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Background: There is a paucity of data examining anterior lumbar interbody fusion (ALIF) with pedicle-screw fixation (ALIF-PSF) or without (standalone, sa-ALIF) for the treatment of low-grade isthmic spondylolisthesis (IS). Treating pathology with sa-ALIF reduces costs, operative times, and posterior access morbidity. This study aimed to investigate the clinical and radiographic outcomes of sa-ALIF for the management of low-grade IS compared with an ALIF-PSF cohort. Methods: Retrospective analysis of prospectively collected data. Consecutive patients from 1 senior spine surgeon performing sa-ALIF or ALIF-PSF for management of low-grade IS. Patient-reported outcome measures (PROMs) were collected at baseline, then postoperatively at 6 weeks, 6 months, 12 months, and a final follow-up timepoint. Computed tomography was conducted at 6 months, 12 months, or until interbody fusion was confirmed. Results: Two cohorts comprised 51 patients (sa-ALIF 22 and ALIF-PSF 29). Both cohorts' PROMs improved from baseline to 12 months postoperatively. There were no significant differences (P = 0.05) in PROMs between the 2 cohorts at 6 months postoperatively, 12 months postoperatively, or at a final follow-up timepoint. There were no significant differences in mean fusion rates 12 months postoperatively (sa-ALIF 82% and ALIF-PSF 88%). Compared with preoperative measurements in sa-ALIF and ALIF-PSF cohorts, listhesis and segmental lordosis showed no significant changes, while disc height significantly increased (P = 0.0001). There were no significant differences in disc L5/S1 radiographic measurements between the cohorts at 12 months. There were 12 complications (sa-ALIF 2 and ALIF-PSF 10). Only 1 patient in the ALIF-PSF cohort required revision surgery. Conclusions: In appropriately selected patients with normal bone density, sacral slope <40°, and a body mass index <35, sa-ALIF is a safe and effective treatment option for grade I IS. The additional morbidity and cost of PSF may not be justified given the satisfactory clinical and radiographic outcomes of sa-ALIF for grade I IS. Clinical Relevance: Clinically, this research continues to suggest that sa-ALIF is a safe and effective method of treatment for low grade IS. [ABSTRACT FROM AUTHOR]

Background: Various strategies have been used to reduce pedicle screw loosening following lumbar instrumented fusion, but all strategies have limitations. In this prospective multicenter cohort study, outcomes of elderly patients with reduced bone density who underwent primary or revision fusion surgery using a novel technique of pedicle screw augmentation with demineralized bone fiber (DBF) anchors were evaluated. Methods: This study included elderly patients (aged >65 years) with dual-energy x-ray absorptiometry-confirmed reduced bone density who required lumbar pedicle screw fixation and were treated with supplemental DBF allograft anchors during primary or revision surgery. The need for DBF anchors was determined by evaluating preoperative computed tomography (CT) scans (for revision surgery) and by the surgeons’ tactile feedback intraoperatively during pedicle screw insertion and removal. After determining the pedicle screw void diameter with a sizing instrument, DBF anchors and pedicle screws of the same diameter were placed into the void. CT scans were obtained on postoperative day 2 to assess pedicle breach, pedicle fracture, or anchor material extrusion and at 6 and 12 months postoperatively to assess screw loosening. Thereafter, to minimize radiation exposure, CT scans were only performed for recurrence of pain. Results: Twenty-three patients (79% women; mean age, 74 years) received 50 lumbosacral pedicle screws augmented with DBF anchors. Most surgeries (n = 18, 78%) were revisions, and most anchors were inserted into revision pedicle screw trajectories (n = 33, 66%). Day-2 CT scans revealed no pedicle breach/fracture or extrusion of anchor material. During a mean follow-up of 15 months (12–20 months), no screw loosening was detected, and no patient required pedicle screw revision surgery. There were no adverse events attributable to DBF allografts. Conclusions: DBF allograft anchors appear to be safe and effective for augmenting pedicle screws during revision surgeries in female elderly patients with reduced bone density. Clinical Relevance: Clinically, DBF reduced the rate of pedicle screw loosening in patients with reduced bone density. A significant reduction in screw loosening can decrease the need for revision surgeries, which are costly and carry additional risks. Enhanced bone integration from the DBF may promote better healing and long-term stability. [ABSTRACT FROM AUTHOR]

• Evoked potentials in addition to EMG/tEMG is a more sensitive measure of "pre-pathologic" signal change, which was most often reversible. • Patients that experienced intraoperative signal change in our study rarely correlated with a post-operative deficit. • Our findings indicate that there is less clinical indication for routine neural monitoring at rostral lumbar levels. Minimally Invasive Lateral Lumbar Interbody Fusion (MIS LLIF) is a reliable technique for treatment of degenerative disk disease, foraminal stenosis and spinal deformity. The retroperitoneal transpsoas approach risks lumbar plexus injury that may result in anterior thigh pain, sensory loss and weakness. A prospective study of 64 consecutive patients undergoing MIS LLIF with expandable cages (23 standalone, 41 integrated with lateral plate) using multimodal electrophysiological monitoring was performed. We measured sequential retraction times, complications, patient reported outcome scores and electrophysiologic findings with a minimum 12-month follow-up. Incidence of evoked potential and electromyographic signal change was moderate, and rarely resulted in post-operative neurologic deficit. Evoked potential signal changes were frequently resolved by the un-breaking of the surgical table or repositioning of the retractor. Average retraction times were 24 (15–41) minutes for standalone cages and 30 (15–41) minutes for integrated cages. At follow-up, the vast majority (97%) of patients reported significant clinical improvement post-operatively with only 2 patients reporting postoperative neurologic symptoms and subsequent recovery at 12-months. The present study shows that evoked potentials combined with electromyography is a more sensitive measure of pre-pathologic lumbar plexopathy in LLIF compared to electromyography alone, especially at L3/4 and L4/5 levels. Based on our findings, there is limited clinical indication for routine neural monitoring at rostral lumbar levels. The routine inclusion of multimodal electrophysiological monitoring in lateral transpsoas surgery is recommended to minimise the risk of neural injury by enabling optimal patient and retractor positioning and continued surveillance throughout the procedure. [ABSTRACT FROM AUTHOR]

• Sense of place (SoP) interacts with structural factors stabilizing the CCIR pathway. • SoP legitimizes the dominance of coal and carbon-intensive industries. • SoP hinders alternative visions, fosters path dependency, and shapes imaginaries. • Acknowledging SoP can aid just and effective destabilization-reconfiguration. European coal and carbon-intensive regions (CCIRs) face the intricate challenge of navigating destabilization-reconfiguration pathways, requiring a nuanced understanding of how phase-out intertwines with innovation and lock-in mechanisms. The success of this transformation depends on a multitude of factors, including socio-political, economic, and material conditions, as well as psychosocial and cultural dimensions of place. This study examines how feedback loops between structural factors (i.e., socio-political, socio-economic, and infrastructural) and sense of place can either disrupt or reinforce lock-in mechanisms and path dependency in CCIRs. The study focuses on Sulcis CCIR (Sardinia, Italy), where extractive and metal industries are deeply ingrained in the region's culture and economy. To reconstruct the trajectory of the CCIR and gain in depth understanding of feedback mechanisms of path dependency across time, we triangulate different data sources including policy documents, newspapers, participatory workshops, and interviews with key stakeholders. The findings reveal the profound influence of a sense of place grounded in a shared industrial myth along with associated place meanings, identities, and memories on lock-in mechanisms. Positive feedback loops between sense of place and structural factors of lock-in have legitimated the dominance of coal and carbon-intensive industries across time, impeding the recognition of the need for change and obscuring windows of opportunity for low-carbon transformation. Following the definite destabilization of coal, dominant place meanings are being actively challenged, while the legacy of sense of place is serving as a guiding frame for shaping the legitimacy and imaginaries of place transformation and defining a just transition pathway. The study discusses the importance of recognizing and addressing the role of sense of place and its interaction with structural factors in perpetuating lock-in to ensure effective deliberate destabilization efforts and navigate a just reconfiguration of CCIRs. [ABSTRACT FROM AUTHOR]

Wild edible plants are often considered healthier than crops because they are unaffected by fertilizers, herbicides, and pesticides. However, the occurrence of potentially toxic elements in wild plants is poorly known and needs to be assessed. In this study, 22 elements were determined by inductively coupled plasma mass spectrometry in wild asparagus (Asparagus acutifolius L.). Asparagus shoots were collected in uncontaminated environments (20 sites) and in areas contaminated by past mining (15 sites) in Sardinia, Italy. Beryllium, Bi, Te, Tl, and U were not detected in asparagus (<0.03 μg g-1); Ag, As, Co, Cd, Li, and Sb were detected at very low levels (median, 0.01-0.05 μg g-1); B, Cu, Fe, Mn, Rb, and Zn were relatively abundant (median, 10-58 μg g-1); and Ba, Mo, Ni, Pb, and Sr showed large variations (median, 0.4, 0.3, 3, 0.1, and 0.5 μg g-1, respectively). Median concentrations of detected elements were similar in asparagus collected in uncontaminated environments or previously mined areas. An exception was Cd in asparagus collected in mined areas (median, 1.4 μg g-1), whose levels were much higher than in asparagus from uncontaminated environments (median, 0.01 μg g-1), indicating that high Cd in bedrocks affect contents in asparagus shoots. Also, Sb- and As-rich substrates in mined areas resulted in asparagus with Sb and As concentrations much higher than asparagus samples from areas mined predominantly for Pb and Zn. Results of this study indicate potential health hazards to residents living worldwide in areas affected by past mining. [ABSTRACT FROM AUTHOR]

Abstract: Rare earth elements (REE) were determined in 39 groundwater samples collected at 14 sites under low- and high-flow conditions. Water samples derived from aquifers hosted in crystalline, molasse, flysch, carbonate and evaporite rocks located in Western Switzerland. The concentration of REE in groundwater circulating in different rocks showed large variations: lowest concentrations (ΣREE≤10ng/L) occurred in groundwater from evaporite aquifers; highest concentrations (ΣREE up to 516ng/L) were observed in carbonate aquifers, although REE in these waters do vary under different hydrological conditions; groundwater from other aquifers had ΣREE from 10 to 100ng/L. Distinct REE signatures were observed in waters draining specific rocks. The REE patterns in groundwater from crystalline, molasse and flysch aquifers showed heavy-REE enrichment at different degrees. Groundwaters circulating in crystalline rocks were distinguished by negative anomalies in Ce and Eu, whereas those from carbonate aquifers were nearly flat with ΣREE and the magnitude of negative anomaly in Ce is likely to be controlled by iron concentrations. The REE-Post-Archean Australian Shales (PAAS) normalized patterns appear useful to recognize the aquifer type and suggest the possibility to use the REE as geochemical tracers. [Copyright &y& Elsevier]

Background: Aetiology of childhood leukaemia and childhood neoplasm is poorly understood. Information on the prevalence of risk factors in the childhood population is limited. SETIL is a population based case-control study on childhood leukaemia, conducted with two companion studies on non-Hodgkin Lymphoma (NHL) and neuroblastoma. The study relies on questionnaire interviews and 50 Hz magnetic field (ELF-MF) indoor measurements. This paper discusses the SETIL study design and includes descriptive information., Methods: The study was carried out in 14 Italian regions (78.3% of Italian population aged 0-10). It included leukaemia, NHL and neuroblastoma cases incident in 0-10 year olds in 1998-2001, registered by the Italian Association of Paediatric Haematology and Oncology (AIEOP) (accrual over 95% of estimated incidence). Two controls for each leukaemia case were randomly sampled from the Local Health Authorities rolls, matched by gender, birthdate and residence. The same controls were used in NHL and neuroblastoma studies. Parents were interviewed at home on: physical agents (ELF-MF and ionizing radiation), chemicals (smoking, solvents, traffic, insecticides), occupation, medical and personal history of children and parents, infectious diseases, immunizations and associated factors. Occupational exposure was collected using job specific modules. ELF-MF was measured in the main rooms (spot measurement) and close to child's bed (48 hours measurement)., Results: The study included: 683 leukaemia cases (87% ALL, 13% AnLL), 97 NHL, 155 neuroblastomas, and 1044 controls., Conclusions: SETIL represents a data source on exposure of Italian children to a broad array of potential carcinogenic factors.

Aim of the Study: To evaluate the effectiveness of oral amoxicillin/clavulanate (25 mg/kg every 12 h) for prevention of fever and/or infection in neutropenic children with cancer., Methods: Multicenter, prospective, randomized, double blind placebo-controlled trial., Results: In the intention-to-treat analysis, amoxicillin/clavulanate had a 12% benefit increase in terms of reduction in the incidence of febrile or infectious episodes, compared with placebo [44 of 83 (53%) vs.55 of 84 (65%); 95% confidence interval, -28% to +3%; P = 0.101]. This benefit was also associated with a 30% increase in the probability of failure-free survival at Day 15 (P = 0.138). A logistic regression analysis showed the effect of prophylaxis to be relevant, especially in patients with leukemia or lymphoma and in those not receiving hematopoietic growth factors, with 17 and 15% absolute benefit increases (logistic P = 0.014 and 0.034, respectively). Compliance with oral drugs was good, with very few and nonsevere drug-related adverse events., Conclusions: In this study amoxicillin/clavulanate was associated with a detectable clinical effect in the reduction of fever and infection in neutropenic children with cancer, especially those with acute leukemia and not receiving growth factors; the study was not powered to demonstrate a statistically significant effect in the overall patient population.

A case-control investigation of childhood acute lymphoblastic leukemia was conducted in the town of Carbonia (Sardinia, Italy). Parents of 9 cases diagnosed between 1980 and 1989 and 36 controls were interviewed at their respective residences. None of the risk factors analyzed was associated significantly with childhood acute lymphoblastic leukemia. The following were associated with an increased risk for childhood acute lymphoblastic leukemia: parents born outside of Carbonia, family history of cancer, alcohol consumption by fathers that exceeded 60 g/d, exposure of fathers to solvents at their workplaces, maternal smoking, use of antinausea medications during pregnancy, and presence of a well in the backyard. Chance and recall bias likely played a role in generating positive associations. The increases in childhood leukemia risk associated with the presence of a well and with use of antinausea medications during pregnancy are consistent with previous reports and require further investigation.

In response to public concern about an increase in the incidence of leukemia among children in southwestern Sardinia (Italy), incident cases of childhood cancer (ages 0-14) were ascertained among residents in the province of Cagliari, which comprises all of southern Sardinia, in 1974-89. Completeness of the ascertainment of leukemia cases was validated by comparison with estimates derived from official statistics of mortality and survival curves. A significant excess risk of childhood acute lymphoblastic leukemia (cALL) was found for children residing in the town of Carbonia. The risk was highest in 1983-85, when seven cases occurred versus 0.8 expected. No birth-cohort effect was observed. The cALL incidence rate was significantly higher among children born and residing in Carbonia than among children born in Carbonia but residing elsewhere. However, the cALL cases did not cluster within the town of Carbonia. The proximity of the largest industrial settlement in the region of Sardinia raised the suspicion that environmental pollution was responsible for the observed excess. Information about industrial emissions from this settlement prior to the appearance of the cALL cluster was not sufficient to reject or confirm the hypothesis.

Aim and Background: Public concern on an increased incidence of childhood leukemia in SW Sardinia prompted the authors to an epidemiological investigation., Methods: Incident childhood neoplasms observed in the Cagliari province (Sardinia--Italy) in 1974-1989 were registered. Expected cases of the most frequent childhood cancers were calculated for each town, based on the sex-and age-specific incidence rates in the province., Results: An excess risk of childhood acute lymphoblastic leukemia (ALL) was observed in Carbonia, a town located in the SW part of the province. The risk was highest in 1983-85, when 7 cases occurred versus 0.8 expected (RR = 8.7; 95% C.I. = 4.6, 16.3). No spatial clustering of ALL cases was observed within the town., Conclusions: A significantly higher than expected incidence of childhood ALL was observed in the town of Carbonia in 1983-85. In alternative to chance, possible exposure to environmental pollutants from a near industrial settlement is discussed as the cause of the observed excess, but it is far to be proven. Other hypotheses, including a viral infection in a population with increased susceptibility, as suggested for new urban settlements, cannot be discarded.

A total of 290 children off therapy after acute lymphoblastic leukemia, in continuous complete remission for at least 2 years, were evaluated for height at the onset of the disease and at the most recent clinical visit (median time after suspension of treatment 4 years 4 months, range 2 years-11 years 3 months). All patients had been treated with multidrug schedules; intrathecal drugs had been given to 84% of the patients for prevention of CNS involvement, associated with radiotherapy. The height percentiles at the most recent examination were shifted downward significantly compared with the expected pattern (p less than 0.001). The effect on stature was much more marked in girls, with a reduction of height percentiles at most recent examination from expected and from diagnosis; in males there was a reduction from diagnosis to latest follow-up, but the values were within the limits of normal. The short stature was mostly observed in pubertal girls and in patients who had undergone radiotherapy.

A multicentre registry of children who had been successfully removed from therapy for some common childhood cancers (Hodgkin's disease, non-Hodgkin's lymphoma, neuroblastoma, nephroblastoma, acute lymphatic leukaemia and other leukaemias) was established in Italy in 1981. The present study describes mortality and occurrence of second primary malignancies (SPMs) among 1467 children who were alive when the registry was established. Follow-up ended on December 31, 1983 for mortality and 1 year later for the occurrence of SPMs. Sixty-seven deaths were recorded, 11 of which were due to causes other than progression of the original disease. Eleven incident SPMs were identified (i.e. 3 acute myeloid leukaemias, 3 thyroid carcinomas, 1 bilateral breast carcinoma, 1 liver malignant mesenchymoma, 1 astrocytoma, 1 chondrosarcoma and 1 osteosarcoma) corresponding to an incidence rate of 2.1/1000 patient-years at risk. Anecdotal reports were collected regarding 2 further SPMs (a thyroid carcinoma and a myeloid leukaemia) as well as several benign tumours, including 2 mammary fibroadenomas.

Conalbumin, a glycoprotein derived from eggwhite, has the property, like lactoferrin, of binding iron ions. This property prompted the authors to undertake an experimental study on acute enteritis in infants in the first year of life. Forty infants with acute enteritis, not complicated by ionic imbalance or severe dehydration, were randomly allocated to two groups. The subjects of the first group were treated with the traditional dietetic therapy; those of the second were treated with the same diet plus conalbumin for periods ranging from 6 to 10 days. General condition, the alvus and body-weight trends were evaluated during and after the treatment period. Stool cultures were also carried out during treatment. In the group of children treated with conalbumin the results were: excellent in 5 subjects (25%), good in 13 (65%), fair in 1 (5%) and null in 1 (5%). The general status and the time needed to normalize the alvus were statistically significant (p less than 0.001) in favour of conalbumin. Body-weight in the two groups showed no significant difference. Neither metabolic alterations nor intolerance phenomena were noted during treatment with conalbumin. In conclusion, conalbumin demonstrated therapeutic properties against acute enteritis in infants through the rapid normalization of the alvus. No side-effects were noted.