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De novo metastatic Head and Neck Squamous Cell Carcinoma (HNSCC) constitutes 10% of recurrent/metastatic (RM) cases. Radiotherapy (RT) has a crucial role in the treatment of locally advanced HNSCC, however its application on RM diseases is still limited. The advent of immune checkpoint inhibitors (ICIs) improves the survival of RM HNSCC, however median overall survival is still limited. Integration of locoregional RT with ICIs in de novo metastatic HNSCC represents a promising treatment option. This perspective aims to explore the role of the combination of locoregional and systemic treatment in improving outcomes for synchronous de novo metastatic HNSCC patients and highlights the principal crucial point in decision making., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Competing Interests: Declaration of Competing Interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Objectives: Few studies have evaluated surgical options in the treatment of cervical metastatic disease. The aim of this study is to report the surgical outcomes of patients treated with the posterior-only approach for metastatic cervical disease., Methods: In this retrospective analysis, all cases treated in our institution from 2009 to 2017 were reviewed. Six (20%) patients had intracompartimental lesions (Tomita 1-3), whereas 24 (80%) patients had extracompartimental lesions (Tomita 4-7), with extensive anterior column involvement. All patients were surgically treated with laminectomy and posterior stabilization. Pain and neurologic function were evaluated before and after surgery., Results: Thirty patients were included (15 female, 15 male), with a mean age of 60.6 ± 11.56 years (range 35-82 years). Lesions were located in 7 patients (23.3%) in the upper cervical spine and in 14 patients (46.6%) and in 9 patients (30,1%) in the mid-cervical and in the cervicothoracic junction, respectively. At a mean follow up of 13.7 ± 14.8 months, 15 (50%) patients died from their disease. Pain decreased in all patients after surgery, (preoperative NRS 5.57 ± 1.81 postoperative Numeric Rating Scale of 2.1 ± 1.0, P < 0.00001). Two patients (6.7%) had significant neurologic worsening after surgery. Two (6.9%) patients had surgical-site infection that required reintervention. No mechanical failures were observed., Conclusions: In our series, posterior-only fixation provided postoperative pain relief and achieve spinal stability, ultimately improving the quality of life. In conclusion, posterior-approach decompression and stabilization is a safe and feasible procedure in patients with neurologic or mechanical instability for cervical spine metastasis., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The best treatment strategy for infected osteosyntheses is still debated. While hardware removal or eventually early device exchange may be necessary in most of the cases, temporary hardware retention until fracture healing can be a valid alternative option in others. Aim of the present study is to report the long-term results of 215 patients with infected osteosyntheses, treated according to the ICS (Infection, Callus, Stability) classification in two Italian hospitals. Patients classified as ICS Type 1 (N = 83) feature callus progression and hardware stability, in spite of the presence of infection; these patients were treated with suppressive antibiotic therapy coupled with local debridement in 18.1% of the cases, and no hardware removal until bone healing. Type 2 patients (N = 75) are characterized by the presence of infection and hardware stability, but no callus progression; these patients were treated as Type 1 patients, but with additional callus stimulation therapies. Type 3 patients (N = 57), showing infection, no callus progression and loss of hardware stability, underwent removal and exchange of the fixation device. Considering only the initial treatment, performed according to the ICS classification, at a minimum 5 years follow up, 89.3% achieved bone healing and 93.5% did not show infection recurrence. The ICS classification appears as a useful and reliable tool to help standardizing the decision-making process in treating infected osteosynthesis with the most conservative approach., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: The induced membrane technique (IMT) or Masquelet technique, is a two-step surgical procedure used to treat pseudoarthroses and bony defects. Many authors have introduced variants to the technique. This study aims to compare the surgical variants of IMT and to evaluate its efficacy in achieving infection eradication and bone union., Methods: A systematic review was carried out following the PRISMA guidelines. PubMed and other medical databases were explored using keywords "Masquelet technique" and "induced membrane technique". Articles were included if written in English, French or Italian, dealing with IMT employed to long bones in adults, reporting at least 5 cases with a 12 months-mean follow-up. Patients' clinical features, bone defect features, aetiologies, surgical data, complications, reinterventions, union rates and infection eradication rates were searched. Fischer's exact test, chi-square test and unpaired t-test were used for the statistical analysis on the individual patient's data., Results: Seventeen papers met the inclusion criteria (427 patients). Among these, only 10 studies reported individual patient's data (137 cases). The union rate was 89.7% and the infections rectified in 91.1% of cases. The bone defect length ranged from 0.6 to 26 cm. The main complications were superficial (21; 4.9%) and deep surgical site infections (19; 4.4%), failure of one of the IMT steps (persistence of infections or non unions, 77, 18%), with subsequent requirement for further surgery. The surgical variants included the use of antibiotic-coated spacers, internal fixation during the first step, use of Reamer-Irrigator-Aspirator technique, iliac crest grafting, bone substitutes and growth factors. However, univariate analysis only showed a positive correlation of the need for reinterventions with poorer bone union rates (p = 0.005) and complications (p <0.001), while patients undergoing IMT because of bone infections had a higher risk of surgical complications (p <0.001)., Discussion: IMT aims to achieve bone union and infection eradication, but persistence of infection or non-union was noted in 18% of cases necessitating re-interventions. This may be related to the different anatomical sites that the technique has been applied and different local and patient related conditions. We believe the choice of a surgical technique to achieve union should be tailored to the individual patient's needs. This systematic review was limited by the few studies meeting our inclusion criteria, and their high variability in data reporting, making it impossible to undertake a meta-analysis., Conclusion: Further studies are needed to demonstrate the role the patients' clinical features and IMT variants have upon achieving bone union and infection eradication., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The extracts of four rare plants found on the islands of Sicily, Vulcano and Marettimo, Southern Italy, were screened for their inhibitory effect on the production of leukotriene B4 by 5-lipoxygenase in intact cells. The methanol extracts of pods of Cytisus aeolicus and aerial parts of Thymus richardii were the most active extracts, inhibiting almost completely the leukotriene B4 production at 200 and 50 microg/ml, respectively.

A new kaurane diterpene dimer, 15-oxozoapatlin-13alpha-yl-10'alpha,16'alpha-dihydroxy-9'alpha-methyl-20'-nor-kauran-19'-oic acid gamma-lactone-17'-oate (1), together with the known 13-hydroxy-15-oxozoapatlin (2), 10alpha,13alpha,16alpha,17-tetrahydroxy-9alpha-methyl-15-oxo-20-nor-kauran-19-oic acid gamma-lactone (3), 2alpha,10alpha,13alpha,16alpha,17-pentahydroxy-9alpha-methyl-15-oxo-20-nor-kauran-19-oic acid (19,10)-lactone (4), 3alpha,10alpha,13alpha,16alpha,17-pentahydroxy-9alpha-methyl-15-oxo-20-nor-kauran-19-oic acid gamma-lactone (5), and 1beta,16alpha,17-trihydroxy-ent-kaurane (6) were isolated from the leaves of Parinari campestris and identified on the basis of detailed spectral analysis, including 2D NMR spectrometry and ESI-MS.

Twenty-seven new pregnane glycosides were isolated from the whole plant of Caralluma dalzielii, and their structures elucidated from extensive 2D NMR analysis as well as ESI-MS experiments. All isolated compounds were tested for their antiproliferative activity on J774.A1, HEK-293, and WEHI-164 cell lines. Moderate to high potency of cytotoxicities were found in almost all tested compounds, confirming the significant cytotoxic activity of pregnane glycosides.

The essential oils obtained from fifteen relevant and commonly used plants belonging to Cruciferae, Lamiaceae, Lauraceae, Apiaceae, and Zingiberaceae were screened using an in vitro model of peroxynitrite-induced tyrosine nitration. Almost complete inhibition of 3-nitrotyrosine formation (91% at 300 microg/ml) was achieved only with the essential oil obtained from the leaves of Laurus nobilis. 1,8-Cineol, accounting for a 50% of this essential oil, which resulted as inactive in this model, thus evidencing a major role for the minor volatile compounds present in the leaves.

The pyrrolizidine alkaloid (PA) content of flowers, leaves, and roots of Anchusa strigosa (Boraginaceae) was analysed by ESI-LC-MS. Six PAs, including two new natural compounds, were detected, characterized by NMR spectroscopy, and quantified in each plant organ. The results indicated that the highest total concentration of PAs was in the leaves (23.63 mg/g of dried part), followed by the flowers (19.77 mg/g), and finally by the roots (1.80 mg/g). All PAs isolated were subjected to Spodoptera exigua and Pieris brassicae larvae. Feeding activity by both herbivore species using a bioassay was inhibited up to circa 75% depending on PA and applied concentration.

1,5-Anhydroxylitol, a compound never found previously in the vegetal kingdom was obtained from Olea europaea leaves in approximately 0.5-1% yield.

Phytochemical analysis of the polar extracts of the leaves of Helleborus viridis (Ranunculaceae) resulted in the isolation of two new furostanol saponins (25R)-26-[(alpha-L-rhamnopyranosyl)oxy]-22alpha-methoxyfurost-5-en-3beta-yl O-beta-D-glucopyranosyl-(1-->3)-O-[6-acetyl-beta-D-glucopyranosyl-(1-->3)]-O-beta-D-glucopyranoside (1) and (25R)-26-[(alpha-L-rhamnopyranosyl)oxy]-22alpha-methoxyfurost-5-en-3beta-yl O-beta-D-glucopyranosyl-(1-->3)-O-beta-D-glucopyranosyl-(1-->3)-O-beta-D-glucopyranoside (2) and three new quercetin glycosides, quercetin 3-O-(2-E-caffeoyl)-alpha-L-arabinopyranosyl-(1-->2)-beta-D-galactopyranoside-7-O-beta-d-glucopyranoside (3), quercetin 3-O-(2-E-caffeoyl)-alpha-L-arabinopyranosyl-(1-->2)-beta-D-galactopyranoside (4), and quercetin 3-O-alpha-L-arabinopyranosyl-(1-->2)-beta-D-galactopyranoside (5). The structures of the new compounds were determined by spectroscopic analysis, including 2D NMR data and mass spectrometry.

A new acylated quercetin glycoside, quercetin 3-O-(2-t-p-coumaroyl)-beta-D-glucopyranosyl-(1-->2)-beta-D-glucopyranoside-7-O-beta-D-glucopyranoside (1), together with the known 3-(3,4-dihydroxyphenyl)lactic acid (2) were isolated from Ranunculus lanuginosus leaves and identified on the basis of detailed spectral analysis, including 2D-NMR spectrometry and ESI-MS.

Two new acylated flavone glycosides, chrysin 7-(6"-O-acetyl)-O-beta-D-glucopyranoside (1) and chrysin 7-(4"-O-acetyl)-O-beta-D-glucopyranoside (2) were isolated from the aerial parts of Calicotome villosa, along with 17 known flavonoids and one triterpene.

The isolation of five flavonol glycosides (1-5) from the flowers of Aconitum vulparia is reported, together with the 1H- and 13C-NMR spectral data in CD(3)OD of compound 3 and 5.

The volatiles emitted by fresh whole flowers or isolated flower parts of mandarin, Citrus deliciosa Ten. (Rutaceae), were sampled using solid-phase micro-extraction (SPME). This technique offers several advantages over dynamic headspace sampling techniques used in previous investigations. In particular, SPME requires smaller sample sizes and very short sampling times, which can minimize the formation of artifacts due to damage to the plant, and contaminations or loss of compounds. This was especially applicable to the collection of volatiles from pollen.

Two new megastigmane glycosides (1 and 2) and two new flavone glycosides (3 and 4) were isolated from the methanol extract of the whole plant of Caralluma negevensis Zohary (Asclepiadaceae). The structures of the isolated compounds were characterized as (9R)-2beta,9-dihydroxymegastigma-4,7-dien-3-one-9-O-alpha-L-rhamnopyranosyl-(1-->6)-beta-D-glucopyranoside (1), 2beta,9-dihydroxymegastigma-4-en-3-one 9-O-alpha-L-rhamnopyranosyl-(1-->6)-beta-D-glucopyranoside (2), luteolin 3'-O-beta-D-glucopyranoside-4'-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-glucopyranoside (3), and luteolin 3',4'-di-O-beta-D-glucopyranoside (4). The structures of the isolated compounds were established on the basis of spectral evidence and chemical transformation., (Copyright 2003 Elsevier Science Ltd.)

Three flavonoid glycosides were isolated and characterized, together with a further 13 substances belonging to various classes of compounds, in particular two phenolic acids, a coumarin, a sugar and nine flavonoids from the flowered aerial parts of Centaurea pseudoscabiosa subsp. pseudoscabiosa Boiss. et Buhse (Asteraceae). Some considerations about their evolutionary meaning are provided.

The antimicrobial and antifungal properties of several crude extracts and pure saponins, astraverrucins I-VI, from the aerial parts of Astragalus verrucosus were investigated by the disc diffusion method. Antimycotic activity was observed on more polar extracts, but only one saponin showed an appreciable activity.

From the aerial parts of Rubus ulmifolius Schott three new anthrones, rubanthrone A, B and C, have been isolated. Their structures were established by spectral procedures including 1D and 2D NMR techniques and chemical derivatization. Rubanthrone A showed antimicrobial activity against Staphylococcus aureus at 4.5 mg/ml.

The roots of Centaurea bracteata Scop. (Asteraceae) have been studied for the first time. Twenty-three compounds were isolated and identified, namely a sterol glucoside, two quinic acid derivatives, one sugar, and 19 flavonoids (five sulphates), one of which, centaradixin, resulted in a new natural product. Structural elucidation was performed mainly by means of FABMS, 1D and 2D NMR spectroscopy. NMR data of some sulphate flavonoids are reported for the first time.

Three flavonol glycosides quercetin 7-O-(6-trans-caffeoyl)-beta-glucopyranosyl-(1-->3)-alpha-rhamnopyranoside-3-O-beta-glucopyranoside (1), kaempferol 7-O-(6-trans-caffeoyl)-beta-glucopyranosyl-(1-->3)-alpha-rhamnopyranoside-3-O-beta-glucopyranoside (2), and kaempferol 7-O-(6-trans-p-coumaroyl)-beta-glucopyranosyl-(1-->3)-alpha-rhamnopyranoside-3-O-beta-glucopyranoside (3), together with the known beta-3,4-dihydroxyphenethyl beta-glucopyranoside, were isolated from the flowers of Aconitum napellus subsp. neomontanum. Their structures were elucidated by spectroscopic methods, including 2D NMR spectral techniques.

Nine triterpenoids with lupane, oleanane, and ursane skeleton have been isolated and characterized from the leaves of Licania licaniaeflora. The structural identification was based on (1)H and (13)C-NMR spectral data.

The flowering aerial parts of Centaurea bracteata Scop. (Asteraceae) have been studied for the first time. Nineteen compounds were isolated and identified, namely a sterol glucoside, two phenolic acids, three quinic acid derivatives, and 13 flavonoids, two of which, are new natural products. Structural elucidation was performed mainly by mean of FABMS, 1D and 2D NMR spectroscopy.

A new phenolic ester has been isolated from the seeds of Nigella damascena and the structure was established as 1-O-(2,4-dihydroxy)phenylacetyl glycerol (1) by 1H and 13C-NMR spectral data and EI-MS analysis.

Dried leaves of Licania densiflora yielded five myricetin glycosides: myricetin 3'-methylether-3-O-glucoside (1), myricetin 3'-methylether-3-O-galactoside (2), myricetin 4'-methylether-3-O-rhamnoside (3), myricetin 3',5'-dimethylether-3-O-glucoside (4), and myricetin 3',5'-dimethylether-3-O-rhamnoside (5). Their structures were elucidated by spectroscopic methods including mono- and bi-dimensional NMR techniques.

The antimicrobial activity of the n-hexane (H) and chloroform (C) extracts, the methanol extract (M) and its ethyl acetate (E) and n-butanol (B) fractions, and six isolated constituents of the aerial parts of Hypericum hircinum was investigated using an agar diffusion method. The maximum activity was exhibited by the methanolic extract against Staphylococcus aureus, while all pure constituents showed no antimicrobial activity against the tested microorganisms.

Extracts of increasing polarity of 6 Venezuelan plants belonging to the Chrysobalanaceae family were tested for possible letal toxicity against Biomphalaria glabrata Say, a snail intermediate hosts of Schistosoma mansoni Sambon. The piscicidal toxicity of the active extracts was also evaluated with the aim of findings compounds without toxicity in nontarget organisms, principally fishes and humans.

A new triterpenoid saponin, 23-acetoxy,16 alpha-hydroxy-13,28-epoxyolean-11-en-3 beta-yl--beta-D-glucopyranosyl- (1-->2)---beta-D-glucopyranosil(1-->3)-beta-D-fucopyranoside, has been isolated from the roots of Bupleurum fruticosum, along with eight coumarins, scopoletin, scoparone, prenyletin, capensin, fraxetin, aesculetin,7-(3-methyl-2-butenyloxy-6-methoxycoumarin, 7-(2-hydroxy-3-methyl-3-butenyloxy)-6-methoxycoumarin and 5,7-dihydroxy-6-methoxy-8-(3-methyl-2-butenyl)coumarin. The last compound has not been previously encountered in nature. The structures were determined by analysis of NMR spectral data including two-dimensional techniques.

Two new flavonoids, 5,8-dihydroxy-4'-methoxy-6,7-methylenedioxyisoflavone and carthamidin-7-O-alpha-L-rhamnopyranoside and a new triterpenoid saponin, 3 beta,16 beta,22 beta,24-tetrahydroxy-olean-12- ene-3-beta-yl-]beta-D-glucopyranosyl (1-->2)]-alpha-L-rhamnopyranoside (junceoside), were isolated from Spartium junceum. Their structures were elucidated by means of IR, UV, MS, 1H, 13C NMR, 13C NMR DEPT and 2D NMR experiments. Apigenin-7-O-beta-D-glucopyranoside and genistein-8-C-beta-D-glucopyranoside, never previously found in this plant, were also isolated.