Surgical treatment of traumatic thoracolumbar fractures: a retrospective review of 101 cases.

PURPOSE: To evaluate the outcomes of vertebral stabilisation after acute traumatic thoracolumbar fractures, correlating the outcome with patient clinical data, type and location of fracture, presence of neurological damage, timing of surgical intervention and number of instrumented levels. The results have been evaluated also through the AO classification and AOSIS score. METHODS: Retrospective analysis of 101 patients with traumatic thoracolumbar injuries from T3 to L5 operated 2011-2016 by posterior or antero-posterior fixation. The demographic data, trauma dynamics, number and type of fractures, associated lesions, timing of surgery, hospital stay, AOSIS score, RKA, SF-36 and ODI scores, pre- and post-operative neurological condition (ASIA grade), possible complications and re-interventions were evaluated for each patient. RESULTS: Fractures mainly involved the region between T11 and L2. The probability of medullary involvement increases with the increase in severity of the main fracture type with no relation with the vertebral region. Type B and C fractures were common in the thoracic region and rare in the thoracolumbar junction. ODI and SF-36 scores were significantly better in patients with a lower AOSIS score, specifically in lesions classified as type A, amyelic and with no comorbidity. No difference was found in the clinical scores between thoracic, thoracolumbar and lumbar fractures, nor between male and female patients. None of the 10 patients with ASIA A lesion at presentation achieved any degree of recovery: 50% of them had a thoracic lesion. Re-intervention rate was 15%. Hospital stay was significantly higher in patients with type C fractures, and complication rate was on average 14% (7% in type A fractures, 16% in B and 25% in C). CONCLUSIONS: This study confirmed the validity of the posterior approach in the surgical treatment of thoracolumbar fractures. Outcomes and complication risks are related to fracture severity. Surgical treatment can be recommended even with an AOSIS score of two or three. The combined antero-posterior approach could be useful in cases with LSC > 8, especially in the thoracolumbar region. The degree of neurological recovery depends on fracture type, location, ASIA score and presence of comorbidities. Early intervention in myelic patients allows for a better prognosis. Level of evidence III retrospective case series.

Assessing the citizen science approach as tool to increase awareness on the marine litter problem.

This paper provides a quantitative assessment of students' attitude and behaviors towards marine litter before and after their participation to SEACleaner, an educational and citizen science project devoted to monitor macro- and micro-litter in an Area belonging to "Pelagos Sanctuary" (Mediterranean Sea). This approach produced interesting outcomes both for the research sector of marine pollution and environmental monitoring, as well for the scientific and environmental education. Here we focus on citizen science as an effective vector for raising young people awareness of marine litter and fostering sound behaviors. A specially designed questionnaire was administered to 87 High School students, to test the validity of such approach. The results state that the students change quantitatively their perception of beach-litter causes and derived problems, and they improved their knowledge about the main marine litter sources and the role of the sea in the waste transport and deposition along the coast.

Long-term changes on estuarine ciliates linked with modifications on wind patterns and water turbidity.

Planktonic ciliates constitute a fundamental component among microzooplankton and play a prominent role in carbon transport at the base of marine food webs. How these organisms respond to shifting environmental regimes is unclear and constitutes a current challenge under global ocean changes. Here we examine a multiannual field survey covering 25 years in the Bahía Blanca Estuary (Argentina), a shallow, flood-plain system dominated by wind and tidal energy. We found that the estuary experienced marked changes in wind dominant regimes and an increase in water turbidity driven from the joint effect of persistent long-fetch winds and the indirect effect of the Southern Annular Mode. Along with these changes, we found that zooplankton components, i.e. ciliates and the dominant estuarine copepod Acartia tonsa, showed a negative trend during the period 1986-2011. We showed that the combined effects of wind and turbidity with other environmental variables (chlorophyll, salinity and nutrients) consistently explained the variability of observed shifts. Tintinnids were more vulnerable to wind patterns and turbidity while showed a loss of synchrony with primary productivity. Water turbidity produced a dome-like pattern on tintinnids, oligotrichs and A. tonsa, implying that the highest abundance of organisms occurred under moderate values (∼50 NTU) of turbidity. In contrast, the response to wind patterns was not generalizable probably owing to species-specific traits. Observed trends denote that wind-induced processes in shallow ecosystems with internal sources of suspended sediments, are essential on ciliate dynamics and that such effects can propagate trough the interannual variability of copepods.

Time-varying environmental control of phytoplankton in a changing estuarine system.

Estuaries are among the most valuable aquatic systems by their services to human welfare. However, increasing human activities at the watershed along with the pressure of climate change are fostering the co-occurrence of multiple environmental drivers, and warn of potential negative impacts on estuaries resources. At present, no clear understanding of how coastal ecosystems will respond to the non-stationary effect of multiple drivers. Here we analysed the temporal interaction among multiple environmental drivers and their changing priority on shaping phytoplankton response in the Bahía Blanca Estuary, SW Atlantic Ocean. The interaction among environmental drivers and the number of significant direct and indirect effects on chlorophyll concentration increased over time in concurrence with enhanced anthropogenic stress, changing winter climate and wind patterns. Over the period 1978-1993, proximal variables such as nutrients, water temperature and salinity, showed a dominant effect on chlorophyll, whereas in more recent years (1993-2009) climate signals (SAM and ENSO) boosted indirect effects through its influence on precipitation, wind, water temperature and turbidity. Turbidity emerged as the dominant driver of chlorophyll while in recent years acted synergistically with the concentration of dissolved nitrogen. As a result, chlorophyll concentration showed a significant negative trend and a loss of seasonal peaks reflecting a pronounced reorganisation of the phytoplankton community. We stress the need to account for the changing priority of drivers to understand, and eventually forecast, biological responses under projected scenarios of global anthropogenic change.

Mn 3d bands and Y-O hybridization of hexagonal and orthorhombic YMnO3 thin films.

We report here the O K-edge x-ray absorption spectra of hexagonal and orthorhombic YMnO3 thin films, aiming at comparing the changes in the Mn 3d bands as well as the role of Y 4d-O 2p hybridization. The experimental results were analyzed using first principles (GGA) band structure calculations. The spectra present clear differences in the Mn 3d bands, which are attributed to changes in the Mn-O coordination and symmetry. A strong Y 4d-O 2p hybridization is observed in both the hexagonal and orthorhombic films, and its possible role on the occurrence of the observed ferroelectricity is discussed.

Targeted therapies and immunotherapy in non-small-cell lung cancer.

Non-small-cell lung cancer is still considered a difficult disease to manage because of its aggressiveness and resistance to common therapies. Chemotherapy remains the gold standard in nearly 80% of lung cancers, but clinical outcomes are discouraging, and the impact on median overall survival (OS) barely reaches 12 months. At the end of the last century, the discovery of oncogene-driven tumours completely changed the therapeutic landscape in lung cancers, harbouring specific gene mutations/translocations. Epidermal growth factors receptor (EGFR) common mutations first and anaplastic lymphoma kinase (ALK) translocations later led new insights in lung cancer biology knowledge. The use of specific tyrosine kinases inhibitors overturned the biological behaviour of EGFR mutation positive tumours and became a preclinical model to understand the heterogeneity of lung cancers and the mechanisms of drug resistance. In this review, we summarise the employment of targeted agents against the most representative biomolecular alterations and provide some criticisms of the therapeutic strategies.

Microplankton dynamics under heavy anthropogenic pressure. The case of the Bahía Blanca Estuary, southwestern Atlantic Ocean.

Quantifying biotic feedbacks in response to environmental signals is fundamental to assess ecosystem perturbation. We analyzed the joint effects of eutrophication, derived from sewage pollution, and climate at the base of the pelagic food web in the Bahía Blanca Estuary (SW Atlantic Ocean). A two-year survey of environmental conditions and microplankton communities was conducted in two sites affected by contrasting anthropogenic eutrophication conditions. Under severe eutrophication, we found higher phytoplankton abundance consistently dominated by smaller sized, non siliceous species, while microzooplankton abundance remained lower and nutrient stoichiometry showed conspicuous deviations from the Redfield ratio. Phytoplankton growth in such conditions appeared controlled by phosphorous. In turn, microplankton biomass and phytoplankton size ratio (<20µm:>20µm) displayed a saturation relationship with nutrients in the highly eutrophic area, although mean phytoplankton growth was similar in both eutrophic systems. The strength of links within the estuarine network, quantified through path analysis, showed enhanced relationships under larger anthropogenic eutrophication, which fostered the climate influence on microplankton communities. Our results show conspicuous effects of severe sewage pollution on the ecological stoichiometry, i.e., N and P excess with respect to Si, altering nutrient ratios for microplankton communities. This warns on wide consequences on food web dynamics and ultimately in ecosystem assets of coastal pelagic environments.

Effects of Ni vacancies and crystallite size on the O 1s and Ni 2p x-ray absorption spectra of nanocrystalline NiO.

We have studied the electronic structure of nanocrystalline NiO thin films, grown by radio-frequency magnetron sputtering under different experimental conditions, using x-ray absorption spectroscopy. The O 1s and Ni 2p spectra showed distinct changes as a function of O2 content in the plasma, which were reproduced with cluster model calculations. These changes are attributed to the incrementing of the surface contribution due to a decrease of the crystallite size as the O2 content in the plasma increases, and to the presence of induced nickel vacancies. Thus, the changes in the electronic structure can be related to the modification of structural and transport properties of these nanocrystalline films.

Is the toxic dinoflagellate Ostreopsis cf. ovata harmful to Mediterranean benthic invertebrates? Evidences from ecotoxicological tests with the polychaete Dinophilus gyrociliatus.

Toxicity tests were performed exposing the polychaete Dinophilus gyrociliatus to seawater samples containing the toxic dinoflagellate Ostreopsis cf. ovata. Experiments were carried out twice in mid summer, when O. cf. ovata bloomed, and twice in late summer, when the dinoflagellate density declined. Each time, four treatments were considered: original sample; reference sample, which always contained 200 O. cf. ovata cells ml(-1); filtered-seawater sample; artificial seawater (control). All the time, almost all worms survived in the controls and filtered-seawater treatments. In mid summer, the mortality of worms in the treatments containing O. cf. ovata was high and density-dependent. On the other hand, mortality in groups exposed to the original and reference samples collected in late summer was negligible. The high per cell toxicity of O. cf. ovata during mid summer could represent an allelopathic response. The test with D. gyrociliatus appears to be a promising tool for assessing the ecological risk of toxic dinoflagellate blooms.

Similarities in the screening effects of the core level and valence band spectra of VO2.

We calculated the core level and valence band spectra of VO(2) using an extended cluster model. The distribution of spectral weight is similar in both core level and valence band spectra and is related to the different screening mechanisms. Namely, the low energy structures in the spectra correspond to well screened final states, whereas the poorly screened final states appear at higher energies. The latter produce the charge transfer satellite observed in the core level spectra, and are related to the resonance in the constant initial state spectra of the valence band. The changes in the spectral weight across the metal-insulator transition are due to the different non-local screening channels present in each phase, and are also similar in both core level and valence band spectra. The calculation also shows a relatively large O 2p contribution in both spectra, which, in turn, helps to explain the enhancement of the coherent feature at higher photon energies. This suggests that the incoherent peak cannot be solely attributed to the lower Hubbard band.

Electronic structure of the band-filling-controlled CaVO3 and LaVO3 compounds.

We studied the electronic structure of the band-filling CaVO(3) and LaVO(3) compounds. The experimental techniques were photoemission (PES) and x-ray absorption (XAS) spectroscopy. The experimental results were analyzed using an extended cluster model. The ground states of CaVO(3) and LaVO(3) are highly covalent and contain a considerable 3d(n + 1)L contribution. The CaVO(3) compound is in the charge transfer regime (Δ < U), whereas the LaVO(3) material is in the intermediate regime (Δ âˆ¼ U). The spectral weight distributions reveal that CaVO(3) is a coherent metal and that LaVO(3) is a p-d insulator. The photoemission of CaVO(3) shows the coherent peak (3d(1)C) and the incoherent feature (3d(1)L). The spectrum of insulating LaVO(3) presents only the incoherent structure (3d(2)L), whereas the coherent peak is replaced by the Mott-Hubbard screening (3d(2)D). This transfer of spectral weight is responsible for the opening of the experimental bandgap. The incoherent feature contains a considerable O 2p character and cannot be attributed to the lower Hubbard band. Further, the relative V 3d-O 2p cross section helps to explain the photon energy dependence of the PES spectra. The addition spectra of both CaVO(3) and LaVO(3) are dominated by the 3d(n + 1) final state configuration. The distribution of spectral weight is mainly dictated by intra-atomic exchange and crystal field splittings. The coherent contribution is less important than in photoemission, and is greatly diminished in the O 1s x-ray absorption spectra.

[High-dose CEF (cyclophosphamide, epirubicin, fluorouracil) as primary chemotherapy in locally advanced breast cancer: long-term results]. / CEF (ciclofosfamide, epirubicina, fluorouracile) ad alte dosi come chemioterapia primaria nel trattamento del carcinoma mammario localmente avanzato: risultati a lungo termine.

PURPOSE: To determine wether primary CEF is effective in locally advanced breast cancer, as measured by response, local recurrences, disease free survival (DFS) and overall survival (OS). MATERIAL AND METHODS: From 1990 to 1998, 62 patients with stage III disease were enrolled into a prospective study at Regina Elena Institute for Cancer Research, Rome. Inflammatory breast cancer (IBC) was included. Patients received three 21 days cycles of chemotherapy that consisted in epirubicin 50 mg/m2, cyclophosphamide 400 mg/m2, and fluorouracil 500 mg/m2 i.v. on days 1 and 8. G-CSF (300 microg) was given subcutaneously every other day from day 5 to day 17. After primary chemotherapy, whenever possible, mastectomy or conservative surgery was performed. Subsequently responding patients received the same regimen, while non responders were given a non cross resistant chemotherapy. In case of conservative surgery or initial T4 tumor radiation therapy was performed at the end of adjuvant chemotherapy. ER positive patients received tamoxifen 20 mg/d for five years. RESULTS: Seven IIIA patients had a median OS of 43 months (C.I. 95%, 31-55) and DFS of 42 months (C.I. 95%, 16-68), while 15 IBC patients had a median OS of 52 months (C.I. 95%, 52-79) and DFS of 27 months (C.I. 95%, 14-39). Forty IIIB non inflammatory breast cancer patients had a median DFS of 87 months (C.I. 95%, 1-175); median OS was not reached. Ten-year OS was 28.6% for stage IIIA, 50.6% for stage IIIB and 36% for IBC. CONCLUSION: Primary CEF appear to be an effective treatment. In our study we obtained a good local control and interesting long term data of disease free and overall survival.

[New combination chemotherapy regimens in the primary treatment of operable breast cancer]. / Nuove combinazioni chemioterapiche nel trattamento primario del carcinoma mammario operabile.

Primary (neoadjuvant) systemic chemotherapy is the standard treatment for locally advanced breast cancer and a standard option for primary operable disease. Although survival results are similar, primary chemotherapy has the following advantages in comparison to adjuvant chemotherapy: it represents a chemosensitivity test in vivo and can be of value in determining the prognosis of the patient since pathologic complete responses are related to improved survival. Among a variety of primary chemotherapy regimens currently available, the most effective seem to be those containing both anthracyclines and taxanes, expecially when these agents are administered sequentially. There are also several ongoing studies evaluating primary hormonal therapy and the combination of cytotoxic chemotherapy and targeted agents. It is conceivable that in the future primary chemotherapy of breast cancer will be increasingly used. In fact, besides its clinical effectiveness, primary chemotherapy is extremely important to evaluate new agents and to find useful prognostic and predictive factors.

PRES: posterior or potentially reversible encephalopathy syndrome?

Posterior reversible encephalopathy syndrome (PRES) is an acronym that identifies a new clinico-neuroradiologic entity occurring in association with different conditions. We report a patient with eclamptic encephalopathy whose clinico-radiological picture normalised after prompt treatment. We suggest defining this condition as potentially RES, to emphasise that reversibility is not spontaneous but is usually related to an adequate treatment, and that the posterior localisation of the lesions, even if constant, may not represent the most relevant finding in some patients.

Imatinib ameliorates renal disease and survival in murine lupus autoimmune disease.

Platelet-derived growth factor (PDGF) has been proved to play an important role in progressive glomerular disease of systemic lupus. The present study investigated the tyrosine kinase inhibitor of PDGF receptor, imatinib, as a novel therapeutic approach for the cure of lupus nephritis in New Zealand Black/White (NZB/W)F1 hybrid mice with established disease. Two groups of NZB/W mice (N=30 each group), starting at 5 months of age, were given by gavage vehicle or imatinib (50 mg/kg b.i.d). Fifteen mice for each group were used for the survival study. The remaining were killed at 8 months. Imatinib significantly (P=0.0022) ameliorated animal survival with respect to vehicle. The drug significantly delayed the onset of proteinuria (% proteinuric mice, 7 and 8 months: 33 and 47 vs vehicle, 80 and 87, P<0.05) and limited the impairment of renal function. Imatinib protected the kidney against glomerular hypercellularity and deposits, tubulointerstitial damage, and accumulation of F4/80-positive mononuclear cells and alpha-smooth actin-positive myofibroblasts. The abnormal transforming growth factor-beta mRNA expression in kidneys of lupus mice was reduced by imatinib. In conclusion, findings of amelioration of animal survival and renal manifestations in NZB/W lupus mice with established disease by imatinib suggests the possibility to explore whether imatinib may function as steroid-sparing drug in human lupus nephritis.

Acute drug treatment of migraine attack.

The availability of an effective drug for attack treatment is a main need of migraine patients. Symptomatic therapy of migraine now includes three main classes of drugs: ergot alkaloids, nonsteroidal antiinflammatory drugs (NSAIDs) and triptans. Clinical randomised placebo-controlled trials affirmed the efficacy and tolerability of these drugs, when used at the recommended doses and in the absence of contraindications. The efficacy data from comparative trials showed a trend in favour of triptans vs. ergot alkaloids, but failed to show significant differences between triptans and NSAIDs. However, clinical practice experience of most headache clinicians suggests that triptans provide superior efficacy in comparison with nonspecific agents, mainly in that they better satisfy migraine patient expectations. In fact, these selective specific antimigraine drugs are an advance in acute migraine treatment.