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Objectives Performance evaluation of routine laboratory methods to determine the susceptibility of Enterobacterales urinary isolates to fosfomycin (oral administration) and mecillinam. Methods We collected 347 Enterobacterales isolates from monomicrobial midstream urine samples from women with significant bacteriuria and leukocyturia. Mostly non- Escherichia coli isolates (i.e. Klebsiella spp. Citrobacter koseri , Enterobacter cloacae complex and Proteus mirabilis) were included (n  = 298). Performance of VITEK®2, ETEST®, and disc diffusion to determine fosfomycin and mecillinam susceptibility was evaluated following International Organization for Standardization (ISO) 20776-2:2021 (or 20776-2:2007 for disc diffusion) in comparison with the agar dilution reference method. Results For fosfomycin testing, VITEK®2 and ETEST® were close to reaching ISO requirements (essential agreement  ≥ 90%; bias  ±30%) for C. koseri , E. coli and P. mirabilis. Categorical agreement (CA) and major error rates were acceptable for disc diffusion. Fosfomycin displayed lower activity against E. cloacae complex and Klebsiella spp. with MIC50 (minimum inhibitory concentration required to inhibit the growth of 50% of tested isolates) equal to the E. coli EUCAST breakpoint (8 mg/L). For these species, the three alternative techniques overestimated MICs and resistance, and did not meet performance criteria. For mecillinam testing of Enterobacterales isolates, apart from P. mirabilis , ETEST® nearly fulfilled ISO requirements, and CA rates were acceptable for disc diffusion. ISO criteria were reached for C. koseri and E. coli testing with VITEK®2, apart from too high rates of very major errors. For P. mirabilis, performances were unacceptable, whatever the routine method used. Conclusions Commercially available tests may serve as alternatives to agar dilution to assess fosfomycin (oral) and mecillinam susceptibility of Enterobacterales urinary isolates, with important interspecies variabilities. Additional studies comprising more fosfomycin- and mecillinam-resistant isolates are needed to strengthen our conclusions. [ABSTRACT FROM AUTHOR]

Emergency Medical Services play a fundamental societal role since they provide pre-hospital care to patients in critical and time-constrained conditions. In this context, the hospital selection decision is vital to respond in a timely, effective and efficient way. By means of simulation experiments, the present study compares the effects of different assignment logics against a set of performance dimensions. To this end, we develop a Discrete Event Simulation model that covers the entire Emergency Medical Service process, from the ambulance transportation to final departure of the patient from the Emergency Department. Results demonstrate that the use of effectiveness-related criteria (e.g. expected waiting time, resource saturation) significantly enhances the overall performance and, at the same time, guarantees higher quality of care. Thus, the study contributes in enhancing hospital selection decisions by supporting decision-makers through a comprehensive decisional model, distancing from prior researches that predominantly considered efficiency-driven criteria (i.e. proximity). [ABSTRACT FROM AUTHOR]

Background and importance: Intramedullary spinal cord metastases (ISCMs) are rare and no cases of ISCM from an adenoid cystic carcinoma (ACC) of the external auditory canal (EAC) have been reported. Clinical presentation: We report a 54-year old man complaining backpain and worsening myelopathy. He had an ACC of the EAC resected years prior. A spinal MRI demonstrated a contrast-enhancing intramedullary lesion within the conus medullaris. The histopathological diagnosis of the patient was consistent with the patient's primary cancer. At 3 months follow-up, the neurological condition of the patient was unchanged. Conclusions: This is the first reported case of ISCM from a primary ACC of the EAC. [ABSTRACT FROM AUTHOR]

Electromagnetic emissions from earthquakes are known as precursors and are of considerable importance for the purpose of early alarms. The propagation of low-frequency waves is favored, and the range between tens of mHz to tens of Hz has been heavily investigated in the last thirty years. This work describes the self-financed Opera 2015 project that initially consisted of six monitoring stations over Italy, equipped with electric and magnetic field sensors, among others. Insight of the designed antennas and low-noise electronic amplifiers provides both characterization of performance (similar to the best commercial products) and the elements to replicate the design for our own independent studies. Measured signals through data acquisition systems were then processed for spectral analysis and are available on the Opera 2015 website. Data provided by other world-known research institutes have also been considered for comparison. The work provides examples of processing methods and results representation, identifying many exogenous noise contributions of natural or human-made origin. The study of the results occurred for some years and led us to think that reliable precursors are confined to a short area around the earthquake due to the significant attenuation and the effect of overlapping noise sources. To this aim, a magnitude-distance indicator was developed to classify the detectability of the EQ events observed during 2015 and compared this with some other known earthquake events documented in the scientific literature. [ABSTRACT FROM AUTHOR]

A letter to the editor of Acta Neurochirurgica discusses the use of flexible endoscopes to aspirate intraventricular hemorrhage (IVH) and other lesions. The author commends a recent technique described by Yamashiro et al. that uses an angiographic catheter in combination with a flexible endoscope to aspirate IVH, as it provides a clearer surgical view. However, the author suggests that transaqueductal navigation of the IV ventricle remains the safest method for aspirating clots, especially in cases of IVH. The author also highlights the challenges faced by surgeons in developing new instruments for ventricular neuroendoscopy due to strict regulations and limited support. Nonetheless, the author emphasizes the importance of ventricular neuroendoscopy in effectively and minimally invasively treating patients. [Extracted from the article]

The prognostic factors for surgically removed spinal hemangioblastomas, the impact of VHL disease on outcome, and the role of intraoperative neuromonitoring are still not completely clear. The aim of this study was to review our experience with spinal hemangioblastomas in order to assess potential predictors of neurological outcome after surgery. All cases of spinal hemangioblastomas removed at two Italian academic institutions from 1985 to 2020 were reviewed. Data about clinical presentation and symptom duration, diagnosis of VHL, surgical approach, use of IONM, duration of hospital stay, follow-up, and modified McCormick grade before and after surgery were extracted. Sixty-one patients (31 F, 30 M) underwent 69 surgeries to remove 74 spinal hemangioblastomas (37 cervical, 32 thoracic, 5 lumbar). Improvement was found in 32.3% of cases, neurological condition remained stable in 51.6% of cases, and deteriorated in 16.1% of patients. A worsening trend in VHL patients and an improvement trend in non-VHL patients were detected, despite the lack of statistical significance. Laminotomy and use of IONM were found to be associated with better outcome, although no association was found between surgery without IONM and worse outcome. In most cases, patients affected by spinal hemangioblastomas can expect a good long-term outcome. In our experience, laminotomy seems to be associated with better outcome compared to laminectomy. While its absence is not associated with worse outcome, IONM seems to be associated with a better neurological outcome. Our study suggests that the more impaired the preoperative neurological condition, the worse the outcome. [ABSTRACT FROM AUTHOR]

Triathlon´s popularity is rapidly increasing, and epidemiological data relating to its related medical conditions is crucial to the development of proper medical plans and safety guidelines for it. This study examined the data from the medical reports collected during three consecutive editions of Ironman Italy, from 2017 to 2019. Out of 10,653 race-starters, 3.3% required medical attention sustaining 472 medical conditions. A significantly higher injury risk was found for females versus males (χ2 = 9.78, p = 0.02) and in long-distance (IR: 4.09/1,000hours) rather than in Olympic/middle distance races (IR: 1.75/1,000hours). Most (68.4%) conditions (including muscular exhaustion, hypothermia, and dehydration) were systemic, whilst only 10.2% were acute traumatic injuries. Of a total of 357 triathletes requiring medical assistance, 8.1% were a candidate for hospitalisation. The equipment and personnel that are required for the medical assistance in future triathlon events were estimated based on Maurer's algorithm, and ten practical recommendations for triathlon medical support were formulated. [ABSTRACT FROM AUTHOR]

Paratecoma peroba is a native forest species of great economic and ecological interest, currently at risk of extinction from selective and illegal exploitation; however, there are no established parameters for the production of seedlings of this species. The objective of this study was to analyze the growth and nutritional balance of P. peroba seedlings grown in polypropylene tubes of different sizes with variable doses of controlled-release fertilizer (CRF). Three volumes of tubes (120, 180, and 280 cm3), four CRF doses (0, 2.5, 5, and 7.5 kg m-3), and a conventional mineral fertilizer (CF) were tested as indicated in the literature for native forest species: arranged in a completely randomized design in a 3 × 5 factorial scheme, with four replicates composed of 16 seedlings. After 180 days, the percentage of survival, growth variables, indices of the diagnosis and recommendation integrated system, and the average nutrient balance index of the seedlings were analyzed. Based on the total dry matter and the mean nutritional balance index, the combination of a 280 cm? tube with a 7.5 kg m-3 CRF dose was the most effective in the production of P. peroba seedlings. [ABSTRACT FROM AUTHOR]

Historians have recently and fruitfully resumed work on early medieval laws. As regards the problem of the reception of post-roman normative collections in contemporary legal practice, Italian documentation offers a rich working field that allows for a comparison between the charters and the laws. On the basis of this material, it is possible to evaluate the spread, and primary characteristics, of legal expertise in Lombard Italy. Northern Italic charters show strict bonds with Lombard laws. The effects of the royal edicts can be observed in the procedure of the legal acts and are sometimes recognizable in the wording of the charters as well. These laws are often referred to and, in some cases, openly quoted. A group of charters involving purchases of women’s mundium and two charters settling disputes regarding usurpations of lands and accompanying violence reveal flexible uses of the laws, which in any case appear to be well known to the authors of the documents. The possibility to deviate from the law was indeed granted by a provision of king Liuthprand (chapter 91 of his laws). On the other hand, two judgment records show the lex scripta at the core of the procedure of the public hearing. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to conduct a diagnostic and cost-effective analysis of the cytopathology assistance in the ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) for characterising thyroid nodules. Materials and methods: We reviewed the reports relative to 9061 US-guided FNABs for the histologic definition of the nature of thyroid nodules: 45.4% completed with the cytopathologist assistance and 54.6% by the radiologist alone. We also performed the cost-effectiveness analysis (CEA) of the procedure with and without the cytopathologist assistance. Results: We found a significant positive correlation between the adoption/non-adoption of cytopathologist assistance and the number of indeterminate (TIR1) (Chi-square; z-score, Z = 10.22; critical value 5%, C = 1.96; p < 0.001). The cytopathologist's absence was correlated with the number of TIR 1 (Pearson correlation, product–moment correlation r = 0.059; critical value 5%, C = 0.008; p < 0.001). The total cost of the model's cytopathologist-assistance branch is 109.87€, while the total cost of the non-cytopathologist-assistance branch is 95.08€. Conclusion: The cytopathologist assistance resulted in fewer nondiagnostic results, thus excluding the procedure's repetition but involved a higher expense, mainly due to the professional cost of the pathologist's participation. These data may provide decision-makers in healthcare with a practical evidence based on the opportunity to include the cytopathologist assistance in the thyroid nodule's FNAB depending on the available resources and the population's expectance. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to describe the variation of surgical plan and technique required in a rare subset of hemangioblastomas compared with the accepted general strategy. The established rule in hemangioblastoma surgery is to avoid cyst wall removal, as it is not neoplastic, and it will not recur if mural nodule is completely removed. However, the wall of the associated cyst is occasionally enhanced by gadolinium on preoperative magnetic resonance imaging. We present the case of a patient with a hemangioblastoma that was progressively compressed by a growing cyst, with the final appearance of a contrast-enhanced cyst wall. We collected similar cases reported in the literature. Our study points out the need for a tailored preoperative strategy, the usefulness of intraoperative fluorescent dyes, and the crucial role of frozen section histopathologic analysis to confirm diagnosis and optimize treatment. When a hemangioblastoma is associated with a contrast-enhanced cyst, care must be taken to intraoperatively confirm the presence of neoplastic cells and eventually remove the neoplastic cyst wall to reduce the risk of recurrence. [ABSTRACT FROM AUTHOR]

Background: As intraventricular blood is a strong negative prognostic factor, intraventricular hemorrhage requires prompt and aggressive management to reduce intracranial hypertension. Method: A flexible scope can be used to navigate and to aspirate blood clots from all four ventricles. Complete restoration of CSF pathways from the lateral ventricle to the foramen of Magendie can be obtained. Conclusion: Flexible neuroendoscopic aspiration of IVH offers the opportunity to immediately reduce intracranial hypertension, reduce EVD obstruction and replacement rates, and decrease infections and shunt dependency. [ABSTRACT FROM AUTHOR]

Background. Kitesurfing is one of the world's fastest growing Olympic aquatic sports. However, previous scientific literature on this sport has mainly focused on acute injuries. The aim of this study was, therefore, to capture a picture of the burden of overuse injuries in kitesurfing. Methods. Active kite-surfers regularly completed an online questionnaire, describing the health of their shoulders, lower back and knees as well as any injury related symptoms. Results. Forty-three participants completed a total of 304 questionnaires, covering a total period of 2,096 distinct person-days. Person-days of reduced participation related to shoulder, lower back and knee problems were 8 %, 3% and 8% of the total respectively. Performance was affected related to shoulder, lower back and knee problems in 11%, 22% and 16% of person-days respectively. Conclusions. Overuse injuries emerged as an important predictor of reduced participation, decreased performance and discomfort in kitesurfing. The prospective survey method captured a picture of overuse injuries in kitesurfing not previously described. [ABSTRACT FROM AUTHOR]

Introduction: Early repair in patients affected by myelomeningocele (MMC) is of paramount importance in order to prevent infection, minimize neural tissue damage, and reduce mortality. Treatment must include duraplasty and possibly an adequate soft tissue coverage. Delayed surgery in MMC patients can be more tedious due to the less clear borders between the placode and the skin. Moreover, the risks of wound infection and breakdown increase significantly. Case Presentation: We present the unusual case of a large MMC in a 3-year-old patient treated by combining the recently described cryopreserved amniotic membrane (AM) as homograft for dural reconstruction and a bilateral Keystone flap for soft tissue reconstruction. Discussion: Thanks to its anti-inflammatory and elastic proprieties, the AM can play an important role in preventing adhesion between the reconstructed layers, thus reducing the risk of spinal cord tethering. The Keystone flap, at the same time, allows the wound tension to be distributed widely over the flap margins and not only along the midline, which overlies the duraplasty, enhancing the scar quality and lowering the risk of cerebrospinal fluid recurrence and wound dehiscence, with no donor site morbidity. [ABSTRACT FROM AUTHOR]

Venetoclax is a Bcl-2 homology domain 3 (BH3) mimetic currently approved for the treatment of chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML) that has proven to be highly effective in reinstating apoptosis in leukemic cells through the highly selective inhibition of the anti-apoptotic protein B-cell lymphoma-2 (Bcl-2). Clinically, venetoclax has provided lasting remissions through the inhibition of CLL and AML blasts. However, this activity has often come at the cost of grade III/IV neutropenia due to hematopoietic cells' dependence on Bcl-2 for survival. As life-threatening infections are an important complication in these patients, an effective management of neutropenia is indispensable to maximize patient outcomes. While there is general consensus over dose reduction and scheduling modifications to minimize the risk of neutropenia, the impact of these modifications on survival is uncertain. Moreover, guidelines do not yet adequately account for patient-specific and disease-specific risk factors that may predict toxicity, or the role combination treatment plays in exacerbating neutropenia. The objective of this review is to discuss the venetoclax-induced mechanism of hematological toxicity, the potential predictive risk factors that affect patient vulnerability to neutropenia, and the current consensus on practices for management of neutropenia. [ABSTRACT FROM AUTHOR]

Background Arteriovenous malformations (AVMs) of the scalp are rare and infrequently encountered by the neurosurgeon. Case Description We report a unique case of a 42-year-old patient who presented with a progressive worsening of visual acuity in the right eye (lower quadrantanopia) and palpebral ptosis. Physical examination revealed a right exophthalmos and a right frontoparietal scalp soft swelling when the patient was in the supine position. Neurologic work-up showed a scalp AVM extending into the orbit and connected to an intraorbital cavernous angioma. The patient was treated with a frontotemporal craniotomy and decompression of the orbit. Conclusions In the rare case of intraorbital extension of a scalp AVM, neurologic symptoms may appear when the size of the vascular malformation increases with age. The aims of surgery should be decompression of the orbit and aesthetic preservation, rather than complete excision. A review of the literature is also provided. [ABSTRACT FROM AUTHOR]

Complex intracranial aneurysms (CIAs) rank high among the most technically demanding neurosurgical pathologies. Microsurgery and clip ligation can be challenging in CIAs as circumferential visualization of the aneurysm, parent vessels, branches, perforators, and other neurovascular structures is important to prevent residual aneurysms or strokes from vessel or perforator occlusion. Decompression of the aneurysm sac is often required for CIAs. We reviewed the literature and PubMed advanced search showed 13 results of adenosine-induced flow arrest to facilitate intracranial complex aneurysm clip ligation which included three independent case reports and ten cases in a case series from 1999 to May 2016. Few case series have described the use of adenosine in intracranial aneurysm surgery. Satisfactory aneurysm decompression was achieved in all cases, and all aneurysms were clipped successfully. We recommend that adenosine cardiac arrest is a relatively novel method for decompression of intracranial aneurysms to facilitate clip application. With appropriate safety precautions, it is a reasonable alternative method when temporary clipping of proximal vessels is not desirable or not possible. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this article is to describe the role of second-level imaging techniques after an initial ultrasonography evaluation in the assessment of scrotal diseases. While ultrasonography remains central as the primary imaging modality for the evaluation of pathologic conditions of the scrotum, the role of magnetic resonance imaging continues to evolve: it can actually be valuable as a problem-solving tool when sonographic findings are equivocal or inconclusive. Magnetic resonance imaging of the scrotum may provide accurate detection and characterization of scrotal diseases, well depicting the precise location of scrotal masses (intratesticular or extratesticular) and reliably characterizing benign conditions simulating neoplastic processes, thus preventing unnecessary radical surgery. Advanced magnetic resonance techniques, most of all diffusion weighted imaging and magnetic resonance spectroscopy, play in the meanwhile a more significant role in evaluating scrotal diseases.Teaching points: • Multiparametric ultrasonography usually represents the initial imaging modality for approaching scrotal diseases.• MRI is well established as a problem-solving tool for inconclusive sonographic findings.• Advanced MRI techniques can be successfully applied in scrotal pathology assessment.• MRI is valuable in differentiating benign conditions from neoplastic processes.• CT plays a role in trauma assessment and cancer staging alongside PET/CT. [ABSTRACT FROM AUTHOR]

Skateboarding has become an international action sport attractive to young people. For this reason, skateboarding has been promoted by some researchers as important for encouraging young people to become more physically active. However, skateboarding is also considered to be inherently dangerous by the medical and broader community and as a result skateboarding is banned in many places. This paper reviews scientific literature on the features, outcomes and risk factors related to skateboarding injuries. Findings suggest that while skateboarding injuries can be severe, skateboarding is not as dangerous as it might appear if appropriate risk management steps are taken. Skateboarding should be encouraged as a worthy physical activity and local communities should consider providing specialised, supervised spaces for young people to practice this sport. [ABSTRACT FROM AUTHOR]

Objective Indocyanine green videoangiography (ICG-VA) is a valuable tool to assess vessel and aneurysm patency during neurovascular surgical procedures. However, ICG-VA highlights vascular structures, which appear white over a black background. Anatomic relationships are sometimes difficult to understand at first glance. Dual-image videoangiography (DIVA) enables simultaneous visualization of light and near-infrared fluorescence images of ICG-VA. Methods The DIVA system was mounted on an OPMI Pentero Flow 800 intraoperative microscope. DIVA was used during microsurgical procedures on 5 patients who were operated for aneurysm clipping and superficial temporal artery–middle cerebral artery bypass. Results DIVA provides real-time simultaneous visualization of aneurysm and vessels and surrounding structures including brain, nerves, and surgical clips. Although visual contrast between vessels and background is higher with standard black-and-white imaging, DIVA makes it easier to understand anatomic relationships between intracranial structures. DIVA also provides better vision of the depth of field. Conclusions DIVA has the potential to become a widely used intraoperative tool to check patency of intracranial vessels. It should be considered as an adjunct to standard ICG-VA for better understanding of vascular anatomy in relation to surrounding structures and can have an impact on decision making during surgery. [ABSTRACT FROM AUTHOR]

Purpose: Subdural empyemas are considered neurosurgical emergencies, and the parafalcine location is particularly insidious. We revised the experience of general surgeons who are used to manage chronic pleural purulent collections with video-assisted thoracoscopy. Methods: With a similar technique, we successfully aspirated a parafalcine empyema using a flexible scope avoiding a more invasive craniotomy. A review of the treatment options of empyematous collections is also provided, focusing particularly on the hazardous parafalcine location. Results: The management of subdural empyemas poses different decision-making problems compared to common brain abscesses, urging a more rapid and holistic surgical treatment with minimally invasive approach. Endoscopic aspiration of parafalcine empyema was followed by complete recovery in our patient. Conclusions: Flexible endoscopy is a promising method to obtain complete pus removal even from loculated collections through a bur hole, avoiding large craniotomies and consequent potential complications. [ABSTRACT FROM AUTHOR]

Background: Neuroendoscopy is currently recommended as the first choice to treat posterior fossa arachnoid cysts. It has proven to be effective, providing improved outcome, and safe, having a low complication rate. Compared to craniotomy and shunt placement, it has lower surgical morbidity, minimizing or avoiding risks of subdural fluid collections, shunt infection, malfunction, overdrainage, and dependence. Usually, rigid scopes maneuvered through a suboccipital approach are used. When symptomatic obstructive hydrocephalus develops, CSF diversion is the first aim of surgery. Methods: In these patients, a flexible scope introduced through a frontal burr hole allows not only immediate and efficient management of hydrocephalus with endoscopic third-ventriculostomy, but in selected cases also direct cyst inspection and fenestration. Navigation of an enlarged cerebral aqueduct is actually safe when performed by experienced neurosurgeons. Results: We describe the cystocisternostomy of a cisterna magna arachnoid cyst using a transaqueductal trans-Magendie approach. Conclusions: This minimally invasive technique gives the possibility of performing both endoscopic third-ventriculostomy and cyst fenestration, which alone may not be enough to efficiently treat hydrocephalus. [ABSTRACT FROM AUTHOR]

Purpose: Forking of the cerebral aqueduct is a developmental malformation that is infrequently encountered by neurosurgeons as a rare cause of hydrocephalus, sometimes with a delayed onset. The etiology of an apparently forked aqueduct might be different. However, neuroendoscopy can often be the optimal treatment. The purpose of this study was to review the literature by analyzing the anatomical, functional, diagnostic, and therapeutic features of this unusual condition and adding our personal cases. Methods: We present a case of forking of the cerebral aqueduct that was detected in vivo and treated with a flexible scope. A thorough review of the pertinent literature is also discussed. In the past years, diagnosis of forked aqueduct was possible only postmortem. Results: A forked aqueduct is occasionally encountered in patients when a delayed hydrocephalic decompensation occurs. Conclusions: Flexible neuroendoscopy enables for a direct, in vivo diagnosis and immediate treatment through a third ventriculostomy. [ABSTRACT FROM AUTHOR]

Background: Small soft ventricular tumors are good candidates for complete removal by a purely endoscopic technique. This approach is particularly interesting for lesions located in the posterior third ventricle and aqueductal lumen. Methods: We present our method of endoscospic aspiration through direct contact between the tumor and the working channel of a flexible scope. Results: Aspiration without the intermediate use of cannulas is safe and has proved to be effective in the apparently total or partial removal of three soft tumors of different pathologies located in the third ventricle or aqueductal lumen. In one case, a second neuroendoscopy a few months later to repeat endoscopic third ventriculostomy (ETV) offered a unique opportunity to observe the absence of the tumor and the restored anatomy. Conclusions: Neuroendoscopy provides a safe, effective way to radically resect small soft tumors in these troublesome locations and can be a valuable alternative to microsurgery. [ABSTRACT FROM AUTHOR]

Background: Little is known about the changes in organs and tissues that may make elder patients more vulnerable to acute stressors such as SARS-CoV-2 infection. Methods: In 80 consecutive elderly patients with SARS-CoV-2 infection, we evaluated the association between the descending thoracic aorta calcium score, L1 bone density and T12 skeletal muscle density measured on the same scan by high-resolution computed tomography. Results: At median regression, the ln-transformed DTA calcium score was inversely associated with L1 bone density (−0.02, 95%CI −0.04 to −0.01 ln-Agatston units for an increase of 1 HU) and with T12 muscle density (−0.03, −0.06 to −0.001 ln-Agatston units for an increase of 1 HU). At penalized logistic regression, an increase of 1 ln-Agatston unit of DTA calcium score was associated with an OR of death of 1.480 (1.022 to 2.145), one of 1 HU of bone density with an OR of 0.981 (0.966 to 0.996) and one of 1 HU of muscle density with an OR of 0.973 (0.948 to 0.999). These relationships disappeared after correction for age and age was the stronger predictor of body composition and death. Conclusions: Age has a big effect on the relationship between vascular calcifications, L1 bone density and T12 muscle density and on their relationship with the odds of dying. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the mid-term results, success rates, and time-to-failure of secondary endoscopic third ventriculostomy (secondary ETV), as well as the complex management of preoperative and postoperative cares. To this purpose, a retrospective analysis of a pediatric population of 22 children who underwent endoscopic third ventriculostomy (ETV) after shunt malfunction (secondary ETV) was performed. The failure rate, given by the percentage of new shunt replacement in the first 3 months after ETV, was 36%, with a mean time to failure of 14.3 days. All the failures were evident within 1 month after the ETV. Despite the small number of patients in our series, we found no significant correlation between ETV failure and both patient age and hydrocephalus etiology ( p = 0.47 and p = 0.78, respectively). In our experience, ETV secondary to shunt malfunction in pediatric patients has a success rate of 64%. As it is a safe and rapid treatment option even in emergency conditions, it is worth performing this procedure in previously shunted children. [ABSTRACT FROM AUTHOR]

Bodies found in water present several diagnostic challenges for the forensic examiner, such as the identification of the time and mechanism of death, the postmortem submersion time, and above all the circumstances of drowning. We report the case of a 33-year-old security guard found dead in Venice, in the water of the lagoon, who at autopsy presented a previously undiagnosed hydrocephalus with macrocephaly. The victim remained asymptomatic until 2 months before death and had never undergone a neurological or radiological examination. In the article, we emphasize the need to perform a thorough autopsy in all suspected drownings, discuss the etiopathogenesis of the neurological disease and hypothesize a possible relationship between the hydrocephalus and the drowning accident. Finally, we discuss the major clinical and forensic implications of macrocephaly and hydrocephalus in adults. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare, through scanning electron microscope (SEM), the ability of four Ni-Ti rotary instrument systems in shaping root canal walls and their ability in removing smear layer and dentin debris. Methods: Forty-six extracted single-rooted human teeth were divided into four groups and prepared to size 35 (Alpha System, FlexMaster, MFile) or 30 (NRT files). Irrigation was carried out with NaOCl and EDTA. Three parameters were evaluated in the coronal, middle, and apical thirds of the root canals: smear layer morphology, pulpal-inorganic debris presence and surface profile morphology. Data were statistically analyzed using the Kruskal-Wallis test (ANOVA). Results: None of the Ni-Ti rotary instrument systems resulted in being able to obtain constantly regular shaped surfaces in apical thirds, where smear layer, pulpal and inorganic debris were often present. Conclusions: NRT file specimens resulted in being relatively free from debris and smear layer and gained better results and scores at any canal level. [ABSTRACT FROM AUTHOR]

Meningiomas in early infancy are rare lesions, worth to be reported for their exceptional occurrence. The authors report a case of an 11-month-old female child with asymmetric macrocephaly due to the presence of a cystic atypical meningioma associated to bilateral subdural collections. Conclusion: This unusual and unique case of atypical cystic meningioma in early infancy showed a high positivity to immunostaining of aquaporin 1, and this pattern could correlate with the coexistence both of cysts and subdural collections. [ABSTRACT FROM AUTHOR]

Pseudotumor cerebri occurs quite rarely in the pediatric population and its clinical features differ from adults in many ways. Intracranial hypertension with papilledema should obviously be treated promptly to avoid permanent visual damage, but various more or less invasive options have been proposed over the years, from bariatric surgery for obesity to optic nerve sheath fenestration. We report a prospective study on a group of 15 children, aged 3–16 years, with clinical and instrumental diagnosis of pseudotumor cerebri. All the patients were treated simply by external lumbar cerebrospinal fluid drainage with a mean volume of 10 ml/h for 3–5 days, with hypocaloric diet and with appropriate dosages of acetazolamide. All had immediate relief of headache, a considerable reduction in papilledema and marked improvement of both visual loss and cranial nerve palsies within 2 months. None of the patients relapsed during the follow-up period, ranging from 12–48 months. [ABSTRACT FROM AUTHOR]

Aneurysms of the vein of Galen are uncommon vascular malformations. They are most frequently seen in infants and children, leading to heart failure and hydrocephalus. Exceptionally, they are detected in adults. Several theories have been proposed to explain hydrocephalus in these patients: obstruction of the cerebral aqueduct, impaired absorption of CSF after subarachnoid hemorrhage, passive ex-vacuo mechanism, or thrombosis of an aneurysm. Hydrocephalus has been treated mainly with cerebrospinal shunt procedures, but also direct surgery, radiosurgery and embolisation of the malformation have proved to be effective. We report the case of a partially thrombosed ectasia of the vein of Galen in a 44-year-old male, with huge hydrocephalus successfully treated with an endoscopic third ventriculostomy. [ABSTRACT FROM AUTHOR]

Abstract: Pleomorphic xanthoastrocytoma (PXA) is a rare primary low-grade astrocytic tumor, recently classified as a neuroglial tumor. It generally occurs in children and young adults and shows benign behaviour (WHO II), although an anaplastic variant and malignant potential have been described. Pleomorphic xanthoastrocytomas with malignant transformation have been reported in three out of eight patients operated on for this type of tumor in our department in the last 15 years. The three patients were two adult women and a child, the primary tumors were located in the cortex of the right temporal lobe, and treatment consisted of complete surgical resection. Histological examination revealed simple PXA in two patients and a PXA with anaplastic foci in the other. Mean recurrence time was 5.7 years, with the original xanthoastrocytoma evolving to glioblastoma in two cases and anaplastic astrocytoma in the third. All three patients underwent a second operation, followed by adjuvant therapies. Two died from tumor progression and one from brain edema after intracerebral haemorrhage. A review of the available PXA literature dating back to 1979 revealed 16 cases of primary anaplastic astrocytoma and 21 cases of PXA with malignant transformation. Our experience adds three more cases of malignant transformations, outlining once again the potential malignancy of pleomorphic xanthoastrocytomas and the fact that prognosis in these cases is the same as for primary anaplastic astrocytoma and glioblastoma. Analysis of glioneuronal markers, Ki67 and p53 in all pleomorphic xanthoastrocytomas did not prove to be a discriminating factor to identify a subgroup of xanthoastrocytomas prone to malignancy. Accordingly, these tumors demand close long-term clinical and radiological follow-up. [Copyright &y& Elsevier]

The objective of this work was to evaluate the minicutting as a vegetative propagation technique and the effect of the application of different doses of indolebutyric acid (AIB) on the rooting of minicuttings of Lecythis lanceolata. The treatments consisted of two collections of shoots, at doses of 0, 2,000, 4,000 and 8,000 mg L-1 of IBA, (factorial 2 x 4), with four replications, in a completely randomized design. The seminal mini garden of Lecythis lanceolata has the potential for the supply of minicuttings. However, adventitious rooting is low, regardless of the application of auxin. [ABSTRACT FROM AUTHOR]

The objective of this work was to evaluate the minicutting as a vegetative propagation technique and the effect of the application of different doses of indolebutyric acid (AIB) on the rooting of minicuttings of Lecythis lanceolata. The treatments consisted of two collections of shoots, at doses of 0, 2,000, 4,000 and 8,000 mg L-1 of IBA, (factorial 2 x 4), with four replications, in a completely randomized design. The seminal mini garden of Lecythis lanceolata has the potential for the supply of minicuttings. However, adventitious rooting is low, regardless of the application of auxin. [ABSTRACT FROM AUTHOR]

Gliomas of the brainstem represent a small percentage of central nervous system gliomas in adults. Due to the proximity of the tumor to critical structures, radical surgery is highly challenging and limited to selected cases. In addition, postoperative treatments, which become exclusive to non-operable patients, do not guarantee satisfactory disease control, making the progression of the disease inevitable. Currently, there is a lack of therapeutic options to control tumor growth after the diagnosis of recurrence. The rarity of these tumors, their distinct behavioral characteristics, and the limited availability of tumor tissue necessary for the development of prognostic and predictive biomarkers contribute to the absence of a standardized approach for treating recurrent brainstem gliomas. A salvage radiotherapy (RT) retreatment could represent a promising approach for recurrent brainstem gliomas. However, to date, it has been mainly evaluated in pediatric cases, with few experiences available to assess the most appropriate RT dose, safety, and clinical responses in adult patients. This comprehensive review aims to identify instances of adult patients with recurrent brainstem gliomas subjected to a secondary course of RT, with a specific focus on the analysis of treatment-related toxicity and outcomes. Through this investigation, we endeavor to contribute valuable insights into the viability and efficacy of salvage RT retreatment in managing recurrent brainstem gliomas in the adult population. [ABSTRACT FROM AUTHOR]

Our case refers to a 77 year-old man with a history of porphyria cutanea tarda (PCT) who presented with pruritic eruption consisting of erythematous papules localized in a zosteriform area on the right part of the trunk which had appeared three years previously. He gave a history of tong exposure to the sun. A biopsy showed a spongiotic pattern, dyskeratotic acantholytic cells and carp ronds in the granular layer. Diagnosis of persistent acantholytic dermatosis (Grover's disease) was made. To the best of our knowledge no case of association of PCI' and persistent Grover's disease has been previously described in the dermatologic literature. [ABSTRACT FROM AUTHOR]

Highlights `Operation Kauai,' a disaster relief simulation to illustrate the potential of disaster simulation for medical students or faculty in order to develop and assess the integration of professional competencies in medical practice. Simulation as basis for the promotion or assessment of teamwork skills and individual performance.

A letter to the editor is presented about periocular pigmentation associated with the use of travoprost for the treatment of alopecia areata of the eyelashes.

A response from the authors of the article "If it can be done, it should be done,... or not?," in the 158(4) issue is presented.

Background: The purpose of this descriptive, epidemiological study is to classify injury patterns and determine dynamics of injuries, possible causes and preventive measures. Methods: A questionnaire was filled in by 127 kite buggying enthusiasts in 17 countries. Injuries were classified by type and anatomical site. Incident causes were analysed using the Haddon matrix. Results: Injuries classified as moderate or severe (AIS score ≥ 2) were sustained by 26% of kite buggy enthusiasts. The most common incident dynamic (61.8%) was the OBE (an acronym for 'out-of-buggy experience'). Causal factors were largely equipment-related (42.3%), with remaining incidents being equally attributable to environmental and human factors. While upper and lower limbs were equally involved in incidents, the most frequently affected anatomical site was the shoulder (23%). Conclusion: Kite buggying can be considered a sport with the potential for serious injury. Injury prevention in this sport needs to be approached from several angles and should include the development and adoption of automatic release systems and shoulder guards, the establishment of formal training programs covering the subject of meteorology and the establishment of secure, designated kite buggying areas. Findings from this study are important for two reasons. First, they demonstrate the significance of understanding specific sports when considering health and safety, and second, the study provides specific data for the fast growing extreme sport of kite buggying. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the "Adult idiopathic occlusion of Monro foramina: Intraoperative endoscopic reinterpretation of radiological data and review of the literature," by C. Schonauer and colleagues in the August 2015 issue.

Background. Traditional monitoring of athletes during sports has long been hampered by bulky, complicated and tethered systems. In the past decade, this has changed due to the miniaturization of sensors and improvement of systems to store and transmit data. These systems have been integrated into textiles to create 'smart clothing' which has been so ubiquitous that a review of the recent literature is crucial for understanding its full potential and potential use in extreme sports. Methods. An electronic data base search was performed from 2003 to April 2019 for full length articles including "Smart" AND "Clothing" OR "Clothing" AND "Sport(s)" written in English with human subjects. Articles were evaluated according to the Newcastle-Ottawa Scale. Results. Twenty-four studies resulted in 18 systems comprised of 22 types of clothing with various capabilities, including: monitoring heart rate, electromyography, respiratory rate, steps, GPS, energy expenditure, posture, body temperature and identifying the activity. Conclusions. Many types of smart clothing from socks and gloves, to pants, shirts and bras are increasingly utilized to monitor sports activity worldwide and gather previously unavailable, yet highly valuable data. This provides a unique opportunity to study athletes during training and competition, potentially providing more effective training and better safety protocols. [ABSTRACT FROM AUTHOR]

Severe non-infectious or non-haemorrhagic brain edema surrounding the electrode represents a rare complication of subthalamic nucleus deep brain stimulation (STN-DBS) surgery. The aim of this study is to report three patients with advanced Parkinson's Disease (PD) who developed symptomatic brain edema after STN-DBS surgery treated with intravenous steroids with a specific profile of reversible cognitive alterations. Patients were both assessed with a comprehensive neuropsychological battery including attention, memory, visuo-spatial and executive tasks. They were also briefly assessed for emotional and behavioural alterations, and for possible limitations in the activities of daily living. Normative data for an Italian population were available for all neuropsychological tests. The patients were firstly assessed before the surgery (baseline) as soon as they became symptomatic for the post-surgery edema and a few more times in follow-up up to ten months. In all patients we observed the resolution of cognitive deficits within six months after surgery with the corresponding reabsorption of edema at brain CT scans. The appearance of post-DBS edema is a fairly frequent and clinically benign event. However, in some rare cases it can be very marked and lead to important clinical—albeit transient—disturbances. These events can compromise, at least from a psychological point of view, the delicate path of patients who undergo DBS and can prolong the post-operative hospital stay. In this setting it could be helpful to perform a brain CT scan in 2–3 days with the aim of detecting the early appearance of edema and treating it before it can constitute a relevant clinical problem. [ABSTRACT FROM AUTHOR]

Background Among the rare intraventricular cavernomas, purely intra-aqueductal cavernomas are exceptionally rare. Case Description A 62-year-old patient presented with progressive headache, memory loss, gait instability, and urinary incontinence. Magnetic resonance imaging showed the presence of a mass lesion located in the lumen of the cerebral aqueduct, associated with triventricular hydrocephalus. Conclusions We discuss the rationale that led us to treat hydrocephalus with neuroendoscopy, which offered the possibility to directly inspect the intra-aqueductal lesion, make the diagnosis of cavernoma, and treat symptoms resulting from hydrocephalus without increasing the risk of bleeding. [ABSTRACT FROM AUTHOR]

The article describes the case of a 60-year-old female patient with a history of asthenia, depression and occasional headache and vomiting, which are consistent with the diagnosis of subependymal metastasis of melanoma with intratumaral bleed after primary tumor. The diagnosis was confirmed after the patient was subjected to computed tomography (CT) and contrast magnetic resonance (MRI). A chart on cases of metastatic intraventricular melanoma is offered.

The present review aims to investigate the survival and functional outcomes in adult high-grade brainstem gliomas (BGSs) by comparing data from resective surgery and biopsy. MEDLINE, EMBASE and Cochrane Library were screened to conduct a systematic review of the literature, according to the PRISMA statement. Analysis was limited to articles including patients older than 18 years of age and those published from 1990 to September 2022. Case reports, review articles, meta-analyses, abstracts, reports of aggregated data, and reports on multimodal therapy where surgery was not the primary treatment were excluded. The ROBINS-I tool was applied to evaluate the risk of bias. Six studies were ultimately considered for the meta-analysis. The resective group was composed of 213 subjects and the bioptic group comprised 125. The analysis demonstrated a survival benefit in those patients in which an extensive resection was possible (STR HR 0.59 (95% CI 0.42, 0.82)) (GTR HR 0.63 (95% CI 0.43, 0.92)). Although surgical resection is associated with increased survival, the significantly higher complication rate makes it difficult to recommend surgery instead of biopsy for BSGs. Future investigations combining volumetric data and molecular profiles could add important data to better define the proper indication between resection and biopsy. [ABSTRACT FROM AUTHOR]

Objective: To assess the long-term effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on gait in a cohort of advanced Parkinson's Disease (PD) patients. Methods: This observational study included consecutive PD patients treated with bilateral STN-DBS. Different stimulation and drug treatment conditions were assessed: on-stimulation/off-medication, off-stimulation/off-medication, and on-stimulation/on-medication. Each patient performed the instrumented Timed Up and Go test (iTUG). The instrumental evaluation of walking ability was carried out with a wearable inertial sensor containing a three-dimensional (3D) accelerometer, gyroscope, and magnetometer. This device could provide 3D linear acceleration, angular velocity, and magnetic field vector. Disease motor severity was evaluated with the total score and subscores of the Unified Parkinson Disease Rating Scale part III. Results: Twenty-five PD patients with a 5-years median follow-up after surgery (range 3–7) were included (18 men; mean disease duration at surgery 10.44 ± 4.62 years; mean age at surgery 58.40 ± 5.73 years). Both stimulation and medication reduced the total duration of the iTUG and most of its different phases, suggesting a long-term beneficial effect on gait after surgery. However, comparing the two treatments, dopaminergic therapy had a more marked effect in all test phases. STN-DBS alone reduced total iTUG duration, sit-to-stand, and second turn phases duration, while it had a lower effect on stand-to-sit, first turn, forward walking, and walking backward phases duration. Conclusions: This study highlighted that in the long-term after surgery, STN-DBS may contribute to gait and postural control improvement when used together with dopamine replacement therapy, which still shows a substantial beneficial effect. [ABSTRACT FROM AUTHOR]