Are severity and location of facial trauma risk factors for cervical spine injuries? 10-year analysis based on the use of the AO spine injury classification and the comprehensive facial injury (CFI) score.

PURPOSE: This study aims to demonstrate a correlation between cervical spine injury and location and severity of facial trauma. METHODS: We did a 10-year retrospective analysis of prospectively collected patients with at least one facial and/or cervical spine injury. We classified facial injuries using the Comprehensive Facial Injury (CFI) score, and stratified patients into mild (CFI < 4), moderate (4 ≤ CFI < 10) and severe facial trauma (CFI ≥ 10). The primary outcome was to recognize the severity and topography of the facial trauma which predict the probability of associated cervical spine injuries. RESULTS: We included 1197 patients: 78% with facial injuries, 16% with spine injuries and 6% with both. According to the CFI score, 48% of patients sustained a mild facial trauma, 35% a moderate one and 17% a severe one. The midface was involved in 45% of cases, then the upper facial third (13%) and the lower one (10%). The multivariate analysis showed multiple independent risk factors for associated facial and cervical spine injuries, among them an injury of the middle facial third (OR 1.11 p 0.004) and the facial trauma severity, having every increasing point of CFI score a 6% increasing risk (OR 1.06 p 0.004). CONCLUSIONS: Facial trauma is a risk factor for a concomitant cervical spine injury. Among multiple risk factors, severe midfacial trauma is an important red flag. The stratification of facial injuries based on the CFI score through CT-scan images could be a turning point in the management of patients at risk for cervical spine injuries before imaging is available.

Inflammatory molecules in Frontotemporal Dementia: cerebrospinal fluid signature of progranulin mutation carriers.

Mutations in progranulin gene (GRN) are one of the major causes of autosomal dominant Frontotemporal Lobar Degeneration (FTLD). Progranulin displays anti-inflammatory properties and is likely a ligand of Tumor Necrosis Factor (TNF) receptor 2, expressed on microglia. A few cytokines and chemokines are altered in cerebrospinal fluid (CSF) from patients with sporadic FTLD, whereas no information is available in familial cases. We evaluated, through BioPlex, levels of 27 inflammatory molecules, including cytokines, chemokines, and related receptors, in CSF and matched serum, from FTLD patients carrying GRN mutations as compared with sporadic FTLD with no GRN mutations and controls. Mean±SD Monocyte Chemoattractant Protein-1 (MCP-1) levels were significantly increased in CSF from sporadic FTLD patients as compared with controls (334.27±151.5 versus 159.7±49pg/ml; P⩽0.05). In GRN mutation carriers versus controls, CSF levels of MCP-1 were unchanged, whereas Interferon-γ-inducible protein-10 (IP-10) levels were increased (809.17±240.0 versus 436.61±202.5pg/ml; P=0.012). In the same group, TNFα and Interleukin (IL)-15 levels were decreased (3.18±1.41 versus 35.68±30.5pg/ml; P=0.013 and 9.34±5.54 versus 19.15±10.03pg/ml; P=0.023, respectively). Conversely, Regulated upon Activation, Normal T-cell Expressed, and Secreted (RANTES) levels were decreased in patients, with or without mutations, as compared with controls (4.63±3.30 and 2.58±20 versus 87.57±70pg/ml, respectively; P<0.05). Moreover, IP-10, IL-15 and RANTES CSF levels were not influenced by age, whereas MCP-1 levels increased with age (ρ=0.48; P=0.007). In conclusion, inflammatory de-regulation was observed in both sporadic FTLD and GRN carriers compared to controls, with a specific inflammatory profile for the latter group.

Hypertension in adult after operation of aortic coarctation.

AIM: The benefit of coarctation repair on the resolution of systolic hypertension in adults has been questioned. METHODS: Between March 1997 and July 2009, 65 consecutive adult patients (≥ 16 years) underwent repair of aortic coarctation. There were 40 men (65%) and 25 women (35%) with a mean age of 22.3 ± 4.8 years (range, 16 to 34 years). All patients had critical systolic blood hypertension (SBP ≥ 140 mmHg). SBP ranged from 140 to 205 mmHg, with a mean of 163.5 ± 17.6 mmHg. The mean diastolic BP was 95.1 ± 18.3 mmHg (range, 70 to 120 mmHg). Most patients (41/65, 74%) were on a regimen of at least one antihypertensive drug. RESULTS: The patients were followed up after coarctation repair for 2 to 144 months (mean, 68 ± 39 months). There was no death. No other major complications occurred. There have been no repeat interventions during follow-up. Four patients were lost to follow-up. Of the 61 patients with preoperative hypertension, 53 (87%) were normotensive (SBP <140 mmHg) at the most recent follow-up visit. The remaining eight patients showed substantial improvement versus the preoperative status. The mean SBP after operation was 122.5 ± 12.4 mmHg. Mean diastolic blood pressure was 79.5 ± 11.6 mmHg. Forty-one (67%) patients were taking no medication at the last follow-up. CONCLUSION: Surgical repair of coarctation of the aorta in adults can lead to regression of systolic hypertension and a decreased requirement for antihypertensive medication.

Bovine valved venous xenograft in pulmonary position: medium term evaluation of risk factors for dysfunction and failure after 156 implants.

AIM: This study evaluated risk factors for dysfunction and failure of the bovine Contegra valved conduit for right ventricle outflow tract reconstruction. METHODS: A total of 156 bovine jugular vein conduits were reviewed. Early and late mortality were evaluated. Seriate echocardiography was performed through the follow-up (mean 58±43.2 months, range 12 to 108 months), and risk factors and adverse events evaluation were analyzed by multivariate logistic regression. RESULTS: Hospital mortality was 7% (11/156). The only independent predictor of early mortality were cardiopulmonary bypass time >120 minutes and age <1 year. Postoperative mean RV to PA gradient was 10.4±9.1 mm Hg, increased to 18.7±14.5 mm Hg during the follow-up. A late gradient >30 mm Hg was assessed in 22 patients (15.1%),while 12 patients developed conduit valve regurgitation greater than 2+ without evidence of aneurismal formation. All patients with right ventricular (RV) to left ventricular (LV) pressure ratio >0.6 had conduit valve regurgitation. Acquired distal conduit stenosis was observed only in 1 patient. Thirteen patient underwent conduit replacement, diameter ≤14 mm was the only independent risk factor for reoperation. All explanted conduits were free from calcification and valve leaflets were intact and pliable. The Contegra graft itself was never cause of adverse event. CONCLUSION: The Contegra conduit provided excellent results and freedom from calcification in a medium-term follow-up. Younger age at operation was associated with higher need of replacements for conduit patient mismatch due to patient growth.

Correlation between modification of membrane phospholipids and some biological activity of lymphocytes, neutrophils and macrophages.

Our study considered the possibility of modifying the functional response of human neutrophils, of mouse lymphocytes and macrophages treated with phospholipids having different polar groups, different isomerisms with saturated and unsaturated fatty acids from C12 to C20 carbon atoms. The results are as follows. a) Most of the phospholipids containing fatty acids from C12 to C20 cause inhibition of the blastogenic capacity of the polyclonal activators tested. b) The phospholipids tested cause a decrease in adherence of polymorphonuclear leukocytes with the exception of the phosphatidyl-choline containing saturated and unsaturated fatty acids. c) A decrease in polymorphonuclear leukocytes migrational capacity almost always occurs. d) The cells treated with L-phosphatidyl-ethanolamine having fatty acids from C14 to C17 show an increase in chemiluminescence; those treated with phosphatidyl-choline and L-phosphatidyl-glycerol show a decrease of the chemiluminescence; L-phosphatidic acid and L-phosphatidyl-ethanolamine having Microbial fatty acids (FAs) at C16 cause a decrease in the formation of phagolisosomes in the macrophages tested.

Anti HSV-2 properties of amniotic fluid.

Some antiviral properties of amniotic fluid (AF) were studied. A close relationship between maternal blood and AF antiviral antibodies was seen. Substances other than antibodies which could have an effect on viruses were assumed to be present in AF. Using HSV2 as a model, we found a virus-neutralizing activity in 6 out of 7 specimens studied which does not appear to be related to antibodies.