neural circuits. A reduction of interhemispheric imbalance was detected after tDCS but not after rTMS. tDCS seems to be more effective than rTMS in restoring interhemispheric imbalance and improving anxiety and depression in OCD.

Steroid resistance in nasal polyposis: role of glucocorticoid receptor and TGF-beta1.

BACKGROUND: Glucocorticoids (GCs) are considered drugs of choice for treating nasal polyps (NPs). However, a subset of patients shows a limited clinical response even to high doses of GCs. Altered expression of glucocorticoid receptors (GRs), namely GR-alpha; and GR-beta;, is a potential mechanism underlying GC insensitivity. GCs modulate the expression of several cytokines, including transforming growth factor-beta (TGF-beta), which may contribute to cellular proliferation in NPs. The study investigates some biomolecular features of GC-resistant NPs, and examines possible differences from normal mucosa (NM). METHODOLOGY: Radioligand binding assay (binding) was used to determine GR-alpha; binding capacity; Western blotting was used to evaluate GR-alpha;, GR-beta;, and TGF-beta; expression and GR-alpha; subcellular distribution. NPs were sampled in 32 patients during ethmoidectomy; NM was taken from 15 healthy patients during rhinoplasty. RESULTS: GR-alpha; was present in NPs and NM, with lower affinity for the ligand in NPs. GR-alpha; was prevalent in the cytosol of NPs that were GR-alpha-negative to the binding assay. GR-beta was expressed in NPs and absent in the majority of NM. TGF-beta1 expression was higher in NPs than in NM. CONCLUSIONS: GR-beta and TGF-beta1 might be involved in NP pathogenesis, but their role in modulating GC sensitivity is still unclear.

Exogenous and endogenous orienting of visuospatial attention in P300-guided brain computer interfaces: a pilot study on healthy participants.

OBJECTIVE: Studies on brain computer interfaces (BCIs) have been mainly concerned with algorithm improvement for better signal classification. Fewer studies, however, have addressed to date the role of cognitive mechanisms underlying the elicitation of brain-signals in BCIs. We tested the effect of visuospatial attention orienting on a P300-guided BCI, by comparing the effectiveness of three visual interfaces, which elicited different modalities of visuospatial attention orienting (exogenous vs. endogenous). METHODS: Twelve healthy participants performed 20 sessions, using the abovementioned P300-guided BCI interfaces to control a cursor. Brain waves were recorded on each trial and were subsequently classified on-line using an ad hoc algorithm. Each time the P300 was correctly classified, the cursor moved towards the target position. RESULTS: The "endogenous" interface was associated with significantly higher performance than the other two interfaces during the testing sessions, but not in the follow-up sessions. CONCLUSIONS: Endogenous visuospatial attention orienting can be effectively implemented to increase the performance of P300-guided BCIs. SIGNIFICANCE: The study of visuospatial attention underlying participants' performance is essential for implementing efficient visual BCIs.

Event-related brain potential modulation in patients with severe brain damage.

OBJECTIVE: The limited evidence and inconsistency of purposeful behaviors in patients in a minimally conscious state (MCS) asks for objective electrophysiological marker of the level of consciousness. Here, a comparison between event-related potentials (ERPs) was investigated using different level of stimulus complexity. METHODS: The patients in vegetative state were 11 and the MCS patients were 6 [corrected]. Three oddball paradigms with different level of complexity were applied: sine tones, the subject's own name versus sine tones and other first names. Latencies and amplitudes of N1 and P3 waves were compared. RESULTS: Cortical responses were found in all MCS patients, and in 6 of 11 patients in VS. Healthy controls and MCS patients showed a progressive increase of P3 latency in relation to the level of stimulus complexity. No modulation of P3 latency was observed in the vegetative patients. CONCLUSIONS: These results suggest that the modulation of P3 latency related to stimulus complexity may represent an objective index of higher-order processing integration that predicts the recovery of consciousness from VS to MCS when clinical manifestations are inconsistent. SIGNIFICANCE: Modulation of P3 latency related to stimulus complexity could provide valuable information about the cognitive capabilities of unresponsive patients.

Ischemia/reperfusion injury is increased and cardioprotection by a postconditioning protocol is lost as cardiac hypertrophy develops in nandrolone treated rats.

We hypothesized that nandrolone (ND)-abuse induces cardiac hypertrophy, increases myocardial susceptibility to ischemia/reperfusion (I/R) injury, and reduces responsiveness to postconditioning (PostC) cardioprotection. Wistar-rats were ND treated for 2 weeks (short_ND) or 10 weeks (long_ND). Vehicle-treated rats served as controls. Hearts were retrogradely perfused and left ventricular pressure (LVP) was measured before and after 30-min global ischemia. In subgroups of hearts, to induce cardioprotection a PostC protocol (five cycles of 10-s reperfusion and 10-s ischemia) was performed. ß-adrenoreceptors, kinases (Akt and GSK-3ß) and phosphatases (PP2A sub A and PP2A sub B) were examined by Western blot before and after ischemia. After 120-min reperfusion, infarct size was measured. Short_ND slightly increased cardiac/body weight ratio, but did not affect cardiac baseline nor post-ischemic contractile function or infarct size when compared to vehicle hearts. However, PostC limited cardiac dysfunction much more in short_ND hearts than the other groups. Although cardiac/body weight ratio markedly increased after long_ND, baseline LVP was not affected. Yet, post-ischemic contracture and infarct size were exacerbated and PostC was unable to reduce infarct size and ventricular dysfunction. While short_ND increased phosphatases, non-phosphorylated and phosphorylated Akt, long_ND reduced phosphatase-expression and Akt phosphorylation. Both short_ND and long_ND had no effect on the GSK-3ß-phosphorylation but increased the expression of ß(2)-adrenoreceptors. In reperfusion, PostC increased Akt phosphorylation regardless of protective effects, but reduced phosphatase-expression in protected hearts only. In conclusion, short_ND improves post-ischemic myocardial performance in postconditioned hearts. However, long_ND increases myocardial susceptibility to I/R injury and abolishes cardioprotection by PostC. This increased susceptibility might be related to steroid-induced hypertrophy and/or to altered enzyme expression/phosphorylation.

Synergistic effects against post-ischemic cardiac dysfunction by sub-chronic nandrolone pretreatment and postconditioning: role of beta2-adrenoceptor.

Beta(2)-adrenoreceptor overexpression is beneficial against ischemia/reperfusion (I/R) injury. Whether beta-adrenoreceptors are involved in postconditioning (PostC) is unknown. We investigated whether nandrolone-decanoate (ND)-pretreatment can modulate (1) beta-adrenoreceptor expression and (2) post-ischemic cardiac function in response to I/R and PostC. Finally, we tested whether cardioprotection can be prevented by the inhibition of beta(2)-adrenoreceptors. Isolated rat hearts from ND pretreated (15 mg/kg/day i.m., for 14 days) and untreated-animals underwent 30-min ischemia and 120-min reperfusion. In subgroups, at the end of ischemia a PostC protocol (five cycles of 10-s reperfusion and 10-s ischemia) was applied and/or a beta(2)-adrenoreceptor blocker, ICI-118.551 (10 microM), was infused. Left ventricular pressure (LVP) was measured with an electromanometer, and infarct-size was evaluated using nitro-blue-tetrazolium staining. ND-pretreatment increased beta(2)-adrenoreceptor expression, but did not alter cardiac-weight, LVP and maximum rate of increase of LVP (dP/dt(max)). After I/R, infarct-size was smaller in ND-pretreatment than in untreated-animals. Infarct-size was also reduced by PostC, both in untreated and ND-pretreated animals. Contracture was less marked in ND-pretreated animals. PostC reduced contracture in both ND-pretreated and untreated hearts. Moreover, PostC improved post-ischemic recovery of developed LVP and dP/dt(max) much more in earts of ND-pretreated than untreated-animals. ICI-118.551 abolished ND protection and PostC-protection both in ND-pretreated and untreated hearts. Data show that two-weeks ND-pretreatment induces 1) an overexpression of beta(2)-ARs without cardiac hypertrophy and 2) improves the post-ischemic diastolic and systolic cardiac function. Intriguingly, ND-pretreatment potentiates the improvement of systolic function induced by postconditioning via beta(2)-adrenoreceptor activation.

P300-based brain computer interface: reliability and performance in healthy and paralysed participants.

OBJECTIVE: This study aimed to describe the use of the P300 event-related potential as a control signal in a brain computer interface (BCI) for healthy and paralysed participants. METHODS: The experimental device used the P300 wave to control the movement of an object on a graphical interface. Visual stimuli, consisting of four arrows (up, right, down, left) were randomly presented in peripheral positions on the screen. Participants were instructed to recognize only the arrow indicating a specific direction for an object to move. P300 epochs, synchronized with the stimulus, were analyzed on-line via Independent Component Analysis (ICA) with subsequent feature extraction and classification by using a neural network. RESULTS: We tested the reliability and the performance of the system in real-time. The system needed a short training period to allow task completion and reached good performance. Nonetheless, severely impaired patients had lower performance than healthy participants. CONCLUSIONS: The proposed system is effective for use with healthy participants, whereas further research is needed before it can be used with locked-in syndrome patients. SIGNIFICANCE: The P300-based BCI described can reliably control, in 'real time', the motion of a cursor on a graphical interface, and no time-consuming training is needed in order to test possible applications for motor-impaired patients.

Masked myoclonus in corticobasal degeneration: neurophysiological study of a case.

A single case study of a 58 year-old male with right asymmetric apraxia and akinetic-rigid syndrome is described. Brainimaging scans (MRI, SPECT) indicated asymmetric cortical atrophy compatible with the diagnosis of Corticobasal Degeneration. Reflex myoclonus was absent and myoclonic discharges only appeared in response to pharmacological treatment of limb dystonia and rigidity. Electromyographic evidence of jerky movements was recorded only in the affected right hand and forearm after muscle relaxation, and myoclonus was not preceded by an EEG paroxysm. The cortical components of the correspondent SEPs were not increased in amplitude while LLRs recordings showed a late response over the muscles of the affected side. Furthermore, the duration of post MEP silent period was bilaterally reduced. This single case study report points out that sometimes myoclonus in Corticobasal Degeneration can be masked by the presence of increased muscle tone.

Laparoscopic Burch colposuspension: a randomized controlled trial comparing two transperitoneal surgical techniques.

OBJECTIVE: To compare the effectiveness of two transperitoneal laparoscopic Burch procedures. METHODS: The sample size required was 30 subjects per group to detect a statistically significant estimated difference of 15% between two surgical procedures with an alpha = 0.05 and a power of 0.7. Sixty women affected by genuine stress incontinence (GSI) were enrolled and randomly assigned to two groups of 30 women each. All women were treated with the transperitoneal laparoscopic Burch procedure using nonabsorbable sutures (group A) or Prolene mesh (Ethicon, Somerville, NJ) fixed with tacks or staples (group B). The failure rate was defined subjectively and objectively. The subjective evaluation was performed by asking the women to rate their urine loss on a visual analog scale. The objective evaluation was a clinical evaluation using multichannel urodynamic studies. RESULTS: The subjective failure rate was not significantly different between the two groups at 3 months (0% for both groups), 6 months (3.7% versus 3.8% for groups A and B, respectively), and 12 months (7.4% versus 15.4% for groups A and B, respectively) after surgery. At 3 months (3.7% versus 3.8% for groups A and B, respectively) and 6 months (7.4% versus 15.4% for groups A and B, respectively) follow-up, the objective failure rate was not significantly different between the two groups. However, at 12 months after the surgical procedure, the objective failure rate was significantly lower in group A than in group B (11.1% versus 26.9%, respectively; P <.05). CONCLUSION: Transperitoneal laparoscopic Burch colposuspension performed using sutures was more effective than the mesh technique.

[Prenatal diagnosis of beta-thalassemia. A study based in Calabria]. / Diagnosi prenatale di beta-talassemia. Esperienza in Calabria.

BACKGROUND: The aim of this study was to underline, given the well-known incidence of beta thalassemia in Calabria, the possibility of establishing a prevention programme based on an increased awareness among the population using information and health education, genetic consultancy to identify high-risk subjects and prenatal diagnosis. METHODS: Between January 1992 and December 1999, we analysed 181 high-risk couples for beta thalassemia using chorionic villi sampling (CVS) performed with an echoguided transcervical or transabdominal route. A steady rise was observed over the years in the number of couples asking for prenatal diagnosis, thus demonstrating that patients and doctors are increasingly aware of the importance of a correct prenatal diagnosis. The variability of molecular defects found and the number of complications linked to the technique used are underlined. RESULTS: Prenatal diagnosis revealed 46 fetuses with the disease (24.8%), 97 heterozygotes (53.2%) and 41 healthy fetuses (22%). Only one malformation was observed in the 41 healthy fetuses. The authors also report the incidence of complications linked to CVS. In overall terms, 2.2% of pregnancies ended in spontaneous abortions (4 cases) and 2.75% with preterm births (5 cases). These complications could not be correlated with gestational age at the time of biopsy or the number of attempts made to obtain an appropriate sample.

[Pregnancy management in women with thalassemia]. / Gestione della gravidanza nelle pazienti talassemiche.

Thanks to the improvement of the techniques of assisted fecundation, of the obstetric management and of the fetal and neonatal monitoring now it's possible for a woman suffering from beta-thalassemia to have a child. Our purpose is to stress the importance to control the high maternal and fetal risk through the monitoring of several scales. The problems, connected with pregnancy of beta-thalassemic women are discussed, emphasizing the connection between pregnancy management and gestational and neonatal outcome. A variety of problems should be considered such as the informed consent about maternal and fetal risks, the problems caused by infectious agents or due to the use of some antiviral; the difficulties connected with heart and endocrine diseases are also discussed. Personal experience, from 1995 to 1999, on 4 beta-thalassemic pregnant women (three with the intermediate type and one with the major type) is reported.

Botulinum toxin treatment of apraxia of eyelid opening in progressive supranuclear palsy: report of two cases.

We report two patients, with postural instability and dystonic parkinsonism whose adjunctive disabling feature was blindness due to an inability to reopen the eyes after voluntary closure of the eyelids, as in apraxia of lid opening (ALO). Supranuclear downgaze paresis permitted the diagnosis of progressive supranuclear palsy (PSP) in one case. Electromyographic studies showed a loss of normal reciprocal inhibition between the levator palpebrae and the pretarsal portion of the orbicularis oculi, with a cocontraction of these two antagonist muscles. The evoked blink reflex, tested with the paired shock technique, showed enhanced recovery of R2 response. Botulinum toxin A injections directed toward the junction of the preseptal and pretarsal parts of the palpebral orbicularis oculi muscle improved eyelid motility in both patients. Successive static and dynamic balance training and development of compensatory strategies for visual scanning deficits reduced gait imbalance, the number of falls, and the disability level as measured on the Northwestern University Disability Scale.

Therapeutic synergism between hyaluronic acid and dexamethasone in the intra-articular treatment of osteoarthritis of the knee: a preliminary open study.

In vitro studies on the effects of dexamethasone on human synovial cells have shown that with high concentrations of the steroid in the culture medium cellular activity was completely blocked whereas with low concentrations (10(-6)M), cellular density decreased but there was an increase in the synthesis of RNA, DNA, protein and hyaluronic acid. These data, coupled with clinical experience of using intra-articular hyaluronic acid to treat patients with osteoarthritis of the knee, prompted the investigators to carry out an open, randomized study of the use of very small doses of dexamethasone in association with hyaluronic acid in 40 osteoarthritic patients. Twenty patients received a weekly intra-articular injection of 20 mg sodium hyaluronate in 2 ml phosphate buffer for 5 weeks; the other 20 patients followed a similar treatment regimen, the only difference being the addition of 0.4 mg dexamethasone phosphate to the first injection. Clinical examination of the knee was made before each injection, 7 days after the fifth injection and 60 days after the start of the trial. Rating scale assessments were made at each visit of spontaneous pain, pain during the day, at night, weight bearing and whilst walking. The results showed that whilst a progressive decrease in all pain parameters was evident and persisted after the end of treatment in both patient groups, pain intensity decreased more rapidly and to lower levels in all but weight-bearing pain, as did improvement in joint mobility, in the combined treatment group. Local tolerance was good with both treatment regimens, with no untoward signs or symptoms at any time.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of dexamethasone on human synovial fibroblast-like cells, from osteoarthritic joints, in culture.

The effect of Dexamethasone (DEX) on cell division and macromolecular synthesis was investigated in a line (McCoy cells, A 9) of synovial fibroblast-like cells derived from human osteoarthritic joints. DEX markedly reduced the proliferation of McCoy cells in a time and dose-dependent manner. The maximal inhibition (45%) was found at 500 nM DEX 24 h after incubation and was accompanied by the appearance of giant macrophage-like cells. After DEX treatment cells showed increased content of DNA, proteins and RNA together with the reduction of [3H]-thymidine incorporation into the TCA-precipitable fraction.

[Socio-demographic considerations concerning Italian emigration, 1950-1985]. / Considerazioni socio-demografiche sull'emigrazione italiana, 1950-1985.

PIP: Trends in emigration from Italy from 1950 to 1985 are reviewed using data from official Italian sources. The characteristics of the principal Italian communities living abroad in 1984 are analyzed, including demographic and professional characteristics.^ieng

Immune therapy of osteoarthritis: an open assessment of clinical results with heterologous antibodies to articular tissue ('Serocytol').

Forty-three out-patients received treatment (6 months in 13 cases of spondylarthrosis, 12 months in 30 cases of gonarthrosis) with heterologous antibodies to articular tissue, given as 1 rectal suppository once every other day for periods of 4 weeks out of every 5. The treatment produced complete freedom from symptoms and signs of the illness in 5 (12%) patients and overall positive therapeutic results in 36 (84%), equally distributed in the disorders of the vertebral column and of the knee. This was accompanied by a significant improvement, both in terms of percentage improvement and the percentage of patients improved, of all monitored symptoms. The percentage improvement was similar for all components of the illness: pain, mobility and inflammatory-reactive component. No local or systemic side-reactions were recorded throughout the observation period, and there were no adverse effects on haematology, haematochemistry or renal function. A high percentage of patients reported a remarkable improvement in their quality of life, an overall measure of the therapeutic benefit-risk ratio as experienced by the individual patient.