Angioleiomyoma of the knee: An uncommon cause of leg pain. A systematic review of the literature

Abstract Objective Angioleiomyoma is a rare benign painful soft tissue tumor, whose knee location is rare. Due its rarity, and not characteristic aspect on MRI the preoperative diagnosis is difficult. Methods We performed a systematic review of the literature, including a case of venous type angioleiomyoma that we have recently managed. Results A total of 24 published papers with 30 cases (including our illustrative case) were identified and included in our review. The mean patient age was 42.3 years (range18-63). The average size of the lesion was 17.8 mm. The presenting symptom was leg pain in 90% of cases. On magnetic resonance imaging (MRI), the lesion appeared isointense in T1 in 80% of cases and hyperintense on T2 in 90% of cases. Avid homogeneous enhancement after gadolinium administration was detected in 94% of cases. All patients underwent surgery and total resection was achieved in 100% of cases. No recurrence was observed after a mean follow-up of 19.5 months. Conclusion Angioleiomyoma occurs rarely in the knee and generally is associated with localized or radiating pain. The preoperative diagnosis is difficult also after completion of MRI study and requires high index of suspicion. Angioleiomyoma widens the spectrum of soft tissue lesions of the extremities and should be included in the differential diagnosis of lesions in this area

Second surgery for recurrent glioblastoma: A concise overview of the current literature

Optimal treatment for recurrent glioblastoma continues to evolve. Currently, however, there is no consensus in the literature on the role of reoperation in the management of these patients, as several studies provide evidence for a longer overall survival in selected patients with recurrent glioblastoma who underwent second surgery and other studies report a limited impact of second surgery in the clinical course. In this paper, a review of the current literature was performed to analyze the role of reoperation in patients with recurrent glioblastoma and to report the overall survival from diagnosis, progression-free survival and quality of life. Using PubMed and Ovid Medline databases, we performed a review of the literature of the last seven years, finding a total of 28 studies and 2279 patients who underwent second surgery, that were included in the final analysis. The median overall survival from diagnosis and the median survival from second surgery were 18.5 months and 9.7 months, respectively. Extent of resection at reoperation improves overall survival, even in patients with subtotal resection at initial operation. Preoperative performance status and age are important predictors of a longer survival, reason why younger patients with a good preoperative performance status could benefit from reoperation

Augmented Reality-Assisted Craniotomy for Parasagittal and Convexity En Plaque Meningiomas and Custom-Made Cranio-Plasty: A Preliminary Laboratory Report

Background: This report discusses the utility of a wearable augmented reality platform in neurosurgery for parasagittal and convexity en plaque meningiomas with bone flap removal and custom-made cranioplasty. Methods: A real patient with en plaque cranial vault meningioma with diffuse and extensive dural involvement, extracranial extension into the calvarium, and homogeneous contrast enhancement on gadolinium-enhanced T1-weighted MRI, was selected for this case study. A patient-specific manikin was designed starting with the segmentation of the patient’s preoperative MRI images to simulate a craniotomy procedure. Surgical planning was performed according to the segmented anatomy, and customized bone flaps were designed accordingly. During the surgical simulation stage, the VOSTARS head-mounted display was used to accurately display the planned craniotomy trajectory over the manikin skull. The precision of the craniotomy was assessed based on the evaluation of previously prepared custom-made bone flaps. Results: A bone flap with a radius 0.5 mm smaller than the radius of an ideal craniotomy fitted perfectly over the performed craniotomy, demonstrating an error of less than ±1 mm in the task execution. The results of this laboratory-based experiment suggest that the proposed augmented reality platform helps in simulating convexity en plaque meningioma resection and custom-made cranioplasty, as carefully planned in the preoperative phase. Conclusions: Augmented reality head-mounted displays have the potential to be a useful adjunct in tumor surgical resection, cranial vault lesion craniotomy and also skull base surgery, but more study with large series is needed

Effetti della riduzione degli input di coltivazione sul girasole (<i>Helianthus annuus</i> L.) coltivato in diversi ambienti mediterranei

A two year field experiment was carried out on six different environmental sites of Middle and Southern Italy with the aim of evaluating the effects of some low input cultural techniques on yield of sunflower (Helianthus annuus L.). In each sites sunflower commerciai hybrids were sown at different dates between January to April. Normal and minimum soil tillage were included in the experimental design, and irrigation treatments were also tested in two sites. Yield response of sunflower to minimum tillage treatments did not show in most cases a significant variation in comparison with ordinary tillage methods. Early sowing enhanced or decreased sunflower performance according to the agrometeorological features of the sites. Irrigation determined a significant yield effect but in some cases water efficiency was lower in early sowing treatments. The results indicate the possibility of reducing energy input in sunflower without remarkable yield depression, by adapting cultural techniques and hybrid choice to the environmental characteristics. Due anni di sperimentazione in campo sono stati condotti in sei differenti ambienti dell'Italia Centro-Meridionale al fine di valutare la possibilità di una semplificazione della tecnica colturale in girasole. Sono stati saggiati ibridi di diversa precocità seminati in differenti epoche e sottoposti ad un diverso grado di intensificazione delle lavorazioni. In due delle unità operative (UUOO) sono stati sperimentati anche diversi trattamenti irrigui. Nella maggior parte dei casi la lavorazione ridotta non ha determinato differenze significative di resa rispetto alla tecniche tradizionali di preparazione del terreno, mettendo in evidenza la capacità del girasole di sfruttare l'effetto residuo delle lavorazioni. L'anticipo delle semine ha avuto un effetto sulle rese variabile a seconda del sito di sperimentazione, indicando che in alcuni ambienti questo accorgimento consente di utilizzare al meglio le eventuali piogge invernali e primaverili. L'eliminazione o la riduzione degli apporti irrigui ha invece determinato significative riduzioni di produzione, anche se in alcune situazioni questo effetto è risultato meno marcato con le epoche di semina anticipate. Il primo biennio di sperimentazione ha messo in evidenza che la riduzione degli input nella coltivazione del girasole sia proponibile anche dal punto di vista economico purché si adegui la scelta delle tecniche colturali e dei genotipi alle caratteristiche ambientali

Multibiomarker approach to fipronil exposure in the fish Dicentrarchus labrax under two temperature regimes

Fipronil is a phenylpyrazole insecticide widely used to control pests in agriculture even though evidence of harmful side effects in non-target species has been reported. A comprehensive study on the effects of dietary administration of Regent®800WG (80 % fipronil) in European sea bass juveniles was carried out under two temperature regimes: a) natural conditions, and b) 3 °C above the natural temperature (an increase predicted for the NW Mediterranean by the end of this century). Fipronil was added to the fish food (10 mg fipronil /Kg feed) and the effects were studied at several time points including right before administration, 7 and 14 days after daily fipronil feed and one-week after the insecticide withdrawal from the diet (depuration period). A wide array of physiological and metabolic biomarkers including feeding rate, general condition indices, plasma and epidermal mucus metabolites, immune response, osmoregulation, detoxification and oxidative-stress markers and digestive enzymes were assessed. General linear models and principal component analyses indicated that regardless of water temperature, fipronil resulted in a significant alteration of several of the above listed biomarkers. Among them, glucose and lactate levels increased in plasma and decreased in epidermal mucus as indicators of a stress response. Similarly, a depletion in catalase activity and higher lipid peroxidation in liver of fipronil-exposed fish were also indicative of an oxidative-stress condition. Fipronil induced a time dependent inhibition of Cytochrome P450-related activities and an increase of phase II glutathione-S-transferase. Moreover, fipronil administration was able to reduce the hypo-osmoregulatory capability as shown by the increase of plasmatic osmolality and altered several digestive enzymes including trypsin, lipase, alpha amylase and maltase. Finally, analyses in bile and muscle confirmed the rapid clearance of fipronil but the persistence of the metabolite fipronil-sulfone in bile even after the 7-day depuration period. Altogether, the results reveal a notable impact of this compound on the physiological condition of the European sea bass. The results should be considered in future environmental risk assessment studies since fipronil could be hazardous to fish species, particularly those inhabiting estuarine ecosystems exposed to the discharge of agriculture runoffs where this pesticide is mainly used

Surgical management of adult Brainstem Gliomas: a systematic review and meta-analysis

The present review aims to investigate the survival and functional outcomes in adult high-grade brainstem gliomas (BGSs) by comparing data from resective surgery and biopsy. MEDLINE, EMBASE and Cochrane Library were screened to conduct a systematic review of the literature, according to the PRISMA statement. Analysis was limited to articles including patients older than 18 years of age and those published from 1990 to September 2022. Case reports, review articles, meta-analyses, abstracts, reports of aggregated data, and reports on multimodal therapy where surgery was not the primary treatment were excluded. The ROBINS-I tool was applied to evaluate the risk of bias. Six studies were ultimately considered for the meta-analysis. The resective group was composed of 213 subjects and the bioptic group comprised 125. The analysis demonstrated a survival benefit in those patients in which an extensive resection was possible (STR HR 0.59 (95% CI 0.42, 0.82)) (GTR HR 0.63 (95% CI 0.43, 0.92)). Although surgical resection is associated with increased survival, the significantly higher complication rate makes it difficult to recommend surgery instead of biopsy for BSGs. Future investigations combining volumetric data and molecular profiles could add important data to better define the proper indication between resection and biopsy

Role of stem cells-based in facial nerve reanimation: A meta-analysis of histological and neurophysiological outcomes

BACKGROUND Treatments involving stem cell (SC) usage represent novel and potentially interesting alternatives in facial nerve reanimation. Current literature includes the use of SC in animal model studies to promote graft survival by enhancing nerve fiber growth, spreading, myelinization, in addition to limiting fibrotic degeneration after surgery. However, the effectiveness of the clinical use of SC in facial nerve reanimation has not been clarified yet.AIMTo investigate the histological, neurophysiological, and functional outcomes in facial reanimation using SC, compared to autograft.METHODSOur study is a systematic review of the literature, consistently conducted according to the preferred reporting items for systematic reviews and meta-analyses statement guidelines. The review question was: In facial nerve reanimation on rats, has the use of stem cells revealed as effective when compared to autograft, in terms of histological, neurophysiological, and functional outcomes? Random-effect meta-analysis was conducted on histological and neurophysiological data from the included comparative studies.RESULTSAfter screening 148 manuscript, five papers were included in our study. 43 subjects were included in the SC group, while 40 in the autograft group. The meta-analysis showed no significative differences between the two groups in terms of myelin thickness [CI: -0.10 (-0.20, 0.00); I-2 = 29%; P = 0.06], nerve fibers diameter [CI: 0.72 (-0.93, 3.36); I-2 = 72%; P = 0.6], compound muscle action potential amplitude [CI: 1.59 (0.59, 3.77); I-2 = 89%; P = 0.15] and latency [CI: 0.66 (-1.01, 2.32); I-2 = 67%; P = 0.44]. The mean axonal diameter was higher in the autograft group [CI: 0.94 (0.60, 1.27); I-2 = 0%; P &lt;= 0.001].CONCLUSIONThe role of stem cells in facial reanimation is still relatively poorly studied, in animal models, and available results should not discourage their use in future studies on human subjects

Temporomandibular disorders and fibromyalgia: A narrative review

Temporomandibular disorder (TMD) and fibromyalgia (FM) have some clinical characteristics in common, for instance the chronic evolution, the pathophysiology incompletely understood and a multifactorial genesis. The incidence and the relationship between TMD and FM patients are the aims of this review. A MEDLINE and Pubmed search was performed for the key words "temporomandibular disorder" AND "fibromyalgia" from 2000 to present. A total of 19 papers were included in our review, accounting for 5449 patients. Ten studies, reporting a total of 4945 patients with TMD, showed that only 16.5% of these patients had diagnosis of FM, whereas 12 studies, reporting a total of 504 patients with FM, demonstrated that 77.0% of these patients had diagnosis of TMD. A comorbid relationship exists between TMD and FM. The complexity of both diseases shows the importance of a multimodal and interdisciplinary

Oral Microbiome and Preterm Birth: Correlation or Coincidence? A Narrative Review

AIM: Physiological changes that occur during pregnancy involve, as a natural consequence, also modifications of oral microbiome. However, the addition with microbial imbalance due to pre-existing periodontal infection might impair a pathological alteration in the phylogenetic community structure and composition in the oral cavity, exacerbating an inflammatory status, and becoming a potential risk factor for preterm birth. From the empirical findings about the relationship between periodontal pathogens and systemic diseases, a clear interest focused on the potential impact of some periodontal pathogens on the preterm birth risk has emerged. In this close emerging link, the potential interdependence existing between dysbiosis of oral microbiome and changes in maternal-fetal barrier in premature rupture of membranes was explored. MATERIALS AND METHODS: In accordance with Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines, a Medline search was performed for studies focusing on oral microbioma and its association with pre-term birth, and completed by additional hand searching. Two reviewers independently selected studies and extracted data. The search was restricted to only reports written in English. RESULTS: The electronic search produced 66 items. Six duplicates were found. Among the collected studies, 56 were discarded because they met the exclusion criteria. The articles and reports in our review showed a connection between preterm birth and altered oral microbiome, suggesting a potential key role of Fusobacterium nucleatum, a notable periodontal pathogen involved in several pathological periodontal conditions, in increasing the risk of premature birth. CONCLUSIONS: Since F. nucleatum is frequently associated with preterm birth, it is coherent to hypothesize a potential role for the oral microbiota for preterm birth risk. Further studies should be carried out to determine the changes of the oral microflora in pregnancy and to provide comprehensive knowledge of the diversity of oral bacteria involved in preterm birth