Accuracy of CT and MRI to assess resection margins in primary malignant bone tumours having histology as the reference standard.

AIM: To evaluate the accuracy of magnetic resonance imaging (MRI) and computed tomography (CT) in assessing the resection margins of primary malignant bone tumours. MATERIALS AND METHODS: Resected primary malignant bone tumour specimens removed from 46 patients (27 male; mean age: 48±22 years) were imaged using MRI (fat-saturated proton density-weighted and three-dimensional fat-suppressed T1-weighted gradient-recalled-echo) and CT immediately after surgery. A radiologist and an orthopaedist evaluated bone and soft-tissue margins of the specimens on both examinations. Histological evaluation was performed by a senior orthopaedic oncology pathologist. Margins were classified as R0 (safe margins), R1 (residuals between 0 and 1 mm), and R2 (macroscopic residuals). Cohen's k, chi-square, and McNemar's statistics were used. RESULTS: Having histology as the reference standard, reproducibility of the radiologist ranged from moderate (k=0.544) to substantial (k=0.741) for bone and soft-tissue margins on CT, respectively, while that of the orthopaedist ranged from fair (k=0.316) to moderate (k=0.548). When comparing R2 and R0+R1 scores, reproducibility of readers' evaluation of bone margins increased ranging from substantial (k=0.655) to perfect (k=1.000). Inter-reader agreement ranged from fair (k=0.308) to substantial (k=0.633). Accuracy of the radiologist and orthopaedist ranged from 76% to 83% and from 68% to 72%, respectively. When comparing R2 and R0+R1 scores, the accuracy of both readers ranged from 83% to 100%. There was no association between local recurrence and margin scores of histology, MRI, and CT (p≥0.058). CONCLUSIONS: MRI and CT may be useful for extemporaneous analysis of resection margins of primary malignant bone tumours, although wide accuracy variability between the different imaging methods was observed.

Influence of continuous rotation or reciprocation of Optimum Torque Reverse motion on cyclic fatigue resistance of nickel-titanium rotary instruments.

AIM: To evaluate the resistance to cyclic fatigue of ProTaper Next (PTN; Dentsply Sirona, Ballaigues, Switzerland), Revo-S (Micro-Mega, Besançon, France), Mtwo (Sweden & Martina, Padova, Italy), Twisted Files (TF, SybronEndo, Orange, CA, USA) and EndoWave (J Morita Corporation, Osaka, Japan) used in continuous rotation or in reciprocation of Optimum Torque Reverse motion (OTR). METHODOLOGY: A total of 120 nickel-titanium files were tested. Twenty-four instruments for each brand were divided into two groups (n = 12) on the basis of the motion tested: continuous rotation (Group 1) or reciprocation of OTR motion (Group 2). Resistance to cyclic fatigue was determined by recording time to fracture (TtF) in a stainless steel artificial canal with a 60° angle of curvature and 5 mm radius of curvature. The TtF data were analysed by using two-way analysis of variance (anova) and Bonferroni's post hoc tests at 0.05. RESULTS: Mtwo and TF had significantly higher TtF when compared with all other instruments, both in continuous rotation and in reciprocation of OTR motion (P < 0.0001 and P < 0.05, respectively). No difference was observed between Mtwo and TF (P > 0.05), in both motions. PTN was associated with higher cyclic fatigue resistance than Revo-S and EndoWave, both in continuous rotation and in reciprocation of OTR motions (P < 0.0001). No difference was observed between Revo-S and EndoWave, in both motions (P > 0.05). Reciprocating OTR motion improved TtF of all instruments (P < 0.0001). CONCLUSIONS: Reciprocation of OTR motion improved significantly cyclic fatigue resistance of all instruments tested compared with continuous rotation. Mtwo and TF had significantly higher cyclic fatigue than the other instruments, in both continuous rotation and reciprocation of OTR motion.

Introduction to a community dataset from an infrasound array experiment at Mt. Etna, Italy.

Volcanic activity represents a hazard to population and infrastructure worldwide. The study of acoustic waves in the atmosphere by volcanic activity is growing in popularity as an effective tool to monitor and understand the mechanisms of eruptions. In 2019, we deployed two 6-element infrasound arrays at Mt. Etna, Italy, one of the most active volcanoes in the world. Our experiment captured a range of acoustic signals associated with diverse activity ranging from background degassing to energetic Strombolian explosions, lava flows, and atmospheric injection of volcanic ash. Here, we present a description of this valuable, publicly available, research dataset. We document the design and scope of the experiment, report on data availability, and present a brief summary of the activity observed at Mt. Etna during our deployment aiming to facilitate future use of these valuable data. This dataset is the first example of open data from a multiple infrasound array experiment at Mt. Etna and one of the few available globally.

The role of multiparametric resonance and biopsy in prostate cancer detection: comparison with definitive histological report after laparoscopic/robotic radical prostatectomy.

PURPOSE: Magnetic Resonance Imaging (MRI) targeted biopsy increases overall detection rates and decreases the risk of clinically insignificant PCa detection. The aim of this retrospective study is to compare concordance rates regarding side of lesion and Gleason Score at fusion targeted/systematic biopsy and MRI with the definitive histologic report of prostatectomy specimen. METHODS: 115 patients underwent multiparametric (mp) MRI and successively fusion targeted/systematic biopsy. 107 patients, with a positive biopsy for PCa, further underwent laparoscopic/robotic radical prostatectomy. We compared surgical histologic report with biopsy histologic report for side of lesion and Gleason Score. We further compared PIRADS score at mpMRI with Gleason Score of both histologic reports. RESULTS: Concordance rate for mpMRI lesion side was 74% compared to biopsy and 52.3% compared to surgical histologic report (p < 0.0001). Fusion targeted/systematic biopsy reported a concordance rate with surgical histologic report of 67.3% for side of the lesion, while Gleason Score was concordant for 73.6% for clinically significant cancer (Gleason Score ≥ 7) (p < 0.0001). PIRADS score ≥ 3 was further associated with clinically significant cancer at surgical histologic report in 92.4% of cases (p = 0.359). CONCLUSION: Multiparametric MRI of the prostate reaches a good and improvable accuracy in the detection of suspicious PCa before biopsy. A combined approach of fusion targeted and systematic biopsy could further increase the overall accuracy in PCa diagnosis, especially in biopsy-naïve patients, reaching concordance rates with definitive histologic report up to 52.3% and 85.5%.

Proximal humeral fracture fixation: multicenter study with carbon fiber peek plate.

BACKGROUND: Locking plate fixation is a reliable treatment for many displaced proximal humeral fractures. Carbon fiber-reinforced-poly-ether-ether-ketone (CFR-PEEK) plates have recently been introduced as an alternative to traditional metallic plates. METHODS: In a multicenter study involving the Orthopedic Services of 6 Italian hospitals, 182 patients with a proximal humeral fracture were treated with a Diphos H (Lima Corporate, San Daniele del Friuli, Italy) CFR-PEEK plate, 160 of whom were followed clinically and radiographically for 2 years or more. Fractures were classified by Neer's system. The functional results were assessed by Constant and DASH scores. RESULTS: The average time to radiographic healing was 5.6 months in 158 of 160 cases. Mean Constant score was 76, and mean DASH score was 28 at 2 years. There were two nonunions (one septic and one aseptic) and 13 cases of partial (9) or massive (4) humeral head necrosis. In three of the 78 patients treated with the first-generation plates, hardware breakage happened during the operation and the plate was replaced. There was no failure among the cases treated with the thicker second-generation plate. In eight cases, there was a perforation of the humeral head by the cephalic screws. CONCLUSIONS: CFR-PEEK plates proved as reliable as metallic plates in the treatment of proximal humeral fractures. The advantages of these new devices include a better visualization of fracture reduction during intraoperative fluoroscopic assessment and easy hardware removal due to the absence of screw-plate cold fusion.

Variations in method in the use of the coracoacromial ligament for the surgical treatment of acromioclavicular dislocations.

Many authors have used the coracoacromial ligament to treat acromioclavicular dislocations. The variation in method proposed in this study includes: a) detachment of the coracoacromial ligament from the acromial aspect, b) its section into two bands, medial and lateral, of which one inserted by means of a transosseous hole at the clavicle and the second one anchored bridge-like on the clavicle suturing it to the soft tissues; c) temporary fixation of the acromioclavicular joint by means of a Kirschner wire or Ghisellini screw pin that is threaded at one end. The study conducted may be considered preliminary, as the series is constituted by 16 patients affected with grade IV acromioclavicular displacement according to Rockwood, acute in 13 cases and inveterate in 3. The results which were excellent and good in terms of pain, recovery of range of movement, and the subjective opinion of the patients, reveals a subdislocation measuring from 3 to 5 mm in 2 patients in our series. Currently, the hypothesis may be advanced that the variation in the method described may have the advantage of guaranteeing physiological anchoring of the ligament to the clavicle and thus providing a greater guarantee should trauma occur in the future.

Surgery in massive ruptures of the rotator cuff: results as related to prognosis.

The results obtained in the surgical treatment of massive lesions of the rotator cuff are quite often inferior to what is expected, because prognosis is not respected. To demonstrate that the quality of the results obtained is directly proportional to the preoperative prognostic factors a retrospective study was conducted on 28 patients submitted to massive lesion repair of the rotator cuff between 1990 and 1996; the criteria of inclusion was: a) patients aged under 65 years; b) preoperative radiographic findings with acromiohumeral distance not less than 6 mm; c) degeneration of the tendons not greater than a Goutallier stage 2; d) absence of inveterate pseudoparalysis of the limb involved; e) absence of anterosuperior subdislocation of the humeral head. The results obtained with a mean follow-up of 5 years revealed a mean Constant score of 85 points (minimum 79, maximum 91) that may correspond to excellent results, showing how this type of surgery may guarantee good results only when factors of prognosis are respected preoperatively.

Neer capsular shift surgery in the treatment of recurrent antero-inferior shoulder dislocations.

A total of 47 patients affected with recurrent multidirectional shoulder dislocation with a prevalent anteroinferior component were submitted to Neer inferior capsular shift surgery. Bankart lesion, present in 24 patients, was repaired prior to performing capsuloligamentous surgery. The patients included in the study presented with generalized ligamentous hyperlaxity in 20 cases, while hyperlaxity was localized in the pathological shoulder in the remaining cases, presumably related to the high number of dislocations. The choice of performing Neer inferior capsular shift surgery was initially based on the data and the modern conceptions that emerged in the literature. Successively, the good results obtained encouraged us to follow the path taken, and we are currently encouraged to advise this surgical procedure for the category of patients mentioned above.

Ultrasound and MRI for the long-term evaluation of surgical repair of the rotator cuffs.

About 1 year after surgery to repair the rotator cuff, a total of 20 patients (80% monotendinous injuries, 20% bitendinous injuries) were submitted to ultrasound and MRI to evaluate repair, quality of residual tissue, and to reveal any discrepancies between the two instrumental tests. The results showed that there was normal tendinous integrity in 16 cases (group A), while there were partial injuries, without evidence of complete lesion, in 4 cases (group B); tendinous thinning was evident in 10 patients (50%), while there were areas of intratendinous degeneration in 40% of the cases. The authors observed agreement between the data obtained by the two methods in 75% of cases, and emphasize the effectiveness of the two methods in postoperative evaluation of the cuff; they also confirm the tendinous dishomogeneousness observed in the patients in group B, not associated with poor clinical results, considering the absence of significant differences in the functional results between the two groups.

Delta infection in eastern Sicily.

Sera from 619 HBsAg+ subjects living in eastern Sicily, consecutively collected from 1975-1985, were tested for markers of delta virus (HDV) infection: delta antigen (HDAg), antibodies to delta (anti-HDIg), and also for antibodies to HBcore of IgM type (anti-HBcIgM) and for the system HBe-anti-HBe. The subjects included 210 asymptomatic carriers, 238 patients with acute hepatitis and 171 patients with chronic liver disease. HDAg was not found in any of the samples. Anti-HD was found in 28/171 (16.3%) patients with chronic liver disease, in 13/210 (6%) asymptomatic HBsAg carriers and in 13/238 (5.4%) patients with acute hepatitis. None of our patients were drug addicts. One had a history of blood transfusion, and nine came from the same family unit. The prevalence of HDV infection in eastern Sicily is lower than in other areas of Sicily possibly because of the lower percentage of HBsAg carriers in the local population. Parenteral transmission of HDV does not seem to play a major role in our area, while the familial clustering suggests close body contact as an important way of spread.