High-Resolution Ultrasound of Odontogenic Cutaneous Sinus Tract: An International Multicentric Experience and a Review of the Literature.

OBJECTIVES: To investigate the role of high-resolution ultrasound (HR-US) in the initial and differential diagnosis of the Odontogenic Cutaneous Sinus Tract (OCST) in a multicentric setting. METHODS: Skin HR-US examinations of OCSTs performed between January 2019 and June 2023 at different Institutions were retrospectively reviewed. Epidemiological and clinical data (age, gender, location of the skin lesion, causative tooth, and the clinical suspicion) as well as HR-US imaging findings (morphology and length of the sinus tract, Doppler signal, and cortical bone interruption of maxilla or mandible) were collected. US examinations were performed by expert radiologists using a high-performance US scanner, employing a high-frequency linear probe (15 MHz or higher frequencies). In only one patient the HR-US exam was integrated with strain elastography (SE). RESULTS: Sixteen patients were enrolled with a median age of 37.6 years (range 16-70 years). The most frequent clinical suspicion was epidermal cyst, while OCST was suspected in only two cases. In all cases, HR-US depicted the sinus tract as a nodular, triangular or "champignon-shaped" lesion in the subcutaneous layer, which continued with a slightly tortuous band structure, up to the focally interrupted cortical bone plate. Furthermore, color Doppler evaluation showed color signals around and/or within the lesion, expression of inflammation. On SE, the sinus tract showed a hard pattern, due to fibrous and granulomatous tissue. CONCLUSIONS: HR-US, thanks to its high spatial resolution, allows the evaluation of OCST, and play a crucial diagnostic role, mainly when the clinical suspicious is different.

Breast ultrasound: An opportunity to detect unsuspected pleural and pulmonary abnormalities.

PURPOSE: While scanning women for breast US, is possible to observe changes in the appearance of the pleural line or in the most superficial portion of the lung. The objective of this single-center, prospective study was to determine the prevalence of a variety of pleural and pulmonary US findings during routine breast US. METHODS: In this study, there were 200 women undergoing standard breast US examination. The presence of pleural and pulmonary abnormalities in these cases was recorded. Two off-site reviewers confirmed the presence of pleura and lung changes. RESULTS: There was no abnormal finding in 168 out of 200 cases (84%) while there were one or more abnormal findings in 32 cases (16%). Pleural effusion was observed in 0.5% of cases, thickening of the pleural line 5% of cases, irregularity of the pleural line in 6% of cases, increased number of vertical artifacts in 9% of cases, subpleural nodulations in 2% of cases, and lung consolidation in 0.5%. CONCLUSION: Pleural and lung changes are not uncommon during breast US. Operators performing breast US examinations should be aware of the possibility to identify unsuspected pleuro-pulmonary abnormalities.

Isolate scapulothoracic dislocation: Radiological findings and management.

Scapulothoracic dislocation (STD) is a rare condition consisting in the loss of anatomical relations of the scapula with the posterior chest wall. This pathological condition commonly occurs after a scapular region trauma or an upper arm distractive injury. Here-in, we present a case of STD occurring in a young male patient, and we discuss the mechanism of injury, the radiological imaging features, and how it can guide and help the orthopedist in the management.

Aortic dissection: How to identify it during an abdominal ultrasound examination and achieve a potentially lifesaving diagnosis.

Aortic dissection (AD) is a rare and potentially fatal condition that may be diagnosed late. During an emergency or elective abdominal ultrasound (US) examination, when going to evaluate the abdominal aorta for other reasons, it may happen that we find ourselves suspecting an AD. It is therefore important to know the US characteristics of this pathology to avoid wrong or missed diagnoses. Here, we present our practical experience regarding the application of US in the study of the abdominal aorta, which allowed us on several occasions to find an unexpected dissection in patients brought to our attention for other reasons.

High-resolution ultrasound approach to quadrangular joint in carpal boss: Everything musculoskeletal sonographer should know.

At the quadrangular joint (QAJ) of the carpus, a rare bony protuberance called carpal boss (CB) may occur. This bone abnormality may be due to osteophytes development or os styloideum. Symptomatic patients may complain pain, swelling, and restrictions in hand motion. These symptoms result from joint degenerative-inflammatory changes, development of ganglion cyst/bursitis, or tendons pathology. Correct diagnosis and appropriate management can be achieved through high-resolution ultrasonography (HR-US). The purpose of this review is to define the pathology spectrum around and within the QAJ in CB. The role of HR-US is highlighted and the standard technique for the QAJ assessment is described.

Complications Subsequent to Urinary Tract Stent Placement: An Overview Focusing on the Imaging of Cancer Patients.

Ureteral involvement by a tumor is common, and both partial and complete obstructions can result in symptoms that are distressing and debilitating, especially in cancer patients for whom the resection of the primary tumor is not considered an option. Maintaining ureteric patency in these patients is a challenge. In addition, in cases where a patient has undergone nephroureterectomy due to primary transitional cell cancer, it becomes necessary to decompress the urinary tract to preserve the contralateral kidney from irreversible damage. This is possibly due to ureteral stenting, both retrograde and anterograde, and percutaneous nephrostomy (PCN). Since imaging plays an important role in the routine monitoring of stents, their more and more increasing use requires radiologists to be familiar with these devices, their correct position, their potential complications, and their consequences. The aim of this review is to offer a comprehensive review of the imaging features of some urinary stents and to show the complications encountered in cancer patients as a direct consequence of an invasive diagnostic or therapeutic procedure. Specifically, we focus on ureteral stents and PCN.

"Daddy wrist": A high-resolution ultrasound diagnosis of de Quervain tenosynovitis.

De Quervain's tenosynovitis involves the first of the six dorsal compartments of the wrist, which contains the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons. It seems to be associated with female sex (F:M = 10:1), middle age (30-50 years) and activities involving repetitive hand and wrist motions such as typing, piano playing or repetitively lifting children head, such as in postpartum females (hence the term "baby wrist" or "mommy wrist"). Aim of this paper was to illustrate high-resolution ultrasound (US) features of the DQD by describing a well-documented case that occurred in a "new dad" taking care of his babe. Hence, firstly in literature we could refer to this condition with the term of "daddy wrist".

Multiparametric Ultrasound Diagnostic Approach to Malignancy-Mimicking Adenomatoid Tumors of the Scrotum: Is Strain Elastography Enough?

Background: Paratesticular tumors (PTs) are very uncommon, accounting for almost 5% of intrascrotal tumors. Of these, adenomatoid tumors (ATs) represent about 30% and most frequently arise in the tail of the epididymis. Ultrasound (US) examination is the first-choice imaging method employed for the evaluation of the scrotum. Unfortunately, there are no specific US-imaging features useful for distinguishing an AT from a malignant lesion. To increase diagnostic accuracy and confidence, new sonographic techniques have incorporated real-time tissue elastography (RTE) under the assumption that malignant lesions are "harder" than benign lesions. Case report: In our paper, we describe a very rare case of a 60-year-old patient with a giant paratesticular mass mimicking malignancy when examined using RTE, i.e., it was stiffer than the surrounding tissue (a hard pattern), which, upon histologic examination, was identified as an AT. Discussion: Our case underscores that there is also a significant overlap between different types of scrotal lesions when RTE is used for examination. Thus, if a PT is found, the imaging approach should always be supplemented with more definitive diagnostic methods, such as FNAC or FNAB, which are the only diagnostic methods capable of leading to a certain diagnosis. Conclusions: Alongside underlining the importance of pre-operative imaging for making correct diagnoses and selecting the correct therapy, we wish to draw our readers' attention to this report in order to demonstrate the clinical implications of a giant AT presenting as stiff lesions when examined using SE.

Assessment of apathy minimising the effect of motor dysfunctions in Parkinson's disease: a validation study of the dimensional apathy scale.

PURPOSE: Apathy is associated with motor symptoms in Parkinson's disease (PD); therefore, its evaluation could be influenced by motor disability. The Dimensional Apathy Scale (DAS) evaluates apathy excluding confounding effects of motor symptoms. The present study had three major aims: (a) to explore the psychometric properties of the DAS in non-demented PD patients; (b) to determine an optimal cut-off score of the DAS to identify apathetic PD patients; and (c) to determine a specific apathy profile in PD patients as compared to healthy controls (HC). METHODS: One hundred and seven PD patients and 100 HC completed the DAS. To explore convergent and divergent validity of the DAS in PD, patients underwent the Apathy Evaluation Scale and tools for assessing depressive symptoms, anxiety and cognition. Clinical aspects were recorded. Receiver operating characteristic curve analyses were carried out to estimate the optimal cut-off score to identify clinically significant apathy. RESULTS: The DAS scores showed high internal consistency and good evidence for convergent and discriminant validity. Maximum discrimination between apathetic and non-apathetic patients was obtained with a cut-off score of 28.5 (total score range: 0-72 with higher score indicating more severe apathy). Comparison between PD and HC groups revealed significant differences on total DAS, behavioural/cognitive initiation and emotional subscales. CONCLUSIONS: The DAS is a valid and reliable tool to assess multidimensional apathy in PD, independently of severity of motor symptoms. Reduced initiation of thought and behaviour and emotional blunting characterised PD patients, without confounding effects of motor disability.

Nasal mucosa healing after endoscopic sinus surgery in chronic rhinosinusitis of elderly patients: role of topic alpha-tocopherol acetate.

BACKGROUND: Chronic rhinosinusitis (CRS) in European country ranges in elderly patients from 4.5 to 12% of population and has a significant effect on quality of life. In these patients, rhinosinusitis is linked to immune functions changes with age and to mucosal paraphysiological alterations such as crusting formations with atrophic epithelium, variations of nasal airflow and modifications of the mucociliary clearance. Failure of medical treatments leads to surgery in patients with persistent symptoms and radiographic signs of CRS. The choice of appropriate post-surgical topic treatments is important for healing time and for preventing mucosal complications such as synechiae, crusting formation and atrophy with secondary bacterial and fungal infections. AIMS: Defining the effects of topic alpha-tocopherol acetate administration on nasal mucosa healing after endoscopic sinus surgery in CRS of elderly patients. METHODS: In this study were included 32 patients, mean age 68.6, who underwent FESS because affected by CRS not responsive to medical treatments. After surgical treatment, we distinguish two groups basing on local nasal therapy. RESULTS: We investigated, in the postoperative time, the role of alpha-tocopherol acetate compared to gomenol oil. Follow-up was performed at 7-15 days and 1-3 months after surgery. We evaluated mucosal restoration using Rhinoscopy Sum Score and quality of life using Nasal Six Items Symptom Questionnaire. We observed a faster healing time and less recurrence of complications in patients who underwent topic treatment with alpha-tocopherol acetate. DISCUSSION: In our research, we observed that alpha-tocopherol acetate has no contraindications and side effects. CONCLUSIONS: Our study showed the effectiveness of alpha-tocopherol acetate topic treatment in elderly patients affected by CRS after FESS, in improving and speeding up the process of restoring the sinonasal mucosa, compared to another topic medication.

Laterality of a second player position affects lateral deviation of basketball shooting.

Asymmetrically placed visual distractors are known to cause a lateral bias in the execution of a movement directed toward a target. The aim of the present experiment was to verify if the trajectory of the ball and the trajectory of the jump for a basket-shot can be affected by the sole position of a second player, who stays in front of the shooting player in one of three possible positions (centre, left or right) but too far to physically interfere with the shot. Young basketball players were asked to perform 60 shots at 6.25 m from a regular basket, with or without a second player staying in front of them in, alternately, a centre, left or right position. A computerised system measured the angular deviation of the jump direction from the vertical direction and the lateral deviation of the ball trajectory from the midline. The results showed that both the jump direction and the entry position of the ball deviated toward the opposite side from the second player's side; however, these effects were too small to significantly affect the mean goal percentage. This result confirms that some placements of the players can have an effect as visual distractors. Further studies are necessary to find what game conditions can make such distractors harmful for the athletic performance.

Cell-surface receptors transactivation mediated by g protein-coupled receptors.

G protein-coupled receptors (GPCRs) are seven transmembrane-spanning proteins belonging to a large family of cell-surface receptors involved in many intracellular signaling cascades. Despite GPCRs lack intrinsic tyrosine kinase activity, tyrosine phosphorylation of a tyrosine kinase receptor (RTK) occurs in response to binding of specific agonists of several such receptors, triggering intracellular mitogenic cascades. This suggests that the notion that GPCRs are associated with the regulation of post-mitotic cell functions is no longer believable. Crosstalk between GPCR and RTK may occur by different molecular mechanism such as the activation of metalloproteases, which can induce the metalloprotease-dependent release of RTK ligands, or in a ligand-independent manner involving membrane associated non-receptor tyrosine kinases, such as c-Src. Reactive oxygen species (ROS) are also implicated as signaling intermediates in RTKs transactivation. Intracellular concentration of ROS increases transiently in cells stimulated with GPCR agonists and their deliberated and regulated generation is mainly catalyzed by enzymes that belong to nicotinamide adenine dinucleotide phosphate (NADPH) oxidase family. Oxidation and/or reduction of cysteine sulfhydryl groups of phosphatases tightly controls the activity of RTKs and ROS-mediated inhibition of cellular phosphatases results in an equilibrium shift from the non-phosphorylated to the phosphorylated state of RTKs. Many GPCR agonists activate phospholipase C, which catalyze the hydrolysis of phosphatidylinositol 4,5-bis-phosphate to produce inositol 1,4,5-triphosphate and diacylglicerol. The consequent mobilization of Ca2+ from endoplasmic reticulum leads to the activation of protein kinase C (PKC) isoforms. PKCα mediates feedback inhibition of RTK transactivation during GPCR stimulation. Recent data have expanded the coverage of transactivation to include Serine/Threonine kinase receptors and Toll-like receptors. Herein, we discuss the main mechanisms of GPCR-mediated cell-surface receptors transactivation and the pathways involved in intracellular responses induced by GPCR agonists. These studies may suggest the design of novel strategies for therapeutic interventions.

The effect of dopaminergic treatment on whole body kinematics explored through network theory.

Three-dimensional motion analysis represents a quantitative approach to assess spatio-temporal and kinematic changes in health and disease. However, these parameters provide only segmental information, discarding minor changes of complex whole body kinematics characterizing physiological and/or pathological conditions. We aimed to assess how levodopa intake affects the whole body, analyzing the kinematic interactions during gait in Parkinson's disease (PD) through network theory which assess the relationships between elements of a system. To this end, we analysed gait data of 23 people with PD applying network theory to the acceleration kinematic data of 21 markers placed on participants' body landmarks. We obtained a matrix of kinematic interactions (i.e., the kinectome) for each participant, before and after the levodopa intake, we performed a topological analysis to evaluate the large-scale interactions among body elements, and a multilinear regression analysis to verify whether the kinectome's topology could predict the clinical variations induced by levodopa. We found that, following levodopa intake, patients with PD showed less trunk and head synchronization (p-head = 0.048; p-7th cervical vertebrae = 0.032; p-10th thoracic vertebrae = 0.006) and an improved upper-lower limbs synchronization (elbows right, p = 0.002; left, p = 0.005), (wrists right, p = 0.003; left, p = 0.002; knees right, p = 0.003; left, p = 0.039) proportional to the UPDRS-III scores. These results may be attributable to the reduction of rigidity, following pharmacological treatment.

Classroom-Based Physical Activity as a Means to Improve Self-Efficacy and Academic Achievement among Normal-Weight and Overweight Youth.

Although physical activity has positive physical and mental health outcomes, particularly among adolescents, a significant percentage of young people maintain a largely sedentary lifestyle. Considering that the youths spend the greater part of the day at school, this is considered an ideal setting to foster active and healthy living. Consequently, this study is intended to investigate the connection between physical activity, self-efficacy and academic achievement in normal-weight and overweight adolescents. In total, 100 students (aged 14-15) from a public high school placed in the south of Italy were enrolled. They participated either in a 12-week classroom-based physical activity break program performed during science classes (60'/2 days per week) in which a nutritional educational program was carried out or in regular science lessons (60'/2 days per week). At the beginning and end of the intervention programs, a set of standardized motor evaluation tests (standing long jump test, Harvard step test, push up, sit and reach test), the scholastic self-efficacy test and the Amos 8-15 were administered. As a result, a meaningful Time × Group interaction for the self-efficacy variable and Amos 8-15 was observed in the intervention group. Specifically, they reported significant improvement in study skills, motivational factors, concentration and self-efficacy, as well as a decrease in anxiety and BMI (p < 0.001). No significant change was observed in the control group. The conclusions of this research underpin the notion that classroom-based physical activity break is a successful approach for enhancing students' psycho-physical well-being, as well as academic achievement.

Incidental Focal Spleen Lesions: Integrated Imaging and Pattern Recognition Approach to the Differential Diagnosis.

Spleen lesions and pseudolesions, detected incidentally in imaging, are not uncommon and may require further work-up. The imaging appearance of focal splenic lesions (FSLs) may not be pathognomonic, because of considerably overlapping features. Consequently, all imaging techniques lack specificity to fully characterize FSLs. Clinical correlation is mandatory, so as, first of all, to categorize the patient as having or not having a history of solid or hematologic malignancy. Nowadays, many patients have old imaging studies available for comparison and, consequently, it is important to understand if the lesion was previously present or not, and if the size is the same or has changed. In the absence of comparison studies, and with a lack of imaging features of benignity, further investigation may be necessary, using PET, biopsy, or short-term follow-up. Some algorithms have been proposed to manage incidental FSLs; however, none of these strategies has been validated by prospective studies to date. In this review we illustrate the topic of incidental FSLs and we analyze a number of published algorithms.

Non-glandular findings on breast ultrasound. Part II: a pictorial review of chest wall lesions.

The breast ultrasound (US) field-of-view (FOV) includes glandular parenchyma as well as tissues located anterior to and posterior to it, up to pleural line. For that, it is possible to incidentally identify lesions unrelated to breast parenchyma during screening or diagnostic US; sometimes a palpable lump may be the reason of the imaging exam. Furthermore, abnormality related to chest wall are easier and more accurate detected after mastectomy. Hence, radiologists should know the US appearance of lesions which may develop from all tissues present in this region and displayed in the US FOV, without focusing only on glandular abnormalities while performing the exam. This is the second of a two-part series on non-glandular breast lesions; in detail, part two provide an overview of US appearance, differential diagnosis, and pitfalls of chest wall lesions. They may have an infectious, traumatic, inflammatory etiology or be benign or malignant neoplasms. The US role in the assessment of chest wall abnormalities is limited, usually computed tomography and/or magnetic resonance are requested as second-level imaging exams to characterize and to assess better their relationship with surrounding structures because of larger and panoramic view. Finally, US could be useful to guide biopsy.

Neuronal dysfunction and gene modulation by non-coding RNA in Parkinson's disease and synucleinopathies.

Over the last few decades, emerging evidence suggests that non-coding RNAs (ncRNAs) including long-non-coding RNA (lncRNA), microRNA (miRNA) and circular-RNA (circRNA) contribute to the molecular events underlying progressive neuronal degeneration, and a plethora of ncRNAs have been identified significantly misregulated in many neurodegenerative diseases, including Parkinson's disease and synucleinopathy. Although a direct link between neuropathology and causative candidates has not been clearly established in many cases, the contribution of ncRNAs to the molecular processes leading to cellular dysfunction observed in neurodegenerative diseases has been addressed, suggesting that they may play a role in the pathophysiology of these diseases. Aim of the present Review is to overview and discuss recent literature focused on the role of RNA-based mechanisms involved in different aspects of neuronal pathology in Parkinson's disease and synucleinopathy models.

COVID-19: Correlation between HRCT findings and clinical prognosis and analysis of parenchymal pattern evolution.

Objectives: Severe acute respiratory syndrome - coronavirus 2 (SARS-CoV-2) is a single-stranded positive ribonucleic acid virus of the coronaviridae family. The disease caused by this virus has been named by the World Health Organization coronavirus disease 19 (COVID-19), whose main manifestation is interstitial pneumonia. Aim of this study is to describe the radiological features of SARS-CoV-2 infection in its original form, to correlate the high-resolution computed tomography (HRCT) patterns with clinical findings, prognosis and mortality, and to establish the need for treatment and admission to the intensive care unit. Material and Methods: From March 2020 to May 2020, 193 patients (72 F and 121 M) who were swab positive for SARS-CoV-2 were retrospectively selected for our study. These patients underwent HRCT in the clinical suspicion of SARS-CoV-2 interstitial pneumonia. Results: Our results confirm the role of radiology and, in particular, of chest HRCT as a technique with high sensitivity in the recognition of the most peculiar features of COVID-19 pneumonia, in the evaluation of severity of the disease, in the correct interpretation of temporal changes of the radiological picture during the follow-up until the resolution, and in obtaining prognostic information, also to direct the treatment. Conclusion: Chest computed tomography cannot be considered as a substitute for real-time - polymerase chain reaction in the diagnosis of COVID-19, but rather supplementary to it in the diagnostic process as it can detect parenchymal changes at an early stage and even before the positive swab, at least for patients who have been symptomatic for more than 3 days.

The Potential Role of Nutrition in Overtraining Syndrome: A Narrative Review.

Competition between athletes and an increase in sporting knowledge have greatly influenced training methods while increasing the number of them more and more. As a result, the number of athletes who have increased the number and intensity of their workouts while decreasing recovery times is rising. Positive overtraining could be considered a natural and fundamental process when the result is adaptation and improved performance; however, in the absence of adequate recovery, negative overtraining could occur, causing fatigue, maladaptation, and inertia. One of the earliest forms of fatigue is overreaching. It is considered to be an accumulation of training that leads to reduced sports performance, requiring days or weeks to recover. Overreaching, if followed by adequate recovery, can lead to an increase in athletic performance. Nonetheless, if overreaching becomes extreme, combined with additional stressors, it could lead to overtraining syndrome (OTS). OTS, caused by systemic inflammation, leads to central nervous system (CNS) effects, including depressed mood, further inflammation, central fatigue, and ultimately neurohormonal changes. There are therefore not only physiological, biochemical, and immunological but also psychological symptoms or markers that must be considered, independently or together, being intrinsically linked with overtraining, to fully understand OTS. However, to date, there are very few published studies that have analyzed how nutrition in its specific food aspects, if compromised during OTS, can be both etiology and consequence of the syndrome. To date, OTS has not yet been fully studied, and the topic needs further research. The purpose of this narrative review is therefore to study how a correct diet and nutrition can influence OTS in all its aspects, from prevention to treatment.

Usefulness of dynamic ultrasound in the diagnosis of epigastric herniation of stomach.

Introduction: Abdominal wall hernia contents usually consist of omental or mesenteric fat or loops of small or large bowel. Gastric involvement has been only rarely reported. Case report: We present a case of a 62-year-old woman who was admitted to our hospital due to epigastric pain and vomiting. On physical examination, the only observed abnormality was a soft, painless, epigastric bulge located in the upper midline. Based on the clinical presentation, the patient was diagnosed with a probable epigastric hernia. Dynamic ultrasound evaluation of the palpable bulge confirmed the presence of epigastric hernia demonstrating the movement of abdominal contents through a large wall defect. Surprisingly, the herniated contents were found to contain also the anterior wall of the distal stomach together with omental fat and vessels. The patient opted for surgery, which confirmed the presence of an epigastric hernia containing the distal portion of stomach. Discussion: In this case, dynamic ultrasound provided added value over computed tomography by clearly demonstrating stomach passing from the abdominal cavity to enter into the hernia sac and it is therefore reported for both its rarity and interest. To our knowledge, this is the first such ultrasound-based case report presented in literature and certainly the best sonographically documented. Conclusion: We anticiapte that this case report will promote the use of dynamic ultrasound in current practice as an effective imaging tool to recognise unusual types of hernias.