Severe neurologic manifestations from cervical spine instability in spondylo-megaepiphyseal-metaphyseal dysplasia.

Spondylo-megaepiphyseal-metaphyseal dysplasia (SMMD; OMIM 613330) is a dysostosis/dysplasia caused by recessive mutations in the homeobox-containing gene, NKX3-2 (formerly known as BAPX1). Because of the rarity of the condition, its diagnostic features and natural course are not well known. We describe clinical and radiographic findings in six patients (five of which with homozygous mutations in the NKX3-2 gene) and highlight the unusual and severe changes in the cervical spine and the neurologic complications. In individuals with SMMD, the trunk and the neck are short, while the limbs, fingers and toes are disproportionately long. Radiographs show a severe ossification delay of the vertebral bodies with sagittal and coronal clefts, missing ossification of the pubic bones, large round "balloon-like" epiphyses of the long bones, and presence of multiple pseudoepiphyses at all metacarpals and phalanges. Reduced or absent ossification of the cervical vertebrae leads to cervical instability with anterior or posterior kinking of the cervical spine (swan neck-like deformity, kyknodysostosis). As a result of the cervical spine instability or deformation, five of six patients in our series suffered cervical cord injury that manifested clinically as limb spasticity. Although the number of individuals observed is small, the high incidence of cervical spine deformation in SMMD is unique among skeletal dysplasias. Early diagnosis of SMMD by recognition of the radiographic pattern might prevent of the neurologic complications via prophylactic cervical spine stabilization. © 2012 Wiley Periodicals, Inc.

Seventy-five genetic loci influencing the human red blood cell.

Anaemia is a chief determinant of global ill health, contributing to cognitive impairment, growth retardation and impaired physical capacity. To understand further the genetic factors influencing red blood cells, we carried out a genome-wide association study of haemoglobin concentration and related parameters in up to 135,367 individuals. Here we identify 75 independent genetic loci associated with one or more red blood cell phenotypes at P < 10(-8), which together explain 4-9% of the phenotypic variance per trait. Using expression quantitative trait loci and bioinformatic strategies, we identify 121 candidate genes enriched in functions relevant to red blood cell biology. The candidate genes are expressed preferentially in red blood cell precursors, and 43 have haematopoietic phenotypes in Mus musculus or Drosophila melanogaster. Through open-chromatin and coding-variant analyses we identify potential causal genetic variants at 41 loci. Our findings provide extensive new insights into genetic mechanisms and biological pathways controlling red blood cell formation and function.

A simple bypass technique for superior vena cava reconstruction.

Superior vena cava (SVC) clamping can be required during thoracic surgery for SVC replacement or repair. In such cases, bypass techniques can be necessary to avoid hemodynamic instability, cerebral venous hypertension and hypoperfusion. Here, we report a novel and simple SVC bypass technique which does not require full systemic heparinization, specialized cannulation techniques or pumping devices and which can be applied percutaneously in the preoperative phase or intraoperatively. The preoperative shunt consisted in two Swan-Ganz catheters inserted in the jugular and femoral veins and connected by perfusion tubing with a three way stopcock. The intraoperative shunt consisted of a Pruitt(®)-catheter inserted in the left innominate vein and connected to a femoral Swan-Ganz catheter by perfusion tubing. We validated our system in seven patients undergoing SVC reconstruction. We monitored the systemic arterial blood pressures, the heart rate and vasoactive peptide requirements throughout the procedure. We also determined the neurological status and the in-hospital morbidity and mortality for each patient. Using this bypass, SVC clamping caused no hemodynamic instability, no neurological impairments and no in-hospital complications or deaths. This simple temporary SVC bypass procedure is safe and avoids hemodynamic instability and cerebral venous hypertension.

Isolated limb perfusion: distinct tourniquet and tumor necrosis factor effects on the early hemodynamic response.

HYPOTHESIS: Recent evidence indicates that tumor response rates after isolated limb perfusion (ILP) are improved when tumor necrosis factor (TNF) is added to the locoregional perfusion of high doses of chemotherapy. Other factors, related to the patient or the ILP procedure, may interfere with the specific role of TNF in the early hemodynamic response after ILP with TNF and high-dose chemotherapy. DESIGN: Case-control study. SETTING: Tertiary care university hospital. PATIENTS: Thirty-eight patients with a locoregionally advanced tumor of a limb treated by ILP with TNF and high-dose chemotherapy (TNF group) were compared with 31 similar patients treated by ILP with high-dose chemotherapy alone (non-TNF group). INTERVENTIONS: Swan-Ganz catheter hemodynamic recordings, patients' treatment data collection, and TNF and interleukin 6 plasma level measurements at regular intervals during the first 36 hours following ILP. MAIN OUTCOME MEASURES: Hemodynamic profile and total fluid and catecholamine administration. RESULTS: In the TNF group, significant changes were observed (P<.006): the mean arterial pressure and the systemic vascular resistance index decreased, and the temperature, heart rate, and cardiac index increased. These hemodynamic alterations started when the ILP tourniquet was released (ie, when or shortly after the systemic TNF levels were the highest). The minimal mean arterial pressure, the minimal systemic vascular resistance index, the maximal cardiac index, the intensive care unit stay, and the interleukin 6 maximal systemic levels were significantly (P<.001 for all) correlated to the log(10) of the systemic TNF level. In the non-TNF group, only a brief decrease in the blood pressure following tourniquet release and an increase in the temperature and in the heart rate were statistically significant (P<.006). Despite significantly more fluid and catecholamine administration in the TNF group, the mean arterial pressure and the systemic vascular resistance index were significantly (P<.001) lower than in the non-TNF group. CONCLUSIONS: Release of the tourniquet induces a blood pressure decrease that lasts less than 1 hour in the absence of TNF and that is distinct from the septic shock-like hemodynamic profile following TNF administration. The systemic TNF levels are correlated to this hemodynamic response, which can be observed even at low TNF levels.

Evaluación de la litigiosidad en el "rapporto tributario in Italia"

[spa] El presente estudio tiene como finalidad realizar un análisis descriptivo de la litigiosidad observada en los tribunales italianos que conocen de la materia tributaria.

Brevia de fide catholica (f. 1-52v). Acta paparum (f. 53-139v).

F. 1-52v. Recueil de textes de piété, en italien sauf le premier. « Confiteor Deo omnipotenti Patri et Filio et Spiritui sancto (...) martiribus tuis Grisanto et Darie, confessoribus tuis Prospero et Venerio atque beato Francisco... - ... eternam amen » (1). — [Rubrique :] « Quisti son li X comandam. de la leze ». « Primo non adorare altro che uno solo dio et per questo commandamento se veta le idole... - ... non e » (1v-3v). — [Rubrique :] « Quisti son li XII articoli de la fede ». « Credo in Dio padre omnipotente creatore del celo et de la terra. 1. S. Petro. Et in Yesu... - ... alli boni. 11. S. Thadeo. 12. S. Mathia » (3v). — [Rubrique :] « Quisti son li septe peccati mortali. Lo primo Elatio ». « Superbia cio e reputare de havere bene per propria virtu et non da Dio... - ... tante fiade pecca mortalmente » (3v-10). — [Rubriques :] « Quisti son li dexe comandamenti soto brevita » (...) « Quisti sono li septe sacramenti » (...) « Que son le VII opere de la misericordia temporale » (...) « Queste son le spirituale » (...) « Questi son li setti peccati mortali » (...) « Circha de sopra in li dexe comandamenti. Quista sun li V sentimenti de lo corpo » (...) « Quisti sono li septi doni del Spirito sancto che sono contra li VII peccati mortali » (...) « Queste sono le III virtu theologie » (...) « Quatuor sono le cardinale » (...) « Queste son le conditione de la confessione » (...) « Quisti son li casi de la papa sive papali » (...) « Casus exclusi » (...) « Quisti sun li cassi de lo episcopo sive episcopali » (...) (10-12). — [NICOLAUS DE AUXIMO, O. F. M. (Nicolò da Osimo), Compendio de salute], cf. Umberto Picciafuoco, Fr. Nicolò da Osimo: vita, opera, spiritualità, 1980 ; « Per dare breve introductione delle cose necessarie ad la salute ad ciaschuno simplice lo quale desidera de salvarse, me sono studiato de redirre le dicte cose sotto breve compendio, retracto de uno libro dicto Quadriga spirituale... - ... molto cose secondo li doctori » (12-52v).F. 53-139v. Actes pontificaux et varia. EUGENIUS IV papa, Bulla [ad Jacobum de Primadiciis de Bononia, O. F. M. (Giacomo Primadizzi) ?], de communione pascali, [07/07/1446], cf. Archivum Franciscanum Historicum, 21, 1928, p. 270 n. 1, 282-283 « Eugenius papa IIIIus. Dilecte fili salutem et apostolicam benedictionem. Fidedigna relatione percepimus in civitate Licii non parvam... - ... VIII kal. julii 1446, po. no. anno XVI° » (éd. ibid., p. 282-283, avec une date corrigée) (53-54). — [PAULUS II papa], Bulla, 14/04/1469 « I ». [Rubrique :] « Bulla que quotannis in cena Domini publicari per summum pontificem consuevit ». « Dilecti filii salutem et apostolicam benedictionem. Consueverunt predecessores nostri romani pontifices annis singulis in die cene Domini sedentes...-... die XIIII° aprilis 1469 p. n. anno quinto. L. Dathus » (55-56). — PAULUS II papa, Bulla, 30/03/1469 « 2. Bulla. Paulus (...). Consueverunt sancte memorie romani pontifices predecessoris [sic] nostri ad retinendam puritatem... - ... tertio kal. aprilis, p. n. anno quinto. De curia. Signata A. Ingherannus, L. Dathus » (56v-64). — PAULUS II papa, Bulla, 06/06/1469 « 3. Paulus (...). Decet romanum pontificem sic in suis fore gratiis liberalem quod in ecclesiarum... - ... octavo id. junii, p. n. anno quinto. De curia, B. Lunensis » (64v-67). — PAULUS II papa, Bulla, 02/07/1469 « Paulus papa II. 4. [Rubrique :] Presidenti monasteriorum Sancte Justine de Padua ». « Dilecte fili salutem et apostolicam benedictionem. Bullam presentibus alligatam constitutionis et decreti nostri circa annexa et juncta beneficia... - ... die IIa julii M° CCCC LXVIIII p. n. anno quinto. L. Dathus » (67v-68). — PAULUS II papa, Bulla, de casibus reservatis, [03/03/1470] cf. Cesare Censi, Manoscritti francescani della Biblioteca Nazionale di Napoli, 2 vol., 1971 (Spicilegium bonaventurianum, VII-VIII), t. I, p. 222, qui renvoie au ms. Napoli, Biblioteca Nazionale, V H 33 (n° 125 a de la liste de Cenci) ; incomplet de la fin « 5. [Rubrique :] Bulla pro casibus reservatis ». « Paulus (...). Etsi dominici gregis saluti semper intenti singulis cum humilitate poscentibus ea benigne... - ... omnipotentis Dei et beatorum » [Petri et Pauli...] (68v-70). — PAULUS II papa, Bulla, 23/11/1464 « 6. [Rubrique :] Contra symoniacos ». « Paulus (...). Cum detestabile scelus simoniace pravitates tam divinorum quam sacrorum canonum... - ... nono kal. decembres, p. n. anno primo » (70v-72). — PAULUS II papa, Bulla, [01/03/1468], cf. C. Censi, op. cit., ms. Napoli, Bibl. Naz., I H 43 et V H 33 (n° 50 ap et 125 d) « 7. [Rubrique :] Bulla prohibens ne bona ecclesiarum et Dei alienari possint ultra triennium ». « Paulus (...). Ambitiose perversorum cupiditati illorum precipue qui divinis et humanis legibus affectata... - ... M° CCCC LXVII kalendis martii p. n. anno quarto » (72v-74). — PAULUS II papa, Bulla, 31/01/1468 « 8. [Rubrique :] De celebratione dierum festorum in terris ecclesie ». « Paulus (...). Perniciosa consuetudo aut verius corruptela que in gravem divine majestatis ac sanctorum... - ... M° CCCC LXVII pridie kal. febr. anno p. n. IIII° » (74v-76v). — Exemplum de Raymundo cardinale nepote Honorii pape et beata Maria virgine et Annunciatione ejus. [Rubrique :] « Pro jejunio domine nostre ». « Honorius summus pontifex habuit ex sorore nepotem Raymundum nomine tituli sanctorum Johannis et Pauli cardinalem libidini ita deditum... - ... regna migravit » (77-79). — PAULUS II papa, Bulla, de jubilaeo, 19/04/1470 « 10 ( ?). [Rubrique :] De publicatione anni jubilei redacti ad M CCCC LXXV ». « Paulus (...). Ineffabilis providentia summi patris qui pro redemptione humani generis ejusque reconcilianda natura... - ... tertiodecimo kalendas maii p. n. anno sexto » (79-85). — PAULUS II papa, Breve, ad episcopum Cumanensem, 22/04/1471 « Breve pontificis ad episcopum Cumanensem. Paulus II. Venerabilis frater (...). Expositum fuit nobis nonnullos istius civitatis Cumane ejusque diocesis existere qui contra libertatem... - ... XXII aprilis 1471 p. n. anno septimo » (86-86v). — PAULUS II papa, Breve, ad episcopum Cumanensem, 07/06/1471 « Suprascriptum breve non habuit locum sed reformatum fuit in formam infrascriptam : Paulus II. Ven. (...). Expositum nobis fuit pro parte dilecti filii nobilis viri Galeaz Marie ducis Mediolani nonnullos istius civitatis Cumane... - ... 7° junii 1471 p. n. anno 7° » (86v-87v). — PAULUS II papa, Breve, [ad Galeazzum Mariam Sforza ducem Mediolanensem], 31/05/1471 « Dilecte fili (...). Diligenter exposuit nobis dilectus filius Augustinus de Rubeis eques et doctor Parmensis consiliarius et orator ad nos tuus... - ... ultimo maii 1471, p. n. anno septimo » (87v-88v). — NICODEMUS [TRANCHEDINI], Littera ad Galeazzum Mariam Sforza ducem Mediolanensem, 13/05/1471, cf. Paola Sverzelatti, « Per la biografia di Nicodemo Tranchedini [1413-1481] di Pontremoli, ambasciatore sforzesco », Aevum, 1998, LXII, 485-557 [4° Z 4794] « Littere Nicodemi ad illustrissimum d. ducem. El papa me ha dicto questa sera che heri sera deputo et immediate hebbe ad se li inferri... - ... Johachinus et Franciscus de Padua advocati consistoriales ». « Suprascriptis videnda commissa fuit bulla pontificis » (89-89v). — AUGUSTINUS DE RUBEIS (Agostino de’Rossi) et NICODEMUS [TRANCHEDINI], Littera ad Galeazzum Mariam Sforza ducem Mediolanensem, 25/05/1471 « Littere d. Augustini et Nicodemi ad principem. Illustrissimo (...). Questi xi sonno mo stati piu volte insieme et col papa anchora et heri se fece el consistorio... - ... XXV maii 1471. Augustinus et Nicodemus » (89v-91). — Iidem ad eumdem, 27/05/1471 « Eorundem. Illustrissimo (...). Credace la vestra signoria per cosa se havesse ad agitar. qua postquam questo nostro sancto patre fu facto papa... - ... XXVII maii 1471 » (91-94v). — [EUGENIUS IV papa, Gratiae concessae Francisco de Platea de Bononia, O. F. M., 01/1440], cf. Cesare Censi, Manoscritti francescani della Biblioteca Nazionale di Napoli, 2 vol., 1971 (Spicilegium bonaventurianum, VII-VIII), t. II, p. 1060, qui renvoie à deux exemplaires du texte, mss. Napoli, Biblioteca Nazionale, cod. VII G 50 et VII G 66 [n° 371 et 383 de la liste de Cenci] « Copia. Ego frater Franciscus de Bononia frater venerabilis viri fratris Jacobi de Primidiciis de Bononia Florentiam accessi... - ... M CCCC XL die III et die decima januarii » (95-98v). — PAULUS II papa, Breve ( ?), ad Julium Cesari de Varano domicellum, incomplet de la fin « Paulus episcopus (...) dilecto filio nobili viro Julio Cesari de Varano domicello civitatis nostre Camerini et pro nobis (...) gubernatori (...). Inter cura multiplices quibus assidue permimur illa precipue sollicitat mentem nostram... - ... merito commendari » (100-106v). — NICOLAUS V papa, Breve ( ?), ad Franciscum Sforza, 24/07/1447 « Nicolaus (...) dilecto filio nobili viro Francisco Sfortie vicecomiti, comiti et marchioni (...). Sedes apostolica pia mater recurrentibus ad eam cum humilitate filiis post excessum libenter... - ... nono kal. augusti, p. n. anno primo. Pe. de Noxeto » (107-111v). — FRANCISCUS PHILELPHUS ( ?), [De Sacerdotio Christi (extractum et translatum e graeco Souda), versio italica], cf. Giovanni Mercati, Ultimi contributi alla storia degli Umanistici, 1939, I, p. 74-76 (4° Z 1722 (90)) « Tractatello traducto per messere Francescho Philelpho singularissimo poetha de greco in latino per luy trovato presso autentici et antiqui autori, reducto in volgare ad contemplatione d’alcuni devoti cortesani del illustrissimo signiore duca di Milano, ad confirmatione de la fede nostra et confusione de Judei. Regnando Justiniano imperatore clementissimo fo uno homo principe de Judei chiamato Theodosio... - ... teneva occulto » (112-118v). — « Electi beneficii et superni doni data ad quella anima che oldira la sancta messa integramente monifestati per li sancti doctori... - ... ligno de la vita » (118v-119). — MARTINUS V papa, Bulla, de excommunicatione hereticorum, [28/03/1426 ?], incomplète de la fin ; cf. C. Censi, op. cit., I, p. 501-502 (n° 304 f) « 1. Excommunicationes plures contente in processu qui fit annuatim in curia in cena Domini. Martinus (...). Excommunicamus et anathematizamus ex parte omnipotentis Dei Patris et Filii et Spiritus sancti auctoritate Petri... - ... incursurum. Datum Rome etc » (120-122v). — « Item excommunicamus et anathematizamus omnes illos qui per se vel per alium vel alios directe vel indirecte... - ... cautione prestitis » (122v-123v). — PAULUS II papa, Bulla, 11/04/1471 « 2. Paulus (...). Consueverunt sancte memorie romani pontifices predecessores nostri ad retinendam puritatem... - ... tertio idus aprilis, p. n. anno VII° » (124-130v). — SIXTUS IV papa, Bulla, de excommunicatione hereticorum, 26/03/1472 « 2. Sixtus (...). Excommunicamus et anathematizamus ex parte omnipotentis Dei Patris et Filii et Spiritus sancti auctoritate quoque beatorum... - ... septimo kal. aprilis etc. anno primo » (131-134v). — SIXTUS IV papa, Breve ( ?), ad Ferdinandum I regem Sicilie, 01/03/1472 « 4. Sixtus (...) carissimo in Christo filio Ferdinando regi Sicilie illustri (...). Dum eximie fidelitatis devotionis atque prudentie tue ceterasque tibi a Domino traditas virtutes...-... kalendis martiis [sic] p. n. anno primo. M. Milinus » (135-139v).