Background:Previous studies on the correlation between cervical sagittal balance with improvement in quality of life showed significant results only for parameters of the anterior translation of the cervical spine (such as C2-C7 SVA).Objective:We test whether a new parameter, cervicothoracic lordosis, can predict clinical success in this type of surgery.Methods:The focused group involved patients who underwent surgical treatment of cervical degenerative disk disease by the posterior approach, due to myelopathy, radiculopathy or a combination of both. Neurologic deficit was measured before and after surgery with the Nurick Scale, postoperative quality of life, physical and mental components of SF-36 and NDI. Cervicothoracic lordosis and various sagittal balance parameters were also measured. Cervicothoracic lordosis was defined as the angle between: a) the line between the centroid of C2 and the centroid of C7; b) the line between the centroid of C7 and the centroid of T6. Correlations between postoperative quality of life and sagittal parameters were calculated.Results:Twenty-nine patients between 27 and 78 years old were evaluated. Surgery types were simple decompression (laminectomy or laminoforaminotomy) (3 patients), laminoplasty (4 patients) and laminectomy with fusion in 22 patients. Significant correlations were found for C2-C7 SVA and cervicothoracic lordosis. C2-C7 SVA correlated negatively with MCS (r=-0.445, p=0.026) and PCS (r=-0.405, p=0.045). Cervicothoracic lordosis correlated positively with MCS (r=0.554, p= 0.004) and PCS (r=0.462, p=0.020) and negatively with NDI (r=-0.416, p=0.031).Conclusion:The parameter cervicothoracic lordosis correlates with improvement of quality life after surgery for cervical degenerative disk disease by the posterior approach.

Epidermoid cysts (ECs) of the central nervous system (CNS) constitute benign circumscribed lesions that are more common in lateral than in midline sites. Epidermoid cysts of the CNS arise more frequently in the cerebellopontine angle, around the pons, near the sella, within the temporal lobe, in the diploe, and in the spinal canal. Most common tumoral lesion of sellar region is pituitary adenoma, and sellar cystic epithelial masses may be difficult to differentiate based only on clinical and imaging findings. Epidermoid cysts are covered by keratinized squamous epithelium and are usually filled with keratin lamellae. The process is, for the most part, maldevelopmental in origin, presumably arising from trapped surface ectodermal elements in association with the developing CNS during the closure of the neural groove or formation of the secondary cerebral vesicles. In the present study, the authors describe a case of sellar epidermoid cyst producing endocrine alterations and visual disturbance in a 35 years woman, and review the physiopathological and diagnostic criteria of this lesion.

Objective To analyze the cumulative effect of risk factors associated with early major complications in postoperative spine surgery. Methods Retrospective analysis of 583 surgically-treated patients. Early “major” complications were defined as those that may lead to permanent detrimental effects or require further significant intervention. A balanced risk score was built using multiple logistic regression. Results Ninety-two early major complications occurred in 76 patients (13%). Age > 60 years and surgery of three or more levels proved to be significant independent risk factors in the multivariate analysis. The balanced scoring system was defined as: 0 points (no risk factor), 2 points (1 factor) or 4 points (2 factors). The incidence of early major complications in each category was 7% (0 points), 15% (2 points) and 29% (4 points) respectively. Conclusions This balanced scoring system, based on two risk factors, represents an important tool for both surgical indication and for patient counseling before surgery.

Introduction:Globally, more than one billion people are affected by fungal infection, resulting in approximately 13.5 million life-threatening infections and more than 1.7 million deaths annually.Therapeutic strategies against systemic mycoses can involve antifungal resistance and significant toxicity. One of the main approaches to overcome biopharmaceutical challenges is the use of polymeric nanoparticles, which can carry drugs, such as amphotericin B. Its main advantages over other nanostructured systems are the increased potential for drug solubilization in small doses, great encapsulation capacity and possibility of functionalization of the surface of the nanocarriers.Objective: To assess the in vitro effect of NanoAmB on pathogenics fungal.Methodology: Polycaprolactone (PCL) and poly (lactic acid) (PDLLA) polymeric nanoparticles were produced by the nanoprecipitation method. Pathogenic fungal species, Criptococcus neoformans (serotype A clinical isolate H99), Candida albicans (ATCC 90028), THP-1 (ATCC TIB-202) and BHK (ATCC CCL-10) were grown in vitro in the presence of serial dilutions of NanoAmB alone or in combination with monoclonal antibodies (mAb). Cytotoxicity assay was performed by MTT and evaluation of viable yeast fungal and mammal cells was realized spectrophotometrically (540 nm). Results:The PDLLA nanoparticles presented an average size of 137.3 ± 18.4 nm and an AmB concentration of 132.9 ± 17.6 mg/mL, while the PCL nanoparticles displayed an average size of 145.1 ± 11.5 nm. The cytotoxicity assay demonstrated that NanoAmB and nanocarriers without AmB does not show cytotoxicity against mammalian cells at concentrations ranging from 10 μg/mL to 0.1 μg/mL. However NanoAmB demonstrated that cytotoxic effect against C. albicans and C. neoformans after 24 hours in all concentration analyzed (10 μg/mL to 0.1 μg/mL) (p<0.05). However, nanocarriers without AmB showed a cytotoxic effect from 10 to 2.5 μg/Ml. NanoAmB showed an effect from 1.25 to 0.05 μg/mL in both fungal species and a partial effect at concentration up to 0.025 μg/mL only in C. albicans (p<0.05). Concentrations lower than 0.025 showed no cytotoxic effect. Conclusion:Nanocarriers acted as an enhancing agent, potentializing the inhibitory growth effects of AmB on pathogenic fungi. Other novel antifungal therapeutic strategies using NanoAmB, isolated or in combination with mAbs, should be considered in the future.