Fifteenth century Florentine mural investigated in situ with VNIR Hyperspectral Imaging and NIR Photography supports interpretation as a bloodletting scene.

This study provides new data which suggest a novel interpretative hypothesis not only on the specific painting, but on the use of bloodletting as medical practice in the Florentine Quattrocento. As a part of a cycle of frescoes devoted to the Seven Corporal Works of Mercy, the examined lunette depicts the "Visit to the sick" in a domestic interior, but it has never been considered as an historical document of precise medical practices. The scene's definitive interpretation is still unresolved because of the uncertainty of some iconographic details. A campaign of in-situ and non-invasive technical investigations was performed to retrieve possible traces of previous details today concealed. The technical solutions adopted to implement the measurements campaign are illustrated, as an experimental example for remote sensing inspection of mural paintings in-situ. The position of the painting high up on a wall of an historical venue led to opting for stand-alone optical imaging techniques which could operate in remote sensing mode. By combining the use of portable Hyperspectral Imaging with Near Infrared photography a set of detailed images could be obtained that highlighted details not otherwise detectable. Focused on the objects held by the persons present, the analysis of the mural of Visit of the Buonomini in her Lying in Bed, the gift of swaddling cloth could be a tourniquet, shadows of folds of a blanket a thumb lancet, and an object held a blood collection bowl, supported the hypothesis that it could be a medieval bloodletting scene.

The Evolution of Pituitary Gland Surgery from the Ancients to the Millennials.

Located at the base of the skull, the pituitary gland has a long and controversial history, not only in terms of its anatomy, but especially in the functions it performs and in the attempt to approach it surgically. Considered by Galen of Pergamon to have a role in releasing waste products of the brain, a theory accepted until the 17th century, the pituitary gland became a separate entity once with the anatomical descriptions of the famous Andreas Vesalius. At the beginning of the 18th century, researches of the time began to be more and more interested in this gland, trying to identify its functions, and at the same time correcting the traditional theories that were wrong or incomplete. Later, they turned their attention to experimental animal studies that represented the germinal nucleus for the transcranial and endoscopic pituitary surgery. In this review, an attempt has been made to record the entire history of anatomy, physiology and surgery of the pituitary gland, from antiquity to the current day's surgical techniques.

Proprioception Analysis following Anterior Cruciate Ligament Reconstruction using Stabilometry: A Prospective, Longitudinal Study.

Objective Commonly used methods for measuring proprioception have resulted in conflicting reports regarding knee proprioception with anterior cruciate ligament (ACL) rupture and the influence of ACL reconstruction. Methods One hundred subjects (50 patients with radiologically and arthroscopically confirmed unilateral ACL rupture and 50 normal controls) were assessed with regards to proprioception using dynamic single-leg stance postural stabilometry. Instrumented knee ligament laxity and knee outcome scores were also measured. Of the 50 patients in the ACL group, 34 underwent reconstruction and were reassessed postoperatively. Results There was a significant proprioceptive deficiency in the ACL group compared with their contralateral knee ( p < 0.001) and to the control group ( p = 0.01). There was a significant improvement in knee proprioception following ACL reconstruction compared to preoperative findings ( p = 0.003). There was no correlation between ligament laxity measurements and outcome scores. A significant correlation was found preoperatively between outcome scores and proprioception measurements. This correlation was not found post-operatively. Pre-operative proprioception testing had a significant correlation (r = 0.46) with post-operative proprioception ( p = 0.006). Conclusion Patients with an ACL rupture had a proprioceptive deficit which improved following ligament reconstruction. Knee outcome scores had a better correlation with proprioception than ligament laxity. Proprioception may be a superior objective measure than ligament laxity in quantifying functional knee deficits and outcomes in patients with ACL ruptures. Level of Evidence III Therapeutic Study; Prospective Longitudinal Case-Control Study.

Pain and its management: Dante's Divine Comedy.

Dante Alighieri died in 1321; therefore, 2021 is the 700th anniversary of his death. His best known work is the Divine Comedy, which explores Dante's journey through the three realms of the underworld. Each realm is associated with three different sensations: Inferno, bodily (pain); Purgatorio, acoustic (music); and Paradiso, visual (light). The progression of the painful experiences and the resolution through music and light mirror the modern understanding of pain and its management. Music has both direct and indirect benefits and can help with coping. Sunlight promotes well-being and self-awareness.

Proprioception Analysis following Anterior Cruciate Ligament Reconstruction using Stabilometry: A Prospective, Longitudinal Study / Análise de propriocepção por estabilometria após a reconstrução do ligamento cruzado anterior: Um estudo prospectivo e longitudinal

Abstract Objective Commonly used methods for measuring proprioception have resulted in conflicting reports regarding knee proprioception with anterior cruciate ligament (ACL) rupture and the influence of ACL reconstruction. Methods One hundred subjects (50 patients with radiologically and arthroscopically confirmed unilateral ACL rupture and 50 normal controls) were assessed with regards to proprioception using dynamic single-leg stance postural stabilometry. Instrumented knee ligament laxity and knee outcome scores were also measured. Of the 50 patients in the ACL group, 34 underwent reconstruction and were reassessed postoperatively. Results There was a significant proprioceptive deficiency in the ACL group compared with their contralateral knee ( p < 0.001) and to the control group ( p = 0.01). There was asignificant improvement in knee proprioception following ACL reconstruction compared to preoperative findings ( p = 0.003). There was no correlation between ligament laxity measurements and outcome scores. A significant correlation was found preoperatively between outcome scores and proprioception measurements. This correlation was not found post-operatively. Pre-operative proprioception testing had asignificant correlation (r = 0.46) with post-operative proprioception ( p = 0.006). Conclusion Patients with an ACL rupture had a proprioceptive deficit which improved following ligament reconstruction. Knee outcome scores had a better correlation with proprioception than ligament laxity. Proprioception may be a superior objective measure than ligament laxity in quantifying functional knee deficits and outcomes in patients with ACL ruptures. Level of Evidence III Therapeutic Study; Prospective Longitudinal Case-Control Study.

Resumo Objetivo Os métodos comumente usados para medir a propriocepção resultaram em relatos conflitantes sobre a propriocepção do joelho com ruptura do ligamento cruzado anterior (LCA) e a influência da reconstrução do LCA. Métodos A propriocepção de 100 indivíduos (50 pacientes com ruptura unilateral do LCA confirmada à radiologia e artroscopia e 50 controles normais) foi avaliada por estabilometria postural dinâmica em apoio unipodal. A lassidão ligamentar do joelho instrumentado e suas pontuações de desfechos também foram medidas. Dos 50 pacientes do grupo LCA, 34 foram submetidos à reconstrução e reavaliados no período pós-operatório. Resultados O grupo LCA apresentou deficiência proprioceptiva significativa em relaçãoaojoelho contralateral ( p < 0,001) e ao grupo controle ( p = 0,01). A propriocepção do joelho melhorou de maneira significativa após a reconstrução do LCA em relação aos achados pré-operatórios ( p = 0,003). Não houve correlação entre as medidas de lassidão ligamentar e as pontuações de desfechos. Além disso, observamos uma correlação significativa entre as pontuações de desfechos e as medidas de propriocepção antes da cirurgia. Essa correlação não foi detectada no período pós-operatório. O teste pré-operatório de propriocepção teve correlação significativa ( r = 0,46) com a propriocepção pós-operatória ( p = 0,006). Conclusão Os pacientes com ruptura do LCA apresentaram déficit proprioceptivo que melhorou após a reconstrução ligamentar. As pontuações de desfecho do joelho tiveram melhor correlação à propriocepção do que a lassidão ligamentar. A proprio-cepção pode ser uma medida objetiva superior à lassidão ligamentar na quantificação de déficits funcionais e desfechos do joelho em pacientes com ruptura do LCA. Nível de Evidência III Estudo Terapêutico; Estudo de Caso-Controle Longitudinal Prospectivo.

Clinical Outcome Measures in Arthroscopic Meniscectomy: Clinician versus Patient Completed Knee Scores.

Objective The aim of the present study was to investigate the difference between clinician-completed and patient-completed outcome scores in detecting improvement following arthroscopic meniscectomy in patients with meniscal tears of the knee. Methods Thirty-four patients with meniscal tears were prospectively assessed using 9 clinical outcome measures. The five clinician-completed knee scores included the Tegner Activity Score, the Lysholm Knee Score, the Cincinnati Knee Score, the International Knee Documentation Committee (IKDC) Examination Knee Score, and the Tapper and Hoover Meniscal Grading Score. The four patient-completed knee scores included the IKDC Subjective Knee Score, the Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), the Short Form-12 Item Health Survey (SF-12), and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Twenty-nine of the 34 patients underwent an arthroscopic meniscectomy and were reassessed with all 9 outcome scores upon their follow-up review. Results A significant longitudinal improvement was observed in 4 of the 5 clinician-completed scores (Tegner [ p < 0.001], Lysholm [ p = 0.004], Cincinnati [p = 0.002] and Tapper and Hoover [ p < 0.001], but not in the IKDC Examination [ p = 0.332]. However, the IKDC Subjective score ( p = 0.021) was the only patient-completed score to demonstrate significant improvement postoperatively. Conclusion Overall, clinician-completed scoring systems were found to be inconsistent with those of patient-completed instruments. The mode of administering outcome measures can have a significant influence on the outcome results both for research and for clinical practice. A combination of both a clinician-completed with a patient-completed instrument may be a more balanced approach to assessing and quantifying meniscus tears and the outcome following arthroscopic meniscectomy.

From Baltimore to Italy: The contribution of Grace Baxter (1869-1954) to the development of Italian nursing.

The recent discovery of unpublished documents in the archives of the Camerata hospital, (Florence, I) sheds light on an important chapter in the history of nursing education and the role played by Grace Baxter (1869-1954), of English parentage but born and lived in Florence. The introduction of professional nurses was part of the international movement for the emancipation of women that included education for an active role in society. Her contribution, with other women, to the history of Italian nursing resulted in the secularisation the profession away from the attitudes of the nuns, permeation of relevant ethical standards, and the beginning of professionalisation of nurses in Italy in accordance with Florence Nightingale's teaching.

Patient reported outcome measures in anterior cruciate ligament rupture and reconstruction: The significance of outcome score prediction.

BACKGROUND: Numerous anterior cruciate ligament (ACL) clinical outcome measures exist. However, the result of one score does not equate to the findings of another even when evaluating the same patient group. AIM: To investigate if statistically derived formulae can be used to predict the outcome of one knee scoring system when the result of another is known in patients with ACL rupture before and after reconstruction. METHODS: Fifty patients with ACL rupture were evaluated using nine clinical outcome measures. These included Tegner Activity Score, Lysholm Knee Score, Cincinnati Knee Score, International Knee Documentation Committee (IKDC) Objective Knee Score, Tapper and Hoover Meniscal Grading Score, IKDC Subjective Knee Score, Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), Short Form-12 Item Health Survey and Knee Injury and Osteoarthritis Outcome Score. Thirty-four patients underwent an ACL reconstruction and were reassessed post-operatively. RESULTS: The mean total of each of the nine outcome scores appreciably differed from each other. Significant correlations and regressions were found between most of the outcome scores and were stronger post-operatively. The strongest correlation was found between Cincinnati and KOS-ADLS (r = 0.91, P < 0.001). The strongest regression formula was also found between Cincinnati and KOS-ADLS (R 2 = 0.84, P < 0.001). CONCLUSION: The formulae produced from this study can be used to predict the outcome of one knee score when the results of the other are known. These formulae could facilitate the conduct of systematic reviews and meta-analysis in studies relating to ACL injuries by allowing the pooling of substantially more data.

Clinical Outcome Measures in Arthroscopic Meniscectomy: Clinician versus Patient Completed Knee Scores / Medidas de desfechos clínicos na meniscectomia artroscópica: Pontuações de joelho segundo médicos e pacientes

Abstract Objective The aim of the present study was to investigate the difference between clinician-completed and patient-completed outcome scores in detecting improvement following arthroscopic meniscectomy in patients with meniscal tears of the knee. Methods Thirty-four patients with meniscal tears were prospectively assessed using 9 clinical outcome measures. The five clinician-completed knee scores included the Tegner Activity Score, the Lysholm Knee Score, the Cincinnati Knee Score, the International Knee Documentation Committee (IKDC) Examination Knee Score, and the Tapper and Hoover Meniscal Grading Score. The four patient-completed knee scores included the IKDC Subjective Knee Score, the Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), the Short Form-12 Item Health Survey (SF-12), and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Twenty-nine of the 34 patients underwent an arthroscopic meniscectomy and were reassessed with all 9 outcome scores upon their follow-up review. Results A significant longitudinal improvement was observed in 4 of the 5 clinician-completed scores (Tegner [p< 0.001], Lysholm [p= 0.004], Cincinnati [p = 0.002] and Tapper and Hoover [p< 0.001], but not in the IKDC Examination [p= 0.332]. However, the IKDC Subjective score (p= 0.021) was the only patient-completed score to demonstrate significant improvement postoperatively. Conclusion Overall, clinician-completed scoring systems were found to be inconsistent with those of patient-completed instruments. The mode of administering outcome measures can have a significant influence on the outcome results both for research and for clinical practice. A combination of both a clinician-completed with a patient-completed instrument may be a more balanced approach to assessing and quantifying meniscus tears and the outcome following arthroscopic meniscectomy.

Resumo Objetivo O objetivo do presente estudo foi investigar a diferença entre instrumentos de desfechos preenchidos por médicos e pacientes na detecção de melhora após a meniscectomia artroscópica para tratamento de rupturas de menisco. Métodos Trinta e quatro pacientes com rupturas de menisco foram avaliados de forma prospectiva usando 9 medidas de desfechos clínicos. Os cinco instrumentos de avaliação de joelho respondidos por médicos foram o Escore de Atividade de Tegner, o Escore de Joelho de Lysholm, o Escore de Joelho de Cincinnati, o Escore de Exame do Joelho do International Knee Documentation Committee (IKDC, na sigla em inglês) e o Escore de Classificação do Menisco de Tapper e Hoover. Os quatro instrumentos de avaliação do joelho respondidos por pacientes foram o Escore Subjetivo do Joelho do IKDC, a Pesquisa de Desfecho de Joelho - Escala de Atividades de Vida Diária (KOS-ADLS, na sigla em inglês), o Formulário Curto de Pesquisa em Saúde de 12 Itens (SF-12, na sigla em inglês) e o Escore de Desfecho de Osteoartrite e Lesões no Joelho (KOOS, na sigla em inglês). Vinte e nove dos 34 pacientes foram submetidos a uma meniscectomia artroscópica e reavaliados com todos os 9 instrumentos na sua consulta de acompanhamento. Resultados Uma melhora longitudinal significativa foi observada em 4 dos 5 instrumentos respondidos por médicos (Tegner [p< 0,001], Lysholm [p= 0,004], Cincinnati [p= 0,002] e Tapper e Hoover [p< 0,001], mas não no IKDC [p= 0,332]). Por outro lado, o Escore Subjetivo do Joelho do IKDC (p= 0,021) foi o único instrumento respondido por pacientes a demonstrar melhora pós-operatória significativa. Conclusão De modo geral, os instrumentos respondidos por médicos foram considerados inconsistentes em relação àqueles respondidos por pacientes. O modo de administração dos instrumentos pode ter influência significativa nos resultados, tanto para fins de pesquisa quanto para a prática clínica. A combinação de um instrumento respondido pelo médico com um instrumento respondido pelo paciente pode ser uma abordagem mais equilibrada para a avaliação e a quantificação das rupturas do menisco e do desfecho após a meniscectomia artroscópica.

Dino Buzzati's 50th death anniversary: an appraisal of medicine and infectivology's influence on his literary production.

BACKGROUND AND AIM: This paper, in the 50th anniversary of the author's death, examines the overall impact and influence of medicine, in particular of infectious diseases, on the literary production of Italian writer and novelist Dino Buzzati (1906-1972). METHODS: Analysis of literary sources and historical study. RESULTS AND CONCLUSIONS: Buzzati's literary world is great fun for the reader, being both intriguing and anxiety forming at the same time. One finishes reading his books only to discover the one truth which overturns everything that seemed to be true. In particular, in his short stories, which stem mostly from episodes taken from everyday life, the plot suddenly comes to life. The atmosphere becomes surreal, and in a moment the incredible happens. Behind the apparent lightness of the fairytale narrative there lies hidden the important issues addressed by the author. He uses the hospital as a metaphor for a categorised life, in which we are at risk of no longer being masters of ourselves, in which we suffer a continuous steady drip that makes us head downwards day after day, floor after floor. We will come back up, but not today, tomorrow perhaps, or at the latest, the day after tomorrow. Corte on the second floor hopes, and screams to give strength to his hope, that he will soon return to the top, towards the seventh floor.

PERFECTED enhanced recovery pathway (PERFECT-ER) versus standard acute hospital care for people after hip fracture surgery who have cognitive impairment: a feasibility cluster randomised controlled trial.

OBJECTIVES: Assess feasibility of a cluster randomised controlled trial (RCT) to measure clinical and cost-effectiveness of an enhanced recovery pathway for people with hip fracture and cognitive impairment (CI). DESIGN: Feasibility trial undertaken between 2016 and 2018. SETTING: Eleven acute hospitals from three UK regions. PARTICIPANTS: 284 participants (208 female:69 male). INCLUSION CRITERIA: aged >60 years, confirmed proximal hip fracture requiring surgical fixation and CI; preoperative AMTS ≤8 in England or a 4AT score ≥1 in Scotland; minimum of 5 days on study ward; a 'suitable informant' able to provide proxy measures, recruited within 7 days of hip fracture surgery. EXCLUSION CRITERIA: no hip surgery; not expected to survive beyond 4 weeks; already enrolled in a clinical trial. INTERVENTION: PERFECT-ER, an enhanced recovery pathway with 15 quality targets supported by a checklist and manual, a service improvement lead a process lead and implemented using a plan-do-study-act model. PRIMARY AND SECONDARY OUTCOME MEASURES: Feasibility outcomes: recruitment and attrition, intervention acceptability, completion of participant reported outcome measures, preliminary estimates of potential effectiveness using mortality, EQ-5D-5L, economic and clinical outcome scores. RESULTS: 282 participants were consented and recruited (132, intervention) from a target of 400. Mean recruitment rates were the same in intervention and control sites, (range: 1.2 and 2.7 participants/month). Retention was 230 (86%) at 1 month and 54%(144) at 6 months. At 3 months a relatively small effect (one quarter of an SD) was observed on health-related quality of life of the patient measured with EQ-5D-5L proxy in the intervention group. CONCLUSION: This trial design was feasible with modifications to recruitment. Mechanisms for delivering consistency in the PERFECT-ER intervention and participant retention need to be addressed. However, an RCT may be a suboptimal research design to evaluate this intervention due to the complexity of caring for people with CI after hip fracture. TRIAL REGISTRATION NUMBER: ISRCTN99336264.

Intertwining art, religion and anatomy: did Michelangelo Buonarroti influence Berengario da Carpi's representation of a maternal death?

AIM: To confirm that the sixteenth century surgeon-anatomist, Jacopo Berengario da Carpi, used a woman who died of a ruptured uterus as a model for a woodcut of female genital anatomy, and that the presentation was based on the cloak in Michelangelo's Creation of Adam after visiting the Sistine Chapel in the Vatican whilst he was in Rome. METHOD: Analysis of the woodcut for evidence of a uterus at term, and comparison with the shape of the cloak in the Creation of Adam, coupled with Berengario's own description. RESULTS: The size of the uterus is that in the 38th to 40th week of pregnancy, further supported by striations of the endometrial surface, rather than the smooth surface of the non-gravid. By rotating the woman's image 90° counterclockwise, the outline of the woman's cloak becomes almost perfectly superimposed over God's cloak. CONCLUSION: In the woodcut, the open belly of the model shows typical features of the full-term uterus. The use of God's cloak softens the features. At the same time, it exemplifies the creative power of God and describes the birth of humanity in both theological and physiological ways. Intertwining art, religion and anatomy, Michelangelo and Berengario allow scholars to appreciate the concepts of divinity and humanity at multiple levels.