Intratumoral Haemorrhage Causing an Unusual Clinical Presentation of a Vestibular Schwannoma.

We present a case of an elderly woman with no history of audiological disease with sudden onset of visual and hearing deficits associated with systemic clinical signs. On examination she had impairment of right CNs from V to X. CT and MR imaging demonstrated a cystic vestibu- lar schwannoma with a rare intralesional fluid-fluid level correlated to a recent bleed. We include high quality MR images to show the acute impairment of the cranial nerves next to the tumour after acute bleeding. Our case report includes a voxel-based morphometry (VMB) analysis of the tumour that, as far as we know, has never been done before for such a tumour. VBM analysis was performed to calculate the hypothesized volume changes after the acute bleed which likely resulted in a sudden increase in the overall size of the tumour resulting in atypical clinical signs and symptoms due to the establishment of a mechanical conflict with the adjacent cranial nerves

Mediterranean diet and dietary protein supplementation as possible predicting variables of weight management: An update of the protein project

Introduction: The Mediterranean diet is known to support the prevention of several chronic diseases and excessive weight gains. However, relevant investigations were performed in a clinical setting and healthy and physical active individuals were not considered. The aim of this study was therefore to understand the effects of protein supplements intake on body mass index (BMI) in healthy active individuals following the Mediterranean diet. Materials and methods: A face-to-face questionnaire was administered to 667 subjects, 627 living in a Mediterranean area (MD) and 40 in a non-Mediterranean area (NMD); questionnaire enquired dietary behaviors, including a comparison between dietary patterns and protein consumption between these two populations and within each population. Results: Dietary patterns significantly varied between the MD and NMD populations (p < 0.001), although, BMI was not significantly different. The major significant differences were found between the BMI of protein supplement users and non-protein supplement users within and between the two populations (p < 0.01). No differences were found between the BMI of the protein supplement users of MD and NMD, while moderate differences were displayed between the non-supplement users of the two populations (p < 0.05). Conclusions: The Mediterranean diet does not appear to affect BMI. However, BMI significantly differed between protein supplement users and non-protein supplements users indicating a direct influence of such products on body weight and consequently BMI

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P &lt; .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Magnetic Field Configurations and Locked modes in RFX

The Reversed Field Pinch experiment RFX (R0=2m, a=0.46m) is presently run at approximately 500 kA of plasma current to study confinement properties at reduced levels of energy and power. The magnetic configuration is presently characterized by rather large distortions that, like in other RFP experiments [1], play an important role in detemining energy losses. Active control of the poloidal field structure has been one of the main subjects of experiments so far, and good results have been obtained by centering the plasma column and by reducing the stray field at the poloidal gaps; nevertheless, unstable MHD modes grow early during the pulse and lock to the first wall, producing highly localized heat fluxes on it. First, the paper deals with horizontal plasma equilibrium, that has been controlled by means of a bias vertical field, since the long time constant of the stabilizing shell prevents fast control during the pulse. Then the field perturbatins are analyzed and the characteristics of mode locking are described. Finally, the origin of mode locking and the effect of field errors on plasma confinement are discussed

Comparison of Different RFX Operation Modes

The results obtained in operating the RFX reversed field pinch experiment up to a plasma current of 0.8 MA are reported. Different reversed field pinch setting-up methods are discussed. The effect on energy confinement of control of the plasma column equilibrium, of the field errors at the gaps and of the impurities by means of boronization is described. In the best conditions, a constant be (> 10%) has been observed in the current range so far explored