Search Results (364)

Objectives: This study aimed to investigate the impact of platelet-rich plasma (PRP) and platelet-rich gel (PRG) on tympanic membrane closure rates, hearing improvement, and quality of life following tympanoplasty. Methods: Seventy-two patients with chronic tympanic membrane perforations were enrolled in a double-blinded, randomized controlled trial at a single tertiary referral center. All patients underwent tympanoplasty using a temporalis fascia graft and were randomly assigned to one of two groups: one group received standard tympanoplasty alone, while the other received intraoperative application of autologous PRP and PRG, in addition to the standard procedure. Results: The PRP group demonstrated a significantly higher rate of complete tympanic membrane closure compared to the control group (32/36; 88.9% vs. 24/36; 66.7%; p < 0.05). Bone conduction hearing remained unchanged in both groups, while air conduction hearing improved significantly from pre- to post-treatment in each group. However, the difference in air conduction improvement between the PRP group and the control group was not statistically significant (PRP group: Mdn = −8.25; control group: Mdn = −12.20; U = 618; z = −0.54; p = 0.30). Quality of life improved in both the PRP and control groups; however, the difference between the groups was not statistically significant (PRP group: 10.44 ± 10.46; control group: 10.47 ± 8.22; 95% CI [−4.45; 4.40]; t(66) = −0.01; p = 0.16). Conclusions: Our findings suggest that intraoperative application of autologous PRP and PRG may improve tympanoplasty outcomes, particularly in cases with lower expected success rates or when performing minimally invasive transcanal procedures under local anesthesia. However, variability in PRP preparation, application methods, and graft materials across studies limits direct comparisons. Standardized protocols and further controlled studies are necessary to clarify PRP’s clinical value in tympanoplasty. Full article

Background/Objectives: Cycling has become a popular recreational sport, but it can lead to injuries and overload syndromes. The goal of this study is to evaluate the effectiveness of a training-accompanied myofascial self-massage intervention on two primary outcomes: injury occurrence and perceived training intensity. Methods: To achieve this goal, we conducted a randomized controlled trial (RCT) with 35 cyclists. A difference-in-differences (DiD) regression analysis was employed to analyze the effects of the intervention. Results: The DiD analysis revealed, on the one hand, no statistically significant effect of the intervention on the overall injury score. On the other hand, the intervention group showed a significantly smaller increase in perceived training intensity compared to the control group, supporting the hypothesis that myofascial self-massage decreases the perception of training intensity. In one of our strongest models, which estimated the impact of the intervention from baseline to the second post-test, we observed an adjusted R-squared value of 0.89 and an interaction term coefficient of 1.35 at a significance level of p < 0.01. This indicates that, on average, the increase in perceived training intensity was 1.35 points higher (on a scale of 0 to 10) in the control group than in the intervention group. Conclusions: This study found no evidence to support the effectiveness of a training-accompanied myofascial self-massage in reducing injury levels, but it demonstrated that the intervention may reduce perceived training intensity. Future studies with larger sample sizes and more objective injury tracking methods are needed to further explore these findings and their long-term implications for injury prevention in cycling. Full article

Background: Total hip arthroplasty (THA) improves the quality of life by alleviating pain and restoring function. The optimal pain control with minimal muscle weakness is paramount for early rehabilitation and for reducing complications. Although PROSPECT and ICAROS guidelines recommend the Fascia Iliaca Compartment Block (FICB), it is associated with insufficient pain relief and a prolonged quadriceps motor block. The association of the PENG (Pericapsular Nerve Group) with LFCN (lateral femoral cutaneous nerve) blocks may address these limitations, provide improved motor-sparing pain control, and offer a more tailored approach that enhances both an early postoperative recovery and patient satisfaction. Methods: A randomized controlled trial (November 2023–July 2024) compared the PENG + LFCN to the FICB in patients undergoing elective THAs under spinal anesthesia. The primary outcome was quadriceps weakness at 6 h post-block. Secondary outcomes included the degree of hip flexion and pain scores at 6, 24, and 48 h post-block, opioid consumption, and time to ambulation. Results: Fifty-eight patients were randomized (twenty-nine per group). The PENG + LFCN group achieved a significantly greater muscle strength (MRC: 4 [4; 4] vs. 3 [3; 4], p < 0.0001) and better hip flexion at all measured moments (6 h: 45° [37; 60] vs. 30° [25; 43], 24h: 59° [49; 66] vs. 47° [36; 50], 48 h: 62° [55; 70] vs. 50° [40; 55], all p < 0.0001). Resting pain was lower in the PENG + LFCN group (0 [0; 1], 0 [0; 2], and 0 [0; 1] vs. 2 [0; 3], 1 [0; 3], 1 [0; 3]), as was the dynamic pain during movement (1 [0; 2], 2 [2; 4], and 2 [1; 2] vs. 3 [2; 5], 3 [2; 4], and 3 [1; 3]; all p < 0.001), along with a lower total opioid consumption (0 [0; 0] vs. 7.5 [7.5; 22.5] MME, p < 0.001). Conclusions: The PENG + LFCN block outperformed the FICB in muscle strength, hip flexion, pain control, and opioid use, suggesting it may be a more effective option for THAs. Full article

(1) Background: Plantar heel pain (PHP), a common overuse foot injury, significantly impacts runners. While the mechanical role of the plantar fascia during gait is established, its effect on foot function during running, particularly foot joint coupling, remains unclear. This study investigated foot joint coupling during running in runners with and without PHP using statistical parametric mapping (SPM). (2) Methods: Thirteen uninjured runners (seven m, six f; age = 30.5 ± 5.9 years; BMI = 23.5 ± 3.0 kg/m²) and thirteen runners with PHP (six m, seven f; age = 29.0 ± 8.0 years; BMI = 23.1 ± 2.0 kg/m²) performed running trials at 4.0 m/s. A seven-segment foot model that defined six functional articulations (rearfoot, medial and lateral midfoot, medial and lateral forefoot, first metatarsophalangeal) was used to quantify foot kinematics, vector coding was used to calculate joint coupling between adjacent foot segments, and SPM was used to analyze joint stance phase coupling angles. (3) Results: There were statistically significant differences in rearfoot frontal plane–medial midfoot frontal plane joint coupling between runners with and without PHP from 69 to 70% stance phase (mean difference = 39.41°) and at 76% stance (mean difference = 47.89°). The differences were indicative of greater medial midfoot eversion rotation relative to rearfoot complex inversion in the PHP group. (4) Conclusions: The difference in the rearfoot complex and medial midfoot frontal plane coupling occurred during the propulsion phase of the running stance when the foot should be transitioning to a more supinated position, which may reflect compromised supination due to plantar fascia degeneration. Full article

Background/Objectives: Immediate implant-based breast reconstruction is an established option for selected patients undergoing mastectomy. However, patients with large and ptotic breasts present specific reconstructive challenges, often requiring tailored approaches to minimize complications and optimize aesthetics. This pilot study aimed to evaluate the clinical feasibility and effectiveness of a mobile application developed to support intraoperative decision-making based on an institutional algorithm for breast reconstruction. It is also important to underline that this pilot study was exploratory in nature and primarily aimed at assessing feasibility and adherence to an app-based decision pathway, rather than comparative efficacy. Methods: We conducted a prospective observational study from October 2023 to December 2024 at the University Hospital of Sassari. Female patients with large and ptotic breasts undergoing immediate implant-based reconstruction were included. A mobile app, developed using MIT App Inventor 2, implemented our institution’s algorithm and guided surgeons through both preoperative and intraoperative decision-making. Surgical options included subpectoral, prepectoral with autologous fascial flaps, or prepectoral with acellular dermal matrix (ADM) reconstruction, depending on flap thickness and fascia integrity. Results: Sixteen patients (21 reconstructed breasts) were included. Surgical planning and execution followed app-generated recommendations in all cases, with no intraoperative deviations. Subpectoral reconstruction was performed in six patients, prepectoral with ADM in eight, and prepectoral with fascial flaps in two. The app was rated positively by all surgeons and facilitated consistent decision-making. Conclusions: The proposed mobile application, described in this pilot study, proved to be a feasible and effective decision-support tool for implant-based breast reconstruction in patients with challenging anatomy. It standardized surgical choices, supported training, and has the potential to enhance reproducibility and safety in complex reconstructive procedures. Full article

Background: Myopericytoma is a rare benign vascular tumour characterised by concentric spindle cell proliferation around blood vessels, often misdiagnosed due to its resemblance to other soft tissue masses. Dupuytren’s disease (DD), a fibroproliferative disorder of the palmar fascia, causes progressive contractures, typically affecting the ring and little fingers. While these conditions are well-documented individually, their coexistence in the same region is rare and diagnostically challenging. Case Presentation: This report highlights a 67-year-old male with longstanding DD and a recurrent palmar mass initially attributed to fibrosis. Magnetic resonance imaging revealed hallmark vascular features suggestive of myopericytoma, confirmed by histopathological analysis showing spindle cell proliferation and immunohistochemical positivity for alpha-smooth muscle actin and h-caldesmon. Concurrent DD, characterised by fibrosis and activated myofibroblasts, further complicated the clinical picture. Methodology: PubMed, Scopus, Web of Science, and Embase databases were searched from January 1901 to December 2024, and 20 studies were found, reporting 41 cases of myopericytoma in hand and upper extremity. Histopathological analysis consistently showed spindle cell proliferation and smooth muscle actin positivity. Coexistence with DD was rare, highlighting the need for detailed imaging and histological evaluation for accurate diagnosis. Conclusions: This case emphasises the complexity of differentiating overlapping pathologies. Surgical excision of myopericytoma and tailored DD management yielded favourable outcomes. Further research into shared fibroinflammatory pathways, including tumour necrosis factor-alpha and interleukin-6, may enhance diagnostic accuracy and treatment strategies for overlapping conditions. Full article

This study investigates the influence of probe angulation on echogenicity and thickness measurements of the deep fascia, addressing methodological challenges in musculoskeletal ultrasound examination. The anisotropic nature of connective tissues can lead to distortions, affecting US imaging accuracy and diagnostic reliability. Echogenicity and thickness variations were analyzed across different probe inclinations in both transverse and longitudinal orientations. Measurements at 0° were compared with −5° and +5° angles to assess their impact on imaging consistency due to 3D-printed support. Echogenicity differed significantly with probe angulation, in particular in transverse scan at 0°, which showed substantial variation at −5° (mean diff. = 55.14, p < 0.0001) and +5° (mean diff. = 43.75, p = 0.0024). Thickness measurements also varied, reinforcing that non-perpendicular probe angulation introduces distortions. The same results were reported for longitudinal scans. These findings highlight the need for the use of standardized scanning protocols to improve reliability. The protean nature of deep fascia anisotropy, highly sensitive to minimal changes in probe orientation, necessitates precise and consistent imaging to accurately reveal its structural organization. Optimizing probe orientation is essential for advancing fascial US diagnostics. Full article

This study examined the impact of different breath-holding conditions on iliopsoas and other hip flexor muscle activity in individuals with chronic ankle instability (CAI). It has been hypothesised that impaired diaphragmatic function influences iliopsoas activation, potentially contributing to motor control deficits in patients with CAI. Eleven adults with a history of chronic ankle sprain participated in this study. Maximal isometric hip flexion was assessed under three breath-holding conditions: end-expiration, end-inspiration, and the intermediate state. Surface electromyography was used to record the muscle activity of the iliopsoas, rectus femoris, sartorius, and tensor fasciae latae, while the peak hip flexion torque was measured using an isokinetic dynamometer. Under the end-inspiration condition, iliopsoas activity on the affected side was significantly lower than that on the control side (p < 0.05). However, no significant differences were observed between the affected and control sides in the activity of the other hip flexor muscles or the peak hip flexion torque across breath-holding conditions. This study highlights the association between reduced iliopsoas activity during end-inspiration and compromised diaphragmatic function in patients with CAI. Future research should explore dynamic movement tasks and larger sample sizes to elucidate neuromuscular mechanisms further and refine rehabilitation strategies. Full article

Intra-tissue endoscopy, providing real-time images at all scales, from macroscopic to microscopic, from inside living tissue during surgical procedures, has revealed the existence of a body-wide fibrillar architecture that extends from the surface of the skin to the cell. Different types of cells are housed within this fibrillar architecture and gather together to carry out specific functions. This challenges the commonly accepted notion of the organization of living matter that associates separate organs with connective tissue packaging. We are thus confronted with the global nature of the living human body and its vital processes. This paper sets out to describe the architecture of this fibrillar network which could be assimilated with the fascial tissue and which attributes a more constitutive role to connective tissue. It also demonstrates how movements within this fibrillar network can occur with minimal local distortion while maintaining tissue continuity. The authors propose that the gliding of tissues can be explained by the existence of a highly adaptable fibrillar network that enables the gliding of distinct anatomical structures such as tendons and muscles, without any dynamic influence on the surrounding tissues. The authors propose a new model of tissue movement based on the observation of a ubiquitous dynamic polyhedric fibrillar network with an apparently dispersed and complex pattern of organization, that forms fluid-filled microvolumes, and is found everywhere in the human body. Furthermore, this fibrillar network appears to act as a force absorption system, in addition to providing a framework or scaffolding for cells throughout the body. Observation during intra-tissue endoscopy suggests that this fundamental architectural organization extends into the extracellular matrix that is the natural environment of all cells in the living body, regardless of their size, location or specific function. Full article

The evolution of regional anesthesia in total hip arthroplasty (THA) has significantly impacted perioperative management, particularly in older adults, where age-related physiological vulnerability requires optimized strategies. Adequate pain control is crucial in enhancing recovery, minimizing opioid consumption, and reducing complications. Traditional nerve blocks such as lumbar plexus and femoral nerve blocks have long been the mainstay of analgesia. However, they are associated with significant motor impairments, which delay mobilization and increase the fall risks. Introducing motor-sparing regional anesthesia techniques represents a substantial advancement in optimizing postoperative pain management while preserving muscle function. Motor-sparing techniques, including the pericapsular nerve group (PENG) block, supra-inguinal fascia iliaca block (SI-FIB), erector spinae plane block (ESPB), and quadratus lumborum block (QLB), have been developed to provide adequate analgesia without compromising motor control. The PENG block selectively targets the articular branches of the femoral, obturator, and accessory obturator nerves, ensuring superior pain relief while minimizing quadriceps weakness. Similarly, the SI-FIB provides extensive sensory blockade with minimal motor involvement, allowing for earlier ambulation. The ESPB and QLB extend analgesia beyond the hip region while preserving motor function, reducing opioid consumption, and facilitating early rehabilitation. Compared to traditional motor-impairing blocks, these newer techniques align with Enhanced Recovery After Surgery (ERAS) protocols by promoting early mobility and reducing the hospital length of stay. Studies suggest that motor-sparing blocks lead to improved functional recovery, lower postoperative pain scores, and decreased opioid requirements, which are critical factors in geriatric THA patients. Moreover, these techniques present a safer alternative, reducing the risk of postoperative falls—a significant concern in elderly patients undergoing hip replacement. Despite their advantages, motor-sparing nerve blocks are still evolving, and further research is necessary to standardize the protocols, optimize the dosing strategies, and evaluate the long-term functional benefits. Integrating these techniques into routine perioperative care may significantly enhance patient outcomes and revolutionize pain management in geriatric THA. As regional anesthesia advances, motor-sparing techniques will improve postoperative recovery, ensuring patient safety and functional independence. Full article

Ultrasound (US) is rapidly gaining attraction among physicians for the evaluation of fasciae. Unlike traditional imaging, which often lacks specificity of pain localization, US examination stands out as a versatile tool, capable of detecting both structural and functional information. This unique capability allows for a comprehensive assessment of fasciae—the intricate connective tissue essential for human biomechanics. US examination offers a multiparametric approach for the assessment of thickness, echogenicity, stiffness, deformation and shear strain. This comprehensive examination is invaluable for identifying fascial pathologies that may not be detected during physical examination. In this study, we render and discuss common/elementary lesions of the fascia. Full article

Background and Clinical Significance: Cystic echinococcosis (CE), also known as hydatid disease, is a zoonosis in whose life cycle humans can be an accidental intermediate host. The liver is the most commonly affected organ, with complications like cyst rupture, hematogenous spread, and infection. Imaging techniques, such as ultrasound, CT, and MRI scans, play a vital role in diagnosing and classifying the disease, facilitating the appropriate therapeutic approach. Treatment options include albendazole for early stage cysts, with more invasive procedures like PAIR, MoCAT, and surgery for advanced cases. This article highlights the importance of imaging modalities in the diagnosis and therapeutic management of CE. Case Presentation: We report a case of a 23-year-old female patient presenting with nausea, fatigue, and loss of appetite to the emergency department, who was diagnosed with a giant echinococcosis lesion. The patient received ultrasound, MR, and CT diagnostics initially. The surveillance included ultrasound and MRI, as well as an anthelmintic therapy, and eventually led to an open resection. Conclusions: This case highlights the importance of imaging modalities in diagnosing and therapeutically managing CE. It explains the key features of each WHO classification stage of the disease for each modality, emphasizing the value of an MRI scan as a possibility for surveillance and a bridge to surgery. Full article

In a world where the incidence of non-specific lower back pain (LBP) is steadily increasing, researchers are still searching for effective solutions for patients. Hyaluronic acid (HA) viscosupplementation is commonly used to restore lubrication in osteoarthritis (OA) and other medical applications, but its rapid metabolism limits efficacy. This study evaluates whether an HA derivative can replace native HA for the treatment of non-specific LBP while maintaining or enhancing its frictional properties and improving in vivo stability. Six HA-based lubricants, both native and derivatized, were tested in a tribological rabbit fascia model and a new synthetic model. Reduced HA derivative showed better tribological properties and longer in vivo residence time compared to native HA, as demonstrated in pharmacokinetic studies in rabbits. The 316 kDa HA and reduced HA exhibited the most stable tribological properties, which were influenced by their molecular weight and concentration. These findings suggest that both native and reduced HA are promising viscosupplements for intrafascial injection in the treatment of LBP, with reduced HA potentially enhancing effectiveness through a prolonged effect. Full article

Background/Objectives: This study evaluates the anatomical and functional outcomes of type 1 tympanoplasty using an autologous two-piece perichondrium-cartilage (CP) graft in pediatric and adult patients with tympanic membrane (TM) perforations. Methods: A retrospective review of 74 patients (59 children, 15 adults) undergoing type 1 tympanoplasty with CP by a single surgeon (IF) was conducted. Preoperative and postoperative audiological outcomes, perforation size, prognostic factors, and complications were analyzed. Success was defined as an intact TM and an air–bone gap (ABG) < 20 dBHL at 12 months postoperatively. Results: TM closure was achieved in 93.2% of patients, with 93.1% attaining an ABG < 20 dBHL. The combined success rate was 86.3%, with no significant differences between children and adults. Larger perforations (>50%) had significantly lower closure rates (55.6% vs. >97%, p < 0.002). Children who underwent prior adenoidectomy had significantly higher success rates (p = 0.04). Conclusions: Tympanoplasty with a CP graft provides high success rates in both children and adults. The procedure can be performed from age five, considering patient cooperation. In children, simultaneous adenoidectomy is recommended if significant adenoid hypertrophy is present to optimize outcomes. Larger perforations were associated with reduced success, while age had no significant impact. Full article

Background: The concept of mesopancreas is frequently discussed in the surgical literature as the neural pathway for metastatic spread in pancreatic head cancer. It generally refers to a retro-pancreatic plane that should be resected to reduce the incidence of regional metastases. However, this concept remains poorly defined, both embryologically and anatomically. Our objective was to establish a clear embryological and anatomical definition of the mesopancreas, making anatomical data more applicable in surgical practice. Methods: We examined seven cadavers (5 males, 2 females, aged 62–71) with no medical or surgical history, preserved in 9% formalin at Carol Davila University’s Anatomy Department. Regional dissections were performed in successive planes, highlighting the celiac ganglia and the associated network of neural connections that comprise the mesopancreas. Results: Our study defines the “mesopancreas” as remnants of primordial mesenteries that coalesced into the Treitz fascia. We identified its functional components as nerve fibers linking the celiac ganglia and superior mesenteric plexus to the pancreas, along with vascular structures, lymphatics, and connective and adipose tissue. These components likely contribute to regional metastasis in pancreatic head cancer. While resection of the mesopancreas could help prevent metastasis, its complex anatomy and proximity to major vessels pose significant surgical challenges. Conclusions: Based on our findings, we propose a plausible definition for the term “mesopancreas”. It encompasses the structures that originated as part of the primordial mesenteries, which subsequently coalesced, resulting in the formation of the Treitz fascia. In essence, the mesopancreas is the functional content of a former mesentery. Full article