The Italian Consensus Conference on FAI Syndrome in Athletes (Cotignola Agreement)

Background. Femoro-acetabular impingement (FAI) is an important topic in literature because of its strong relationship with sport populations. Methods. Sixty-five experts participated in "this Consensus Conference (CC)". They discussed, voted and approved a consensus document on the FAI syndrome in athletes. Results. The CC experts approved document provided suggestions concerning: 1) Epidemiology of FAI; 2) Clinical evaluation; 3) Radiological evaluation; 4) Conserva-tive treatment; 5) Surgical criteria; 6) Surgical techniques; 7) Post-surgical rehabilita-tion; 8) Outcome evaluation; 9) FAI-associated clinical frameworks. Conclusions. The CC offers a multidisciplinary approach to the diagnosis and treat-ment of FAI syndrome in athletes taking into account all the different steps needed to approach this pathology in sport populations

Gotfried percutaneous compression plating (PCCP) versus dynamic hip screw (DHS) in hip fractures: blood loss and 1-year mortality.

Background. Intertrochanteric fractures are among the most common fracture in elderly and are correlated with an average 1-year mortality of 25%. Increased mortality after hip fracture could be related to blood loss and comorbidities. Aims. We compared two groups of patients treated with percutaneous compression plating (PCCP) and dynamic hip screw (DHS) with the hypothesis that treatment with PCCP can reduce blood loss and 1-year mortality. We furthermore investigated the role of several surgical-related and patient-related factors on mortality of all the enrolled patients. Methods. We performed a comparative retrospective study of 280 patients with type 31A1 or 31A2 hip fractures treated in our department from January 2004 to May 2008. Exclusion criteria were age <60 years, multiple injuries and pathological fractures. A total of 194 patients were treated with DHS, and 86 patients were treated with PCCP. Results. No statistical differences were found in term of blood loss, blood transfusion and 1-year mortality between the two groups, whereas we found a significant incidence of gender, age, American Society of Anaesthesiologists score and preoperative haemoglobin on mortality. Discussion. Both plates seem to be comparable in terms of blood loss and blood transfusion rate, and mortality was rather correlated with some patient-related factors reflecting the global health status. Conclusion. Emerging mortality in this kind of patient should encourage us to improve preventative orthogeriatric health care

A new technique for tension-free reconstruction in large incisional hernia

In the surgical management of large incisional hernias, the main target is the closure of the abdominal wall defect on the midline without a dangerous increase in the intraabdominal pressure. In this setting, new intraperitoneal prosthesis and components separation techniques were proposed to solve this problem. Both solutions present some critical issues. A new surgical approach with a free lateral double layer prosthesis totally in polypropylene both sides (FLaPp (R)) is proposed to overcome this problem. This is a retrospective cohort analysis study with a prospectively collected database from two different Italian hospitals. Twenty-nine patients operated from April 2010 to December 2015 were treated using the new prosthesis. Four patients developed postoperative complications: one (3.4%) presented wound infection, two (6.9%) experienced seroma, and one had a hematoma (3.4%). No deaths were recorded. At a median follow-up of 28.5 months (IQR 22-36), no hernia relapse occurred. The application of FLaPp (R) mesh is a safe and feasible option that can be employed to manage Rives repair in cases of abdominal wall defects with difficult closure of the posterior plan when the conventional prosthetic meshes could be unsuitable

A clinical experience of psychiatric diagnostic assessment in epileptic patients of pediatric age: prospective study two years after epilepsy onset.

Introduction According to the scientific literature, the psychiatric comorbidity in children with epilepsy increase if compared to general paediatric population, with a prevalence of anxiety-depressive disorders, thought, attentional, and social problems. The numerous studies on the temporal relationship between epilepsy and psychopathology speculate about common etiopathogenic pathways to both disorders. Method A sample of 50 children (age 4-18) with new-onset epilepsy (CNOE), in the absence of mental retardation and non- neurological comorbidities, were subjected to periodical psychiatric and psychological diagnostic assessment (every 6 months ) by clinical interview, dimensional and categorical psychometric instruments and, where necessary, specific psychometric tests. The evaluation also explored the cognitive and temperamental profile, family dynamics, and quality of life. The perspective design of the study allowed to analyze the sample from the demographic, psychosocial and epileptologic profile, by following the natural evolution of factors involved with a potential psychiatric comorbidity. Results Baseline data (T0) show psychiatric comorbidity with higher rates for anxiety-depressive disorders (16% with a dominant anxiety component), attentional problems (13%) and thought problems (13%). A reduction of social skills also emerged. Data at 6 months (T6) show a reduction of some of the raised issues and an improvement in social skills, suggesting a stressor role of epilepsy itself. Data to the conclusion of the follow-up remain to be analyzed (end of recruitment in June 2013). Nevertheless analysis at T0 and T6 show numerous associations between psychopathology and neurologic, demographic, and psychosocial variables. Conclusions The high prevalence of psychiatric comorbidity in CNOE and its relationship with the variables here considered support the hypothesis of a possible CNS dysfunction common to both pathological processes: epilepsy and psychopathology. However, the importance of stressing factors at the time of diagnosis in the evolution of psychopathology cannot be ignored

Circulating microRNAs combined with PSA for accurate and non-invasive prostate cancer detection.

The dosage of prostate-specific antigen (PSA), an easily evaluable and non-invasive biomarker, has made early detection of prostate cancer (PCa) possible. However, it leads to high percentages of unnecessary biopsies and may miss aggressive tumors in men with PSA levels below 4 ng/ml. Therefore, we propose to combine circulating microRNAs (miRs) with PSA, to improve the diagnostic route for PCa. Plasma miR profiling identified candidate diagnostic miRs in a discovery cohort of 60 tumors and 60 controls (men with benign prostatic hyperplasia or healthy donors). Linear models with an empirical Bayesian approach and multivariate penalized logistic regression were applied to select tumor-associated miRs and/or clinical variables. A classifier was developed and tested on a validation cohort of 68 tumors and 174 controls consecutively collected, where miRs were evaluated by quantitative real-time polymerase chain reaction. A classifier based on miR-103a-3p, let-7a-5p and PSA could detect both overall and clinically significant tumors better than PSA alone, even in 50-69 years aged men with PSA ≤ 4 ng/ml. Even in the validation cohort, the classifier performed better than PSA alone in terms of specificity and positive predictive value, allowing to correctly identify eight out of nine tumors undetected by PSA, including three high-risk and three tumors in 50-69 years old men. Of carriers of non-malignant lesions with PSA in the 4-16 ng/ml interval, who may avoid unnecessary biopsies, 34% were correctly identified. Coupling two circulating miRs with PSA could be a useful strategy to diagnose clinically significant PCa and avoid an important fraction of unnecessary biopsies