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Distal femoral medial closing wedge osteotomy (DFMCWO) may be a valuable treatment for arthritic valgus knees in young and active adults, with the possible aim of procrastinating knee replacement. 32 valgus knees (mean age : 41.4±11.2) treated with DFMCWO were retrospectively reviewed. All the knees had a lateral compartment osteoarthritis graded I-II-III according to Kellgren Lawrence classification. 20 knees had osteochondral lesions, treated with microfractures (8) or bone marrow derived cells transplantation (12). Patients were clinically (IKDC, KOOS, NRS, Tegner) and radiologically evaluated. A mean follow-up of 62.12±15.65 was achieved. KOOS score peaked at 24 months, showed a decremental trend, achieved a final results of 79,59±17,14. Similar trend was evident for IKDC. The final NRS score was 2.73±1.82 ; the final Tegner score was 4.81±1.56. Radiographs showed degenerative progression in 5 knees : 2 patients underwent knee replacement at the final follow-up. DFMCWO is an effective treatment to treat osteoarthritic symptomatology, delay degenerative progression and avoid knee replacement in valgus knees at mid-term follow-up.

Objective Isolated hypogonadotropic hypogonadism (IHH) is a rare disorder with pubertal delay, normal (normoosmic-IHH, nIHH) or defective sense of smell (Kallmann syndrome, KS). Other reproductive and non-reproductive anomalies might be present although information on their frequency are scanty, particularly according to the age of presentation. Design Observational cohort study carried out between January 2008 and June 2016 within a national network of academic or general hospitals. Methods We performed a detailed phenotyping of 503 IHH patients with: (1) manifestations of hypogonadism with low sex steroid hormone and low/normal gonadotropins; (2) absence of expansive hypothalamic/pituitary lesions or multiple pituitary hormone defects. Cohort was divided on IHH onset (PPO, pre-pubertal onset or AO, adult onset) and olfactory function: PPO-nIHH (n = 275), KS (n = 184), AO-nIHH (n = 36) and AO-doIHH (AO-IHH with defective olfaction, n = 8). Results 90% of patients were classified as PPO and 10% as AO. Typical midline and olfactory defects, bimanual synkinesis and familiarity for pubertal delay were also found among the AO-IHH. Mean age at diagnosis was significantly earlier and more frequently associated with congenital hypogonadism stigmata in patients with Kallmann’s syndrome (KS). Synkinesis, renal and male genital tract anomalies were enriched in KS. Overweight/obesity are significantly associated with AO-IHH rather than PPO-IHH. Conclusions Patients with KS are more prone to develop a severe and complex phenotype than nIHH. The presence of typical extra-gonadal defects and familiarity for PPO-IHH among the AO-IHH patients indicates a common predisposition with variable clinical expression. Overall, these findings improve the understanding of IHH and may have a positive impact on the management of patients and their families.

Background osteochondral lesions of the knee (OLK) are a cause of knee pain and associated diseases. A new bone-marrow-derived mesenchymal stem cells (CSM) technique has been developed for the treatment of OLK. Results: clinical outcomes, by IKDC and KOOS evaluation before surgery and subsequent follow-up, showed a significant improvement in scores. Control MRI and bioptic samples showed an osteochondral regeneration of the lesion site.

The paper describes the general characteristics of a newly developed nonconstant-flow generator for automatic ventilation of the lungs. It is known that the application of very high pressure to high internal resistance leads to a very stable flow, in that the flow itself is unaffected by external load (patient) variations. The stability of the flow means that the inspiratory process can be controlled by means of the ventilated volume, thus extending DIGIT utilization to high resistance patients. The modulation of the flow is implemented via a digital electromechanical system, which allows the ventilator functions to be accurately programmed. The desired flow waveform is obtained by means of a series of pneumatic valves, the apertures of which are digitally controlled. The design is innovative in that it allows the flow waveform in each of the ten digitalized time steps into which each inspiratory phase is divided to be both programmed and controlled. Other ventilators commercially available and currently in use do not have this functional capability, as they are all designed to model the integral flow of the inspiratory waveform without being able to modify the subunit time steps of a single inspiratory phase. The paper also discusses the results of fundamental tests concerning the performance characteristics of the ventilator.

Background: Morpho-functional studies of gastric mucosa are hampered by the lack of a technique allowing direct in situ visualization of the mucus in small living laboratory animals. Methods: The material covering the gastric surface was studied in vivo in rats by magnetic resonance imaging (MRI) at 4.7 Tesla, and modification of its secretion was evaluated after pharmacological treatment. Results: In unstimulated animals, the glandular portion of the stomach was lined by a layer of material emitting a signal of high intensity. Administration of 16,16-dimethyl prostaglandin E2 caused an accumulation of this material within a maximum 30 min after the administration of the drug. At 45 min, gastric emptying occurred and at 60 min, the lumen was almost free of material emitting a signal of high intensity. An increase in the intensity of the signal emitted from the material filling the gastric lumen was found after pentagestrin injection. After 45 min, the intensity of the signal emitted from the material in the gastric lumen decreased. 1H localized spectroscopy showed that after injection of pentagastrin there was an increase in the water proton peak within the gastric lumen. About one hour after stimulation, the water proton peak returned to the basal value. Conclusions: This study demonstrates that MRI displays gastric mucus in living small rodents and represents a sensitive screening test for pharmacological action on this structure, enabling morpho-functional studies. © 1995 Wiley-Liss, Inc.

Rationale and Objectives. We monitored the regeneration of the rat sciatic nerve after its transection and the concomitant alteration in the high-energy phosphates content in the target tibialis anterior muscle. Methods. Rat sciatic nerve was resected and the gap connected with a prosthesis of polytetrafluoroethylene. Progress of reinnervation was monitored by 1 H MR imaging, whereas muscular energy metabolism was evaluated by localized 31 P MR spectroscopy. Results. Reconstitution between the nerve stumps was resumed 8–12 weeks postoperatively. The ratio of phosphocreatine to inorganic phosphate reached a plateau at 46% of the initial level approximately 8 weeks after the operation and recovered thereafter. Immediately after the surgery, muscular pH became slightly alkaline and returned to normal with the progress of reinnervation. Conclusion. Recovery of the muscular energy metabolism began after the reconnection of the severed nerve stumps. The combination of MR imaging and MR spectroscopy followed noninvasively the progress of reinnervation and muscular energy metabolism of the prosthesis-guided nerve regeneration.

Dental enamel is comprised primarily of carbonated apatite, with less than 1% w/w organic matter and 4–5% w/w water. To determine the influence of each component on the microhardness and fracture toughness of rat incisor enamel, we mechanically tested specimens in which water and organic matrix were selectively removed. Tests were performed in mid-sagittal and transverse orientations to assess the effect of the structural organization on enamel micromechanical properties. While removal of organic matrix resulted in up to a 23% increase in microhardness, and as much as a 46% decrease in fracture toughness, water had a significantly lesser effect on these properties. Moreover, removal of organic matrix dramatically weakened the dentinoenamel junction (DEJ). Analysis of our data also showed that the structural organization of enamel affects its micromechanical properties. We anticipate that these findings will help guide the development of bio-inspired nanostructured materials for mineralized tissue repair and regeneration.

Many international protocols related to RMI-QC program are focused on acquisition methods and analysis of several image quality parameters but rarely normality ranges or measurement frequencies are presented. To address this problem we investigated the variability of many magnetic resonance imaging (MRI) systems with the set-up of multicenter trial. The trial was set up to investigate short-and mid-term variability of two fundamental nongeometric image quality parameters: signal-to-noise (SNR) and integral percent uniformity (U%). Ten centers (12 devices) participated to data collection consisting of a three-step-protocol. First, 10 consecutive images of a phantom were collected with a spin echo sequence. As second step the series collection was repeated 24 h later. Finally a single image acquisition was performed twice a week for 5 weeks. The analysis of results allowed us to define a "physiological" variability of +/-3% of the reference level for both parameters and to conclude that a weekly measurement is adequate to detect relevant variations of device performance.

We report the preliminary results of a multicenter trial aimed at defining methods, reference values and frequency of measurements for an MR quality assurance program. In particular, we stress the definition of two attention levels (investigation and intervention) for image uniformity and signal-to-noise ratio (SNR) by means of short- and long-term measurements.The short-term protocol consisted of 10 successive spin-echo (SE, 2 echoes) acquisitions and was repeated after 24 hours. Measurements were made with the same test phantom which was circulated among all the participating centers. Image uniformity and SNR were evaluated using the software available on each MR unit. The long-term protocol, consisting of a single SE acquisition with the same parameters used for the short-term one, was performed once a month for 12 months. A mid term protocol was also performed twice a week for 5 weeks, and the analysis of the results is still in progress.The short-term protocol results allowed absolute comparison of system performance. Uniformity and SNR were significantly different among centers (p0.05), also in the statistical comparison of two MR units of the same model (Siemens Magnetom SP63-1.5 T). Overall, three 1.5 T systems provided similar SNR values, while the results obtained for the 1 T system were markedly lower (51% of the maximum). This result can be explained by the dependence of the analytical expression of SNR on the magnetic field. The other 1.5 T system performed more poorly than the others operating at the same magnetic field. This difference can be explained by the specific characteristics of the coil and by technological aging. Because of the small sample size (5 units), the maximum variation coefficients (3% for the first echo and 3.5% for the second one) were assumed as a reference value for the both parameters (SNR and uniformity). These values were used for the long-term analysis: at every measurement the evaluated parameter was statistically compared with the result of the previous month. We propose to set an investigation level at p = 0.05: when the newly measured parameter differs from the previous value (p0.05), we should investigate if this is due to a normal long-term variation or to a system fault. The intervention level is then defined as the 95% prediction interval of the evaluated parameter regression vs time. Measurements that do not fall within the prediction interval are not used for future statistics.Some preliminary results concerning SNR and uniformity were obtained in the investigation performed on 5 MR systems to define methods and references for a Quality Assurance program. We introduced an "investigation level" and an "intervention level" related to short-term and long-term variability. The investigation levels could be a useful reference value to predict the short-term variability of an MR system with similar characteristics, thus avoiding a long and onerous series of measurements. Concerning the optimization of measurement frequencies, the preliminary analysis of these results showed that a daily measurement frequency is excessive in stable equipment conditions, while monthly measurements showed that the investigation level was often exceeded. However, frequency optimization will be investigated after the analysis of the mid-term measurements, which is still in progress.

In the rat, normal blood flow can be restored in the territory of the occluded artery after an arterial occlusion. This event has been attributed to changes in the collateral vessels supplying the territory of the occluded artery. Since only a limited amount of data is available about the plasticity of the microvascular system after a cortical ischemic lesion, in the present study we have evaluated whether the restoration of blood flow to normal levels in the territory of the middle cerebral artery after permanent ischemia is due only to flow through preexisting collateral vessels or also to the development of new microvessels. Middle cerebral artery occlusion was performed in 45 rats. After 24 h of ischemia, magnetic resonance imaging was used to select 16 rats with cortical lesions of similar size and location. After 2 weeks, vascular corrosion casts were obtained from 8 rats by injection of low-viscosity resin and observed by scanning electron microscopy. A correlative light and electron microscopy study was performed using the remaining 8 rats. Two different patterns of vascular modifications were found, one dorsal and one ventral to the lesion. The dorsal portion of the lesion was vascularized by collateral arteries originating from the anterior or posterior cerebral arteries. Collateral trunks showed a meandering course, mainly in the occipital pole. In the ventral portion of the lesion a complex microvascular system was found characterized by an intense vascular proliferation. The arterioles showed a parallel, candelabrum-like pattern with dichotomic branching. Contraction rings were frequently seen. The capillaries showed a sinusoid-like structure, with a large lumen and a continuous endothelium with many micropinocytotic vesicles. A peripheral ring-shaped venous sinus was composed of a network of flat vessels. These results give the first comprehensive description of the microvascular modifications in a focal model of infarct and suggest that the restoration of blood flow to normal levels described in the territory of the middle cerebral artery after permanent ischemia may be due not only to flow through collateral vessels but also to the development of a new vascular system originating mainly from branches of the middle cerebral artery before the occlusion point.

Repeated and excessive consumption of alcohol leads to pathophysiological disorders in skeletal muscles. A successful management of this syndrome requires a strict abstinence and a nutritionally adequate diet. We propose here a simple and noninvasive investigation using 31 P magnetic resonance spectroscopy (MRS) to monitor the recovery of the basal energy status of eminence thenar muscles from documented chronic alcoholic patients during a controlled 15-day period of abstinence. Cessation of alcohol abuse induced a significant recovery of the PCr(PCr + Pi) ratio otherwise depressed before the abstinence. On the contrary, the relative level of free inorganic phosphate decreased, whereas intracellular pH was not affected. These results demonstrate (a) the rapid improvement of basal muscular energy metabolism during abstinence for patients with a chronic and heavy alcohol consumption, and (b) the feasibility of a follow-up of this recovery by serial examinations using 31 P MRS.

We report a case of acute cardiac tamponade without concurrent myocardial disease occurring in a thalassemia patient early after bone marrow transplantation. The pericardial effusion was preceded by an episode of junctional tachycardia. Repeated evaluation by echocardiography was done shortly after the patient developed the arrhythmia and permitted a detailed, timed observation of the event and description of the symptoms.

Brown adipose tissue (BAT) is the main effector of nonshivering thermogenesis and diet-induced thermogenesis in mammals. Assessment of the magnitude and perturbations of BAT deposits in the intact, living body would be of much relevance for quantitative studies of BAT functions, but such studies have been impossible to date. In this paper it is shown that magnetic resonance imaging (MRI) morphometry can provide the means for accurate, repeated determinations of the volume of BAT deposits in a living animal; moreover, tissue modifications due to acclimation at different ambient temperatures are revealed in vivo by MRI, which correlates with histology and ultrastructure. Furthermore, MRI differentiates areas of BAT responsive to acute adrenergic stimulation, thereby giving information on the thermogenetically active tissue in the intact animal. Therefore, MRI represents a reliable tool for correlative morphological and functional studies of BAT in the living animal.

Sirs: The success of peripheral nerve repair after accidental lesions relies on the surgical techniques of anastomosis [1] or grafting [2], the regeneration potential of the severed nerve [3] and time elapsed from trauma. Wallerian degeneration or muscular dysfunction originating from disuse and/or release of neuromuscular trophic factors may compromise neuromuscular integrity [4]. Electrophysiological examination provides valuable insights into the localisation and pathophysiology of the injury, severity of the dysfunction and the progress of reinnervation [5], whereas 31p magnetic resonance spectroscopy (MRS) probes muscular energetics and function [6]. Alterations of resting metabolism after muscle denervation or chronic disuse have been documented using MRS in man [7] and animal models [8, 9]. We now describe an electromyographic and spectroscopic follow-up of nerve regeneration and muscle reinnervation in man after surgical anastomosis of sectioned median nerve. A 28-year-old healthy male presented with a deep wound at the left wrist (following accidental section with a sharp blade) and total anaesthesia of the hand in the median nerve territory. Inspection revealed a complete section of the median nerve but no damage of tendons or vessels. Direct epineural nerve repair was carried out with a nylon 9-0 suture within 3 h of the accident. Denervation of the opponens pollicis muscle was assessed by needle examination. Orthodromic motor conduction and action potential amplitude of the median nerve were recorded. Antidromic sensory action potential amplitudes were measured for the first four digits with ring electrodes while stimulating at the wrist level. Thenar eminence muscle metabolism was followed by 31p MRS with a SIS 200/330 spectrometer equipped with a 4.7 T horizontal magnet. Spectra were acquired with a 2.5-cm-diameter surface coil (1024 transients, repetition time 0.6 s), yielding a minimum signal to noise ratio of 44 for creatine phosphate (PCr) in the operated hand at day 12 after the accident. Intramuscular pH was determined from the chemical shift difference between inorganic phosphate (Pi) and PCr resonances [6]. Spontaneous activity was abundant and voluntary recruitment limited to single units, indicating severe muscle denervation at day 17 postinjury (Table 1). The follow-up revealed signs of collateral reinnervation, improving over time. Motor and sensory action potential areas and peak-to-peak amplitudes also recovered. Fairly complete restoration of the amplitude of the evoked motor potential developed after 15 months (Table 1), as compared with a period of 2 months required after nerve crushing in a rat model [8]. Two weeks after injury, the patient presented with anaesthesia for all sensory modalities in a territory encompassing the entire cutaneous distribution of the left median nerve. A progressive reduction in the area of anaesthesia was found 2 months after injury, with shrinkage along the borders of the ulnar and radial nerve territories. The area of anaesthesia to warmth remained larger than that of pinprick. At 15 months post-injury the patient reported a satisfactory recovery of all sensory modalities in the entire median nerve territory. He estimated his sensory function to be

On demontre l'equivalence birationelle desI 2,2 3 auxI 2,3 3 et on en deduit l'unirationalite parI 2,3 3 d'uneV 3 ayant une congruence de courbes rationelles et une transformation birationelle en elle-meme.

Phospholipidic liposomes can influence DNA template availability for RNA synthesis when interacting with isolated nuclei by enhancing (when the phospholipids are negatively charged) or by inhibiting (when they are neutral) trascriptional activity. The analysis of the 1H-NMR relaxation behaviour of isolated nuclei, of Small Unilamellar Vesicles (SUV) and of the SUV-Nuclei system has been undertaken to elucidate the mechanism of the interaction between the nuclear core and the phospholipids.

The nuclear magnetic relaxation process is an ensemble of phenomena by which an assembly of nuclei returns to the equilibrium distribution appropriate to B0 after the r.f. field B1 has been turned off. The same phenomena are responsible for the establishment of the equilibrium magnetization when a sample (assembly of nuclei) is first placed in a static magnetic field B0.

In recent years the use of NMR for clinical purposes has been increasing. Magnetic resonance imaging has great diagnostic potential, despite the many problems and drawbacks involved in its practice (1). More controversial is the possibility to exploit NMR spectroscopy as a diagnostic tool in clinical practice. Its applications seem to be restricted to the study of phosphorus containing metabolites (2), in particular to muscle energetics and to the viability of organs. However, some very recent research, based on 1H (3) and 13C (4,5) NMR, opens new fields in the applications of in vivo NMR to clinical problems.

The future of NMR as an in vivo diagnostic tool, both for imaging techniques and for spectroscopic determinations, requires as a preliminary step a precise tissue characterization. In practice, sound relationships should be established between the histology of a tissue and the relevant NMR parameters.

The determination of relaxation times is one of the most critical NMR experiments and needs careful instrumental adjustment and the use of proper models for the interpretation. This is particularly important for relaxation measurements in tissues, both “in vitro” and “in vivo”, where the Bloch equations are not valid and the experimental conditions are quite far from ideal.

The metabolic changes occurring during liver regeneration after partial hepatectomy have been followed by examination of the perchloric extracts by means of NMR spectroscopy. Proton spectra show an abrupt decrease of glycogen, glucose and nucleotides, which are essentially ribonucleotides, in the first hours after hepatectomy. Nucleotides begin to store up again in the third day after hepatectomy, while glucose and glycogen storage builds up from the second day. 31P data evidence a sharp drop of phosphomonoesters, i.e. monophosphosugars (including AMP) and phosphocholine, and phosphodiesters, i.e. GPC and GPE, soon after hepatectomy and a recovery of the initial levels approximately at the 60th hour and a further increase of PDE at later times. The NMR findings are in agreement with the biochemical knowledge of the course of liver regeneration.

A fact finding study was carried out in 58 resuscitation centres and 78 intensive care units to evaluate the current application of computerised techniques in the monitoring and processing of various parameters relating to hospitalised patients. The enquiry revealed a marked interest in the use of computerised systems, particularly in the electrophysiological and haemodynamic field. Promising results were reported from some centres. Some adverse criticisms and points of discussion still exist. International and national experiences matured so far, however, while primarily directed towards scientific research and technological development, open up significant perspectives for the future, for the rational handling of the data collected, and the extension of current knowledge on matters of physiopathology, electrophysiology, and pharmacokinetics.

In vivo 31P NMR spectroscopy was used to determine the ratios of creatine phosphate (PCr) to adenosine triphosphate (ATP) and inorganic phosphate (Pi) in leg and arm muscles of four sprinters, one marathon runner, and two sedentary subjects. Both ratios were definitely higher in the sprinters indicating that, since muscle ATP and Pi concentrations are constant, the PCr muscle content of these athletes is higher than usual. Sprinters are known to have higher percentages of fast-twitch fibers, which are richer in PCr than slow-twitch fibers. It is concluded that measurements of muscle ATP, PCr, and Pi through in vivo NMR spectroscopy could be used to determine muscle fiber composition.

From the beginning of the Great Recession (2008), the issue of European integration acquired increasing salience in many European polities. Extremist and niche parties have been the main agents of the politicization of the European issue; accordingly, mainstream parties have been forced to deal with a crisis of legitimacy of the European project. This chapter sheds light on the radical left (RLPs) and social democratic (SDPs) party families, that have had historically divergent positions on the EU: RLPs have been more sensitive to the issue of a social Europe and have opposed an integration of the EU dominated by neoliberal logic, thus coming to be defined as a Eurosceptic party family; SDPs, on the other hand, have been supportive of EU integration and of the European Social Model. The main research question is the following: to what extent do SDPs and RLPs still diverge in the political and socio-economic field with regard to the European Union? Through the comparison of the Spanish and the Italian cases the chapter concludes that: the crisis brought SDPs closer to a functional Europeanism, while the RLPs Eurocritical pre-crisis position was strengthened; while SDPs have moved leftward vis-à-vis the social Europe issue, the economic and political issues are still divisive for the two families.

La tradizionale incompatibilità tra marxismo e populismo è superata dalle ricerche di Laclau? Questa una delle principali domande che si pone questo contributo orientato verso la ricerca di una prospettiva decisamente post-marxista, ma anche senza nessuna concessione all'antimarxismo oggi d'obbligo. La risposta avanzata è negativa, criticando l'opera di Laclau per il suo eclettismo poco proficuo per un rigoroso bilancio storico e politico della storia del comunismo e incline piuttosto ad avallare gli attuali luoghi comuni dell'antimarxismo imperante.

Il saggio presenta un'interpretazione dell'opera di Mario Tronti, Operai e capitale (1968), proponendo attraverso di essa una lettura dei movimenti del Sessantotto e saggiandone l'attualità alla luce di alcuni dibattiti filosofico-politici contemporanei attorno alla categoria di "universale".

Currently on-line entertainment is an important quality of life issue and represents a cornerstone of human culture and communication. With the growingly significant diffusion of mobile and multimodal devices, on-line entertainment is increasingly considered in an anytime, anywhere, anyone dimension. In this context new forms of on-line entertainment are offered to users, combining networked gaming, story telling and high interactivity in mixed reality contexts. This paper presents design issues related to the development of an accessible game where users cooperate to catch a serial killer. The application has been designed taking into account accessibility and offers multimodal access to sustain users with disabilities in being completely involved in the game scenario. The game, that supports edutainment issues, is built on an agent based simulation system.