Combined nerve and tendon transfer to restore elbow extension in tetraplegic patients: surgical technique and case report.

INTRODUCTION: In individuals with tetraplegia, elbow extension is critical for overhead activities, weight shifting, independent transfers, and to perform self-care tasks such as eating. At present, restoration of elbow extension in tetraplegic patients can be performed using either tendon or nerve transfers. Each procedure presents several advantages and limitations that must be discussed with the potential surgical candidate, based on remaining muscular functions and functional goals. CASE PRESENTATION: We propose a novel combined technique of both tendon and nerve transfer to restore active elbow extension by transferring the posterior deltoid tendon to the triceps tendon and the branch of teres minor nerve to the long head of the triceps nerve. Techniques were performed from the same shoulder posterior surgical approach. DISCUSSION: This surgical technique can add the benefits of each tendon and nerve transfer, leading to a reduction of failure rates, with more predictable outcomes.

Earthquake forecasting during the complex Amatrice-Norcia seismic sequence.

Earthquake forecasting is the ultimate challenge for seismologists, because it condenses the scientific knowledge about the earthquake occurrence process, and it is an essential component of any sound risk mitigation planning. It is commonly assumed that, in the short term, trustworthy earthquake forecasts are possible only for typical aftershock sequences, where the largest shock is followed by many smaller earthquakes that decay with time according to the Omori power law. We show that the current Italian operational earthquake forecasting system issued statistically reliable and skillful space-time-magnitude forecasts of the largest earthquakes during the complex 2016-2017 Amatrice-Norcia sequence, which is characterized by several bursts of seismicity and a significant deviation from the Omori law. This capability to deliver statistically reliable forecasts is an essential component of any program to assist public decision-makers and citizens in the challenging risk management of complex seismic sequences.

Biparametric versus Multiparametric MRI with Non-endorectal Coil at 3T in the Detection and Localization of Prostate Cancer.

AIM: To assess the sensitivity of biparametric magnetic resonance imaging (bpMRI) with non-endorectal coil in the detection and localization of index (dominant) and non-index lesions in patients suspected of having prostate cancer. PATIENTS AND METHODS: We carried-out a retrospective analysis of multiparametric MRI (mpMRI) of 41 patients who underwent radical prostatectomy. Results of MRI for detection and localization of index and non-index lesions were correlated with those of histology. RESULTS: No statistically significant difference in size was seen between tumor lesion at histology and index lesion at MRI. In 41 patients, a total of 131 tumors were identified at histology, while bpMRI (T2-weighted and diffusion-weighted MRI) approach detected 181 lesions. bpMRI gave 27.6% false-positives and 3.3% false-negatives. Sensitivity in lesion detection by bpMRI increased with lesion size assuming high values for lesions ≥10 mm. For bpMRI and mpMRI, the sensitivity for detecting index lesions was the same and equal: 100% in the peripheral zone 97.6% and 94.7% in the entire prostate and transitional zone, respectively. CONCLUSION: bpMRI can be used alternatively to mpMRI to detect and localize index prostate cancer.

Pancreatic tumors imaging: An update.

Currently, ultrasound (US), computed tomography (CT) and Magnetic Resonance imaging (MRI) represent the mainstay in the evaluation of pancreatic solid and cystic tumors affecting pancreas in 80-85% and 10-15% of the cases respectively. Integration of US, CT or MR imaging is essential for an accurate assessment of pancreatic parenchyma, ducts and adjacent soft tissues in order to detect and to stage the tumor, to differentiate solid from cystic lesions and to establish an appropriate treatment. The purpose of this review is to provide an overview of pancreatic tumors and the role of imaging in their diagnosis and management. In order to a prompt and accurate diagnosis and appropriate management of pancreatic lesions, it is crucial for radiologists to know the key findings of the most frequent tumors of the pancreas and the current role of imaging modalities. A multimodality approach is often helpful. If multidetector-row CT (MDCT) is the preferred initial imaging modality in patients with clinical suspicion for pancreatic cancer, multiparametric MRI provides essential information for the detection and characterization of a wide variety of pancreatic lesions and can be used as a problem-solving tool at diagnosis and during follow-up.

Single-phase Whole-body 64-MDCT Split-bolus Protocol for Pediatric Oncology: Diagnostic Efficacy and Dose Radiation.

PURPOSE: To evaluate the image quality and the diagnostic efficacy by single-phase whole-body 64-slice multidetector CT (MDCT) for pediatric oncology. PATIENTS AND METHODS: Chest-abdomen-pelvis CT examinations with single-phase split-bolus technique were evaluated for T: detection and delineation of primary tumor (assessment of the extent of the lesion to neighboring tissues), N: regional lymph nodes and M: distant metastasis. Quality scores (5-point scale) were assessed by two radiologists on parenchymal and vascular enhancement. RESULTS: Accurate TNM staging in term of detection and delineation of primary tumor, regional lymph nodes and distant metastasis was obtained in all cases. On the image quality and severity artifact, the Kappa value for the interobserver agreement measure obtained from the analysis was 0.754, (p<0.001), characterizing a very good agreement between observers. CONCLUSION: Single-pass total body CT split-bolus technique reached the highest overall image quality and an accurate TNM staging in pediatric patients with cancer.

The hybrid technique: potential reduction in complications related to pins mobilization in the treatment of proximal humeral fractures.

BACKGROUND: Proximal humeral fracture fixation has a high incidence of complications especially when pins are used in elderly patients. In 2005, we introduced a new technique that augmented osteosutures by using 2.5-mm fully threaded pins and an external fixator (hybrid technique). The purpose of this study is to compare the outcomes of the hybrid technique (HT) with traditional pins fixation. METHODS: A prospective nonrandomized study was organized on 2 consecutive series of patients: 51 patients treated with percutaneous fixation using 2.5-mm terminally threaded pins and 55 patients treated with the Hybrid technique. In both groups, an open reduction and osteosutures augmented with percutaneous fixation was used when closed reduction was insufficient to provide anatomical reduction. The patients were assessed at 6- and 12-month follows-ups using DASH score, Constant score, and Modified Constant score (MCS). RESULTS: Sixteen patients treated with traditional pins experienced complications compared to 6 patients in the HT group (P = .006). The revision rate was 19% for the traditional pins group and 4% for the HT group (P = .04). Pins migration affected 8 patients in the traditional pins group and 1 case in the hybrid group (P = .01). The MCS at the 12-month follow-up was 89 ± 9 in the HT group and 77 ± 14 in the traditional pins group (P = .03). The MCS was negatively affected by complications and malreduction (P = .001). CONCLUSION: The study suggests that the HT is a valuable option for the treatment of proximal humeral fractures. It has benefits compared to the traditional technique.

New 1,3,4-thiadiazole derivatives endowed with analgesic and anti-inflammatory activities.

Two series of N-[5-oxo-4-(arylsulfonyl)-4,5-dihydro-1,3,4-thiadiazol-2-yl]-amides were synthesized and tested in vivo for their analgesic and anti-inflammatory activities. All the new compounds possess good antalgic action in the acetic acid writhing test and some terms of the series showed also fair anti-inflammatory activity in the carrageenan rat paw edema test. Ulcerogenic and irritative action on the gastrointestinal mucose, in comparison with indomethacin is low.

Synthesis of N-substituted-N-acylthioureas of 4-substituted piperazines endowed with local anaesthetic, antihyperlipidemic, antiproliferative activities and antiarrythmic, analgesic, antiaggregating actions.

Three series of N-acyl and N-cyclohexyl- or N-methyl or N-phenyl-thioureas of 4-substituted (methyl, phenyl, 2-pyridyl)piperazines (4-12) were synthesised according to a highly convergent one-pot procedure and tested in vivo (local anaesthetic, anti-hyperlipoproteinemic, analgesic, anti-inflammatory, antiarrythmic activities) and in vitro (antiaggregating and, for some selected derivatives, antiproliferative activities) experiments. All the test compounds showed local anaesthesia in particular 4Ar(4), 5Ar(4), 12Ar(3) (after 5 min) and 5Ar(2), 5Ar(3), 9Ar(4) (after 30 min) were equipotent to lidocaine. In lowering triglyceride levels, compounds 6Ar(4) and 7Ar(3) were more active than nicotinic acid, whereas 7Ar(4) and 11Ar(4) were approximately equipotent. As concerns analgesic activity, 5Ar(2) and 5Ar(4) were as active as indomethacin. Appreciable anti-inflammatory activity was found in 8Ar(1), 5Ar(2) and 11Ar(2), but inferior to that of indomethacin. High levels of antiarrythmic activity, comparable with that of quinidine, were found in derivatives 4Ar(2) and 10Ar(1). Compounds 4Ar(2) and 8Ar(2), assayed in antitumor in vitro screening system at National Cancer Institute (NCI), showed significant antiproliferative activity against ACHN cell line (GI50: 0.13 microM) and NCI-H226 cell line (GI50: 1.03 microM), respectively.

2-aryl-3-phenylamino-4,5-dihydro-2h-benz[g]indazoles with analgesic activity.

A series of 2-aryl-3-phenylamino-4,5-dihydro-2H-benz[g]indazoles was synthesized and tested for antiarrhythmic, local anaesthetic and analgesic activity. The title compounds showed a good antinociceptive activity.