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Introduction: Artificial intelligence algorithms are increasingly used to highlight refined qualifiers of pathologies and to build treatment protocols based on them. These possibilities open up new perspectives for personalized interventions in psychotherapy. The affective neurosciences that link psychopathological phenomena to the hypersensitization of emotional systems are an excellent field of application of deep learning algorithms Objectives: In this contribution we present the standardization of a psychodiagnostic test that can be analyzed with a deep learning algorithm for the development of personalized treatments for depressive disorders in a perspective of precision psychotherapy Methods: Previously we have constructed a psychodiagnostic test that correlates the psychopathological characteristics to the emotional systems described in affective neuroscience. The construction of this test was carried out with the use of a neural network that discriminated 161 items from a pull of 300 psychopathological and character descriptions. In the present work, the 161 selected items were compared, in a sample of 600 subjects, with the measurement of sadness described in the Panksepp model. Comparation was performed with linear and non-linear statistical analysis methods. Results: The items emerging from the statistical analyzes as strongly indicative of a hypersensitivity of the sadness system outline a psychopathological profile for which it is possible to adapt specific psychotherapeutic treatment protocols. Conclusions: In future prospect, neurobiological and psychophysiological variables such as heart rate variability, skin conductance and activity of the areas of the cortex, measured with a scanner of the near infrared photons, will be correlated to these descriptors of psychopathology. [ABSTRACT FROM AUTHOR]

This work uses a new programme for producing 3D radiological images acquired by means of CT which enables the internal surfaces of the examined structures to be visualized. This new method, which is able to navigate inside organs in a similar way to fibreoptic endoscopy, is known as virtual endoscopy. CT examinations of the temporal bone were carried out using spiral equipment and endoscopic 3D processing was carried out on a separate workstation equipped with a volume-rendering programme. Once the technical parameters necessary for obtaining a representation of the internal surfaces had been defined, a simulation of a virtual otoscopy was conducted by moving the virtual endoscope from the external auditory canal through the annulus to the tympanic cavity. The simulation can be obtained either by moving the endoscope by hand, using the mouse, or by defining a path along which the software automatically creates an endoscopic 3D reconstruction. The images thus obtained are projected sequentially to give a ''movie'' effect, i.e. a continuous progression of the endoscope. The average time required to conduct the procedure ranges from 20 to 30 min. A virtual endoscopic visualization of the middle ear was obtained which, in particular, generated images of the tympanic cavity with the ossicular chain. In our experience, virtual otoscopy shows the anatomy of the structures of the tympanic cavity in excellent detail and may be considered complementary to CT, providing useful images enabling better visual representation and understanding of this complex structure. Although clinical applications of the technique remain to be defined it may have a role to play in presurgical diagnostic evaluation of the ossicular chain, epitympanum and retrotympanum. [ABSTRACT FROM AUTHOR]

Introduction: The evaluation of the crime of impetus poses problems in seeking clinical elements that configure the total or partial defect of mind. Even in the presence of acute psychotic syndromes it is difficult to identify a psychopathological picture that almost overlaps with the times and methods of the crime itself. Objectives: From a longitudinal perspective, this contribution intends to propose a method of integrating data derived from psychopathological, criminological and forensic psychiatric analyzes, in order to identify the link between them and the criminal act that qualifies or excludes the mental defect. Methods: In the analysis of a criminal event generated during an acute psychotic episode, it's described the logic andmethodology of integrating criminological, psychopathological and psychiatric forensic data for which it was possible to identify the pathological nature of the event. Results: The psychopathological analysis allowed the identification of psychotic manifestations before and after the crime. The criminological analysis included the decision to commit the crime, within a framework of alteration of the reality examination and recognized the delusional purpose in the same methods of carrying out the crime. So, the forensic psychiatric analysis clarified the continuity of the psychopathological manifestations in the time frame in which the crime was planned, organized and committed and to codify such manifestations as an acute psychotic episode. Conclusions: Although it's not sufficient to circumscribe the criminal act between two pathologically relevant moments, this contribution shows how integrating different methods of analysis makes it possible to identify the quality of the behavior intended as a crime. [ABSTRACT FROM AUTHOR]

Background: Although its validity has recently been questioned since its introduction, the Simpson grade has remained one of the most relevant factors in estimating the recurrence risk of intracranial meningiomas. This study aims to assess its role in spinal meningiomas through a retrospective analysis of a mono-institutional surgical series and literature meta-analysis., Methods: We conducted a systematic review and meta-analysis of the literature from 1980 to 2023, complemented by a mono-institutional series of 74 patients treated at "Santa Maria delle Grazie" hospital. Demographic, clinical, neuroradiological, pathological, surgical, and outcome data of case series were analyzed. For the meta-analysis, studies were selected based on predefined inclusion criteria, and a fixed-effects model was used to synthesize data due to assumed homogeneity among included studies. Statistical analyses included odds ratios (OR) for recurrence risk and assessment of publication bias using Peter's test., Results: Mono-institutional sample included 74 patients, most of whom were women (85%) with a median age of 61.9 years. The thoracic spine was the most common tumor location (81%). Recurrences occurred in patients with Simpson grade II and III resections. The meta-analysis involved 2142 patients from 25 studies and revealed a significantly higher recurrence rate for Simpson grades III-V compared to grades I-II (OR 0.10; CI95 0.06-0.16). Additionally, Simpson grade II had a higher recurrence risk than grade I (OR 0.42; CI95 0.20-0.90)., Conclusions: The Simpson grading remains a valid predictor of recurrence also for spinal meningiomas. Our findings revealed a significant increase in recurrence rate with higher Simpson grades. These results support the need to strive for Simpson grade I resection when feasible.

Head and neck squamous cell carcinoma (HNSCC) can, in rare instances, metastasize to the CNS, which is often associated with a poor prognosis. We present the case of a 65-year-old male with a history of HNSCC who developed two enhancing brain lesions: one in the right parietal region and another in the right insular region. Initially, the patient was managed with CyberKnife radiosurgery targeting both lesions. However, he later experienced neurological symptoms, including confusion, gait instability, and a left Jacksonian march, primarily attributed to the progression of the right parietal lesion. Given this symptomatic presentation, surgical resection of the lesion was performed to confirm the diagnosis and provide symptomatic relief. The surgical approach was selected based on the patient's clinical progression and imaging findings, with the goal of improving his quality of life. Despite surgical intervention, the patient's condition deteriorated, and he passed away seven months later. This case illustrates the complexity of treating CNS metastases from HNSCC, highlighting the challenges in surgical decision-making and the role of adjuvant therapies. The rarity of CNS metastases in HNSCC adds to the difficulty of management, underscoring the importance of a multidisciplinary approach. Further investigation is needed to develop standardized treatment protocols for such rare presentations. CNS metastases in HNSCC are uncommon and typically indicate a poor outcome. This case reinforces the need for ongoing research to enhance management strategies and improve patient survival in similar cases., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Corazzelli et al.)

Background and Objectives: The optimal surgical management of thoracic schwannomas (TSs) remains contentious, with various approaches proposed. Video-assisted thoracoscopic surgery (VATS) and combined VATS with neurosurgical procedures have shown promise, particularly for Eden type IV and III lesions. However, unanimous consent on the most effective surgical intervention and understanding of prognostic factors for tumor recurrence needs to be improved. The aim of this study was to elucidate the optimal surgical approach according to the Eden type and investigate predictive factors for TS recurrence., Methods: This retrospective, multicentric, observational study analyzed 98 surgically treated patients with TS from 2011 to 2023, assessing preoperative and 6-month follow-up clinical (recurrences, pain, and myelopathy recovery) and surgical parameters (operative time, intraoperative blood loss, extent of resection). Surgical procedures included thoracic laminectomy or hemilaminectomy for type I, laminectomy or thoracic transpedicular (TPD) approach for type II, laminectomy alone or combined laminectomy with VATS for type III, and VATS or thoracotomy (open thoracotomy [OT]) for type IV. Descriptive and deductive analyses were conducted between and within the 4 cohorts, with multivariate analysis assessing the contribution of predictor variables., Results: No significant differences were found between hemilaminectomy and laminectomy for all analyzed parameters for type I. Type II lesions treated with TPD exhibited similar outcomes to laminectomy, albeit with longer procedure times. Type III lesions benefited from combined approaches compared with neurosurgical-only approaches. Video-assisted thoracoscopic surgery emerged as more favorable than OT for type IV lesions. Multivariate analysis revealed that patient sex, tumor location, extent of resection, and pathology significantly influenced recurrence rates., Conclusion: For Eden type III TSs, neurosurgical and VATS combined surgery achieved better outcomes than neurosurgery alone; for Eden type IV TSs, VATS achieved better results than OT. For Eden types I and II, hemilaminectomy and bilateral laminectomy and laminectomy and TPD achieved similar outcomes, respectively., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Thoracic meningocele is a rare medical condition that is usually linked to neurofibromatosis type I. 1 Respiratory and neurologic symptoms characterize it. 2 Although there have been some improvements in surgical techniques, the condition has a high recurrence rate, with most cases recurring within a year of surgery. 3 A 56-year-old woman was observed due to respiratory and pyramidal signs. A chest computed tomography scan and magnetic resonance imaging revealed a thoracic meningocele, occupying the lower sectors of the right hemithorax, communicating with the cerebrospinal fluid space at the T10-T11 level. Multidisciplinary surgery was performed. After selectively intubating both bronchi, the patient was placed in prone position and a posterior median thoracic spine approach was performed. After T10-T11 laminectomy, 3 dural longitudinal incisions were performed. The first incision was placed in the middle to deflate the collection, the second was made on the right side to obtain a complete view of the meningocele, and the third was made on the right lateral side to exclude the meningocele. The lateral dura at the last incision was sutured to the dura propria lining the vertebral body of T11 and T10. The paramedian and median incisions were closed, with Tachosil placed above and below the sutures. Subsequently, the patient was placed in a supine position, the right lung was deflated, and a triportal thoracoscopic approach was performed to dissect and remove the lesion. 4 The breach was closed using Tachosil (Baxter Healthcare Corp, Deerfield, Illinois, USA) and fibrin glue. An early 1-month computed tomography and magnetic resonance imaging confirmed the surgery was successful., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Nutrition exerts a fundamental role in the prevention of obesity (OB). The aim of this study was to assess the extent to which well recognized risk factors for early OB can be associated to overweight (OW) or OB under a standardized nutritional approach and surveillance in toddlers., Methods: The eligible population was represented by 676 toddlers aged 24-36 months, assigned to 18 primary care pediatricians trained on nutritional issues who shared a standardized nutritional approach. Six-hundred-twenty-nine children (333 boys), mean age 27.8 ± 4.2 months were effectively included in this observational study. Parents received nutritional advice with particular emphasis to proteins and sugar composition supported by leaflets and reinforced at each visit. Body mass index was assessed at the age of 24-36 months. The following individual and family risk factors were considered: gestational age, birth weight, eutocic/caesarean delivery, milk feeding history, household smoking or antibiotics exposure, parents' weight, height and educational level. Prevalence of OW/OB was compared to a group of 742 toddlers (373 boys) under usual care., Results: Under a standardized nutritional counselling, 28.1% toddlers were classified as OW/OB compared to 36.9% toddlers under usual care (p = 0.005). In unadjusted models, parental OW/OB was significantly associated to OW/OB in toddlers (p < 0.01), while high birth weight did not reach statistical significance (p = 0.07). In adjusted models, including all the explanatory variables studied, only paternal OW/OB vs. normal weight was significantly associated to OW/OB in toddlers (OR 2.035, 95% confidence interval 1.206-3.436). No protective effect of exclusive breast feeding during the first 6 months of age was demonstrated., Conclusions: Toddlers under a standardized nutrition counselling focused to limit protein and simple sugars, showed lower prevalence of OW/OB compared to usual care. Healthy promotion activities should take into account the influence of paternal BMI on the offspring adiposity., (© 2024. The Author(s).)

Dumbbell-shaped schwannomas are slow-growing tumors that are typically benign lesions. They account for 6%-14% of spinal neoplasms, with 30% having intradural and extradural components. 1 A schwannoma is considered "giant" if it extends beyond the spine by >2.5 cm and involves more than 2 vertebral levels. 2 The Eden classification categorizes these tumors into 4 types on the basis of the primary component. 3 Surgery is recommended for individuals experiencing prolonged nerve damage and persistent neurogenic pain that cannot be managed. 2 There are 3 surgical options for managing thoracic dumbbell schwannomas 4 : the single-stage posterior-only approach, 5 the single-stage anterior-only approach, 6 and the single-stage combined posteroanterior neurosurgical and video-assisted thoracoscopic approach. The latter option allows for the most comprehensive lesion control including vascular and nerve structures and optimal hemostasis control. It also avoids spinal instrumentation and provides certainty for complete tumor removal. 7 Video 1 shows a surgical procedure performed on a 58-year-old woman to remove a thoracic dumbbell neurinoma. The patient consented to the procedure and publication of her image. A simultaneous thoracoscopic and neurosurgical approach was performed. The surgical team successfully removed the schwannoma, and the patient's recovery was smooth, with no neurologic issues or pain. This case highlights the benefits of using a single-stage combined approach for treating Eden II and Eden III giant dumbbell thoracic schwannomas., (Copyright © 2024 Elsevier Inc. All rights reserved.)