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Uncovering the underdrawings (UDs), the preliminary sketch made by the painter on the grounded preparatory support, is a keystone for understanding the painting's history including the original project of the artist, the pentimenti (an underlying image in a painting providing evidence of revision by the artist) or the possible presence of co-workers' contributions. The application of infrared reflectography (IRR) has made the dream of discovering the UDs come true: since its introduction, there has been a growing interest in the technology, which therefore has evolved leading to advanced instruments. Most of the literature either report on the technological advances in IRR devices or present case studies, but a straightforward method to improve the visibility of the UDs has not been presented yet. Most of the data handling methods are devoted to a specific painting or they are not user-friendly enough to be applied by non-specialized users, hampering, thus, their widespread application in areas other than the scientific one, e.g., in the art history field. We developed a computer-assisted method, based on principal component analysis (PCA) and image processing, to enhance the visibility of UDs and to support the art-historians and curators' work. Based on ImageJ/Fiji, one of the most widespread image analysis software, the algorithm is very easy to use and, in principle, can be applied to any multi- or hyper-spectral image data set. In the present paper, after describing the method, we accurately present the extraction of the UD for the panel "The Holy Family with St. Anne and the Young St. John" and for other four paintings by Luini and his workshop paying particular attention to the painting known as "The Child with the Lamb". [ABSTRACT FROM AUTHOR]

Background: Hamstring diseases are one of the most widespread diseases in athletes, especially in runners, sprinters, and endurance athletes. Notwithstanding the importance of the problem, risk factors are still marginally known. This transversal study analyzes the correlation between hamstring tendinopathy and hamstring strains and age, gender, weight, height, number of marathons, and impact profile in athletes who took part in the 2019 Rome Marathon., Methods: At the 2019 Marathon of Rome, 700 runners (484 males and 216 females; mean age: 43.6 years, range 17-80 years) filled the VISA-H and FASH questionnaires. an adequately skilled orthopedic surgeon made a diagnosis of hamstring tendinopathy and hamstring strain injuries in line with clinical criteria., Results: A diagnosis of hamstring tendinopathy was made in 537 participants while in 624 of hamstring strains. There was evidence of a positive correlation statistically significant between age, weight and impact profile with hamstring strain injuries, while there was no association between sex and number of marathons and the hamstring strains. No statistically significant positive correlation was found between all of the parameters analyzed and VISA-H. The association between VISA-H score and FASH score has resulted statistically significant., Conclusions: In marathon athletes, there was not found evidence of a statistically significant correlation between gender, weight, height, number of marathons, impact profile and hamstring tendinopathy. Nonetheless, age, weight and impact profile were associated with hamstring strains, while sex and number of marathons had not shown statistically significant positive association with hamstring strain injuries.

A multicenter, nonrandomized, prospective, controlled study was conducted to evaluate, as perioperative prophylactic treatment, the anti-infective effectiveness of 0.66% povidone-iodine eye drops (IODIM ® ) against the bacterial flora of the conjunctival surface of patients who undergo cataract surgery. Eye drops containing 0.66% povidone-iodine were applied to the eye undergoing cataract surgery; the untreated contralateral eye was used as control. One hundred and twenty patients set to receive unilateral cataract surgery were enrolled in 5 Italian Ophthalmology Centers and pretreated for three days with 0.66% povidone-iodine eye drops. The contralateral eye, used as control, was left untreated. Conjunctival swabs of both eyes were collected at the baseline visit and after three days of treatment, just before the cataract surgery. A qualitative and quantitative microbiological analysis of bacterial presence was evaluated by means of bacterial culture, followed by identification. Methicillin resistance determination was also performed on staphylococci isolates. Bacterial load before and after treatment of the eye candidate for cataract surgery was evaluated and compared to the untreated eye. A reduction or no regrowth on the culture media of the bacterial load was observed in 100% of the study subjects. A great heterogenicity of bacterial species was found. The 0.66% povidone-iodine eye drops, used for three days prior to cataract surgery, were effective in reducing the conjunctival bacterial load. The 0.66% povidone-iodine eye drops (IODIM ® ) might represent a valid perioperative prophylactic antiseptic adjuvant treatment to protect the ocular surface from microbial contamination in preparation of the surgical procedure.

Background/objective: This study aimed to investigate the visual performance of a new extended depth-of-focus intraocular lens (EDOF-IOL)., Subjects/methods: In this multicenter, prospective, observational study, we enrolled 97 patients who underwent cataract surgery or refractive lens exchange with implantation of the Mini Well EDOF-IOL (SIFI, Italy). Patients underwent postoperatively the following examinations between 4 and 8 weeks after surgery: corrected distance visual acuity (CDVA), reading speed with Radner's chart, distance-corrected near visual acuity (DCNVA), defocus curve, contrast sensitivity, and haloes quantitative assessment., Results: In the whole sample, the mean monocular CDVA and DCNVA were, respectively, 0.02 ± 0.07 logMAR and 0.38 ± 0.15 logRAD (logarithm of the reading acuity determination). In the 67 bilaterally implanted patients, binocular CDVA and DCNVA were better (0.00 ± 0.05 logMAR and 0.26 ± 0.13 logRAD) than the corresponding monocular values (p = 0.02 and p = 0.0002, respectively). Ninety-two percent of patients bilaterally implanted reached a binocular reading speed >80 words per minute at a 0.5 logRAD print size (corresponding to the common book print size). The defocus curves showed that the EDOF-IOL provided increased depth of focus through 2.0 D of defocus, with the best performance at 1.0 and 1.5 D. Contrast sensitivity was within normal limits at all spatial frequencies. The mean visual disturbance index was 0.08 ± 0.12, suggesting low night visual disturbances., Conclusions: The new EDOF-IOL provided good visual acuity for distance, intermediate, and near vision, with no loss of contrast sensitivity and low risk of night visual disturbances.

With the advent of the molecularly targeted therapies, identifying molecular therapeutic targets and molecolar marker is increasingly important, especially in neoplastic diseases. Several studies show VEGF is involved in neo-angiogenesis in many solid cancers, as breast, lung, renal, gastric carcinomas, through promoting endothelial cell growth and migration. Conversely the relationship between VEFG and tumours of the musculoskeletal system is yet unclear, in particular the role of VEGF has not yet been completely understood in these tumours. Chondrosarcoma, Ewing's Sarcoma and Osteosarcoma are the tumours of the musculoskeletal system in which the activity of VEGF has been closely studied. The present study aims to give an overview focused on the relationship between VEGF and these three cancers.

Osteoarthritis represents an important social economic burden with a high incidence worldwide. Conservative management of knee OA consists in several therapeutic options: pharmacologic therapy such as analgesics, non-steroid and steroid anti-inflammatory drugs, physical therapy, and injective therapy with hyaluronic acid (HA) and platelet-rich plasma injections (PRP). The aim of our study is to evaluate the effect of combined autologous PRP and HHA (Hybrid Hyaluronic Acid) viscosupplementation on clinical outcomes of patients with knee OA, by assessing the subjects before and after injective treatment. The study was conducted on 60 patients with an age between 40 and 70 years old affected by unilateral symptomatic knee osteoarthritis (stage II and III of Kellgren-Lawrence scale) nonresponsive to pharmacologic and rehab treatment. We divided the patients in two groups, and we treated the group A with injection of HHA and group B with HHA+PRP. Each patient received 3 injections at an interval of 1 week for 3 consecutive weeks. The patients were evaluated by the Knee Injury and Osteroartrhitis Outcome Score (KOOS) and Visual Analog Scale (VAS) at 3, 6 and 12 months after treatment. Statistical comparison between groups showed a significantly better result for the group B concerning the KOOS value, at 3 months and at 6 months. This difference, although clinically relevant, lost the statistical significance at 12 months. The VAS trend differently showed a significant difference at 3 and 12 months, while at 6 months the superiority of group B did not achieve statistical significance. Few studies investigated the effects of HA+PRP combined treatment for knee OA. Numerous studies demonstrated the efficacy of HA injection therapy in knee OA for a clinical point of view, reducing the pain and improving the quality of life. PRP preparations also improved functional outcome scores compared to hyaluronic acid and placebo in patients affected by knee OA. Based on our results we can conclude that the combined PRP and HHA treatment is not only a safe and efficacious procedure which can provide functional benefit but is also significantly better than HHA injective therapy alone, as demonstrated by the comparison within our cohort.

Prosthetic replacement with modular implants has become the most common reconstructive tech¬nique of bone loss of the lower limb after tumour resection. The use of the megaprosthesis in bone metastasis, silver-coated megaprosthesis and the use of Trevira tube are not uniform and represent an "open question" about the use of megaprosthesis. The following paper aims to review the current literature in this topic.

There is wide discussion about the association between sport activity and musculoskeletal disorders, as sports-related joint loading increases the risk of osteoarthritis (OA). The present article reviews the current available literature on the connections between participation in several sports and athletic activities and prevalence of knee OA, especially focusing on early knee OA. The study was based on an electronic search through web databases including Medline, Cochrane and Google Scholar. Articles were retrieved and evaluated, and case series, retrospective studies, case-control studies, prospective cohort studies and randomized controlled trials were considered for inclusion. The main data were extracted and summarized in tables and text. Athletic individuals do show an increased prevalence of knee OA, especially for professional athletes when compared to general population or non-professional athletes. Furthermore, several features related to sport activity were associated to increased risk of early knee OA, such as knee ligamentous injury, concussion, high-impact sports and different team roles. Methodology and results of the included studies are barely comparable, thus preventing the authors to carry out an accurate and systematic comparison of the results of the included studies. Only low level evidence studies are available, and better designed studies, with radiological and functional evaluation of the knee based on internationally validated measures, should be planned. Also, follow-up of patients during and after their life-period of sport involvement should be considered.

Purpose  The aim of this study was to compare the accuracy of the coracoid bone graft placement with the open Latarjet-Patte and arthroscopic Latarjet (arthro-Latarjet) procedures in the treatment of anterior instability of the shoulder. Methods  Forty-six patients affected by anterior shoulder instability were divided into two groups. In group A ( n  = 25), patients were operated by arthroscopic Latarjet (arthro-Latarjet) procedure and in group B ( n  = 21), patients were operated by open Latarjet-Patte procedure. Instrumental investigation was based on three-dimensional computed tomography (3D-CT) at a minimum 1-year follow-up. Graft placement and integration, divergence and posterior protrusion of the screws, and glenohumeral osteoarthritis were considered as outcomes. Statistical analysis was performed with chi-square or Fisher's exact test. Significance was set at p  < 0.05. Results  Positioning of the coracoid graft proved to be optimal in 76% (19/25) of patients of group A and in 100% (21/21) of patients of group B (Fisher's exact test, p  = 0.025). Screw placement with respect to the glenoid surface showed a posterior divergence in 44% (11/25) of patients in group A and in 24% (5/21) of patients in group B ( p  = 0.15). Posterior protrusion of screw was observed in 76% (19/25) of patients in group A and 71.4% (15/21) of patients in group B ( p  = 0.73). Graft integration was present in 76% (19/25) of patients in group A and 85.7% (18/21) of patients in group B (Fisher's exact test, p  = 0.48). Mild signs of glenohumeral osteoarthritis were observed in 12% (3/25) of patients in group A and 28.6% (6/21) of patients in group B (Fisher's exact test, p  = 0.26). Conclusion  Patients operated with open Latarjet-Patte procedure showed better results than those of the arthro-Latarjet group in reference to the positioning of the graft on the coronal plane ( p  = 0.025). No significant differences between the groups were observed for graft integration, divergence of the screws, posterior protrusion of the screws, and osteoarthritis. Level of Evidence  Level II, nonrandomized prospective comparative study.

Background: The aim of this study was to compare bone femoral tunnel enlargement in patients who underwent anterior cruciate ligament (ACL) transtibial reconstruction using an adjustable-loop length suspensory fixation device and a fixed-loop length suspensory fixation device., Methods: All patients treated for ACL reconstruction with an ipsilateral hamstring between March 2013 and March 2014 were evaluated. Subjects were assigned to Group A (TightRope™ (TR) femoral fixation) or Group B (EndoButton® (EB) femoral fixation). All patients were evaluated with the Lachman test, pivot-shift test, 2000 International Knee Documentation Committee (IKDC) knee examination and KT1000 arthrometer. The subjective evaluation was performed using the 2000 IKDC Subjective Knee score, the Lysholm knee score, and the Tegner activity scale. CT examination was performed to evaluate femoral tunnel enlargement at four different levels. All patients were assessed at a 12month follow-up visit. Power analysis was performed a priori in accordance with the femoral tunnel enlargement values from the CT scans. Differences with P-values of ≤0.05 were considered to be statistically significant., Results: The groups were homogenous at baseline with regard to age, gender, BMI, dominance and disease duration. At the final follow-up, no statistically significant differences (P>0.05) were found according to subjective and objective clinical outcome measures. According to the femoral tunnel enlargement, no statistically significant difference was found between the two groups (P>0.05)., Conclusion: In transtibial ACL reconstruction, the use of a fixed or adjustable-loop length device products, on the femoral side, led to similar clinical and radiological results., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: Silicone gel-filled implants as opposed to saline-filled breast implants are the most commonly used breast implants in Europe, and this has recently also become the case in the United States. Modern implants have a multiple layer silicone shell and high to very high levels of cohesive silicone gel inside. Although breast magnetic resonance imaging is at present considered the gold standard imaging method for breast implant rupture detection, breast ultrasound (US) imaging is still the first-step investigation in Europe. The aim of this study was to verify whether or not the stepladder sign at US is still associated to intracapsular rupture among the last generation silicone breast implant., Materials and Methods: In this study, 156 patients presenting for breast augmentation, mastopexy with implants and breast reconstruction for a total number of 303 breast implants inserted were enrolled. A preoperative breast ultrasonography was performed, and patients underwent a routine US scan every 6 months for 24 months to evaluate the implant status. A final US evaluation 6 years after implantation was also performed., Results: Stepladder signs were seen at 6 years in 170 implants (56%) of the examined implants at US scan, and only 2 implants showed signs of possible rupture because of severe distortion of the implant profile with or without external silicone collection. A third ruptured implant was detected at magnetic resonance imaging by the presence of breach of the shell at the posterior surface of the implant with small external silicon collection and was eventually confirmed at surgery. Therefore, the overall rupture rate found at the United States at 6 years was about 1% (3 of 303 implants). According to our findings, the stepladder sign at the United States is no longer associated to intracapsular rupture., Conclusions: Plastic surgeons, patients, and financial departments of hospitals would also be delighted to know that surgeons should not take patients back to theater for implant explantation when aging signs are not associated with a visible breach of the implant shell or external silicone collections.

Purpose: the aim of this study was to investigate the relationship between positive painful forced internal rotation (FIR) and lateral pulley instability in the presence of a pre-diagnosed posterosuperior cuff tear. The same investigation was conducted for painful active internal rotation (AIR)., Methods: a multicenter prospective study was conducted in a series of patients scheduled to undergo arthroscopic posterosuperior cuff repair. Pain was assessed using a visual analog scale (VAS) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) was administered. The VAS score at rest, DASH score, and presence/absence of pain on FIR and AIR were recorded and their relationships with lesions of the lateral pulley, cuff tear patterns and shape of lesions were analyzed., Results: the study population consisted of 115 patients (mean age: 55.1 years) recruited from 12 centers. The dominant arm was affected in 72 cases (62.6%). The average anteroposterior extension of the lesion was 1.61 cm. The mean preoperative VAS and DASH scores were 6.1 and 41.8, respectively. FIR and AIR were positive in 94 (81.7%) and 85 (73.9%) cases, respectively. The lateral pulley was compromised in 50 cases (43.4%). Cuff tears were partial articular in 35 patients (30.4%), complete in 61 (53%), and partial bursal in 19 (16.5%). No statistical correlation between positive FIR or AIR and lateral pulley lesions was detected. Positive FIR and AIR were statistically associated with complete lesions. Negative FIR was associated with the presence of partial articular tears., Conclusions: painful FIR in the presence of a postero-superior cuff tear does not indicate lateral pulley instability. When a cuff tear is suspected, positive FIR and AIR are suggestive of full-thickness tear patterns while a negative FIR suggests a partial articular lesion., Level of Evidence: level I, validating cohort study with good reference standards.

Purpose: The purpose of this study was to compare the clinical outcome of arthroscopic rotator cuff repair with single-row and double-row techniques., Methods: Eighty patients with a full-thickness rotator cuff tear underwent arthroscopic repair with suture anchors. They were divided into 2 groups of 40 patients according to repair technique: single row (group 1) or double row (group 2). Results were evaluated by use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Work-DASH self-administered questionnaires, normalized Constant score, and muscle strength measurement. On analyzing the results at a 2-year follow-up, we considered the following independent variables: baseline scores; age; gender; dominance; location, shape, and area of cuff tear; tendon retraction; fatty degeneration; treatment of biceps tendon; and rotator cuff repair technique (anchors or anchors and side to side). Univariate and multivariate statistical analyses were performed to determine which variables were independently associated with the outcome. Significance was set at P < .05., Results: Of the patients, 8 (10%) were lost to follow-up. Comparison between groups did not show significant differences for each variable considered. Overall, according to the results, the mean DASH scores were 15.4 +/- 15.6 points in group 1 and 12.7 +/- 10.1 points in group 2; the mean Work-DASH scores were 16.0 +/- 22.0 points and 9.6 +/- 13.3 points, respectively; and the mean Constant scores were 100.5 +/- 17.8 points and 104.9 +/- 21.8 points, respectively. Muscle strength was 12.7 +/- 5.7 lb in group 1 and 12.9 +/- 7.0 lb in group 2. Univariate and multivariate analysis showed that only age, gender, and baseline strength significantly and independently influenced the outcome. Differences between groups 1 and 2 were not significant., Conclusions: At short-term follow-up, arthroscopic rotator cuff repair with the double-row technique showed no significant difference in clinical outcome compared with single-row repair., Level of Evidence: Level I, high-quality randomized controlled trial with no statistically significant differences but narrow confidence intervals.

Study Objective: To study intraoperative and postoperative complications of laparoscopic myomectomy and patients' characteristics influencing this risk., Design: Prospective study, with a review of the patient records by the first author (Canadian Task Force classification II-2)., Setting: Four Italian referral centers., Patients: The incidence and type of complications occurring in 2050 laparoscopic myomectomies undertaken from January 1998 through December 2004 were recorded., Interventions: The surgical technique, as well as the expertise of the operators, was the same for the 4 centers. Injection of vasoconstrictive agents was used in 37%. The serosa was always incised in a vertical fashion; mechanical enucleation of the myoma was completed whenever possible; suture was performed in 1 or 2 layers with deep and large stitches swaged to 1 or 0 polyglactin sutures that were tied intracorporeally or extracorporeally., Measurements and Main Results: Single or multiple myomectomies (n = 2050) for symptomatic myomas measuring at least 4 cm in diameter were performed. Most patients (48%) had more than 1 myoma, with a maximum of 15 per patient (myomas removed for patients: 2.26 +/- 1.8, mean +/- SD). Myoma size ranged from 1 to 20 cm (mean 6.40 +/- 2.6 SD). Myomas smaller than 4 cm were removed during myomectomy for larger ones. Total complication rate was 11.1% (225/2050 cases). Minor complications accounted for 9.1% (187/2050 cases) and major complications for 2.02% (38/2050 cases). The most serious events were hemorrhages (14 cases, 0.68%) requiring blood transfusions in 3 cases (0.14%); 10 postoperative hematomas (0.48%, one in the broad ligament and 9 in the myomectomy scar); 1 bowel injury (0.04%); 1 postoperative acute kidney failure (0.04%); and 2 unexpected sarcomas (0.09%). Failure to complete planned surgery occurred in 7 cases (0.34%). Two patients were readmitted for surgery (0.09%): 1 had a laparoscopic hysterectomy because of a severe blood loss, and the other had drainage of a hematoma in the broad ligament. After a follow-up period of 41.70 +/- 23.03 months (mean +/- SD), 386 (22.9%) patients conceived, with a pregnancy rate in patients wishing pregnancy of 69.8%; among them, 1 (0.26%) recorded spontaneous uterine rupture at 33 weeks gestation. Odds ratio computed to estimate the risk of complications in relation to the patient characteristics showed that the probability of complications significantly rises with an increase in the number (more than 3 myomas OR: 4.46, p <.001) and with the intramural (OR: 1.48, p <.05) or the intraligamentous location of myomas (OR: 2.36, p <.01) whereas the myoma size seems to influence particularly the risk of major complications (OR: 6.88, p <.001)., Conclusions: This is one of the largest series reported of laparoscopic myomectomy and the first focused on complications. The complication rate appears to be better than acceptable in comparison with complication rates reported after laparotomic myomectomies. Laparoscopic myomectomy, when performed by an experienced surgeon, can be considered a safe technique with an extremely low failure rate and good results in terms of pregnancy outcome.

Objectives: Conflicting opinions about laparoscopic myomectomy (LM) are still present regarding indications and risks related to reproductive outcome. We reviewed our 13-year experience (1) to identify risk factors or changes in methods that have improved our myomectomy technique and (2) to evaluate how the learning curve and improved surgical devices influenced our procedures, and (3) to study the myomectomy scar with a power color Doppler ultrasound (US)., Methods: From January 1991 to December 2003, we studied 332 patients who underwent laparoscopic myomectomy. We analyzed, as the learning curve, how the introduction of the Steiner morcellator, the use of vasoconstrictive agents, and different techniques of suturing have influenced parameters such as operating time and blood loss., Results: We performed 332 single or multiple myomectomies for symptomatic myomas. Most patients (47%) had more than one myoma, with a maximum of 8 per patient (average myomas removed for patients: 2.23, range 1 to 8). Myoma size ranged from 1cm to 20 cm (mean, 60.20+/-SD27.1 mm). Myomas <4cm were removed during myomectomy for larger ones. The conversion rate to laparotomy was 1.51%. The average drop in hemoglobin concentration was 1.06+/-SD0.86 g/100 mL (range, 0.7 to 2.2 g/100 mL). No blood transfusions were required. No major intraoperative complications occurred. The duration of the procedure ranged from 30 minutes to 360 minutes (mean, 124+/-SD52.6). The dimensions of the myomas removed increased with experience (4.91+/-SD2.2 cm of the earlier cases to 6.76+/-SD2.7 of the latest group, P<0.000). The learning curve positively influenced the length of the procedures in the first cases. The introduction of electromechanical morcellation in 1996 reduced the procedure time. Data showed significantly reduced Hb drop after the introduction in 1998 of vasoconstrictive agents (DeltaHb 1.62 g/100 mL versus 0.95; P<0.001). The running suture offered few advantages in terms of procedure time. However, the drop in hemoglobin was advantageous (DeltaHb 1.1 g/100mL vs 0.61, P<0.01). The overall rate of intrauterine pregnancy following LM was 65.5%. No uterine ruptures occurred. We had 2 serious postoperative complications., Conclusion: With increased experience, the technical improvements and clinical results have changed our approach and decision making regarding laparoscopic myomectomy. Our results and extremely low conversion rate suggest that laparoscopic myomectomy is a safe and reliable procedure even in the presence of multiple or enlarged myomas.