Narrative Mini-review Research Articles

Cranioplasty Following Decompressive Craniectomy.

Cranioplasty (CP) after decompressive craniectomy (DC) for trauma is a neurosurgical procedure that aims to restore esthesis, improve cerebrospinal fluid (CSF) dynamics, and provide cerebral protection. In turn, this can facilitate neurological rehabilitation and potentially enhance neurological recovery. However, CP can be associated with significant morbidity. Multiple aspects of CP must be considered to optimize its outcomes. Those aspects range from the intricacies of the surgical dissection/reconstruction during the procedure of CP, the types of materials used for the reconstruction, as well as the timing of the CP in relation to the DC. This article is a narrative mini-review that discusses the current evidence base and suggests that no consensus has been reached about several issues, such as an agreement on the best material for use in CP, the appropriate timing of CP after DC, and the optimal management of hydrocephalus in patients who need cranial reconstruction. Moreover, the protocol-driven standards of care for traumatic brain injury (TBI) patients in high-resource settings are virtually out of reach for low-income countries, including those pertaining to CP. Thus, there is a need to design appropriate prospective studies to provide context-specific solid recommendations regarding this topic.

The Role of Proopiomelanocortin and α-Melanocyte-Stimulating Hormone in the Metabolic Syndrome in Psychiatric Disorders: A Narrative Mini-Review.

The metabolic syndrome (MetS) comprises abdominal obesity, preclinical or full diabetes type 2, arterial hypertension, and dyslipidemia and affects a significant proportion of the general population with a remarkably higher prevalence in patients suffering from psychiatric disorders. However, studies exploring the pathogenetic link between MetS and psychiatric diseases are rare. Here, we aim to narrow this gap in knowledge by providing a narrative review on this topic that focuses on two psychiatric diseases, namely on schizophrenia and posttraumatic stress disorder (PTSD) since we assume them to be associated with two different main causalities of MetS: in schizophrenia, MetS evidently develops or aggravates in response to antipsychotic drug treatment while it assumingly develops in response to stress-induced endocrine and/or epigenetic alterations in PTSD. First, we compared the prevalences of MetS and associated pathologies (which we took from the latest meta-analyses) among different psychiatric disorders and were surprised that the prevalences of arterial hypertension and hyperglycemia in PTSD almost doubles those of the other psychiatric disorders. Next, we performed a literature search on the neurobiology of MetS and found numerous articles describing a role for proopiomelanocortin (POMC) in MetS. Thus, we concentrated further analysis on POMC and one of its downstream effector hormones, α-melanocyte-stimulating hormone (α-MSH). We found some evidence for a role of POMC in both PTSD and schizophrenia, in particular in antipsychotic-induced MetS, as well as for α-MSH in schizophrenia, but, surprisingly, no study on α-MSH in PTSD. Taken together, our synopsis reveals, first, a potential interaction between the POMC system and stress in the assumingly at least partially shared pathogenesis of psychiatric disorders and MetS, second, that modulation of the POMC system, in particular of the melanocortin 3 and 4 receptors, might be a promising target for the treatment of MetS and, third, that the DNA methylation status of POMC might speculatively be a promising biomarker for MetS in general and, possibly, in particular in the context of stress-related psychiatric conditions such as PTSD. To best of our knowledge, this is the first review on the role of the POMC system in MetS in psychiatric disorders.

Immune Response to Mycobacterium tuberculosis: A Narrative Review.

The encounter between Mycobacterium tuberculosis (Mtb) and the host leads to a complex and multifaceted immune response possibly resulting in latent infection, tubercular disease or to the complete clearance of the pathogen. Macrophages and CD4+ T lymphocytes, together with granuloma formation, are traditionally considered the pillars of immune defense against Mtb and their role stands out clearly. However, there is no component of the immune system that does not take part in the response to this pathogen. On the other side, Mtb displays a complex artillery of immune-escaping mechanisms capable of responding in an equally varied manner. In addition, the role of each cellular line has become discussed and uncertain further than ever before. Each defense mechanism is based on a subtle balance that, if altered, can lean to one side to favor Mtb proliferation, resulting in disease progression and on the other to the host tissue damage by the immune system itself. Through a brief and complete overview of the role of each cell type involved in the Mtb response, we aimed to highlight the main literature reviews and the most relevant studies in order to facilitate the approach to such a complex and changeable topic. In conclusion, this narrative mini-review summarizes the various immunologic mechanisms which modulate the individual ability to fight Mtb infection taking in account the major host and pathogen determinants in the susceptibility to tuberculosis.

Pheochromocytoma, Paraganglioma, Neuroblastoma, Catecholamine Secreting Tumor Perioperative and Anesthetic Management in Children

Background: Catecholamine secreting tumors are responsible of 0.5-2% of hypertension in children. Intraoperative instability in these patients during surgical resection can occur. The objective of this mini-review was to describe the perioperative management of pheochromocytomas, paragangliomas, neuroblastomas and catecholamine secreting tumors in children. Methods: Narrative mini-review. Results and Conclusion: Preoperative medical and intraoperative anesthetic management aim to reduce intraoperative instability in catecholamine secreting tumors.

Mini Review on the Impact of Mobile Parts' Exchange During the DAIR Procedure (Debridement, Antibiotics, Irrigation, Retention) for Infected Total Joint Arthroplasties

A prosthetic joint infection (PJI) requires a combined approach (infectiology and surgery). The therapeutic DAIR approach (debridement, antibiotics, irrigation, and retention) is an option for acute and stable PJI yielding remission incidences that oscillate between 70% and 90%; in a literature mostly composed of retrospective single-center trials. DAIR can be performed with or without mobile part’s exchange during debridement. Scientific data proving the necessity of mobile part exchanges (by leaving other infected components in situ) remain scarce. In this narrative mini review, we evaluate the existing literature that analyses the benefit of exchanging mobile parts with at least ten own cases. We moreover discuss the optimal duration of concomitant targeted systemic antibiotic therapy and reveal some insights in the surgical difficulties in performing DAIR. Our conclusion tends to favor of the mobile part’s exchange whenever feasible.

Chikungunya Virus Infections in Military Deployments in Tropical Settings-A Narrative Minireview.

Chikungunya fever is a vector-borne viral disease in subtropical and tropical areas of endemicity. Apart from the burden on local populations, chikungunya virus infection also poses a risk for travelers and, in particular, soldiers during prolonged deployment-associated outdoor activities. The absence of rapid diagnostic tests makes surveillance challenging during military deployments in war and crisis zones with restricted medical infrastructure. Consequently, both historical and up-to-date surveillance data from battlefields are scarce. From several studies and postdeployment assessments, some information on the epidemiology of chikungunya virus infections in deployed military personnel is nevertheless available. The few published data homogeneously suggest a low infection risk in the endemic setting. During outbreaks, however, the infection risk of military personnel is comparable to that of the local population. Infection clusters of soldiers without pronounced outdoor activity have been reported under such circumstances as well. In spite of efforts focusing on the development of a chikungunya virus vaccine, no licensed product is available so far.

Mini review shows that structured light plethysmography provides a non-contact method for evaluating breathing patterns in children.

Structured light plethysmography (SLP) is a novel light-based method that captures chest wall movements to evaluate tidal breathing. We carried out a narrative mini review of the clinical use of SLP in paediatrics. PubMed and Google Scholar were searched for papers published in English up to December 2018. This identified a methodology paper published in 2010 and eight full papers, including three paediatric studies and one paediatric case report. We also included data from ten conference abstracts and one clinical case study. We found data that validated the ability of SLP to differentiate airway obstruction from tidal breathing parameters and bronchodilator responsiveness for children aged two years and over. Non-contact measurement of regional chest wall movement was a unique feature. Feasibility data were scarce and more studies are needed, especially in infants. Preliminary studies suggest that SLP has the potential to be used in cases of dysfunctional breathing and neuromuscular diseases and as a follow-up tool after lung infections or surgery. Structured light plethysmography has been validated to demonstrate lung function abnormality in paediatric asthma, but further studies are needed to demonstrate its benefits over current practice and how it can be used for other conditions.

Intraoperative ICG-fluorescence imaging for robotic-assisted urologic surgery: current status and review of literature.

With the availability of near-infrared fluorescence (NIRF) imaging using indocyanine green dye (ICG) to the robotic platform, utility of this imaging technology has evolved significantly across the board for ablative and reconstructive procedures. Herein, we describe the potential indications of indocyanine green for both oncologic and non-oncologic applications in robot-assisted laparoscopic urologic surgery. A narrative mini-review was performed in November 2018 using PubMed, Scopus, EMBASE, and Web of Science databases utilizing the following search phrase: "indocyanine green fluorescence robotic surgery" resulting in 104 articles of which 30 articles had urologic-pertinent applications. All 30 articles, and the references within, were reviewed and judged for scientific integrity and merit. Articles with non-novel findings or similar conclusions to original papers were omitted. ICG does not have a urologic FDA indication, though it has been used off-label for urologic surgery since 2006. Fluorescence-augmented surgery with ICG can facilitate oncologic surgery in the adrenal gland, kidney, bladder, prostate, and retroperitoneum, in addition to lymph node dissection for various malignant pathologies. ICG-NIRF can enhance non-oncologic surgery including ureterolysis, ureteroureterostomy, ureteral re-implantation, pyeloplasty, and urinary diversion in both the adult and pediatric populations. Although it is not necessary to utilize fluorescence-enhanced surgery in all cases, the authors find the utilization of ICG-NIRF in complex and highly technical surgeries useful.

The Impact of Metabolic Syndrome and Its Components on Female Sexual Dysfunction: A Narrative Mini-Review

Background: The impact of metabolic syndrome on female sexual dysfunction received modest consideration in clinical practice. The aim of the research was to analyze the international literature to determine the relationship between the metabolic syndrome, its components and female sexual disorders. Methods: We identified relevant full-length papers by electronic databases as Index Medicus/Medline, Scopus, Life Science Journals, from 2005 to the present. Studies were searched using the following as search query: metabolic syndrome, female sexual dysfunction, obesity, systemic arterial hypertension, diabetes mellitus, dyslipidemia. Results: Women with metabolic syndrome showed higher prevalence of sexual inactivity and low sexual desire, orgasm and satisfaction respect to women without metabolic syndrome. Particularly metabolic components as diabetes mellitus, dy-slipidemia, systemic arterial hypertension were strongly associated with lower sexual desire, activity and Female Sexual Function Index total score. In contrast, other studies showed no relationship. Conclusion: Our study showed that in the clinical evaluation of women with metabolic syndrome routine inquiring about female sexual dysfunction should be recommended to ameliorate sexual function and quality of life. However more prospective and longitudinal studies on the sexual effects of metabolic syndrome should also be suggested to know the factors related to women's sexuality better.

Risk assessment tools in hypertensive patients who are likely to develop target organ damage: A narrative mini-review

Risk assessment tools in hypertensive patients who are likely to develop target organ damage: A narrative mini-review

Enhanced Cognition, Enhanced Self? On Neuroenhancement and Subjectivity

This paper investigates the implications of neuroenhancement from a first-person and phenomenological perspective that focuses on the role of the human brain and body as mediators of subjective experience. This analysis is conducted both on historical-philosophical and empirical grounds. At the historical-philosophical level, this article examines the frameworks of phenomenology and embodied cognition to explore how these theoretical approaches link the materiality of the body (including that of exogenous integrations such as implants) to the way in which subjects perceive themselves and experience reality. At the empirical level, the article attempts to corroborate this philosophical stance by critically assessing the emerging body of scientific evidence on the phenomenological effects of neuroenhancement technologies. Based on a narrative mini-review, this paper will argue that the quantitative enhancement of a cognitive or other physical function of the human body does not necessarily result in an equal qualitative improvement of a subject’s phenomenological experience. Indeed, a physical alteration designed to quantitatively augment a specific human capability may have ambivalent effects on how the subject experientially perceives that modification. This indeterminacy between the quantitative and qualitative dimension of neuroenhancement seems to challenge the thesis that any objectively measured improvement of a cognitive or other physical function of the human body directly corresponds to better personal and psychological well-being.

Sodium-glucose Cotransporter 2 Inhibitors: Nephroprotective Impact on Diabetic Kidney Disease.

Diabetic nephropathy is a crucial microvascular complication of diabetes mellitus that is associated with elevated cardiovascular risk. SGLT-2 inhibitors are a new class of hypoglycemic drugs that positively affect several risk factors of cardiorenal damage. The study aimed to review and critically discuss available data on the association of SGLT-2 inhibitors treatment with kidney function, progress of diabetic kidney disease, and renal related outcomes, as well to unveil potential mechanisms of action that mediate such effects. We conducted a comprehensive search of the literature on the renal related effects of SGLT-2 inhibitors, to compose a narrative mini-review. The administration of SGLT-2 inhibitors was observed to exert beneficial effects on a wide cluster of risk factors of chronic kidney disease, such as hyperglycemia, blood pressure, serum uric acid, and body weight. Data from the first two large, randomized, clinical trials of SGLT-2 inhibitors conducted to address the renal related outcomes of SGLT-2 inhibitors suggest substantial benefits on estimated glomerular filtration rate decline and albuminuria. The initial data suggest clinically meaningful benefits of the SGLT-2 inhibitors in diabetic patients in relevance with chronic kidney disease. Future, well-designed randomised clinical trials need to be further investigated such as nephroprotective outcomes, that if confirmed, could lead to new perspectives in the management of diabetic nephropathy.

Partial 2-Stage Revision in Chronic Hip Arthroplasty Infections: A Review

Background: Periprosthetic hip infections (PHIs) are troublesome complications of hip arthroplasties. The gold standard procedure for treating chronic PHI is a 2-stage approach. Recently, however, more conservative approaches have been developed to spare the osseointegrated components and avoid sequestra, bone loss, devascularization, and difficult reconstructions. The partial two-stage approach, which leaves the well-fixed component in situ and removes the loosened component, may be an effective strategy. Objective: This paper, a narrative mini-review, analyzed the preliminary results of a partial 2-stage approach to treating chronic hip arthroplasty infections. Methods: Pertinent papers describing the partial 2-stage approach (leaving the well-fixed component in situ and removing the loosened component) were collected and evaluated. Results: Six main case series were selected. A total of 76 patients were included. Many patients were treated with socket removal and stem retention with quite similar surgical techniques. Many cases included highly virulent bacteria, and no pre-operative selection about comorbidities was performed. The first outcomes of this approach were promising, with a rate of infection control ranging from 81.3% to 100% at mid-term follow-up. Conclusion: This approach proved good at mid-term follow-up; however, many concerns still exist. In particular, the indications are imprecise, and the role of biofilm is still unclear. Despite the first good outcomes, the partial 2-stage approach for chronic PHI should be validated by multicenter prospective studies.

Percutaneous Left Appendage Closure with the Watchman Device; The Challenges Lie Ahead: A Narrative Mini Review

Percutaneous Left Appendage Closure with the Watchman Device; The Challenges Lie Ahead: A Narrative Mini Review

Alexithymia and Suicide Risk in Psychiatric Disorders: A Mini-Review.

It is well known that alexithymic individuals may show significantly higher levels of anxiety, depression, and psychological suffering than non-alexithymics. There is an increasing evidence that alexithymia may be considered a risk factor for suicide, even simply increasing the risk of development of depressive symptoms or per se. Therefore, the purpose of this narrative mini-review was to elucidate a possible relationship between alexithymia and suicide risk. The majority of reviewed studies pointed out a relationship between alexithymia and an increased suicide risk. In several studies, this relationship was mediated by depressive symptoms. In conclusion, the importance of alexithymia screening in everyday clinical practice and the evaluation of clinical correlates of alexithymic traits should be integral parts of all disease management programs and, especially, of suicide prevention plans and interventions. However, limitations of studies are discussed and must be considered.

Involvement of cytochrome P450 in cisplatin treatment: implications for toxicity.

The aim of this study is to evaluate the relationship between the CYP450 enzyme family and cisplatin toxicity. This article examined a collection of studies suggesting that CYP450 enzymes may influence cisplatin toxicity. We performed a narrative mini-review. The studies review showed that CYP450 enzymes have an important role in drug-induced hepatotoxicity and nephrotoxicity, mainly CYP2E1 and CYP4A11. The studies also suggested that the cisplatin and CYP2E1 interaction leads to the generation of reactive oxygen species (ROS) and other oxidants resulting in renal injury; and that ROS generated by both the use of cisplatin and by the CYP2E1 increases tissue damage, induces apoptosis, and causes liver failure. We observed that there is an important relationship between CYP450 and cisplatin, involving increased toxicity. However, the possible mechanisms described for the involvement of CYP450 enzymes in nephrotoxicity and hepatotoxicity induced by cisplatin need to be confirmed by further studies. Therefore, there is a need for a deeper investigation focusing on cisplatin toxicity mediated by CYP450 enzymes, which would undoubtedly contribute to a better understanding of the mechanisms that have been implicated so far.

Biomarkers for Early Diagnosis ofAlzheimer's Disease in the Oldest Old: Yes or No?

In recent years, many efforts have been spent to identify sensitive biomarkers able to improve the accuracy of Alzheimer's disease (AD) diagnosis. Two different workgroups (NIA-AA and IWG) included cerebrospinal fluid (CSF) and neuroimaging findings in their sets of criteria in order to improve diagnostic accuracy as well as early diagnosis. The number of subjects with cognitive impairment increases with aging but the oldest old (≥85 years of age), the fastest growing age group, is still the most unknown from a biological point of view. For this reason, the aim of our narrative mini-review is to evaluate the pertinence of the new criteria for AD diagnosis in the oldest old. Moreover, since different subgroups of oldest old have been described in scientific literature (escapers, delayers, survivors), we want to outline the clinical profile of the oldest old who could really benefit from the use of biomarkers for early diagnosis. Reviewing the literature on biomarkers included in the diagnostic criteria, we did not find a high degree of evidence for their use in the oldest old, although CSF biomarkers seem to be still the most useful for excluding AD diagnosis in the "fit" subgroup of oldest old subjects, due to the high negative predictive value maintained in this age group.

Poor oral health and fertility problems: A narrative mini-review

Background & aim: Currently, it has been known that oral infections, especially periodontitis, may affect the pathogenesis of a number of systemic conditions. Evidence has also suggested a possible role of oral diseases in subfertility and infertility. Therefore, this study aimed to evaluate the association between poor oral health and fertility problems. Methods: In this narrative review, relevant English articles, or those with English abstracts with no publication date limitation, were extracted from PUBMED, Scopus, ScienceDirect and Google Scholar. Moreover, research keywords were “subfertility”, “infertility”, “sperm count”, “erectile dysfunction”, “conception”, “oral hygiene”, “oral infections”, “periodontitis” and “periodontal disease”. In total, 40 titles were found, from which letters to the editor, commentaries, as well as case reports and series were excluded, leading to the final assessment of 37 original articles. Results: In this study, a consistency was observed among studies conducted to assess the association between poor oral health and signs of fertility problems, such as improper spermatological parameters, erectile dysfunction (ED), increased time to conceive (TTC) and endometriosis. However, no significant association was observed between maternal periodontitis and male subfertility in future. Conclusion: According to the results of this study, oral hygiene could be an important component of general health and also a contributing factor for improved sexual health. Control of oral inflammation and regular dental check-ups by men and women, particularly prior to conceiving, could enhance reproductive ability.

BARIATRIC SURGERY AND OSTEOPOROSIS

Introduction. Bariatric surgery, regardless the type of approach, has aggressively extended nowadays. The procedure saves lives due to substantial improvement of severe cardio-metabolic co-morbidities, but the influence of nutritional status might not be completely harmless including bone and muscle changes. Our purpose is to introduce data regarding skeleton after bariatric surgery. This is a narrative mini-review including papers from PubMed. A selection of 33 papers has been done. General data. Longitudinal better than cross-sectional studies confirmed an annual rate of losing bone mineral density at lumbar and femoral neck of 3-10% starting with first year after surgery and continuing within the third year; low vitamin D and calcium absorption with associated secondary hyperparathyroidism is described; others anomalies include elevated bone remodelling markers, damage of bone microarchitecture, fracture healing disturbances and sarcopenia. Conclusion. Overall, despite spectacular results after bariatric surgery, the bone and muscle are expected to suffer a level of deterioration, which should be taken into account for assuring an adequate quality of life and an immediate and distant good post-operatory prognosis.

Does environmental exposure to the greenhouse gas, N2O, contribute to etiological factors in neurodevelopmental disorders? A mini-review of the evidence.

Neurodevelopmental disorders are increasing in prevalence worldwide. Previous work suggests that exposure to the environmental air pollutant and greenhouse gas - nitrous oxide (N2O) - may be an etiological factor in neurodevelopmental disorders through the targeting of several neural correlates. While a number of recent systematic reviews have addressed the role of general anesthesia in the surgical setting and neurodevelopmental outcomes, a narrative mini-review was conducted to first define and characterize the relevant variables (i.e., N2O, attention-deficit hyperactivity disorder [ADHD] and autism spectrum disorders [ASD]) and their potential interactions into a coherent, hypothesis-generating work. The narrative mini-review merges basic principles in environmental science, anesthesiology, and psychiatry to more fully develop the novel hypotheses that neurodevelopmental impairment found in conditions like ADHD and ASD may be due to exposure to the increasing air pollutant, N2O. The results of the present mini-review indicate that exposure to N2O, even at non-toxic doses, may modulate central neurotransmission and target many neural substrates directly implicated in neurodevelopmental disorders, including the glutamatergic, opioidergic, cholinergic, and dopaminergic systems. Epidemiological studies also indicate that early and repeated exposure to general anesthesia, including N2O, may contribute to later adverse neurodevelopmental outcomes in children. The current evidence and subsequent hypotheses suggest that a renewed interest be taken in the toxicological assessment of environmental N2O exposure using validated biomarkers and psychiatric endpoints. Given the relevance of N2O as a greenhouse gas, societies may also wish to engage in a more robust monitoring and reporting of N2O levels in the environment for climactic benefit as well.