Schwannoma of the foot: report of four cases and literature review

Schwannoma is a soft tissue tumor that rarely presents in the foot. Patients are usually asymptomatic, but in some cases symptoms typically result from the mass effect and direct involvement of the nerve and surrounding tissue. We report on four consecutive cases. The first patient was a 57-years-old female that referred symptoms similar to the Morton's neuroma with a mass arising from the medial plantar nerve. The second patient was treated for a schwannoma in the plantar area. The third case was a female with a schwannoma arising from the sural nerve and the fourth patient had a tumor arising from the medial plantar nerve. All patients underwent surgical excision and histological evaluation. No signs of neurological deficit or recurrence were observed at final follow-up. Purpose of the study was to define clinical features, optimal management and outcome of schwannomas of the foot, through an accurate review of the literature

Proximal femur fractures in elderly patients: gender-related differences in survival and functional outcomes

Proximal femur fractures (PFFs) represent approximately 20% of all fragility fractures, consistently affecting mortality and morbidity of aging patients with osteoporosis. This study aims to investigate gender-related differences in survival and functional outcome after PFFs in elderly patients, analyzing possible gender-specific prognostic factors. Methods. It is a retrospective analysis of elderly patients with PFF who were surgically treated in a traumatology referral center in 2020. Demographic data, pre-injury ability to walk and use of aids, American Society of Anesthesiologists (ASA) score, medications, age-adjusted Charlson comorbidity index (ACCI) score, types of surgery performed, postoperative complications, type of discharge, functional outcomes, and mortality were recorded and analyzed to understand if there were gender-specific differences. Results. This series included 362 patients: 111 males (31%) and 251 (69%) females, with a mean age of 84 years at surgery. The two groups had the same baseline characteristics; however, males were more frail patients than females since the higher rate of anticoagulation, higher ASA and ACCI scores. Walking ability recovery occurred in 70% of males and 80% of females, without statistically significant differences (p = 0.1727), with an increase in the use of aids in 30% of males and 38% of females (p = 0.4366). Besides, 31% of males and 18% of females died within 1 year after surgery. In the general population, mortality was statistically significantly higher in males, older than 85 years, treated more than 48 hours after trauma and anticoagulated. Multivariate analysis showed only gender (p = 0.0289) and age (p <0.0001) as independent prognostic factors. Discussion. PFFs are more frequent in females; however, the multiple comorbidities that affected males when involved in PFFs lead to problematic functional recovery and higher mortality. Therefore, understanding and knowing these gender differences is fundamental to communicate adequately with patients and relatives. Moreover, these gender differences should be strongly considered to optimize treatments and rehabilitation protocols during hospitalization

Double fractures of the femur: a review of 16 patients

Background Double ipsilateral femoral fractures account for 1\u20139% of femoral fractures. There is no clear advantage between single or double implant osteosynthesis. We present a series of patients with double ipsilateral femoral fractures, to address the challenges in treatment, namely the implants for osteosynthesis and complications of treatment. Materials and methods We retrospectively studied 16 patients (7 men, 9 women; mean age, 51 years) treated from January 2015 to December 2018. Motor vehicle accidents were the leading cause of injury. Types of fractures were pertrochanteric and shaft (6), pertrochanteric and distal (2), double shaft (3), neck and shaft (2), neck and distal (1), shaft and distal (1), and triple fracture including a pertrochanteric, shaft and distal (1). In five patients, two different implants were used (plate and screws, cannulated hip screws, femoral nail), whereas in 11 patients a long femoral nail was used. Results Fourteen patients experienced union at a mean of 3 months (2\u20136 months). Two patients experienced nonunion: both had plate and screws osteosynthesis. One patient died 15 days after admission from polytrauma and another patient experienced central venous catheter thrombosis and pneumonia. Surgical complications (2 patients) included a thigh skin necrosis, and external fixator pin tract infection/infected non-union. Weight-bearing was delayed in all patients; full weight-bearing was allowed in 11 patients at 4 months postoperatively, and in four patients at 5 months. Conclusion Due to the rarity and the difficulty of standardization of double ipsilateral femoral fractures, there is variable information on the optimal osteosynthesis of the fractures and the outcome of the patients. It seems that closed reduction and long hip nailing is the treatment of choice, with few complications

A Scoping Review with Bibliometric Analysis of Para-Rowing: State of the Art and Future Directions

Para-rowing is a format of rowing practiced by people with different types of disabilities, thanks to adapted equipment set-ups and regulations. Para-rowing made its debut recently at the 2008 Paralympic Games. According to the mandate of the “International Paralympic Committee”, para-rowers should be enabled to pursue sporting excellence. Therefore, rigorous research is needed in terms of well-designed, high-quality studies. To the best of our knowledge, there are no systematic appraisals of the body of scholarly evidence in the field of para-rowing. As such, a scoping review enhanced by bibliometric analyses was carried out to provide a comprehensive synthesis of knowledge related to para-rowing for the perusal of practitioners and athletes. By mining eighteen major databases, 17 studies were retained in the present review. The included studies were found to focus on a range of aspects involving health, the etiology of injuries (n = 5), psychological and physiological responses (n = 5), performance, biomechanical analysis (n = 4), and new analytical approaches for kinematic assessments and predictions of mechanical outputs in para-rowers (n = 3). The scholarly community on para-rowing consists of 78 researchers, 16 (20.51%) of whom are highly interconnected. The most prolific author was Smoljanovi´c T., from Croatia, with three items/documents. In total, 93.6% of scholars have authored one single document. Topological features indicated a highly fragmented and dispersed, poorly connected community characterized by a high number of clusters and a low strength of connections. In terms of publication years, the first scholarly article dates back to 2008, with four articles (23.5%) published in the current year, showing an increasing interest in this para-sports discipline. Finally, gaps in current research on para-rowing were identified in terms of overlooked topics, including sports nutrition, doping, and psychological aspects in para-rowers other than those with visual impairment

Bronchoalveolar lavage fluid characteristics and outcomes of invasively mechanically ventilated patients with COVID-19 pneumonia in Genoa, Italy

BACKGROUND: The primary objective of the study is to describe the cellular characteristics of bronchoalveolar lavage fluid (BALF) of COVID-19 patients requiring invasive mechanical ventilation; the secondary outcome is to describe BALF findings between survivors vs non-survivors.MATERIALS AND METHODS: Patients positive for SARS-CoV-2 RT PCR, admitted to ICU between March and April 2020 were enrolled. At ICU admission, BALF were analyzed by flow cytometry. Univariate, multivariate and Spearman correlation analyses were performed.RESULTS: Sixty-four patients were enrolled, median age of 64years (IQR 58-69). The majority cells in the BALF were neutrophils (70%, IQR 37.5-90.5) and macrophages (27%, IQR 7-49) while a minority were lymphocytes, 1%, TCD3+92% (IQR 82-95). The ICU mortality was 32.8%. Non-survivors had a significantly older age (p=0.033) and peripheral lymphocytes (p=0.012) were lower compared to the survivors. At multivariate analysis the percentage of macrophages in the BALF correlated with poor outcome (OR 1.336, CI95% 1.014-1.759, p=0.039).CONCLUSIONS: In critically ill patients, BALF cellularity is mainly composed of neutrophils and macrophages. The macrophages percentage in the BALF at ICU admittance correlated with higher ICU mortality. The lack of lymphocytes in BALF could partly explain a reduced anti-viral response

Clinical characteristics, management and in-hospital mortality of patients with COVID-19 In Genoa, Italy

To describe clinical characteristics, management and outcome of COVID-19 patients; and to evaluate risk factors for all-cause in-hospital mortality