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To compare brain magnetic resonance imaging (MRI) using T1 3D Silent and fast T1 3D Gradient-Echo (GRE) BRAin VOlume (known as BRAVO) sequences. The primary aim is to assess the quantitative and qualitative analysis of Silent and BRAVO images by the measurement of the contrast (C), the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR). The second aim is to estimate the subjective sound levels and the specific absorption rate (SAR). Twenty-two subjects had T1 3D Silent and T1 3D BRAVO sequences added to the standard MR examination. The qualitative analysis of the two sequences was performed by two radiologists independently. The quantitative analysis was performed by placing regions of interest on the cerebrospinal fluid, on the white and grey matter. The C, the CNR and the SNR were calculated for each sequence. After each T1-3D sequence, subjects gave a score rating to evaluate the acoustic noise. Finally, the SAR was evaluated by the digital imaging and communications in medicine (DICOM) tags. The image quality scores obtained by the two radiologists were higher for BRAVO compared to the Silent. However, qualitatively, the Silent images were similar to BRAVO for diagnostic use. Quantitatively, CNR for GM-CSF was comparable in the two sequences and SNR in CSF was higher in Silent than BRAVO. The acoustic noise of Silent sequence was statistically lower compared with BRAVO. The maximum SAR measured was 1.4 W/kg. 3D T1 Silent can be a valid alternative technique to conventional BRAVO to reduce the acoustic noise preserving the diagnostic accuracy. However, radiologists preferred the conventional sequence to Silent.

Background Intracranial vascular malformations are increasingly being treated via the endovascular route. Though generally safe, a multitude of intraprocedural complications that potentially lead to disastrous clinical outcomes may arise. It is crucial for the operators to be well versed with the various techniques that are available to overcome any procedure-specific complications. Methods We present 2 cases in which we encountered premature intravascular detachment of the microcatheter tip and coil migration while treating a dural arteriovenous fistula and aneurysm, respectively. We used a stentriever to remove the detached microcatheter tip and suction using the reperfusion catheter to remove the migrated coil, both techniques that have not been reported in the literature thus far. Results Detached microcatheter tip and migrated coil were successfully retrieved using a stentriever and aspiration catheter. Conclusions These novel techniques could potentially reduce mortality and morbidity associated with neurointervention.

Multiple myeloma is a type of blood cancer arising from the uncontrolled clonal proliferation of malignant plasma cells resulting in impaired hematopoiesis, hyper production of monoclonal protein, bone tissue destruction leading and renal system alterations up to kidney failure. The aim is to review the state-of-the-art of radiological imaging in multiple myeloma. Radiological techniques as well as the advancements in imaging technology have been reviewed and summarized. The main radiological findings of different imaging techniques in patients suffering from multiple myeloma are also illustrated. Different radiological techniques provide structural and functional data. In the last years, conventional skeletal survey has gradually lost its utility and it has been replaced by whole body low-dose computed tomography which allows to identify also small lytic lesions, the medullary and the extramedullary involvement. Nowadays, magnetic resonance is the most sensitive imaging technique for detecting of skeletal as well as medullary involvement in patients with multiple myeloma. Thanks to the multiparametric evaluation (morphological, diffusion weighted and perfusion imaging sequences) and to the quantitative analysis, magnetic resonance imaging is proved to be useful in the early evaluation of response to therapy. Finally, positron emission tomography has greater sensibility compared to computed tomography as it provides quantitative data; however, the lower expression levels of the specific gene involved in the glycolysis pathway are associated with false-negative results with consequent underestimation of the disease. The only use of the advanced combined multimodal imaging allows a better evaluation, staging and early assessment of treatment response in patients with multiple myeloma.

Post-pulmonary embolism (PE) syndrome is an important clinical condition that can affect the long-term prognosis after acute PE.We aimed to evaluate the prevalence of residual pulmonary thrombi and the thrombotic burden 1 year after acute PE, by using our refined computed tomography (CT) imaging method.In this prospective study, patients diagnosed with acute PE were recruited and examinations were conducted at 1 month, 6 months, and 1 year. Especially at 1 year, patients were evaluated multifacetedly, including by laboratory tests, quality-of-life, 6-min walking test, and enhanced CT.Fifty-two patients were enrolled. Two patients (3.8%) developed chronic thromboembolic pulmonary hypertension. A total of 43 patients completed evaluation at 1 year, among whom (74%) had residual thrombi, with a median modified CT obstruction index (mCTOI) of 10.7%. In multivariate analysis, residual thrombi at 1 month was the only factor significantly related to residual thrombi at 1 year (odds ratio, 103.4; 95% confidence interval, 4.2-2542.1). The tricuspid regurgitation pressure gradient ≥60 mmHg and left ventricular end-diastolic dimension at diagnosis were significantly related to mCTOI at 1 year (β = 0.367, P = .003; and β = -0.435, P = .001, respectively).Using our improved CT imaging protocol, we found a high prevalence of residual thrombi 1 year after acute PE. Furthermore, right ventricular overload was related to the thrombotic burden. The long-term treatment strategy of acute PE could be modified to include precise CT imaging.

Highlights • Vascular myelopathies include different aetiology and mechanism of damage. • The level of the lesion and the localization within the SC correlates with the clinical symptoms. • CT, MRI and angiography are essential for diagnosis and treatment playing a complementary role. • MRI is the gold standard for the evaluation of spinal cord lesions. • Spinal angiography is the gold standard for evaluation of spinal cord vasculature and vascular malformations., Background Vascular lesions of the spinal cord are rare but potentially devastating conditions whose accurate recognition critically determines the clinical outcome. Several conditions lead to myelopathy due to either arterial ischemia, venous congestion or bleeding within the cord. The clinical presentation varies, according with the different aetiology and mechanism of damage. Purpose The aim is to provide a comprehensive review on the radiological features of the most common vascular myelopathies, passing through the knowledge of the vascular spinal anatomy and the clinical aspects of the different aetiologies, which is crucial to promptly address the diagnosis and the radiological assessment.

Low Back Pain (LBP) is the most common spine disease and it is the most common cause of absence from work in developed countries. At lumbar level, the natural history of herniated disc is characterized by a disappearance of clinical symptoms in up to 60% with conservative treatment through simple rest for about 6 weeks and reduction of the disk heniation revealed by CT or MR scans within eight to nine months after the onset of back pain. Surgery is considered the treatment of choice for extruded, migrated and free fragment herniated disk associated to clinical symptomatology of cono-cauda syndrome, progressive foot droop and hyperalgic radiculopathy. patients with a small or contained herniated disk, without any benefit from conservative medical treatment, can be candidates for one of minimally invasive percutaneous techniques, whose outcome, though, depends on the characteristics of hernia itself and on the chosen technique. The aim of this paper is to discuss about O2-O3 treatment for symptomatic not extruded herniated disk at lumbar level, highlighting about indication inclusion exclusion criteria and our results.

Additional file 4: TableS4. Solutions to encourage IOP

Additional file 3: TableS3. Challenges to encourage IOP

Additional file 1: TableS1. Perception of the integration of oncology and palliative care programs in Japan

Hypophysitis (HP) is a rare acute or chronic inflammatory condition of the pituitary gland. The greatest challenge in the management of HP is establishing a diagnosis through clinical criteria and non-invasive methods and predicting the patients’ clinical outcome. The aim of this review is to describe the neuroradiological findings of this rare disease, providing some information regarding the possible differential diagnosis in order to avoid unnecessary surgery. Gadolinium-enhanced pituitary magnetic resonance imaging (MRI) is considered the neuroradiological investigation of choice. The features suggestive for HP include an enlarged triangular- or dumbbell-shaped gland with a thickened and not obviously deviated stalk, further supported by the absence of posterior pituitary bright spot on T1weighted images, particularly in patients presenting with diabetes insipidus. Contrast enhancement pattern is quite variable; dural enhancement has been reported in some cases after intravenous contrast administration. The characterization of the unusual sellar mass is not straightforward and generally results in a wide differential. HP should be primarily differentiated from pituitary adenomas (including pituitary apoplexy), from pituitary metastases, and from other sellar and parasellar tumors, e.g., craniopharyngiomas, germinomas, gliomas, lymphomas, meningiomas, pituicytomas, chordomas, teratomas, dermoids and epidermoids, Rathke’s cleft cysts, and abscesses. In patients suspected for secondary forms related to systemic pathology, additional imaging is helpful in identifying other involved sites. Neuroradiologists need to know MRI appearance of this rare disease, as well as its typical symptoms and serological markers. A strict collaboration with endocrinologists and neurosurgeons is mandatory in order to reach a definitive diagnosis, allowing to promptly initiating an appropriate treatment.

Lumbar disc herniation is the most common cause of low back pain and sciatica in Western country with classical irradiation along the nerve root course.

Additional file 2: TableS2. Qualitative analysis of opinions toward the integration of oncology and palliative care

We studied the evolution of cooperation in the framework of evolutionary game theory, implementing voluntary participation in the prisoner's dilemma. Although previous studies have tried to overcome the dilemma by introducing voluntary participation called a "loner," the question of which strategies among various strategies including voluntary participation are adaptive under competitive circumstances is still an unsolved puzzle. Here we have developed a model that consists of all possible strategies using a one-period memory of past actions. This model enables us to analyze a "melting pot" of strategies, wherein several strategies interact and compete with each other. Our results revealed that one strategy, in which one escapes if a partner defects or cooperates if a partner becomes a loner, dominates and maintains cooperation in an alternating prisoner's dilemma game. However, the so-called "win-stay, lose-shift" strategy dominates in a simultaneous prisoner's dilemma game. Our simulations clearly show that voluntary participation in the prisoner's dilemma game works in the alternating situation rather than the simultaneous one.

Synthetic magnetic resonance imaging (SyMRI) allows to obtain different weighted-images using the multiple-dynamic multiple-echo sequence lasting 6 min. The aim is to compare quantitatively and qualitatively synthetic- and conventional MRI in patients with multiple sclerosis (MS) and controls assessing the contrast (C), the signal to noise ratio (SNR), and the contrast to noise ratio (CNR). We evaluated the lesion count and lesion-to-white matter contrast ( $${\text{C}}_{{\text{l } - \text{ WM}}} {)}$$ in the MS patients. 51 patients underwent synthetic- and conventional MRI. Qualitative analysis was evaluated by assigning scores to all synthetic- and conventional MRI sequences by two neuroradiologists. Lesions were counted in MS patients both in the conventional- and synthetic T2-FLAIR. Regions of interest were placed in the cerebrospinal fluid, in the white- and grey matter. For the sequences were evaluated: C, CNR, and SNR. Synthetic T2-FLAIR images are qualitatively inferior. C and CNR were significantly higher in synthetic T1W and T2W images compared to conventional images, but not for T2-FLAIR. The SNR value was always lower in synthetic images than in conventional ones. SyMRI can be used in clinical practice because it has a similar diagnostic accuracy which reduces the scanning time compared to the conventional one. However, synthetic T2-FLAIR images need to be improved.

Background Few studies have assessed associations of non-enzymatic antioxidant capacity (NEAC) in the overall diet with all-cause or specific mortality, and their results have been inconsistent. Objectives The present study investigated the association between dietary NEAC and all-cause or cause-specific mortality. Methods The study was a large-scale population-based prospective cohort study in Japan consisting of 42,520 men and 50,207 women aged 44-76 y, who had no history of cancer, stroke, ischemic heart disease, or chronic liver disease. We evaluated FFQ-based dietary NEAC with use of published databases in which the NEACs of individual foods were analyzed by ferric reducing antioxidant power (FRAP) and oxygen radical absorbance capacity (ORAC) assays. Dietary NEAC was calculated by multiplying the estimated NEAC with the consumed amount and summing up those values for all foods, and was categorized in quartiles. We identified death and cause of death with use of residential registry and death certificates. HRs and 95% Cls for death from the second survey, which was conducted from April 1995 to December 2014 were estimated with Cox proportional hazards regression analysis. Results After 1,498,308 person-years of follow-up, 12,978 total deaths occurred. The multivariable-adjusted HRs (95% Cls) for all-cause mortality for the highest compared with the lowest quartile of FRAP and ORAC were 0.85 (0.80, 0.89) and 0.84 (0.79, 0.89), respectively. Dietary NEACs were inversely associated with mortality from cardiovascular disease (CVD), but not from cancer. The multivariable-adjusted HRs (95% Cls) for CVD for the highest compared with the lowest quartile of FRAP and ORAC were 0.83 (0.75, 0.92) and 0.79 (0.70, 0.89), respectively. Conclusions Higher dietary NEACs from FRAP and ORAC were associated with lower risk of all-cause mortality and mortality from CVD in Japanese adults.

Basilar Artery Occlusion (BAO) is a devastating and challenging disease with a mortality and morbidity rateup to 90% and a severe residual deficit in more than 65% of survivors. Best treatmentstrategy for BAO combined with proximalvertebral stenosis or dissection (tandem occlusion) is not clear yet. We describe a case of acute stroke due to tandem occlusion of posterior circulation (acute V2 dissection plus BAO) treated by acute stent-assisted vertebro-basilar reconstruction (Telescoping StentsTechnique) with a long-term follow-up.

Transmutation using intense negative muon beams is useful to mitigate long-lived fission products from nuclear plants. To produce high intensity negative muon beams, the MERIT (multiplex energy recovery internal target) scheme was suggested. To prove the MERIT scheme, a proof-of-principle experiment was performed at KURNS (Institute of Radiation and Nuclear Science at Kyoto University). This paper presents the results of the experiment.

The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic pain, much more difficult to treat. The clinical assessment of pain source can be a challenge because of the complex anatomy and function of the spine; the advanced imaging methods are often not sufficient for a definitive diagnosis because similar findings could be present in either asymptomatic and symptomatic subjects: a clinical correlation is always mandatory and the therapy cannot rely uniquely upon any imaging abnormalities. Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. Special attention will be done to the discogenic pain, actually considered as the most frequent cause of chronic low back pain.

The incidence of neuroendocrine tumors (NETs) is progressively increasing. Most cases arise from the digestive system, where ileum, rectum and pancreas represent the commonest site of origin. Liver metastases are frequently detected at diagnosis or during the follow-up. Contrast-enhanced ultrasound (CEUS) is used in patients with pancreatic NETs (P-NETs) and liver metastases from P-NET but its role has not been standardized. The aim of this retrospective study was to investigate CEUS in patients with P-NETs and liver metastases from P-NET both as prognostic factor and predictor of response to therapy with somatostatin analogues (SSAs). CEUS was performed at the diagnosis of NET and 3, 6 and 12 months after the beginning of SSAs. CEUS pattern was compared with contrast-enhanced computed tomography (CT) pattern. There was a significant association between CEUS and CT pattern (X 2 = 79.0; p

Wearable sensorized smart textile are gaining interests in medicine for monitoring physiological parameters. Moreover, sensing solutions based on fiber optic technologies have shown promising results for applications in Magnetic Resonance (MR) environment. The aim of the present study was to evaluate the functionality of an MR-compatible smart textile based on six fiber Bragg grating (FBG) sensors inside the MR environment for the monitoring of both respiratory and cardiac activities during apnea and quiet breathing stages. The proposed textile was tested on two healthy volunteers undergoing 1.5 Tesla MR examination. By analyzing the raw data collected by the six FBGs, respiratory parameters (i.e., respiratory rate, inspiratory and expiratory periods, inspiratory/respiratory ratio and inspiratory/expiratory ratio) have been computed. Thus, considering the raw data collected by the FBG sensor closest to the heart the resting heart rate was calculated by using the Fast Fourier transform (FFT). Results show that both the big displacements at low frequency (related to the breathing) and the small displacements at higher frequency (related to the heart activity) can be collected with the proposed system allowing the evaluation of both the respiratory and cardiac activities during quiet breathing and apnea without artifacts on images, providing useful information about patient condition. © 2017 IEEE.

CRANIAL cruciate ligament (CCL) rupture (CCLR) is one of the most common causes of hindlimb lameness in dogs (Kowaleski and others 2012). It is diagnosed on orthopaedic examination by a drawer test to detect abnormal cranial translation of the tibia and a tibial compression test for cranial tibial thrust (Piermattei and others 2006). These can have false-negative results, however, since stifle instability after CCL injury leads to fibrosis, joint effusion, muscle stiffness or meniscal injury, making cranial movement difficult to elicit (Flo and DeYoung 1978). Stress radiography is more accurate in assessing cranial tibial translation. By comparing two lateral radiographs taken before and after tibial compression or anterior/posterior force has been applied (de Rooster and others 1998, Lopez and others 2004, Plesman and others 2012), the examiner can measure the relative displacement of two osseous landmarks (e.g. the posterior point of the femoral condyles, the caudal projection of the tibial plateau). But these techniques place stress on an injured ligament and, in some cases, require specialised equipment and advanced technical skill (e.g. the implantation of radiopaque markers) in order to evaluate cranial tibial translation (Plesman and others 2012). The purpose of the present study is to introduce a novel objective method of measuring tibial translation that uses the angle formed by the distal femur and the proximal tibia with the long axis of the tibia, as viewed on a …

The seismic response of two tall steel moment frame buildings and their variants is explored through parametric nonlinear analysis using idealized sawtooth-like ground velocity waveforms, with a characteristic period (T), amplitude (peak ground velocity, PGV), and duration (number of cycles, N). Collapse-level response is induced only by long-period, moderate to large PGV ground excitation. This agrees well with a simple energy balance analysis. The collapse initiation regime expands to lower ground motion periods and amplitudes with increasing number of ground motion cycles.

SummaryObjective: To assess the effects of arthroscopic transection of the cranial arm of the medial glenohumeral ligament on shoulder stability.Animals: Six adult Beagles.Procedures: After transection, the effects were compared with baseline values by orthopaedic and radiographic examinations, by synovial fluid analysis at two, four, and six weeks, and by arthroscopic evaluation at six weeks. The articular surfaces of the glenoid cavity and humeral head were evaluated radiographically and arthroscopically for evidence of arthritis, and five intra-articular regions were examined arthroscopically for villus reactions and vascularisation.Results: According to orthopaedic examinations (including measurement of the abduction angle), radiography, and synovial fluid analyses, there were no abnormal findings. Arthroscopically, the articular surfaces of the glenoid cavity and humeral head showed no signs of degeneration, but the craniomedial and caudal joint capsules had significant villus reactions and the subscapularis tendon and medial glenohumeral ligament had significant vascularisation. The biceps tendon was unchanged.Conclusions: Transection of the cranial arm of the medial glenohumeral ligament in normal Beagles did not appear to affect shoulder stability. However, villus reactions and vascularisation in the medial compartment suggest that damage to the medial glenohumeral ligament may trigger a process in which inflammation can lead to enzymatic breakdown of cartilage. Exacerbated by weight bearing and repetitive motion, this may result in shoulder instability over time.

Ischemic stroke is a leading cause of death and disability worldwide. Much of the long-term disability occurs in patients with Emergent Large Vessel Occlusion (ELVO). In fact, in these patients, occlusion of a major intracerebral artery results in a large area of brain injury often resulting in

In recent decades, U.S. health care costs have risen much faster than the overall rate of inflation, and they now consume over 16 percent of gross domestic product, the highest proportion in the world (Anderson and Frogner 2000; Hartman et al. 1999). Despite higher costs, the quality of U.S. health care appears to be no better than that of other industrialized countries (Davis et al. 1992; Anderson and Frogner 2000). A focus on specialty care at the expense of primary care has been blamed in part for this gap between cost and outcome (Phillips, Dodoo, and Green 2005; Starfield et al. 2005a). Indeed, specialty utilization is much higher in the United States than in other countries (Forrest et al. 1999b, 2000), and effective primary care reduces the need for specialty care and enhances value (Starfield, Shi, and Macinko 2005b). There has been relatively little research on pediatric subspecialty utilization, with the last comprehensive study published over 10 years ago (Forrest et al. 1999a). That study and others demonstrated a broad array of medical and surgical subspecialties to which patients are referred and various reasons for referral, including assistance with diagnosis and management, need for surgery or other procedures, and parental request (Forrest et al. 1999a, 2000; Glade et al. 2006). In addition, research has shown that there is a wide variability in subspecialty referral rates among pediatricians, as well as lesser variability according to type of insurance, region, and demographics (Forrest et al. 1999a, 2000; Kuhlthau et al. 2002). In the current health care context, especially in light of efforts to develop more efficient models of care such as accountable care organizations (Luft 2009), a detailed understanding of specialty care utilization is needed. Thus, to update and further delineate the details of pediatric subspecialty utilization, we analyzed medical claims from a single large not-for-profit health insurer for a large cohort of pediatric primary care practices that are part of a network affiliated with a children's hospital. We sought to define the population-based subspecialty utilization rate and to examine patterns of subspecialty utilization that might be important in designing a system that could deliver higher value pediatric care.

High-performance computing has brought about a renaissance in computational seismology and earthquake engineering. Researchers in both fields are using advanced numeric tools and high-fidelity numerical models synergistically to create rupture-to-rafters simulations. This end-to-end approach promises to significantly advance earthquake damage prediction, preparation, mitigation, and disaster response.

We describe our preliminary experience of a combined treatment with stenting and coiling for ruptured and unruptured complex cerebral aneurysms (AA) using new generation stents (Enterprise®, LeoPlus®, Solitaire®). Eighteen patients, 20 AA, were treated by stenting and coiling. Some had sacciform wide-necked partially thrombosed aneurysms, other had fusiform AA. Six ruptured AA were treated early, while the other 14 were treated electively. In four out of 20 AA coiling was performed by Jailing technique and in three cases a remodelling technique was also performed. Patients with ruptured AA were previously administered a heparin protocol during the procedure and given aspirin (500 mg) after stenting. Patients with unruptured AA were administered plavix and aspirin for seven days before the procedure. Post-intervention medical therapy was plavix and aspirin for six months, then aspirin (100 mg). MRA and DSA at were performed after six to 12 months. Treatment was successfully performed in all cases. The stent could be navigated within the cerebral arteries without any exchange procedure, and thanks to its retractability, it was positioned accurately. No procedure-related complication occurred. Complete occlusion of the aneurysm was observed in 14/20 AA, partial occlusion with residual sac in 2/20. At four months a residual neck was observed in 4/20 with an increase in residual sac at one year in one case treated by coiling. At one year, MRA showed a reduction of the neck in one case and a stable residual neck in the other. Stenting and coiling for sacciform wide-necked or fusiform aneurysms is a safe procedure without complications. Medical-therapy pre and post procedure associated with follow-up are necessary to establish the occlusion rate.

This study assessed the impact and modification of intradiscal, intraforaminal, epidural and intramuscular swine injection of a new material, Discogel®- radiopaque gelified ethanol-recently introduced for the mini-invasive treatment of herniated disc. Discogel® is a sterile viscous solution containing ethyl alcohol, cellulose derivative product, added to a radio-opaque element, tungsten. The pig was sedated and under fluoroscopy guidance a needle was positioned within disc L1-L2 followed by intradiscal, intraforaminal, epidural and intramuscular injection of 1 ml of Discogel. As disc control level L4-L5 was considered where nothing was injected. The pig was sacrifed 48 h after injection of discogel and the spine from D10 to S1 was removed and fixed in 10% buffered formalin. The anatomical specimens were cut with an electric saw and analyzed by routine technique then stained with formalin. The specimens containing bone material were treated by DEKAL solution. The specimens were stained with hematoxylin-eosin method and then analyzed by histochemical (Masson — Van Gieson PAS and trichromic stains) and immunochemical methods. Morphostructural examination disclosed a granular material coloured black by hematoxylin-eosin method (tungsten) in paravertebral tissue both in the muscular and connective tissue. Some inflammatory elements like lymphomonocyte cells and venous stasis were found. No alteration was found where discogel was injected, and the nucleus pulposus, disc, chondromixoid and root ganglium were normal. After intradiscal, intraforaminal, epidural and intramuscular injection of Discogel® no morpho-structural changes in nuclear tissue and annulus were found. Further studies on pigs with immunohistochemical analysis after treatment will confirm the morphological alterations induced by discogel and its action.

This paper illustrates the validity of vertebroplasty (VP) in patients with primary benign or metastatic lesion in the cervical spine. From January 2006 to December 2007, ten consecutive patients were treated with VP for a total of ten vertebral bodies: two symptomatic vertebral haemangiomas at C5 and C4.3, multiple myeloma at C2 (two cases) and one case at C4, five patients with vertebral metastasis from breast or lung cancer at C2, C4 (three cases) and C5. All the patients complained of pain resistant to continuous medical management. All procedures were performed under general anaesthesia by anterolateral approach under CT or fluoroscopy control with manual dislocation of the carotid axis. A transoral approach under fluoroscopy was performed to treat the C2 lesion. Bone biopsy was never performed. VP was performed to prevent fracture after implantation of a double discal prothesis in two patients. For patients with multiple myeloma, VP was performed to prevent new vertebral fracture. VP was performed before of radiotherapy in three patients with metastasis, and just after radiotherapy in two. Two metastatic patients were lost at one year follow-up due to death from systematic diffusion. Results were evaluated on the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODS). A successful outcome was observed with a complete resolution or partial reduction of pain in 90% of patients 24–72 hours after VP. At 12 months follow-up, we recorded a reduction of four points in the VAS evaluation and a 45% reduction in the ODS score. No extravertebral vascular or discal cement leakage was observed. At 12 months, X-ray follow-up showed a stable result. Percutaneous treatment with VP for benign or malignant cervical spine lesions is a valuable, mini-invasive and quick method that allows a complete and enduring resolution of painful vertebral symptoms without fracture of the adjacent or distal vertebral bodies.

This paper describes discolysis by intradiscal, periganglionic and periradicular oxygen-ozone (O(2)-O(3)) injection, a minimally invasive percutaneous technique for the treatment of lumbar disk herniation.From June 2000 to December 2006, we performed O(2)-O(3) chemonucleolysis procedures in 2,900 patients affected by lumbar disk herniation. Patients were selected on the basis of clinical, psychological, neurological and neuroradiological criteria. Exclusion criteria were extruded hernia and/or free disc fragments, hyperalgesic-paralysing sciatica and progressive neurological impairment of the affected limb. All percutaneous treatments were performed under computed tomography (CT) guidance. All patients were evaluated after 1 month, and those showing only partial success were scheduled for a second treatment session.Results were evaluated with the modified MacNab classification, the visual analogue scale and the Oswestry Disability Index at 6 and 12 months. Success rates were 75%-80% for soft disc herniation, 70% for multiple-disc herniations and 55% for failed back surgery syndrome. None of the patients suffered early or late neurological or infectious complications.According to our data, minimally invasive percutaneous treatment by intradiscal, periradicular or periganglionic O(2)-O(3) infiltration is a valuable and competitive technique that provides excellent results at low cost and without complications.

SUMMARY Background The presence of abnormal microcapillaries detected by narrow band imaging (NBI) with magnifying colonoscopy has been reported to be a marker of colorectal neoplasia. Aim To investigate prospectively if NBI with magnification could help predict the histology of early colorectal neoplasia. Methods A series of 104 consecutive patients with 139 colorectal lesions were studied. All lesions were detected by conventional colonoscopy and subsequently evaluated by NBI with magnification. During NBI with magnification, the microvascular architecture observed on the surface of the detected lesions, capillary patterns (CP), was divided into nonneoplastic (CP I) and neoplastic (CP II and CP III) types. Only lesions endoscopically diagnosed as CP II or CP III were included in the study. All of the lesions were resected endoscopically or surgically and examined histologically for comparison. Results

System identification of structures using their measured earthquake response can play a key role in structural health monitoring, structural control and improving performance-based design. Implementation using data from strong seismic shaking is complicated by the nonlinear hysteretic response of structures. Furthermore, this inverse problem is ill-conditioned; for example, even if some components in the structure show substantial yielding, others will exhibit nearly elastic response, producing no information about their yielding behavior. Classical least-squares or maximum likelihood estimation will not work with a realistic class of hysteretic models because it will be unidentifiable based on the data. It is shown here that Bayesian updating and model class selection provide a powerful and rigorous approach to tackle this problem when implemented using a recently developed stochastic simulation algorithm called Transitional Markov Chain Monte Carlo. The updating and model class selection is performed on a previously-developed class of Masing hysteretic structural models that are relatively simple yet can give realistic responses to seismic loading. The theory for the Masing hysteretic models, and the theory used to perform the updating and model class selection, are presented and discussed. An illustrative example is given that uses simulated dynamic response data and shows the ability of the algorithm to identify hysteretic systems even when the class of models is unidentifiable based on the data.

Information on subcortical ischaemic changes (SIC) in young hypertensive patients is scarce. We evaluated the frequency of SIC at magnetic resonance imaging (MRI), the possible effect on cognition of these patients, and the role of plasma markers known as indicators of endothelial and haemostatic activation. Inclusion criteria were age