The study on a subset of 208 patients with diastolic dysfunction with the ejection fraction preserved discusses the possibility of circulating CRP levels to be accepted as a diagnostic marker. In order to carry out a comparative analysis of the significance of hsCRP serum values, the study also included a subgroup labeled as control, consisting of the same number of patients, but diagnosed only with painful chronic ischemic cardiopathy - a stable form of angina pectoris. The conclusion of the study is that the circulating level of hs-CRP can be accepted as a diagnostic marker for both ischemic cardiopathy and diastolic dysfunction with preserved ejection fraction. The result, corroborated with data from other studies that recognize the serum concentration of hs-CRP as a predictor marker in cardiovascular disease, supports its usefulness as a marker for cardiac insufficiency with a history of ischemic cardiopathy, without being a marker for assessing the degree of myocardial contractility deficiency.

Primary hyperparathyroidism (PHPT), an endocrine condition caused by a parathyroid adenoma (PTA) in 80-85% of the cases, has shifted in the modern era to a mildly symptomatic phenotype due to the prompt recognition of hypercalcemia and to a minimally invasive surgical approach which has a curative potential. Clinical complications of PHTH are either related to high calcium or parathyroid hormone [also parathormone (PTH)] or both, while the originating tumor typically is small, without local mass effects. A distinct entity is represented by giant PTA (GPTA) which is considered at a weight of more than 3 (3.5) grams. The present article is a review of the literature involving practical points of non-syndromic PHPT-related GPTA. Most authors agree that pre-operatory calcium and PTH are higher in GPTA vs. non-GPTA. However, the clinical presentation of PHPT may be less severe, probably due to local mass effects that bring the patient to an early medical evaluation. Age distribution, sex ratio, rate of successful pre-operatory location do not differ from non-giant PTA. Hypovitaminosis D is more frequent in PTA of higher dimensions. Post-operative hypocalcemia, but not recurrent/persistent PHPT, is expected, even hungry bone disease. A higher rate of atypia is described although the tumor is mostly benign. Unusual presentations such as cystic transformation, initial diagnosis during pregnancy or auto-infarction have been reported. The ectopic localization of PTA presented in almost 15% of all cases may also be found in GPTA. What are the exact cutoffs for defining GPTA is still an open issue. Contents 1. Introduction 2. Aim 3. Giant parathyroid adenoma: Concept around the size considerations 4. Pre-operative biological correlates 5. Relationship with vitamin D status 6. Histological issues 7. Ectopic PTA of large dimensions 8. Risk of post-operative hypocalcemia 9. Future considerations 10. Conclusions

Ganglioneuroma, a rare neural crest-derived tumor, exhibits a benign profile in contrast to other neuroblastic tumors (neuroblastoma/ganglioneuroblastoma). Ganglioneuromas can be found anywhere autonomic ganglia are located, mostly abdominal/pelvic sites followed by the adrenal glands (one-third of cases), mediastinum/thorax and cervical area. Affecting especially children more than 10 years of age, Ganglioneuroma is either asymptomatic or may cause local compressive effects; rarely inducing nonspecific abdominal complains or arterial hypertension related to oversecretion of epinephrine/norepinephrine/dopamine. Despite a good prognosis, adrenalectomy is necessary in order to rule out a malignancy. Open procedure represents the standard therapeutic option; alternatively, centers with large laparoscopic pediatric experience and good stratification protocols have reported successful procedures. High uptake of I 123 -MIBG is associated with a more severe outcome in cases with increased mitotic index. In neuroblastic tumors, neuron-specific enolase >33 ng/ml, age at diagnosis <49 months, and blood vessel invasion indicate a poor prognosis. Concurrent extra-adrenal/adrenal ganglioneuroma is associated with a more severe prognosis; post-surgical complications are more frequent in non-adrenal vs. adrenal ganglioneuroma. Exceptionally, immune-mediated paraneoplastic neurologic syndromes have been reported: anti-N-methyl-D-aspartate receptor encephalitis and opsoclonus-myoclonus-ataxia syndrome. ROHHAD syndrome is the underlying cause in 40-56% of cases of neuroendocrine tumors including ganglioneuroma; 70% of tumors are diagnosed within the first 24 months after hypothalamic obesity onset, associated with a severe prognosis due to hypoventilation, sleep apnea, and dysautonomia. Recently, the PKB/AKT/mTOR/S6 pathway was identified as a tumorigenic pathway in pediatric ganglioneuroma, not in neuroblastoma; mTOR inhibitors are a potential option for pre-operatory tumor shrinkage. Pediatric adrenal ganglioneuroma has a good prognosis if adequately treated; its recognition requires adrenalectomy. Further development of specific biomarkers is needed. In the present article, we aimed to introduce a review of the literature involving adrenal ganglioneuroma based on a practical, multidisciplinary perspective of prognostic factors.

This article presents the performed experimental measurements for connecting a sensory feedback neuro-prosthesis to the peripheral nervous system of a patient with forearm amputation. The experiments focused on the ring finger motion�s neuron control in the forearm prosthesis and on the neural path transmission of the tactile sensation coming from the pressure sensors fitted on the small finger phalanges (F5). For the ring finger, both motor control and sensory feedback are transmitted through the ulnar nerve�s motor axons, respectively by the ulnar nerve�s sensory axons. At the beginning of this study, the topography of the ulnar nerve has been performed, in order to identify the axons by which motor controls are transmitted for the small finger movement (F5) and the axons through which small finger (F5) tactile information is transmitted. A Carl Zeiss S8 electronic microscope was used to analyze the ulnar nerve�s transverse sections for an anonymous patient. Cross sections in the ulnar nerve have been examined, from the tip of the small finger (F5) to the shoulder area. The separately mappings of motor and sensory axons from the ulnar nerve at the wrist�s level and at the elbow�s level were then performed. 3D modeling was performed using CATIA software solution for mapping the axon topography in the ulnar nerve. By means of the ulnar nerve�s 3D topographic map, the optimal place for the implantation of both motor control electrodes and small finger (F5) sensory feedback electrodes were identified in the particular case of a patient with forearm amputation. Subsequently, by surgical procedures, experimental implantation of a motor control electrode for the small finger (F5) from a neuro-prosthesis was performed as well as a sensory feedback electrode for the same finger. For the next two weeks, measurements were made while the patient has been learning to move the small finger (F5) of the neuro-prosthesis and feel the tactile sensation from this finger. After these two weeks the electrodes were extracted from the patient�s stump by surgery.

This is a narrative review focusing on neuroendocrine neoplasia (NEN) and bone status, in terms of metastases and osteoporosis/fractures. One fifth of NEN have skeletal dissemination, this affinity being regulated by intrinsic tumor factors such as the C-X-C chemokine receptor 4 (CXCR4). Bone colonization impairs the patient quality of life, representing a surrogate of reduced survival. Patients with NEN without bone metastases may exhibit low bone mineral density, perhaps carcinoid-related osteoporosis, yet not a standardized cause of osteoporosis. Case-finding strategies to address bone health in NEN with a good prognosis are lacking. Contributors to fractures in NEN subjects may include: menopausal status and advanced age, different drugs, induced hypogonadism, malnutrition, malabsorption (due to intestinal resection, carcinoid syndrome), hypovitaminosis D, impaired glucose profile (due to excessive hormones such as glucagon, somatostatinoma or use of somatostatin analogues), various corticoid regimes, and high risk of fall due to sarcopenia. Pheocromocytoma/paraganglioma involve bone through malignant forms (bone is an elective site) and potential secondary osteoporosis due to excessive hormonal content and increased sympathetic activity which is a key player of bone microarchitecture/quality as reflected by low Trabecular Bone Score. Glucocorticoid osteoporosis is related to NEN-associated ectopic Cushing syndrome. Currently, there are a lack of studies to emphasis that excessive gut-derivate serotonin in NENs with carcinoid syndrome is a specific activator of bone loss thus a contributor to carcinoid-related osteoporosis.