Laser Interstitial Thermal Therapy for the Treatment of Primary and Metastatic Brain Tumors: A Systematic Review and Meta-Analysis.

BACKGROUND: Laser interstitial thermal therapy (LITT) is a minimally invasive treatment option for intracranial tumors that are challenging to treat via traditional methods; however, its safety and efficacy are not yet well validated in the literature. The objectives of the study were to assess the available evidence of the indications and adverse events (AEs) of LITT and 1-year progression-free survival and 1-year overall survival in the treatment of primary and secondary brain tumors. METHODS: A comprehensive literature search was conducted through the databases PubMed, Embase, and the Cochrane Library until October 2021. Comparative and descriptive studies, except for case reports, were included in the meta-analysis. Separate analyses by tumor type (high-grade gliomas, including World Health Organization grade 4 astrocytomas [which include glioblastomas] as a specific subgroup; low-grade gliomas; and brain metastases) were conducted. Pooled effect sizes and their 95% confidence intervals (CI) were generated via random-effects models. RESULTS: Forty-five studies met the inclusion criteria, yielding 826 patients for meta-analysis. There were 829 lesions in total, of which 361 were classified as high-grade gliomas, 116 as low-grade gliomas, 337 as metastatic brain tumors, and 15 as nonglial tumors. Indications for offering LITT included deep/inaccessible tumor (12 studies), salvage therapy after failed radiosurgery (9), failures of ≥2 treatment options (3), in pediatric patients (4), patient preference (1); indications were nonspecific in 12 studies. Pooled incidence of all (minor or major) procedure-related AEs was 30% (95% CI, 27%-40%) for all tumors. Pooled incidence of neurologic deficits (minor or major) was 16% (12%-22%); postprocedural edema 14% (8%-22%); seizure 6% (4%-9%); hematoma 20% (14%-29%); deep vein thrombosis 19% (11%-30%); hydrocephalus 8% (5%-12%); and wound infection 5% (3%-7%). One-year progression-free survival was 18.6% (11.3%-29.0%) in high-grade gliomas, 16.9% (11.6%-24.0%) among the grade 4 astrocytomas; and 51.2% (36.7%-65.5%) in brain metastases. One-year overall survival was 43.0% (36.0%-50.0%) in high-grade glioma, 45.9% (95% CI, 37.9%-54%) in grade 4 astrocytomas; 93.0% (42.3%-100%) in low-grade gliomas, and 56.3% (47.0%-65.3%) in brain metastases. CONCLUSIONS: New neurologic deficits and postprocedural edema were the most reported AEs after LITT, albeit mostly transient. This meta-analysis provides the best statistical estimates of progression and survival outcomes based on the available information. LITT is generally a safe procedure for selected patients, and future well-designed comparative studies on its outcomes versus the current standard of care should be performed.

Comparison of the Gait Biomechanical Constraints in Three Different Type of Neuromotor Damages.

Background and Objective: Absolute angle represents the inclination of a body segment relative to a fixed reference in space. This work compares the absolute and relative angles for exploring biomechanical gait constraints. Methods: Gait patterns of different neuromotor conditions were analyzed using 3D gait analysis: normal gait (healthy, H), Cerebral Palsy (CP), Charcot Marie Tooth (CMT) and Duchenne Muscular Dystrophy (DMD), representing central and peripheral nervous system and muscular disorders, respectively. Forty-two children underwent gait analysis: 10 children affected by CP, 10 children by CMT, 10 children by DMD and 12 healthy children. The kinematic and kinetic parameters were collected to describe the biomechanical pattern of participants' lower limbs. The absolute angles of thigh, leg and foot were calculated using the trigonometric relationship of the tangent. For each absolute series, the mean, range, maximum, minimum and initial contact were calculated. Kinematic and kinetic gait data were studied, and the results were compared with the literature. Results: Statistical analysis of the absolute angles showed how, at the local level, the single segments (thigh, leg and foot) behave differently depending on the pathology. However, if the lower limb is studied globally (sum of the kinematics of the three segments: thigh, leg and foot), a biomechanical constraint emerges. Conclusion: Each segment compensates separately for the disease deficit so as to maintain a global biomechanical invariance. Using a model of inter-joint co-variation could improve the interpretation of the clinical gait pattern.

System of indexes and indicators for the quality evaluation of HACCP plans based on the results of the official controls conducted by the Servizio di Igiene degli Alimenti della Nutrizione (Food and Nutrition Health Service) of the Local Health Authority of Foggia, Italy.

Within the realm of evaluating self-monitoring plans, developed based on the Hazard Analysis and Critical Control Points (HACCP) method and adopted by food companies, little research has been done concerning the quality of the plans. The Servizio di Igiene degli Alimenti e della Nutrizione (Food and Nutrition Health Service) of the Local Health Authority of Foggia, Italy, has conducted research with the aim to adopt a system of indexes and indicators for the qualitative evaluation of HACCP plans. The critical areas considered were the following: simplicity, specificity, feasibility and adherence. During the period from January 2004 to June 2005, the evaluation grid was used in examining 250 HACCP self-monitoring plans of food companies. For the analysis of the determining factor four groups were considered, with reference to HACCP self-monitoring plans designed: group 1 - with the aid of a qualified team; group 2 - with the aid of an unqualified team; group 3 - with the aid of an unqualified expert; group 4 - without the aid of an expert. The mean values of the measures elaborated decrease towards insufficiency moving from group 1 to group 4. In particular, collaboration by teams of unqualified experts brought about drafting unacceptable HACCP plans on the levels of specificity and adherence, with respect to the HACCP method. The method proposed of the analysis of the indexes and indicators beginning with an evaluation sheet can also help the individual company to better adjust contribution by internal or external professionals to the company.

Functional and Gait Assessment in Children and Adolescents Affected by Friedreich's Ataxia: A One-Year Longitudinal Study.

Friedreich's ataxia is the most common autosomal recessive form of neurodegenerative ataxia. We present a longitudinal study on the gait pattern of children and adolescents affected by Friedreich's ataxia using Gait Analysis and the Scale for the Assessment and Rating of Ataxia (SARA). We assessed the spectrum of changes over 12 months of the gait characteristics and the relationship between clinical and instrumental evaluations. We enrolled 11 genetically confirmed patients affected by Friedreich's ataxia in this study together with 13 normally developing age-matched subjects. Eight patients completed a 12-month follow-up under the same protocol. By comparing the gait parameters of Friedreich's ataxia with the control group, we found significant differences for some relevant indexes. In particular, the increased knee and ankle extension in stance revealed a peculiar biomechanical pattern, which correlated reliably with SARA Total, Gait and Sitting scores. The knee pattern showed its consistency also at the follow-up: Knee extension increased from 6.8±3.5° to -0.5±3.7° and was significantly correlated with the SARA total score. This feature anticipated the loss of the locomotor function in two patients. In conclusion, our findings demonstrate that the selective and segmental analysis of kinetic/kinematic features of ataxic gait, in particular the behavior of the knee, provides sensitive measures to detect specific longitudinal and functional alterations, more than the SARA scale, which however has proved to be a reliable and practical assessment tool. Functional outcomes measures integrated by instrumental evaluation increase their sensitivity, reliability and suitability for the follow-up of the disease progression and for the application in clinical trials and in rehabilitative programs.

Evaluation of HACCP plans of food industries: case study conducted by the Servizio di Igiene degli Alimenti e della Nutrizione (Food and Nutrition Health Service) of the local health authority of Foggia, Italy.

With respect to food safety, many works have studied the effectiveness of self-monitoring plans of food companies, designed using the Hazard Analysis and Critical Control Point (HACCP) method. On the other hand, indepth research has not been made concerning the adherence of the plans to HACCP standards. During our research, we evaluated 116 self-monitoring plans adopted by food companies located in the territory of the Local Health Authority (LHA) of Foggia, Italy. The general errors (terminology, philosophy and redundancy) and the specific errors (transversal plan, critical limits, hazard specificity, and lack of procedures) were standardized. Concerning the general errors, terminological errors pertain to half the plans examined, 47% include superfluous elements and 60% have repetitive subjects. With regards to the specific errors, 77% of the plans examined contained specific errors. The evaluation has pointed out the lack of comprehension of the HACCP system by the food companies and has allowed the Servizio di Igiene degli Alimenti e della Nutrizione (Food and Nutrition Health Service), in its capacity as a control body, to intervene with the companies in order to improve designing HACCP plans.