Moriggia Pelascini Hospital

Background/Objectives: The use of vaginal mesh for pelvic organ prolapse (POP) repair remains controversial following global restrictions due to safety concerns. This study evaluated intra- and perioperative morbidity following a standardized single-incision, six-point fixation approach using an ultralight vaginal mesh in primary surgery for anterior/central POP. Methods: We conducted a retrospective multicenter study including 426 women who underwent primary POP repair with the InGYNious mesh system between May 2016 and February 2024. All surgeries followed a uniform technique across seven Italian centers. Data were collected on perioperative complications, urinary function, postoperative pain, and catheter duration. Results: The overall morbidity rate was 7.3% (31/426), primarily due to hematomas (4.5%), bladder injuries (1.4%), and ureteral injuries (0.7%). Median surgery duration was 40 min with minimal blood loss. Early postoperative pain was associated with higher POP-Q scores, longer surgical duration, and lower BMI. No cases of de novo urinary incontinence or urinary tract infection were reported in the perioperative period. Conclusions: This large multicenter case series suggests that, in experienced hands, this standardized vaginal mesh approach is associated with a low perioperative complication rate. However, the absence of a control group and the short follow-up are major limitations. Long-term outcome data, particularly regarding mesh-related complications, are essential before drawing firm conclusions on the broader safety or role of vaginal mesh in POP repair.

Background/Objectives: Depression, anxiety and apathy are often associated with subjective cognitive complaints (SCCs) in people with Parkinson’s disease (PwPD) without cognitive impairment. Cognitive reserve (CR) enhances emotional resilience, allowing people to better cope with stress and emotional challenges, factors affecting quality of life. We aimed to explore the relationship between CR and mood/anxiety in cognitively intact PwPD with and without SCCs. Methods: In this cross-sectional study we enrolled 133 PwPD and normal cognitive function (age 59.8 ± 6.7 years; disease duration 9.0 ± 5.5 years; male/female 84/49). We assessed cognitive reserve (CR scale), subjective cognitive complaints (with PD-CFRS), QoL (PDQ8), mood, anxiety and apathy (BDI-II; STAI, PAS, Apathy scales). We used a t-test to compare groups (with/without SCC; M/F); correlations and moderation analysis to evaluate the relation between CR and behavioral features and the interplay between CR, behavioral discomfort and QoL. Results: The group with SCCs had significantly (p < 0.05) higher scores in PDQ8, Apathy, STAI, PAS-C and BDI-II scales than those with no SCCs. Males with SCCs had higher scores in PDQ8, Apathy scale and BDI-II while females differed in PDQ8 and Apathy scale scores. In the SCC group, late-life CR was negatively correlated with PAS-C (avoidance behavior) and BDI-II; correlations were confirmed in the male group where CR also correlated with PDQ-8 and PAS persistent anxiety. Conclusions: PwPD and SCCs are more depressed and anxious compared to people without SCCs. Furthermore, we found a relationship between depressive symptoms, anxiety and CR: PwPD with SCCs may rely on cognitive reserve to better cope with the feeling of anxiety and depression, especially in male gender.

The outcome of levodopa/carbidopa intestinal gel (LCIG) in Parkinson's disease carriers of GBA1 mutations (GBA-PD) remains uncertain. To evaluate the safety and efficacy of LCIG in a large PD cohort, focusing on GBA1 variants. This multicenter, retrospective, longitudinal "real-world" study included consecutive patients with advanced PD treated with LCIG at 31 Italian centers; data were collected at baseline, 1-, 5-year, and last-available follow-up. Data from 512 PD patients (59% male, mean age and disease duration at LCIG initiation 67.0 ± 8.0 and 12.9 ± 5.0 years, respectively) were analyzed. GBA1 genotyping was available for 306 patients (60%), of whom 40 (13%) had GBA1 mutations or risk variants. Mean follow-up on LCIG was 3.9 ± 2.9 years; 5-year follow-up data were available for 159 subjects. At baseline, GBA-PD had a younger age, shorter PD duration, worse cognition, and more hallucinations than noncarriers. At 1- and 5-year follow-up, LCIG improved motor and non-motor symptoms, OFF-time, and dyskinesias in the entire population. In GBA-PD, MDS-UPDRS parts I, II, and III scores did not change, while part IV score improved significantly less than in noncarriers; cognition and orthostatic hypotension symptoms worsened more rapidly. Multivariate analysis of predictors for adverse events and LCIG discontinuation found no significant contribution from GBA1 mutation status. GBA1 status does not increase the risk of adverse events or LCIG discontinuation. LCIG is a safe option for advanced GBA-PD, even in patients with cognitive impairment at baseline. However, GBA-PD experiences lower efficacy on motor disability and complications and faster cognitive decline than noncarriers.

The treatment of choice for orbital cavernous hemangiomas (OCHs) is surgical resection, and multiple approaches have been proposed for these challenging deep-seated lesions of the orbit. In the latest years, endoscopic approaches, as the endonasal (EEA) or the transorbital (ETA), have been suggested as minimally invasive alternatives for these tumors, but few large works in literature are reported. In this article, the experience of three Italian referral centers with the endoscopic treatment of OCHs is described. All patients with OCHs operated with an endoscopic approach since January 2015 to January 2024 in 3 Italian referral centers were retrospectively collected. Patients' characteristics and symptoms, OCHs localization and type of endoscopic approach were reported. Postoperative complications, clinical outcome and cosmetic results (evaluated with Clavien-Dindo Classification and Scar Cosmesis Assessment and Rating Scale) at follow-up were assessed. Thirty-four patients were included, 16 were females. ETA was preferred in 19 patients and EEA in 15. All OCHs of the lateral quadrants were treated with ETA. 14/18 cases located in the medial quadrants were treated with EEA, since in 4 of the supero-medial quadrants lesions, an ETA was preferred. Finally, the orbital apex lesion was treated with EEA. Complete resection was achieved in 31 (91.2%) cases. Complications were transient and consisted in 3 cases of diplopia, 1 of medial rectus palsy and 1 of supraorbital neuralgia, all spontaneously regressed at follow-up. An optimal cosmetic outcome was achieved in all patients both after an EEA and an ETA. Endoscopic approaches for the treatment of OCHs are a safe and valid surgical option, allowing a complete resection avoiding any brain manipulation. Thanks to their less invasiveness, endoscopic approaches guarantee limited neurological and functional sequalae. Moreover, they resulted well tolerated and ensured good cosmetic outcomes.

The transorbital approach (TOA) is gaining popularity in skull base surgery scenarios. This approach represents a valuable surgical corridor to access various compartments and safely address several intracranial pathologies, both intradurally and extradurally, including tumors of the olfactory groove in the anterior cranial fossa (ACF), cavernous sinus in the middle cranial fossa (MCF), and the cerebellopontine angle in the posterior cranial fossa (PCF). The TOA exists in many variants, both from the point of view of invasiveness and from that of the entry point to the orbit, corresponding to the four orbital quadrants: the superior eyelid crease (SLC), the precaruncular (PC), the lateral retrocanthal (LRC), and the preseptal lower eyelid (PS). Moreover, multiportal variants, consisting of the combination of the transorbital approach with others, exist and are relevant to reach peculiar surgical territories. The significance of the TOA in neurosurgery, coupled with the dearth of thorough studies assessing its various applications and adaptations, underscores the necessity for this research. This extensive review delineates the multitude of target lesions reachable through the transorbital route, categorizing them based on surgical complexity. Furthermore, it provides an overview of the different transorbital variations, both standalone and in conjunction with other techniques. By offering a comprehensive understanding, this study aims to enhance awareness and knowledge regarding the current utility of the transorbital approach in neurosurgery. Additionally, it aims to steer future investigations toward deeper exploration, refinement, and exploration of additional perspectives concerning this surgical method.

Introdução: O Diabetes Mellitus Gestacional (DMG) é definido como qualquer grau de intolerância à glicose que começa ou é detectado durante a gravidez originada pela insuficiência de insulina gerada pela mãe, o que acarretará hiperglicemia, podendo ou não persistir após a gravidez. A fisiopatologia dessa doença reconhece a gestação como um estado hiperinsulinêmico caracterizado por uma diminuição da sensibilidade à insulina, explicada pela presença de hormônios diabetogênicos, tais como a progesterona, o cortisol, a prolactina e o hormônio lactogênico placentário. Essa doença se configura como um grave problema de saúde pública e contribui diretamente no desenvolvimento de doenças cardíaca, malformações cerebrais, morte intrauterina e outras complicações graves. Objetivos: Identificar as principais repercussões para a saúde fetal decorrentes do Diabetes Melitus Gestacional. Metodologia: O presente trabalho foi realizado através de uma revisão integrativa de literatura. Considerou-se como recorte temporal os anos de 2018-2022 a partir da base de dados Medline. Resultados: O comprometimento fetal associado ao Diabetes Gestacional decorre primordialmente da hiperglicemia materna, que por difusão facilitada chega ao feto. Foi possível identificar que, quanto pior o controle glicêmico da gestante, mais elevada é a taxa de morbimortalidade fetal e perinatal. As repercussões fetais identificadas são graves, com possibilidade de evolução para o óbito ou sequelas graves e permanentes. Conclusão: As principais repercussões para a saúde fetal associadas ao Diabetes Melitus Gestacional (DMG) englobam as seguintes alterações: macrossomia fetal, distocia de ombro, restrição do crescimento intrauterino, asfixia, sofrimento fetal durante o parto, hipoglicemia neonatal, prematuridade, icterícia neonatal, hiperviscosidade sanguínea, óbito fetal, infecções, síndrome da angústia respiratória, distúrbios metabólicos, malformações congênitas (sistema nervoso central, sistemas digestivo, urinário, musculoesquelético e cardíaco), policitemia. Estudos mais recentes apontam para o aumento da probabilidade de, na infância e na vida adulta, os filhos de gestantes portadoras de Diabetes Gestacional desenvolverem quadros de obesidade e Diabetes do Tipo 2.

Technological tools such as highly advanced surgical microscopes, complex microsurgery 43 virtual reality, 3-D printing, surgical robotics, and artificial intelligence (AI) have already become a part of daily in many surgical specialties. To improve 45 the quality of treatment provided in operating rooms, it is essential that such technologies be 46 adapted to every surgical branch in a timely manner and that surgeons become familiar with them 47 in the surgical laboratory (1). In this way, new scientific and technological developments will be 48 training of medical students in Africa. The authors reveal that the use of non-cadaver 3D-printed 66 models could contribute to improving the psychomotor performance of surgeons in microsurgery.translatedThe authors also note that most medical students became more familiar with neurosurgery after 68 using this tool; the students gained neurosurgical skills and developed the orientation skills needed 69 during neurosurgical applications. In addition, according to the study, students expressed their 70 satisfaction with the integration of this method into their medical curriculum.

Dopaminergic medications can trigger impulsive-compulsive behaviors (ICBs) in pre-disposed patients with Parkinson's disease (PD), but what this implies on a neurocognitive level is unclear. Previous findings highlighted potentially exacerbated incentive motivation (willingness to work for rewards) and choice impulsivity (preferring smaller, immediate rewards over larger, delayed rewards) in PD patients with ICBs (PD + ICBs). To deeply understand this evidence, we studied 24 PD + ICBs and 28 PD patients without ICBs (PD-ICBs). First of all, patients underwent the assessment of impulsivity traits, mood, anxiety, and addiction condition. We further administered robust objective and subjective measures of specific aspects of motivation. Finally, we explored whether these processes might link to any heightened antisocial behavior (aggression and risky driving) in PD + ICBs. High levels of positive urgency trait characterized PD + ICBs. They choose to exert more effort for rewards under the conditions of low and medium reward probability and as reward magnitude increases. Findings on choice impulsivity show a great tendency to delay discounting in PD + ICBs, other than a high correlation between delay and probability discounting. In addition, we found what appears to be the first evidence of heightened reactive aggression in PD patients with ICBs. Exacerbated incentive motivation and delay discounting trended toward positively predicting reactive aggression in PD + ICBs. Our promising results suggest that there might be immense value in future large-scale studies adopting a transdiagnostic neurocognitive endophenotype approach to understanding and predicting the addictive and aggressive behaviors that can arise from dopaminergic medication in PD.

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