Non-Compressive, Disabling, Cervical Radiculopathy and Neck Pain: Cave Osteoid Osteoma.

Cervical radiculopathy is a common clinical condition with an annual incidence of 85/10,000. Refractory cases with positive disco-vertebral imaging findings are routinely referred to the Neurosurgeon for evaluation and treatment. In the absence of a clearcut compressive etiology, other rarer but surgically curable causes must be considered before recommending conservative management. We discuss the case of an otherwise active, healthy patient with an invalidating, refractory, relapsing nuchal pain and cervical radiculopathy. Only careful and state-of-the-art neuroimaging led to the correct diagnosis: an osteoid osteoma of the right C6 lamina was diagnosed and microsurgically resected allowing complete recovery and cure. The clinical features of these rare tumors in this unusual location are reviewed. The case is relevant for multifold reasons: it draws attention to rare conditions which can mimic radicular compression; emphasizes the need for a careful evaluation and appreciation of specific clinical symptoms and signs associated with non-compressive radiculopathies; prompts planning of a state of the art imaging workup, in order to rule out such an elusive tumor. All these measures minimize the risk of overlooking the present and other rare pathologies, sparing patients a long path of time-consuming, frustrating and cost-ineffective studies and treatment modalities.

Beyond the bipolar disorder diagnosis: Hypothalamus and its network damage in determining neuropsychiatric and Korsakoff-like memory disorders.

Craniopharyngiomas (CP's) are hypothalamic tumors often associated with psychological disorders. Nevertheless, its diagnosis is still challenging when psychiatric disorders are not associated with any other neurological symptoms. This single-case study describes a patient with a history of bipolar disorder before a diagnosis of a large CP arising the sellar and suprasellar region was posed. At the time of the present study the patient showed emotional/behavioral disorders and Korsakoff-like amnesia, that completely recovered after surgical resection of the tumor. This is one of those few cases described in literature, who presented cognitive/behavioral disorders because the compression of the diencephalic structures due to CP mass effect. This case offers further evidence on the functional neuroanatomy of the hypothalamus and its pathways.

Identification of Beneficial Microbial Consortia and Bioactive Compounds with Potential as Plant Biostimulants for a Sustainable Agriculture.

A growing body of evidence demonstrates the potential of various microbes to enhance plant productivity in cropping systems although their successful field application may be impaired by several biotic and abiotic constraints. In the present work, we aimed at developing multifunctional synthetic microbial consortia to be used in combination with suitable bioactive compounds for improving crop yield and quality. Plant growth-promoting microorganisms (PGPMs) with different functional attributes were identified by a bottom-up approach. A comprehensive literature survey on PGPMs associated with maize, wheat, potato and tomato, and on commercial formulations, was conducted by examining peer-reviewed scientific publications and results from relevant European projects. Metagenome fragment recruitments on genomes of potential PGPMs represented in databases were also performed to help identify plant growth-promoting (PGP) strains. Following evidence of their ability to coexist, isolated PGPMs were synthetically assembled into three different microbial consortia. Additionally, the effects of bioactive compounds on the growth of individually PGPMs were tested in starvation conditions. The different combination products based on microbial and non-microbial biostimulants (BS) appear worth considering for greenhouse and open field trials to select those potentially adoptable in sustainable agriculture.

Present status and future perspectives of breeding for buckwheat quality.

Buckwheat is an important crop globally. It has been processed into cereal grain, noodles, confectionery, bread, and fermented foods for many years. Buckwheat production and processing has supported local economies and is deeply related to the culture of some regions. Buckwheat has many unique traits as a food, with a good flavor and color. In addition, buckwheat is also a healthy food because it contains bioactive compounds that have anti-oxidative, anti-hypertensive, and anti-obesity properties. Therefore, breeding of buckwheat for quality is an important issue to be addressed. Compared to other crops, there is still a lack of basic information on quality, including bioactive compounds generation and enhancement. However, some mechanisms for modifying and improving the quality of buckwheat varieties have recently been identified. Further, some varieties with improved quality have recently been developed. In this review, we summarize the issues around buckwheat quality and review the present status and future potential of buckwheat breeding for quality.

Buckwheat Hull Extracts Inhibit Aspergillus flavus Growth and AFB1 Biosynthesis.

Fungal contamination poses at risk the whole food production chain - from farm to fork - with potential negative impact on human health. So far, the insurgence of pathogens has been restrained by the use of chemical compounds, whose residues have gradually accumulated determining toxic effects in the environment. Modern innovative techniques imply the use of natural and eco-sustainable bioactive plant molecules as pathogens and pests-control agents. These may be profitably recovered in large amounts at the end of industrial milling processes. This is the case of the non-digestible hull of common buckwheat (Fagopyrum esculentum Moench), a natural source of polyphenols, tocopherols, phytosterols and fatty acids. We extract these compounds from the hull of buckwheat; apply them to Aspergillus flavus - aflatoxin producer - under in vitro conditions, checking their ability to inhibit fungal growth and aflatoxin biosynthesis. Moreover, a solvent free method implying the adoption of supercritical CO2 as solvent was set up to extract lipophilic molecules from the buckwheat' hulls. Positive results in controlling fungal growth and aflatoxin biosynthesis let infer that the extracts could be further tested also under in vivo conditions.

Tailoring Endoscopic Approach to Colloid Cysts of the Third Ventricle: A Multicenter Experience.

BACKGROUND: Endoscopic removal of third ventricular colloid cysts has grown in popularity. The biggest issues concern radicality, cure or at least long-term control of the disease, and endoscopic remnants. Technologic advances in instrumentation and introduction of novel tools have greatly improved endoscopic results. Deeper knowledge of surrounding anatomy and awareness that colloid cysts vary in their position (foraminal or retroforaminal) can further improve with the selection of a tailored approach for each patient. METHODS: During the last 12 years, 22 colloid cysts were treated endoscopically in our centers. Cysts were classified into 3 groups: A, foraminal (n = 6); B, foraminal with retroforaminal extension (n = 10); C, retroforaminal (n = 6). The following entry points and trajectories were selected: precoronal foraminal (n = 7), precoronal retroforaminal (n = 4), precoronal combined retroforaminal/foraminal (n = 5), supraorbital foraminal (n = 6). Navigation guidance was used in 17 cases. RESULTS: Major complications resulted in permanent deficits in 1 case, and 2 other patients experienced transient memory impairment. Remnants were noted by surgeon's intraoperative assessment in 6 cases; only 2 remnants were large, whereas the others were small bits of coagulated cyst stem. In 18 cases, no remnant was found on postoperative magnetic resonance imaging. CONCLUSIONS: A traditional precoronal transforaminal approach should be considered only for pure foraminal cysts (group A), as the retroforaminal component is poorly controlled. Retroforaminal cysts (groups B and C) should be resected through a retroforaminal transpellucidum interfornicialis route. A supraorbital transforaminal approach is a more versatile approach suitable for most cases.

Genomic Characterization of Phenylalanine Ammonia Lyase Gene in Buckwheat.

Phenylalanine Ammonia Lyase (PAL) gene which plays a key role in bio-synthesis of medicinally important compounds, Rutin/quercetin was sequence characterized for its efficient genomics application. These compounds possessing anti-diabetic and anti-cancer properties and are predominantly produced by Fagopyrum spp. In the present study, PAL gene was sequenced from three Fagopyrum spp. (F. tataricum, F. esculentum and F. dibotrys) and showed the presence of three SNPs and four insertion/deletions at intra and inter specific level. Among them, the potential SNP (position 949th bp G>C) with Parsimony Informative Site was selected and successfully utilised to individuate the zygosity/allelic variation of 16 F. tataricum varieties. Insertion mutations were identified in coding region, which resulted the change of a stretch of 39 amino acids on the putative protein. Our Study revealed that autogamous species (F. tataricum) has lower frequency of observed SNPs as compared to allogamous species (F. dibotrys and F. esculentum). The identified SNPs in F. tataricum didn't result to amino acid change, while in other two species it caused both conservative and non-conservative variations. Consistent pattern of SNPs across the species revealed their phylogenetic importance. We found two groups of F. tataricum and one of them was closely related with F. dibotrys. Sequence characterization information of PAL gene reported in present investigation can be utilized in genetic improvement of buckwheat in reference to its medicinal value.

Endoscopic Approaches to Intraventricular Lesions.

BACKGROUND: Endoscopy is becoming increasingly popular for the neurosurgical management of intraventricular lesions and has recently been accepted as an effective alternative approach to open surgery. The deep location of intraventricular lesions makes the microsurgical approach difficult. Moreover, many intraventricular tumors do not require aggressive neurosurgical treatment. Some of these lesions are even associated with hydrocephalus or an enlarged ventricular system. METHODS: We collected the data of 32 patients affected by purely intraventricular lesions in the lateral or third ventricles who underwent 33 endoscopic intraventricular procedures from 2006 to 2011. We classified the lesions according to their location within the ventricles so as to plan the best endoscopic trajectory. We approached the lesions using rigid and flexible endoscopes through precoronal or supraorbital trajectories according to their localization and the presence of hydrocephalus. In many procedures we used neuronavigation. RESULTS: Thirty-three endoscopic intraventricular procedures were performed in 32 patients; 27 procedures were performed via the precoronal, and 6 procedures via the supraorbital frontopolar approach. A complete excision of the lesion was obtained in only three cases. In all other cases, a biopsy was taken. CONCLUSIONS: Our series shows that an endoscopic approach to intraventricular lesions should be tailored according to localization of the lesion and ventricular size. The complete excision of intraventricular lesions is often impossible with the endoscope, but biopsies allow diagnoses to be obtained in almost all cases.

Supraorbital endoscopic approach to colloid cysts.

BACKGROUND: Surgical approaches to colloid cysts of the third ventricle have evolved over time. In recent years, endoscopy has been recognized as an effective alternative to open surgery. The disadvantage of endoscopic treatment is the difficulty in controlling the adhesion of the cyst to the roof of the third ventricle and in obtaining complete removal of the cyst. OBJECTIVE: To design and carry out a supraorbital approach to obtain a better viewing angle of the cyst and better control of the adhesion of the cyst to the roof of the third ventricle. METHODS: From September 2005 to February 2008, we operated on 7 consecutive patients with colloid cysts in the third ventricle. All procedures were performed with the endoscopic supraorbital approach. The endoscopic procedure was performed with a rigid STORZ endoscope with 3 working channels. In 4 patients, the surgical supraorbital trajectory was planned with the help of a navigator. RESULTS: The procedures lasted between 60 and 110 minutes, including the registration on the navigation system. Near-total removal of the cyst was achieved in 6 patients. All patients were discharged within 6 days. CONCLUSION: Endoscopic treatment may be an effective and safe alternative to open surgical craniotomy. Our series shows that the endoscopic supraorbital endoscopic resection is a valuable approach to colloid cysts of the third ventricle.

Application of neuroendoscopy to intraventricular lesions.

We present an overview of the history, development, technological advancements, current application, and future trends of cranial endoscopy. Neuroendoscopy provides a safe and effective management modality for the treatment of a variety of intracranial disorders, either tumoral or non-tumoral, congenital, developmental, and degenerative, and its knowledge, indications, and limits are fundamental for the armamentarium of the modern neurosurgeon.

Enhanced sympathetic reactivity associates with insulin resistance in the young Zucker rat.

Somatosympathetic reflexes were studied in young hyperinsulinemic, insulin-resistant (Zucker fatty) rats (ZFR) and a related control (Zucker lean) strain (ZLR). Glucose metabolism was characterized by minimal model analysis of intravenous glucose tolerance test data. Seven-week-old ZFR (n=18) and ZLR (n=17) were studied under pentobarbital anesthesia. Mean body weight and plasma glucose and insulin concentration were significantly greater (P<0.05) in ZFR than in ZLR, whereas basal values of mean arterial pressure (MAP) and heart rate (HR) were not significantly different. Increments of MAP (DeltaMAP) and HR (DeltaHR) elicited by electrical stimulation of the sciatic nerve (5-s trains of 100 pulses, 0.5-ms pulse duration, 100- to 400-microA pulse intensity) were significantly higher (ANOVA, P<0.05) in ZFR at each level of stimulus intensity. Regression analysis showed a linear increase in DeltaMAP and DeltaHR with increasing sciatic nerve stimulus intensity. Pressor responses to phenylephrine after ganglionic blockade demonstrated that vascular reactivity to adrenergic stimulation is not increased in ZFR compared with ZLR. Thus this factor does not contribute to enhancement of somatosympathetic reflexes observed in this strain. Insulin sensitivity in ZFR was one-fourth (P<0.05) that in ZLR. These results suggest that stronger sympathetic nervous reactivity in ZFR is associated with a severe insulin-resistant state before the onset of hypertension and support the hypothesis that insulin-mediated stimulation of the sympathetic nervous system is involved in the development of cardiovascular diseases related to alterations of glucose metabolism.

Purely neuroendoscopic transventricular management of cystic craniopharyngiomas.

INTRODUCTION: This paper reports our series of cystic craniopharyngiomas treated using a purely neuroendoscopic approach. METHODS: Drainage and wide marsupialization into CSF spaces (cysto-ventriculo-cisternostomy) were achieved to ensure mass effect control, continuous dilution, and reabsorption of the cyst's fluid. A steerable, flexible neuroendoscope and a pre-coronal approach were used in 7 patients harboring intra/paraventricular cysts (4 primary and 3 recurrent). RESULTS: These surgical goals were achieved in all but one case and no procedure-related complications were observed. During the follow-up period (range 6-72 months; average 38.3 months) one recurrence and one progression of undrained pouch were observed at 25 and 30 months. Both patients underwent successful repeat neuroendoscopy. CONCLUSIONS: In our hands, this technique has proven minimally invasive, safe, and effective; although oncologically palliative it can be implemented with other therapeutic modalities. Our preliminary experience should stimulate the recruitment of larger groups of patients in order to define the role of neuroendoscopy in the multimodal treatment of craniopharyngiomas.

Age-related analysis of glucose metabolism in spontaneously hypertensive and normotensive rats.

This study was designed to investigate the effect of both hypertension and ageing on the efficiency of glucose metabolism. A 12-sample, 120 min intravenous glucose tolerance test (IVGTT) was applied to 36 rats: two groups of nine young (12 weeks) spontaneously hypertensive and Wistar Kyoto rats (Y-SHR and Y-WKY group, respectively) and two groups of nine old (40 weeks) SHR and WKY rats (O-SHR and O-WKY group, respectively). Insulinaemia and glycaemia data were interpreted in terms of estimates of glucose effectiveness, S(G), and insulin sensitivity, S(I), provided by the minimal model of glucose kinetics. The possible link between insulin resistance and hypertension was investigated by comparing Y-SHR vs. Y-WKY and O-SHR vs. O-WKY groups. Comparison of O-SHR vs. Y-SHR and O-WKY vs. Y-WKY groups enabled us to investigate the role of age in the development of abnormalities in glucose metabolism. No significant differences (P > 0.05) were observed in the mean S(G) and S(I) estimates between SHR and age-matched WKY groups. This finding indicates that exposure of SHR to high blood pressure levels does not necessarily lead to the development of insulin resistance and impaired glucose effectiveness. Similarly, no significant differences (P > 0.05) were observed in S(G) and S(I) estimates between old and young SHR and WKY groups. This finding indicates that, in this animal model of hypertension, insulin sensitivity and glucose effectiveness do not even deteriorate with ageing.