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BackgroundCraniosynostosis is a type of skull deformity caused by premature ossification of cranial sutures in children. Given its variability and anatomical complexity, three-dimensional visualization is crucial for effective teaching and understanding. We developed a VR database with 3D models to depict these deformities and evaluated its impact on teaching efficiency, motivation, and memorability.MethodsWe included all craniosynostosis cases with preoperative CT imaging treated at our institution from 2012 to 2022. Preoperative CT scans were imported into SpectoVR using a transfer function to visualize bony structures. Measurements, sub-segmentation, and anatomical teaching were performed in a fully immersive 3D VR experience using a headset. Teaching sessions were conducted in group settings where students and medical personnel explored and discussed the 3D models together, guided by a host. Participants’ experiences were evaluated with a questionnaire assessing understanding, memorization, and motivation on a scale from 1 (poor) to 5 (outstanding).ResultsThe questionnaire showed high satisfaction scores (mean 4.49 ± 0.25). Participants (n = 17) found the VR models comprehensible and navigable (mean 4.47 ± 0.62), with intuitive operation (mean 4.35 ± 0.79). Understanding pathology (mean 4.29 ± 0.77) and surgical procedures (mean 4.63 ± 0.5) was very satisfactory. The models improved anatomical visualization (mean 4.71 ± 0.47) and teaching effectiveness (mean 4.76 ± 0.56), with participants reporting enhanced comprehension and memorization, leading to an efficient learning process.ConclusionEstablishing a 3D VR database for teaching craniosynostosis shows advantages in understanding and memorization and increases motivation for the study process, thereby allowing for more efficient learning. Future applications in patient consent and teaching in other medical areas should be explored.

Abstract Indigenous Peoples and local communities with nature-dependent livelihoods are disproportionately affected by climate change impacts, but their experience, knowledge and needs receive inadequate attention in climate research and policy. Here, we discuss three key findings of a collaborative research consortium arising from the Local Indicators of Climate Change Impacts project. First, reports of environmental change by Indigenous Peoples and local communities provide holistic, relational, placed-based, culturally-grounded and multi-causal understandings of change, largely focused on processes and elements that are relevant to local livelihoods and cultures. These reports demonstrate that the impacts of climate change intersect with and exacerbate historical effects of socioeconomic and political marginalization. Second, drawing on rich bodies of inter-generational knowledge, Indigenous Peoples and local communities have developed context-specific responses to environmental change grounded in local resources and strategies that often absorb the impacts of multiple drivers of change. Indigenous Peoples and local communities adjust in diverse ways to impacts on their livelihoods, but the adoption of responses often comes at a significant cost due to economic, political, and socio-cultural barriers operating at societal, community, household, and individual levels. Finally, divergent understandings of change challenge generalizations in research examining the human dimensions of climate change. Evidence from Indigenous and local knowledge systems is context-dependent and not always aligned with scientific evidence. Exploring divergent understandings of the concept of change derived from different knowledge systems can yield new insights which may help prioritize research and policy actions to address local needs and priorities.

Positional plagiocephaly is a deformational cranial flattening frequently treated in pediatric neurosurgical practice. Positional maneuvers and orthotic helmet therapy are preferred therapeutic options for moderate-to-severe forms. Treatment response seems to be age-dependent. Nevertheless, predictive data are vague, and cost-efficiency might be a limiting factor for treatment. The purpose of this study was to investigate the early predictive value of sonographic parameters on the efficacy of orthotic helmet therapy through the assessment of changes in skull shape and correlation of the parameters with caliper cephalometry values and with age. A consecutive cohort of 49 patients < 10 months of age, undergoing orthotic helmet therapy for positional plagiocephaly, was recruited prospectively. The authors routinely assessed the patency of the lambdoid sutures by ultrasound and the following additional skull parameters were measured: suture width, adjacent full bone thickness, adjacent cortical bone thickness and occipital angle. Caliper cephalometric values, as well as demographic and clinical data were collected. Retrospective data analysis showed an inverse relation between both cortical and full skull bone thickness and early treatment efficacy, defined by a reduction in the occipital angle. The improvement of sonographic parameters correlated with the development of cranial caliper cephalometry values. In conclusion, the sonographic assessment of skull bone thickness is a safe and cost-effective tool to predict the early efficacy of orthotic helmet therapy in positional plagiocephaly and might, therefore, help the clinician to foresee the potential evolution of the deformity.

Benign paroxysmal positional vertigo (BPPV) is the peripheral vestibular disorder that is most frequently encountered in routine neuro-otological practice. Among the three semicircular canals, the lateral semicircular canal (LSC) is the second most frequently interested in the pathological process. In most cases, LSC BPPV is attributable to a canalithiasis or cupulolithiasis mechanism. The clinical picture of LSC BPPV is that of positional nystagmus and vertigo evoked by turning the head from the supine to the side lateral position. With such a movement, a horizontal positional (and often also paroxysmal) direction-changing nystagmus is generated. Depending on whether the pathogenetic mechanism is that of canalithiasis or cupulolithiasis and depending on where the dense particles are located, LSC BPPV direction-changing positional nystagmus is geotropic or apogeotropic on both lateral sides. Due to its mechanical nature, BPPV is effectively treated by means of physical therapy. In the case of a LSC BPPV, one of the most effective therapies is the forced prolonged position (FPP), in which the patient is invited to lie for 12 h on the lateral side on which vertigo and nystagmus are less intense, to move the canaliths out from the canal (or to shift them inside of the canal from one tract to another) exploiting the force of gravity. Despite its efficacy, FPP is not always well tolerated by every patient, and it cannot be done during the diagnostic session because of its duration. The present study aimed to verify the efficacy of a different forced position, shortened forced position (SFP), with respect to the original FPP. SFP treatment would allow patients to more easily bear the forced position and physicians to control the outcome almost immediately, possibly enabling them to dismiss patients without vertigo. After 1 h of lying on the side where vertigo and nystagmus are the less intense, 38 out of 53 (71.7%) patients treated with SFP were either healed or improved. Although the outcomes are not as satisfying as those of the original FPP, SFP should be considered as a therapeutic prospect, especially by those physicians who work in collaboration with emergency departments or otherwise encounter acute patients to cure them of vertigo as soon as possible.

Positional plagiocephaly is a deformational cranial flattening frequently treated in pediatric neurosurgical practice. Positional maneuvers and orthotic helmet therapy are preferred therapeutic options for moderate-to-severe forms. Treatment response seems to be age-dependent. Nevertheless, predictive data are vague, and cost-efficiency might be a limiting factor for treatment. The purpose of this study was to investigate the early predictive value of sonographic parameters on the efficacy of orthotic helmet therapy through the assessment of changes in skull shape and correlation of the parameters with caliper cephalometry values and with age. A consecutive cohort of 49 patients < 10 months of age, undergoing orthotic helmet therapy for positional plagiocephaly, was recruited prospectively. The authors routinely assessed the patency of the lambdoid sutures by ultrasound and the following additional skull parameters were measured: suture width, adjacent full bone thickness, adjacent cortical bone thickness and occipital angle. Caliper cephalometric values, as well as demographic and clinical data were collected. Retrospective data analysis showed an inverse relation between both cortical and full skull bone thickness and early treatment efficacy, defined by a reduction in the occipital angle. The improvement of sonographic parameters correlated with the development of cranial caliper cephalometry values. In conclusion, the sonographic assessment of skull bone thickness is a safe and cost-effective tool to predict the early efficacy of orthotic helmet therapy in positional plagiocephaly and might, therefore, help the clinician to foresee the potential evolution of the deformity. [ABSTRACT FROM AUTHOR]

Introduction: Sinonasal intestinal-type adenocarcinomas (ITACs) are rare and aggressive tumors, closely related to professional exposure to wood dusts or leather. Here we explored the role of non-coding RNAs controlling MUC2 in liquid biopsies and tumors from ITAC patients with the aim of identifying biomarkers and molecular mechanisms to improve early diagnosis, prognosis, and therapeutic approaches for this rare cancer. Methods: MiR-34c-3p, lncRNA AF147447 and MUC2 were measured in tumors and normal mucosa, in nasal washings (NW) from the affected and non-affected nostril and in plasma from 17 ITAC patients. The Apparent Diffusion Coefficient (ADC) was also evaluated by Magnetic Resonance Imaging. Results: MiR-34c was higher in ITACs compared to the corresponding normal mucosa (p = 0.021). Differentiated tumors exhibited higher miR-34c levels (p = 0.025) and lower ADC values (p

(1) Background: The treatment of recurrent early glottic cancer (rEGC) remains challenging. We wanted to investigate how the oncological outcomes are affected by the initial and recurrent stages, in order to propose our newly developed Same–Up–Down (SUD) staging system. (2) Methods: In our cohort of 258 rEGC patients, we retrospectively assessed the prognostic performances of the rTNM (the TNM staging system for recurrence), CLRSS, CLRSS-2, and SUD staging systems by univariate and multivariate Cox analysis, comparing their predictive capability using Harrell’s C-index. (3) Results: The SUD classification satisfactorily predicted both overall survival (p = 0.022) and second-recurrence-free survival (p = 0.024, as same + down vs. upstage) in our cohort. It also outperformed the other three systems in terms of prediction of survival, with an improvement of 1.52%, 1.18%, and 3.96% in the predictive capacity of overall survival, disease-specific survival, and second-recurrence-free survival, respectively. (4) Conclusions: The SUD staging system can efficiently predict survival in rEGC patients, whose prognosis heavily depends on both the initial and recurrent locoregional extension.

The association of small lymphocytic lymphoma/chronic lymphocytic leukaemia (CLL) with different malignancies has been reported in the literature. Also the occurrence of a second haematological disease has been described, more frequently as a secondary event in patients receiving chemotherapeutic agents. We report a case of CLL with concurrent acute myeloid leukaemia in an untreated patient, with emphasis on the need of a detailed immunomorphological study to identify the coexistence of the two diseases in the same pathological tissue.

Summary: Stress adaptation is essential for neuronal health. While the fundamental role of mitochondria in neuronal development has been demonstrated, it is still not clear how adult neurons respond to alterations in mitochondrial function and how neurons sense, signal, and respond to dysfunction of mitochondria and their interacting organelles. Here, we show that neuron-specific, inducible in vivo ablation of the mitochondrial fission protein Drp1 causes ER stress, resulting in activation of the integrated stress response to culminate in neuronal expression of the cytokine Fgf21. Neuron-derived Fgf21 induction occurs also in murine models of tauopathy and prion disease, highlighting the potential of this cytokine as an early biomarker for latent neurodegenerative conditions. : Restelli et al. show that deletion of mitochondrial fission protein Drp1 in adult mouse neurons activates multiple stress-sensing pathways. These converge on the integrated stress response, resulting in neuron-specific expression of metabolic cytokine Fgf21. Cerebral induction of Fgf21 also occurs in mechanistically independent mouse models of protein misfolding-associated neurodegeneration. Keywords: Alzheimer’s disease, autophagy, biomarker, endoplasmic reticulum, heme, metabolism, mitochondria, neurodegeneration, tau, unfolded protein response

Background: Pharyngocutaneous fistula (PCF) is a frequent complication after total laryngectomy, with an incidence of up to 65%. Many conservative or invasive approaches are available and the choice among them is usually made on a case-by-case basis. The aim of the present review is to critically summarize the available evidence of the effectiveness of the non-surgical management of PCF. Methods: A systematic review and a meta-analysis of the literature were conducted, according to the PRISMA guidelines. Studies investigating botulinum toxin therapy, scopolamine transdermal patch, hyperbaric oxygen therapy (HBOT), and negative pressure wound therapy (NPWT) were assessed. Complete fistula closure after the initiation of non-surgical treatment was the main outcome. Results: After the application of selection criteria, a total of seven articles and 27 patients were included in the present review. All the eligible studies were descriptive case series, while only one article used a standard group as a comparison. The mean age was 63.3 and 14 patients (51.9%) had previously received RT. The reported comorbidities were diabetes, ischemic heart disease, hypertension, dyslipidemia, COPD, and atrial fibrillation. With a mean healing time of 25.0 days, the overall success rate was 92.6%. Conclusions: Non-surgical treatment of PCF is only based on the experience of small series. Although success rates seem promising, the absence of properly designed comparative studies does not allow us, at present, to identify ideal candidates for these non-invasive management strategies for PCF.

The development of minimally invasive neuroendoscopy has advanced in recent years. The introduction of the neuroendoscopic ultrasonic aspirator (NUA) broadened the treatment spectrum of neuroendoscopy. We aim to describe our experience with the use of NUA for the resection of intraventricular lesions. Here, we present consecutive retrospective case series of adult and pediatric patients undergoing resection of an intraventricular lesion with a NUA (Endoscopic Neurosurgical Pen, Söring GmbH, Quickborn, Germany) between January 2019 and April 2020. Eight patients between the age of 0.5 and 73 years underwent surgery using NUA and were included in this study. In four patients, an endoscopic assisted (EA) resection of the lesion was undertaken, while in four patients, the lesion was removed using purely endoscopic (PE) resection. In all cases, gross/near total resection was achieved. The average blood loss was 142.5 ± 90.4 mL (range 50–300 mL). Transient morbidity was seen in four patients (50%), while permanent morbidity or mortality did not occur. The NUA seems to be a safe and valuable tool for the minimally invasive resection of intraventricular lesions in selected cases. The type, size, consistency, and vascularization of the lesion limit at times the purely endoscopic use of the NUA.

Vegetation in freshwater and coastal ecosystems modifies flows, retains sediment, protects banks and shorelines from erosion. Hydraulic laboratory studies with live vegetation or artificial plant mimics, or numerical models with abstracted patches, are often used to quantify the effects of vegetation on water flow and sedimentation. However, the choice of plant and patch characteristics is often not supported by field observations of patch dimensions, density or spacing between consecutive patches. The discrepancy between plants in natural conditions and in flume experiments or numerical studies may affect the relevance of these findings for natural ecosystems. In this study, we provide guidelines for building realistic vegetation patches in hydraulic studies. We collected data on four species of fully submerged freshwater aquatic macrophytes that can grow into well-defined patches. We considered three relevant levels: individual plants (inside patches), isolated patches and multiple neighbouring patches. At the plant level, we observed significant differences in biomechanical traits (Young's modulus, flexural stiffness), resulting in stem Cauchy numbers ranging from 85.25 to 325.84, and leaf Cauchy numbers from 163.81 to 2003.97. At the patch level, we found significant relationships between patch length, width and height, showing covariation among different patch characteristics. The relationships among patch dimensions differed significantly among sampling sites for three of the four species, suggesting high intraspecific variability in patch sizes. By providing a first set of guidelines for choosing correct and ecologically relevant plant characteristics, this dataset aims to improve our understanding of the complex processes occurring inside and around submerged vegetated patches. [ABSTRACT FROM AUTHOR]