Background: The paraspinal, posterolateral, or Wiltse approach is an old technique that observes the principles of an MIS procedure. The aim of this study was to provide a step-by-step description ...from the literature of the Wiltse paraspinal approach and analyze its main advantages and limitations.
Methods: Here, we provide a step-by-step description of the Wiltse approach. Utilizing PubMed and Lilacs and the Mesh terms "Wiltse approach," "paraspinal approach," "muscle sparing approach," and "lumbar spine," we identified 10 papers. We then put together, based on these publications, a step-by-step analysis of the preparation, patient positioning, skin incision, fascial opening, dissection, bone identification, retractors, deperiostization, decompression, discectomy, instrumentation, arthrodesis, and closure for the Wiltse technique.
Results: Most papers underscored the minimally invasive aspects of the typical Wiltse approach. Advantages included minimal intraoperative bleeding, a shorter hospital length of stay, and a low infection rate.
Conclusion: The classical approach described by Wiltse is essentially minimally invasive, sparing both the muscle planes and soft tissues, allowing for ample far lateral lumbar decompression, including discectomy and fusion, with a low complication rate.
In this study, the modified exp
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-expansion function method is utilized in acquiring some new results to the coupled nonlinear Maccari’s system. The Maccari’s system is a nonlinear model ...that describes the dynamics of isolated waves, confined in a small part of space, in various fields such as hydrodynamic, plasma physics and nonlinear optics. We construct some new results with a complex structure to this model, such as; the trigonometric and hyperbolic function solutions. Under the suitable choice of the values of parameters, we plot the 2D, 3D and the contour graphs to some of the obtained solutions in this study. We observed that our results may be helpful in detecting the movement of an isolated wave in a small space to some practical physical problems.
Summary
Background
Therapy of chronic hepatitis D with Interferon is successful when testing for HDV‐RNA turns negative. This end‐point is disputed.
Aim
To assess the role of serum hepatitis B ...surface antigen (HBsAg) in the clearance of HDV‐RNA in pegylated interferon (Peg‐IFN)‐treated chronic hepatitis D (CHD).
Methods
Sixty‐two patients with CHD, treated with Peg‐IFN, were considered. The patients belonged to three groups: 14 patients cleared the HBsAg and HDV‐RNA (responders, R), 12 cleared the HDV‐RNA remaining positive for HBsAg (partial responders, PR) and 36 cleared neither the HBsAg nor the HDV‐RNA (nonresponders, NR).
Results
In responders, at baseline the median value (mv) of HBsAg and HDV‐RNA was 1187 and 188 663 IU/mL. By month 6 of therapy, HBsAg declined to less than 1000 IU/mL and HDV‐RNA was undetectable in 12 patients. In NR, the pre‐therapy median value of HBsAg and HDV viremia was 6577 and 676 319 IU/mL. There was no significant reduction of antigen at month 6; after a decline, HDV‐RNA rebounded to baseline levels. In PR, the median value of baseline HBsAg was 7031 IU/mL; it declined at month 6 in the majority. HDV‐RNA progressively declined from an initial median value of 171 405 IU/mL. HBsAg <1000 IU/mL at month 6 discriminated responders and PR from NR (P < 0.001). By ROC curve, the threshold of 0.105 log reduction of HBsAg associated with 1.610 log reduction of HDV‐RNA from baseline to month 6 predicted the clearance of this marker.
Conclusions
A reduction of serum HBsAg is mandatory for the definitive clearance of the HDV‐RNA. Quantitative HBsAg may predict the long‐term response to Peg‐IFN therapy and provide a guide to prolong or stop treatment.
Summary
Background
The efficacy of direct‐acting anti‐viral (DAA) therapy in patients with a history of hepatocellular carcinoma (HCC) is unknown.
Aim
We prospectively evaluated whether previously ...treated HCC affects DAA efficacy in a large real‐life cohort of cirrhotic patients.
Methods
From January to December 2015 all consecutive HCV mono‐infected patients with cirrhosis and/or history of HCC attending 10 Italian tertiary liver centres were enrolled. Baseline characteristics and response to therapy were recorded. 1927 patients were enrolled (mean age: 62.1 ± 10.9 years; 1.205 males). Genotype 1 was the most frequent (67.9%) followed by genotypes 3 (12.4%), 2 (11.2%) and 4 (8.6%). 88.4% and 10.9% of cases were classified Child A and B, respectively, and 14 (<1%) cases were classified Child C. Ascites and hepatic encephalopathy occurred in 10.7% and 3.2% of patients, respectively. Varices were detected in 39.3% of patients. Suboptimal and optimal treatment was prescribed: 15.9% of patients received sofosbuvir/simeprevir, 33.4% sofosbuvir/ledipasvir, 20.2% a Viekirax + Exviera regimen, 15.7% sofosbuvir/ribavirin, 9.9% sofosbuvir/daclatasvir and 3.4% Viekirax; 1.3% of patients received an interferon‐based regimen.
Results
The sustained virologic response (SVR) rate at intention‐to‐treat analysis was 95.1%. It differed significantly across Child classes, that is, 96.3%, 86.1% and 71.4% Child A, B and C, respectively (P < 0.0001) and across genotypes (P = 0.002). The SVR rate did not differ between patients with (95.0%) and those without previous HCC (95.1%). At multivariable analysis, SVR was significantly associated with HCV genotype, Child class.
Conclusion
This large real‐life study proves that the efficacy of DAA in cirrhotic patients is not impaired by successfully treated HCC.
The use of neural electrodes to stimulate the Peripheral Nervous System (PNS) of upper limb amputees is giving promising results in restoring tactile feedback. The same interfaces could be used to ...record the motor activity originated from the brain and transferred to the muscles. In this paper, the possibility to control a prosthetic hand by means of neural signals acquired through tf-LIFE4 electrodes implanted in a human subject was investigated. A Support Vector Machine (SVM) algorithm was adopted to classify two common demanded grasps. The obtained classes were converted into reference positions for a position-and-slippage control strategy that guarantees to perform stable grasps with a prosthetic hand avoiding slippage events. The achieved results showed an accuracy of the classifier higher than 90% and a success rate of the control strategy equal to 100%.
Thymalfasin exhibited an immunomodulatory and a direct antiviral mechanism of action. The low rate of sustained response of chronic hepatitis with current therapies, underscores the need for new ...therapeutic options. It has been suggested that thymalfasin may have efficacy in the treatment of chronic hepatitis B and C. Pilots studies in patients with chronic hepatitis B treated with thymalfasin in combination with interferon or nucleoside analogue, showed a 70% complete sustained response rate. Studies in chronic hepatitis C patients, would indicate that thymalfasin in combination with standard or pegylated interferon with ribavirin may improve response rate in hepatitis C virus (HCV) naïve and nonresponder patients. However, a large phase‐III randomized study conducted in Europe in HCV patients nonresponder to Peg‐interferon with ribavirin, demonstrated that thymalfasin did not improve the rate of sustained virologic responses, but, in patients who completed therapy, thymalfasin significantly diminished the relapse rate. In conclusion, thymalfasin, in combination with the standard of care, may be helpful as an adjuvant in the treatment of patients with chronic hepatitis B and C.
Colonisation of plant roots by endophytic fungi may confer benefits to the host such as protection against abiotic or biotic stresses or plant growth promotion. The exploitation of these properties ...is of great relevance at an applied level, either to increase yields of agricultural crops or in reforestation activities. Fusarium equiseti is a naturally occurring endophyte in vegetation under stress in Mediterranean ecosystems. Pochonia chlamydosporia is a nematode egg-parasitic fungus with a worldwide distribution. Both fungi have the capacity to colonise roots of non-host plants endophytically and to protect them against phytopathogenic fungi under laboratory conditions. The aim of this study was to evaluate the root population dynamics of these fungi under non-axenic practical conditions. Both fungal species were inoculated into barley roots. Their presence in roots and effects on plant growth and incidence of disease caused by the pathogen Gaeumannomyces graminis var. tritici were monitored periodically. Both fungi colonised barley roots endophytically over the duration of the experiment and competed with other existing fungal root colonisers. Furthermore, colonisation of roots by P. chlamydosporia promoted plant growth. Although a clear suppressive effect on disease could not be detected, F. equiseti isolates reduced the mean root lesion length caused by the pathogen. Results of this work suggest that both F. equiseti and P. chlamydosporia are long-term root endophytes that confer beneficial effects to the host plant.
This paper deals with the qualitative analysis, existence of equilibria and asymptotic behavior of some second-order models of the competition between tumor and immune cells. The background model ...belongs to d’Onofrio A. d’Onofrio, A general framework for modeling tumor–immune system competition and immunotherapy: Mathematical analysis and biomedical inferences, Physica D 208 (2005) 220–235; A. d’Onofrio, Tumor–immune system interaction: Modelig the tumor-stimulated proliferation of effectors and immunotherapy, Math. Models Methods Appl. Sci. 16 (2006) 1375–1401. Various developments proposed in this paper are focussed on the hiding–learning dynamics, followed by the qualitative analysis.
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