Surgical treatment of sporadic vestibular schwannoma in a series of 1006 patients. Trattamento chirurgico degli schwannomi vestibolari: risultati su una serie di 1006 pazienti

La gestione dello schwannoma vestibolare (SV) sporadico si è gradualmente evoluta negli ultimi decenni. Lo scopo di questo studio è di analizzare l’evoluzione negli esiti chirurgici dell’exeresi di queste lesioni, realizzata da un team neurotologico tra il 1990 e il 2006, attraverso differenti approcci. È stata eseguita una revisione retrospettica monocentrica dei dati clinici di 1006 pazienti. Al fine di valutare eventuali modifiche e progressi, il periodo di 17 anni è stato diviso in tre periodi, ciascuno comprendente rispettivamente 268 SV (1990- 1996), 299 SV (1997-2001), e 439 SV (2002-2006). Il follow-up medio è stato di 5,9 ± 2,4 anni. Complessivamente l’asportazione totale è stata ottenuta nel 99,4% dei casi. Il tasso di mortalità è stato dello 0,3%, la meningite e la perdita di liquido cefalo rachidiano (LCR) sono stati osservati nel 1,2% e il 9% dei casi, rispettivamente. La frequenza della perdita di LCR è diminuita dal 11,6% al 7,1% tra il primo e dell’ultimo periodo (p < 0,01) e la revisione chirurgica dal 3,4% al 0,9% (p < 0,05). Il nervo facciale è stato anatomicamente conservato nel 97,7% dei casi. Ad un anno, una buona funzione del nervo facciale è stata osservata nel 85,1% dei pazienti (I e II grado HouseBrackmann), con una variazione tra il primo e l’ultimo periodo che andava dal 78,4% al 87,6% (p < 0,05). Ad un anno post-operatorio la conservazione dell’udito è stata ottenuta nel 61,6% dei pazienti, passando dal 50,9% del primo periodo, al 69,0% del periodo piú recente (p < 0,05) (classe A + B + C dalla classificazione AAO-HNS). L’udito utile (classe A + B) è stato conservato nel 33,5% dei casi complessivamente, con percentuali comprese tra il 21,8% e 42% nel primo e nell’ultimo periodo rispettivamente (p < 0,01). Gli esiti chirurgici dell’asportazion dello schwannoma vestibolare sporadico sono migliorati negli anni per quanto riguarda i risultati funzionali del nervo facciale, la conservazione dell’udito, le perdite di liquido cefalorachidiano, principalmente grazie all’esperienza del team neurotologico. I risultati funzionali dopo la rimozione microchirurgica completa SV di grandi dimensioni dipendono dall’ esperienza maturata sulle lesioni di piccole dimensioniThe management of sporadic vestibular schwannoma (VS) has evolved in the last decades. The aim of this study was to analyse the evolution in surgical outcomes of VSs operated by a neurotological team between 1990 and 2006 by different approaches. A monocentric retrospective review of medical charts of 1006 patients was performed. In order to assess eventual changes and progress, the 17-years period was divided in three periods, each one comprehending 268 VS (1990-1996), 299 VS (1997-2001), and 439 VS (2002-2006). Mean follow-up was 5.9 ± 2.4 years. Overall, complete VS removal was achieved in 99.4% of cases. Mortality rate was 0.3%, meningitis and CSF leaks were observed in 1.2 % and 9 % of the cases, respectively. CSF leakage decreased from 11.6% to 7.1% between the first and last period (p < 0.01) as well as revision surgery from 3.4 % to 0.9 % (p < 0.05). Facial nerve was anatomically preserved in 97.7% of cases. At one year, a good facial nerve function was observed in 85.1% of patients (grade I and II of House-Brackmann grading scale), which ranged between the first and last period from 78.4% to 87.6% (p <0.05). At one year, hearing preservation was obtained in 61.6% of patients, which increased from the first period to the last one from 50.9% to 69.0% (p < 0.05) (class A+B+C from the AAO-HNS classification). Useful hearing (class A+B) was observed in 33.5% of cases overall, with 21.8% and 42% in the first and last period, respectively (p < 0.01). Surgical outcomes of sporadic vestibular schwannoma have improved concerning facial nerve function outcomes, hearing preservation and cerebrospinal fluid (CSF) leaks, mainly due to the neuro-otological team's experience. Functional results after complete microsurgical removal of large VS depend on experience gained on small VS removal

Vascular smooth muscle Sirtuin-1 protects against aortic dissection during Angiotensin II-induced hypertension

BACKGROUND: Sirtuin-1 (SirT1), a nicotinamide adenine dinucleotide(+)-dependent deacetylase, is a key enzyme in the cellular response to metabolic, inflammatory, and oxidative stresses; however, the role of endogenous SirT1 in the vasculature has not been fully elucidated. Our goal was to evaluate the role of vascular smooth muscle SirT1 in the physiological response of the aortic wall to angiotensin II, a potent hypertrophic, oxidant, and inflammatory stimulus. METHODS AND RESULTS: Mice lacking SirT1 in vascular smooth muscle (ie, smooth muscle SirT1 knockout) had drastically high mortality (70%) caused by aortic dissection after angiotensin II infusion (1 mg/kg per day) but not after an equipotent dose of norepinephrine, despite comparable blood pressure increases. Smooth muscle SirT1 knockout mice did not show any abnormal aortic morphology or blood pressure compared with wild-type littermates. Nonetheless, in response to angiotensin II, aortas from smooth muscle SirT1 knockout mice had severely disorganized elastic lamellae with frequent elastin breaks, increased oxidant production, and aortic stiffness compared with angiotensin II-treated wild-type mice. Matrix metalloproteinase expression and activity were increased in the aortas of angiotensin II-treated smooth muscle SirT1 knockout mice and were prevented in mice overexpressing SirT1 in vascular smooth muscle or with use of the oxidant scavenger tempol. CONCLUSIONS: Endogenous SirT1 in aortic smooth muscle is required to maintain the structural integrity of the aortic wall in response to oxidant and inflammatory stimuli, at least in part, by suppressing oxidant-induced matrix metalloproteinase activity. SirT1 activators could potentially be a novel therapeutic approach to prevent aortic dissection and rupture in patients at risk, such as those with hypertension or genetic disorders, such as Marfan's syndrome.R01 HL098028 - NHLBI NIH HHS; HL098028 - NHLBI NIH HHS; HL105287 - NHLBI NIH HHS; T32 HL07224 - NHLBI NIH HH

Basal Cell Carcinoma Masked in Rhinophyma

Rhinophyma, the advanced stage of rosacea, is a lesion characterized by progressive hypertrophy and hyperplasia of sebaceous glandular tissue, connective tissue, and blood vessels. Rhinophyma can lead to a significant facial disfigurement and severe emotional distress, but it is not only an aesthetic problem, since rare cases of simultaneous presence of malignant tissue are described in the literature. The case of an 84-year-old farmer affected by basal cell carcinoma (BCC) and diagnosed in the context of rhinophyma is presented. The anatomical distortion produced by the chronic inflammation and fibrous scarring makes the BCC diagnosis difficult and uncertain. The histological examination of the entire mass and its margins is fundamental. A partial biopsy can lead to a false negative result, and the histological examination must be repeated intra- or postoperatively

Spatiotemporal data management of recurrent debris flow events using object-oriented data modelling

This work is focused on the study of recurrent debris flow events on the north-facing mountain slope of the Bulgheria massif (Cilento Unesco Geopark, southern Italy). These phenomena pose a threat for at least two villages and infrastructures on the lower slope. The main morpho-structure of the mountain slope is strongly controlled by the tectonic overlapping in form of multiple thrust-folding of the Meso-Cenozoic limestone related to the inner margin of the Apennine Carbonate Platform over lower-middle Miocene marly-clay flysch and previously overthrusted basinal units ranging from upper Oligocene to lower Miocene. Therefore, the mountain slope is sculpted by erosional deep incided ravines and sub-structural interfluve cliffed slopes passing downslope to depositional piedmont by evident and abrupt knick-point. Channels along the slope are periodically filled both through rock fall deposits occurring on channel’s flanks and by soil creep and sheet wash phenomena at channel’s heads, which supply new material for future flows. Such relationship between infilling rock fall phenomena and debris flows represents an interesting case study of interaction among different and concurrent landslide types providing an optimal example of space-time evolving landslide system. Landslide classes have been stored and mapped using a previously proposed object-oriented and event-based model and producing in this way a multi-temporal database. Landslide objects have been grouped into landslide subclasses using the latest landslide classification available. In the next step, a hierarchical classification has been applied, introducing two levels of aggregation and one level of decomposition. Landslide complexes group landslide objects of the same class sharing spatial connection, defining rock fall complex objects and granular soil wet flow complex objects. Landslide systems group all the interacting landslides, regardless of their type. Landslide components describe the various portions of a single landslide object. Every stored object has its temporal attributes distinguishing between time points (events) and time intervals (time frames). The integration of complex spatial relations through topological analysis and temporal characterization of data allows to build a flexible database structure adaptable to several specific needs and different outputs, such as basic landslide maps or event maps, multi-temporal and frequency analyses, or the study of the interactions among different types of landslide hazards. In this framework, a neologism could be introduced in landslide studies, as landslide eventory mapping, as a challenge for future applications

Landslide susceptibility assessment in the Upper Orcia Valley (Southern Tuscany, Italy) through conditional analysis: a contribution to the unbiased selection of causal factors

Abstract. In this work the conditional multivariate analysis was applied to evaluate landslide susceptibility in the Upper Orcia River Basin (Tuscany, Italy), where widespread denudation processes and agricultural practices have a mutual impact. We introduced an unbiased procedure for causal factor selection based on some intuitive statistical indices. This procedure is aimed at detecting among different potential factors the most discriminant ones in a given study area. Moreover, this step avoids generating too small and statistically insignificant spatial units by intersecting the factor maps. Finally, a validation procedure was applied based on the partition of the landslide inventory from multi-temporal aerial photo interpretation. Although encompassing some sources of uncertainties, the applied susceptibility assessment method provided a satisfactory and unbiased prediction for the Upper Orcia Valley. The results confirmed the efficiency of the selection procedure, as an unbiased step of the landslide susceptibility evaluation. Furthermore, we achieved the purpose of presenting a conceptually simple but, at the same time, effective statistical procedure for susceptibility analysis to be used as well by decision makers in land management

Elemental Analyzer/Isotope Ratio Mass Spectrometry (EA/IRMS) as a Tool to Characterize Plastic Polymers in a Marine Environment

In the last 60 years, plastic has become a widely used material due to its versatility and wide range of applications. This characteristic, together with its persistence, makes plastic waste a growing environmental problem, particularly in the marine ecosystems. The production of plant-derived biodegradable plastic polymers is assuming increasing importance. Here, we report the results of a first preliminary characterization of carbon stable isotopes (δ13C) of different plastic polymers (petroleum- and plant-derived) and a first experimental study aimed to determine carbon isotopic shift due to polymer degradation in an aquatic environment. The results showed that the δ13C values determined in different packaging for food uses reflect the plant origin for “BIO” materials and the petroleum-derived source for plastic materials. Considering degradation, δ13C values of both bio bags and HDPE bags showed a gradual decrease toward less negative values when kept immersed in seawater, recording a δ13C variation (Δδ13C) of 1.15 and 1.78‰, respectively. With respect to other analytical methods, the characterization of the plastic polymer composition by isotope ratio mass spectrometry is advantageous due to low cost and rapidity of analysis, small amount of sample required, high sensitivity, and the possibility of analyzing colored samples