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This study aimed to examine the concurrent relation between six dimensions of emotion dysregulation, proposed by Gratz and Roemer (2004), and suicide ideation and attempt in a large sample of psychiatric adolescent inpatients. A sample of 547 adolescent inpatients completed measures on dimensions of emotion dysregulation, psychiatric diagnoses, and suicidal ideation and attempt. Binary logistic regression analyses revealed that limited access to emotion regulation strategies, difficulties in impulse control, and mood disorder diagnosis, were significantly associated with past year suicidal ideation, covarying for other emotion dysregulation subscales, anxiety and externalizing diagnoses, sex, and age. However, difficulties in impulse control was not significantly related to suicide ideation when analyses were conducted separately by sex. Binary logistic regressions also revealed that past year suicidal ideation uniquely and significantly associated with lifetime attempt, covarying for sociodemographics, psychiatric diagnoses, and all emotion dysregulation subscales; these results held when analyses were also conducted separately by sex. Results indicating an association between perceived limited emotion regulation strategies and suicide ideation are consistent with existing research and suicide-focused theory. This finding may have some tentative benefit to informing clinical assessment and treatment of suicidal thoughts. Other findings are discussed., (Copyright © 2018. Published by Elsevier B.V.)

Purpose: The use of cortical bone trajectory (CBT) pedicle screws for circumferential interbody fusion represents a viable alternative for single-level procedure with reduced invasiveness and less tissue destruction than the traditional technique. In addition, CBT screws have a potentially stronger pullout strength because of the greater amount of cortical bone intercepted. Only few series exist evaluating clinical and radiological outcomes of CBT screws., Methods: This is a retrospective cohort study. All patients that underwent circumferential lumbar interbody fusion with CBT screws in our institution from 2014 to 2017 were reviewed. Patient demographics, clinical outcome with visual analogue scale (VAS) and Oswestry Disability Index (ODI), radiological data such as fusion, lordosis and muscle trauma, operative blood loss, hospital stay and use of fluoroscopy were evaluated., Results: A total of 101 patients undergoing CBT-arthrodesis for degenerative lumbo-sacral disease were reviewed. Mean procedural time was 187 min. The mean operative blood loss and X-ray dose per procedure was 383 ml and 1.60 mg cm 2 , respectively. The mean hospital stay was 3.47 days. The mean follow-up was 18.23 months. Mean lordosis increment at the treated level was 4.2°. When the follow-up was longer than 12 months (53% of patients), fusion was obtained in 94% of cases. Mean ODI and VAS index improved with statistical significance., Conclusions: This is to our knowledge that the largest available study regarding CBT for circumferential arthrodesis. Results underlined the safety of this technique and the promising clinical and radiological outcomes that will need a longer follow-up. These slides can be retrieved under Electronic Supplementary material.

Borderline personality pathology typically onsets during adolescence. An important consideration in understanding adolescent psychopathology is pubertal development. Perceived pubertal timing is one facet of puberty that is especially relevant to adolescent psychopathology, especially when timing is perceived to be early. Despite links between early pubertal timing and core features of borderline personality disorder, and between early pubertal timing and disruptions in the interpersonal context, perceived pubertal timing has yet to be studied in relation to adolescent borderline pathology. This preliminary study aimed to test the association between perceived pubertal timing and borderline symptoms in adolescent girls, controlling for internalizing and externalizing pathology. Forty-two female adolescent inpatients (ages 12-15, Mage = 14.02, 81% White) completed measures of perceived pubertal development and borderline symptoms and a diagnostic interview. Results indicated that earlier perceived pubertal timing was uniquely associated with higher borderline symptoms even when internalizing and externalizing disorders were covaried.

Children affected by HIV/AIDS are at high risk for poor mental health outcomes. Social and psychological connectedness to school has been identified as an important resilience factor for youth affected by adversity (Centers for Disease Control and Prevention. (2009). School connectedness: Strategies for increasing protective factors among youth. Atlanta, GA: U.S. Department of Health and Human Services). Defined as "the belief by students that adults in the school care about their learning as well as about them as individuals" (Centers for Disease Control and Prevention. (2009). School connectedness: Strategies for increasing protective factors among youth. Atlanta, GA: U.S. Department of Health and Human Services), school connectedness has been shown to be associated with higher academic performance, increased mental health, and quality of life. However, few studies have examined school connectedness in sub-Saharan Africa, and none have examined school connectedness in relation to mental health in children orphaned by HIV/AIDS. Further, existing studies have relied on self-report measures. Against this background, the aim of the current study was to examine orphan status, school connectedness, and their interaction in relation to child mental health by using a multimethod design. 750 children between the ages of 7-11, recruited through South African community-based organizations (224 AIDS/HIV orphans, 276 non-AIDS/HIV orphans, 250 non-orphans; 51.2% girls), completed measures of school connectedness; children, caregivers, and teachers reported on child well-being using the Strengths and Difficulties Questionnaire. AIDS/HIV and non-AIDS/HIV orphans reported lower school connectedness than non-orphans. However, results demonstrated significant relations between school connectedness and overall mental health regardless of group, suggesting that school connectedness buffers against negative mental health outcomes regardless of orphan status. This study identifies a strategic point of intervention to build resilience against the cascading effects of HIV/AIDS and poverty in children in sub-Saharan Africa.

An increased rate of acromegaly was reported in industrialized areas, suggesting an involvement of environmental pollutants in the pathogenesis and behavior of GH-secreting pituitary adenomas. Based on these premises, the aim of the study was to evaluate the effects of some widely diffused pollutants (i.e. benzene, BZ; bis(2-ethylhexyl) phthalate, DEHP and polychlorinated biphenyls, PCB) on growth hormone secretion, the somatostatin and estrogenic pathways, viability and proliferation of rat GH-producing pituitary adenoma (GH3) cells. All the pollutants induced a statistically significant increase in GH secretion and interfered with cell signaling. They all modulated the expression of SSTR2 and ZAC1, involved in the somatostatin signaling, and the expression of the transcription factor FOXA1, involved in the estrogen receptor signaling. Moreover, all the pollutants increased the expression of the CYP1A1, suggesting AHR pathway activation. None of the pollutants impacted on cell proliferation or viability. Present data demonstrate that exposure to different pollutants, used at in vivo relevant concentrations, plays an important role in the behavior of GH3 pituitary adenoma cells, by increasing GH secretion and modulating several cellular signaling pathways. These observations support a possible influence of different pollutants in vivo on the GH-adenoma aggressiveness and biological behavior., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Cervical sagittal alignment parameters are essential to plan stages of surgery. The aims of this study were to evaluate the relationship between cervical sagittal alignment parameters and surgical outcomes after anterior cervical arthrodesis; to identify parameters linked to a better outcome; to determine the role of the T1 slope, C7 slope, cervical lordosis, and C2-C7 plumb line; and to describe an innovative method to calculate cervical lordosis. A cohort of 70 patients without cervical kyphosis was included in our retrospective study. We analyzed C7 slope, T1 slope, cervical lordosis, and the C2-C7 sagittal vertical axis (SVA). Clinical postoperative outcomes were evaluated with the Neck Disability Index (NDI) and Visual Analog Scale (VAS) score., Results: Significant correlation was found between the C2-C7 SVA, C7 slope, T1 slope and the CL/C7 slope. Statistically significant differences were found between group 1 (NDI = 0; VAS = 0) and group 3 (NDI > 17; VAS > 5) regarding C2-C7 SVA (P = 0.0026), C7 slope (P = 0.0014), T1 slope (P = 0.0095) and CL/C7slope (P = 0.0012). A value less than 25 mm found in the C2-C7 SVA correlate with positive outcomes. C7 slope correlated with NDI and VAS (P = 0.0014). CL/C7 slope ratio is significantly correlated to NDI and VAS scores (ratio: -0.52; P = 0.0012). Patients with CL/C7 slope greater than 0.7 had better clinical outcomes., Conclusions: Sagittal parameters are directly correlated with clinical outcome. If C7 slope increases, higher cervical lordosis is necessary to obtain a good outcome. CL/C7 slope (0.7) multiplied by C7 slope can determine the ideal lordosis., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Caulobacter spp. are Gram-negative bacteria that have rarely been found to be pathogenic in humans., Case Description: This report describes the first case, to our knowledge, of meningitis in an adult patient caused by Caulobacter spp. A 75-year-old man was operated for a glioblastoma with no evident signs of primary infection in the wound site. Eight days after surgery, the patient developed signs and symptoms of meningitis. Caulobacter was then isolated on 3 separate occasions in the patient's cerebrospinal fluid. Thereafter, specific antibiotic therapy began. After 2 weeks of therapy, the patient was discharged with complete resolution of any related symptoms., Conclusions: Caulobacter spp. can cause adult meningitis even where there is no evidence of surgical site infection., (Copyright © 2016 Elsevier Inc. All rights reserved.)

The introduction of modern endoscopy in neurosurgery brought light to one of the darkest areas: the skull base. In particular, the trans-nasal route allowed skull base surgeons to visualize and dominate the entire midline skull base. We analyzed our surgical series of 199 patients that were affected by several pathologies (pituitary adenomas, clivalchordomas, craniopharyngioma, Rathke's cleft cysts, tuberculum sellaemeningiomas, and craniovertebral junction pathologies with bulbar compression) and treated each by using a 3D-HD endoscope between December 2012 and December 2015 and reviewed the literature. We present our results in terms of tumor resections and decompression inpatients affected by craniovertebral junction pathologies. Analyzing our direct experience, as well as the literature, we can assert that the amount and accuracy of necessary movements in order to achieve a determined target are affected by the screen clarity and image resolution of the device. Additionally, the experience of the surgeon has an important role in the surgical outcome. Moreover, depth perception is critical in order to obtain precise and accurate movements. Our observations and the experts' opinion indicate that this modality provides improved surgical dexterity by affording the surgeon with depth perception while manipulating tissue and maneuvering the endoscope in the endonasal corridor, which is especially crucial in reducing the learning curve of young neurosurgeons.

Background: Hardware-related complications frequently occur in deep brain stimulation. Microscopy and spectroscopy techniques are effective methods for characterizing the morphological and chemical basis of malfunctioning DBS electrodes. A previous report by our team revealed the morphological and chemical alterations on a malfunctioning explanted electrode when it was compared to a new device. The aim of this preliminary study was to verify whether these morphological and chemical alterations in the materials were a direct result of the hardware malfunctioning or if the failure was correlated to a degradation process over time., Methods: Two DBS electrodes were removed from two patients for reasons other than DBS system impairment and were analyzed by a scanning electron microscope and by an energy-dispersive X-ray spectroscopy. The results were compared to a malfunctioning device and to a new device, previously analyzed by our group., Results: The analysis revealed that the wear of the polyurethane external part of all the electrodes was directly correlated with the duration of implantation period. Moreover, these alterations were independent from the electrodes functioning and from parameters used during therapy., Conclusions: This is the first study done that demonstrates a time-related degradation in the external layer of DBS electrodes. The analyses of morphological and chemical properties of the implanted devices are relevant for predicting the possibility of hardware's impairment as well as to improve the bio-stability of DBS systems.

Objective: Deep brain stimulation (DBS) is a cost-effective strategy for the treatment of different neurologic disorders. However, DBS procedures are associated with high costs of implantation and replacement of the internal pulse generator (IPG). Different manufacturers propose the use of rechargeable IPGs. The objective of this study is to compare the implantation costs of nonrechargeable IPGs versus the estimated costs of rechargeable IPGs in different categories of patients to evaluate if an economic advantage for the health care system could be derived., Methods: The study looked at 149 patients who underwent a surgical procedure for IPG replacement. In a hypothetical scenario, rechargeable IPGs were implanted instead of nonrechargeable IPGs at the time of DBS system implantation. Another scenario was outlined in a perspective period of time, corresponding to the patients' life expectancy. Costs were calculated, and inferential analysis was performed., Results: A savings of €234,194, including the cost of management of complications, was calculated during a follow-up period of 7.9 years. In a comprehensive life expectancy period of 47 years, a savings of €5,918,188 would be obtained (P < 0.05). Long-term group data point out that a relevant savings would be expected from implantation of rechargeable IPGs in dystonic patients (P < 0.05) and patients with Parkinson disease (P < 0.05), and a savings is projected to occur in other categories of patients (P < 0.05)., Conclusions: Implantation of rechargeable IPGs presents clinical advantages compared with nonrechargeable devices. A huge economic savings can be realized with the implantation of rechargeable IPGs in categories of patients implanted with IPGs for DBS., (Copyright © 2015 Elsevier Inc. All rights reserved.)

This paper describes the use of globus pallidus internus (Gpi) local field potentials recorded through pre-implanted deep brain stimulation (DBS) electrodes on a patient affected by generalized dystonia. The recordings were made both before and after radiofrequency-induced posteroventrolateral bilateral stereotactic pallidotomy. LFP patterns and macroelectrode impedances were modified after the pallidotomy, along with the improvement of dystonic symptoms. After implantation, the DBS electrodes were used for subsequent bedside pallidotomies that were required by the evolution and/or persistence of symptoms. In our hands, LFPs were safe and effective in monitoring pallidotomy performed through DBS electrodes.

Unlabelled: The role of hepatitis C virus (HCV) RNA quantification in determining ideal interferon (IFN) treatment of noncirrhotic HCV liver disease is uncertain. The specific aim of this study was to determine whether measurement of baseline HCV RNA or changes in HCV RNA levels (DHCV RNA) early during therapy predict response to IFN alpha in noncirrhotic HCV patients., Patients and Methods: Twenty-one noncirrhotic patients with chronic HCV were treated with 3 MU IFN alpha-2a three times per week. HCV RNA levels were determined at baseline and after two, four, six, eight and 12 weeks of treatment. Baseline HCV RNA and DHCV RNA during therapy were compared with treatment response results at six months. Data were expressed as mean +/- SE, and differences were assessed using Student's t test., Results: Twenty-one patients initiated IFN alpha therapy. Two patients were noncompliant and lost to follow-up. One patient discontinued IFN alpha due to side effects. Apart from age, where responders tended to be younger than nonresponders, the baseline clinical characteristics and alanine aminotransferase (ALT), aspartate aminotransferase, bilirubin and HCV RNA levels did not differ between IFN alpha responders and nonresponders. Levels of HCV RNA were significantly lower after both two and four weeks of therapy in IFN alpha responders compared with nonresponders (P<0.001). Changes in log HCV RNA levels after both two and four weeks of therapy were significantly greater in IFN alpha responders compared with nonresponders (P<0.001). Changes in log HCV RNA of more than 1.0 after two weeks of IFN alpha therapy identified all six-month responders, with a sensitivity of 100% and a specificity of 89%. Potential financial impact of these findings on patients' management was also calculated. Decisions regarding discontinuation of therapy based on early changes in HCV RNA levels would result in a 40% to 50% reduction in IFN alpha cost., Conclusions: In noncirrhotic HCV patients, the change in quantitative HCV RNA after the first two weeks of IFN alpha therapy identifies responders. This finding would result in a 40% to 50% cost savings if decisions about continuing IFN alpha were based on early changes in HCV RNA levels rather than ALT or HCV RNA assessment after the completion of three months of IFN alpha treatment.