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The aim of this study was to analyse whether significant differences exist between free-hand 3D planning-guided screw placement and 3D printed template guided CBT screw positioning in terms of accuracy, size of screws and potential complications.Data were extracted from a prospectively collected database and resumed in a retrospective study. Adult patients fixed with CBT screws for lumbar degenerative pathologies were considered for this analysis. A group of patients in which screws were placed by using 3D planning guided free-hand technique (PG) were compared to a second group of patients that underwent screw positioning by using customised 3D printed guides (TG). Analysed parameters were size of the screws, accuracy, clinical outcomes and complications.A total number of 1004 screws and 251 patients was evaluated for this study. The PG included 158 patients (632 screws) while the TG evaluated 93 patients (372 screws). The TG group involved screws of larger size from L3 to S1. Differences between the two groups in terms of accuracy parameters reached statistical significance (p ≤ 0.05).The use of 3D patient-matched template guides was able to safely increase mean diameter and length of cortical bone trajectory screws, and also improved the accuracy of screw placement. Following previous evidence about CBT biomechanical properties, these advantages could allow to increase fixation strength over traditional convergent pedicle screw trajectories. Further biomechanics studies would be needed.

Radiculomedullary artery malformations are rare conditions: their rupture usually manifests with subarachnoid hemorrhage. To the best of our knowledge no cases of subdural bleeding have been described in the literature. We present the rare case of a 74 year old woman admitted to our Institute with sudden onset of right lower limb motor deficit and hypoesthesia, with no history of trauma: Magnetic Resonance Imaging of the dorsal spine was performed and a subdural hematoma was detected; subsequent dorsal laminectomy for hematoma evacuation was carried out. As the source of bleeding was not recognized, Digital Subtraction Angiography (DSA) was performed: a new leak of contrast agent from a dilation of a spinal radicular artery at the level of T5 was detected; XperCT imaging (an angiographic acquisition of Computed Tomography-like images) confirmed a new acute subdural bleeding. Urgent repeat surgery was considered the best option to identify and close the malformation. Postoperative DSA confirmed complete exclusion of the radicular artery malformation. This is the first report that describes, with an intraoperative video, a case of radiculomedullary artery pseudoaneurysm, responsible of an acute subdural bleeding and associated neurological deficit.

We validated a clinical prediction rule for Legionella based on clinical parameters (dry cough, fever) and laboratory findings (C-reactive protein, lactate dehydrogenase, sodium, platelet counts) in 713 consecutive patients with community-acquired pneumonia. The Legionella Score performed well in estimating the likelihood for Legionella infection and thus may help to direct diagnostic and therapeutic decisions.

We validated a clinical prediction rule for Legionella based on clinical parameters (dry cough, fever) and laboratory findings (C-reactive protein, lactate dehydrogenase, sodium, platelet counts) in 713 consecutive patients with community-acquired pneumonia. The Legionella Score performed well in estimating the likelihood for Legionella infection and thus may help to direct diagnostic and therapeutic decisions.

The streaming potential through poly(acrylic acid)-co-acrylamide polymer hydrogel (poly-AA-co-AM) membranes has been measured as a function of gel composition and ionic strength of the solvent. Polyelectrolyte hydrogels have important potential applications as mechanical transducers. The current work aims at providing a quantitative basis to understanding the relationship between gel composition and structure and the electromechanical coupling properties. The streaming potential increases in magnitude with the spatial density of negative charges in the gel, up to a saturation point where the density of charges on the polymer backbone becomes comparable to the salt concentration of the equilibrating solution. A simple theory of coupled charge and solvent transport based on the model proposed by de Gennes et al. [Europhys. Lett. 2000, 50, 513] quantitatively accounts for the observed effects.

The diagnostic reliability and prognostic implications of procalcitonin (PCT) (ng/ml) on admission in patients with community-acquired pneumonia (CAP) due to Legionella pneumophila are unknown. We retrospectively analysed PCT values in 29 patients with microbiologically proven Legionella-CAP admitted to the University Hospital Basel, Switzerland, between 2002 and 2007 and compared them to other markers of infection, namely, C-reactive protein (CRP) (mg/l) and leukocyte count (10(9)/l), and two prognostic severity assessment scores (PSI and CURB65). Laboratory analysis demonstrated that PCT values on admission were >0.1 in over 93%, >0.25 in over 86%, and >0.5 in over 82% of patients with Legionella-CAP. Patients with adverse medical outcomes (59%, n = 17) including need for ICU admission (55%, n = 16) and/or inhospital mortality (14%, n = 4) had significantly higher median PCT values on admission (4.27 [IQR 2.46-9.48] vs 0.97 [IQR 0.29-2.44], p = 0.01), while the PSI (124 [IQR 81-147] vs 94 [IQR 75-116], p = 0.19), the CURB65 (2 [IQR 1-2] vs 1 [1-3], p = 0.47), CRP values (282 [IQR 218-343], p = 0.28 vs 201 [IQR 147-279], p = 0.28), and leukocyte counts (12 [IQR 10-21] vs 12 [IQR 9-15], p = 0.58) were similar. In receiver operating curves, PCT concentrations on admission had a higher prognostic accuracy to predict adverse outcomes (AUC 0.78 [95%CI 0.61-96]) as compared to the PSI (0.64 [95%CI 0.43-0.86], p = 0.23), the CURB65 (0.58 [95%CI 0.36-0.79], p = 0.21), CRP (0.61 [95%CI 0.39-0.84], p = 0.19), and leukocyte count (0.57 [95%CI 0.35-0.78], p = 0.12). Kaplan-Meier curves demonstrated that patients with initial PCT values above the optimal cut-off of 1.5 had a significantly higher risk of death and/or ICU admission (log rank p = 0.003) during the hospital stay. In patients with CAP due to Legionella, PCT levels on admission might be an interesting predictor for adverse medical outcomes.