Valve Endocarditis, to repair or not to repair, is that really the question?

The meta-analysis by He and collaborators [has the worth to cover, as much as possible, a gap of scientific evidence where conducting a randomized trial appears very complex for ethical and logistical reasons. The authors concluded that mitral valve repair (MVP) provide better pooled results, both early and late, with respect to mitral valve replacement (MVR). However, the superiority of MVP is driven by some single large cohort-studies where surgeons had wide experience in the field of MVP for IE. This finding is also confirmed by other studies. But if mitral repair produces such a better short- and long-term survival than replacement, why are there no clear indications from consensus and guidelines pushing surgeons toward the pursuit of a reconstructive procedure at almost any cost? We wonder but to repair or not to repair, is that really the question? The AATS consensus suggests to repair “whenever possible” but without providing more specific indications. If the two primary goals of surgery are total removal of infected tissues and reconstruction of cardiac morphology, including repair or replacement of the affected valve(s), probably MVP as to perform in case of less extensive tissue detriment by the infection. In more wide valve involvement, MVP may be the choice but only in very expert hands and in Centers with very large volume of valve repairing. This decision cannot therefore be the result of the choice of an individual but must derive from a careful multidisciplinary discussion to be held in an EndoTeam.

Case Report: Creeping Growth in Lymphoplasmacyte-Rich Meningioma—A Radiologic Variant

Lymphoplasmacyte-rich meningioma (LRM) is a rare histologic subtype of meningioma. Creeping-growth pattern is uncommon in meningioma, and the mechanism is unclear. Here, we report a 44-year-old man presented with extremities weakness for 2 months and incontinence for 2 weeks. Head and neck MRI revealed diffuse creeping-growth nodular meningeal masses with skull base, tentorium, sella area, and C1-6 vertebral plane involvement. An operation was carried out, cervical and lower clivus part of the lesion was resected, but gross total resection could not be achieved due to the widespread lesions. Pathologic examination revealed the diagnosis of LRM. The patient is free from progression clinically 3 months postoperatively. We also conducted a systematic literature review about LRM with creeping-growth pattern. A total of only nine cases (including the present case) of creeping-growth LRMs were included and analyzed in terms of clinical manifestations, radiological features, treatment, and outcome. LRMs show a higher rate (7.5%) of creeping-growth pattern than other types of meningiomas. The average creeping length of all creeping-growth LRMs was 11.4 ± 10.9 cm (range, 3–30 cm). Most cases (66.7%) had obvious peritumoral edema. Total removal rate is low (33.3%), and two of them (22.2%) received biopsy, followed by steroids treatment (or further immunosuppressive drugs therapy) and radiotherapy. The recurrence rate is higher than conventional LRMs (22.2 vs. 11.3%), and one patient (11.1%) died 11 months after treatment. Creeping-growth pattern in LRM may be considered as a general radiologic variant. The recurrence rate is higher compared with LRM with round/swelling pattern. We speculated that the pathogenesis of creeping growth in LRM may be associated with damage of lymphatic systems of the central nervous system.

Parameatal urethral cyst in a 9-year-old boy

Parameatal urethral cyst (PUC) is a comparatively unusual pathology in children. Since its first report, approximately 100 cases have been reported in the literature, mostly in the Japanese population. We report such a case in a 9-year old boy who presented with urine stream distortion, successfully managed by complete excision of the cyst, with total removal of the epithelium, which is the treatment of choice to prevent recurrence.

Neoadjuvant fractionated stereotactic radiotherapy followed by piecemeal resection of brain metastasis: a case series of 20 patients

Background The safety and effectiveness of neoadjuvant fractionated stereotactic radiotherapy (FSRT) before piecemeal resection of brain metastasis (BM) remains unknown. Methods We retrospectively reviewed 20 consecutive patients with BM who underwent neoadjuvant FSRT followed by piecemeal resection between July 2019 and March 2021. The prescribed dose regimens were as follows: 30 Gy (n = 11) or 35 Gy (n = 9) in five fractions. Results The mean follow-up duration was 7.8 months (range 2.2–22.3). The median age was 67 years (range 51–79). Fourteen patients were male. All patients were symptomatic. All tumors were located in the supratentorial compartment. The median maximum diameter and volume were 3.7 cm (range 2.6–4.9) and 17.6 cm3 (range 5.6–49.7), respectively. The median time from the end of FSRT to resection was 4 days (range 1–7). Nausea (CTCAE Grade 2) occurred in one patient and simple partial seizures (Grade 2) in two patients during radiation therapy. Gross total removal was performed in seventeen patients and sub-total removal in three patients. Postoperative complications were deterioration of paresis in two patients. Local recurrence was found in one patient (5.0%) who underwent sub-total resection at 2 months after craniotomy. Distant recurrence was found in six patients (30.0%) at a median of 6.9 months. Leptomeningeal disease recurrence was found in one patient (5.0%) at 3 months. No radiation necrosis developed. Conclusions Neoadjuvant FSRT appears to be a safe and effective approach for patients with BM requiring piecemeal resection. A multi-institutional prospective trial is needed.

Agroecosystem Stability In Spring Wheat Crops With The Application Of Fertilizers And Microbial Biological Products

The formation of spring wheat biomass on sod-podzolic soil is carried out mainly due to soil nitrogen, the share of which reaches 1/3 of the total removal of the element when using mineral fertilizers. Inoculation of spring wheat seeds with biologics of rhizosphere microorganisms increases the nitrogen content of fertilizers to 7.3%, increases its immobilization by 5.9-6.7% and reduces losses by 7.4-13.9%. The stability of the agroecosystem is characterized by nitrogen flows. During the growing season of spring wheat with a hydrothermal coefficient of 1.55-1.72, the amount of mineralized nitrogen (mineralization (M)), depending on fertilizers, reaches 9.4-11.1 g/m2, while the reimobilized nitrogen (reimobilization (RI)) – 2.2-3.1 g/m2, net-mineralized (net-mineralization (N-M)) – 6.8 - 8.0 g/m2. The use of nitrogen fertilizers and biological products leads the agroecosystem to the resistance mode (the maximum permissible level of exposure) (RI : M = 27-28%, N-M : RI = 2.5-2.7).

Arachnoid cyst at upper lumbar region - A case report

A young male patient of 22 years was presented with the complaints of low back pain, hypoesthesia and inability to walk. MRI of lumbosacral spine reveals intradural mass lesion extending from L2-L3 with no enhancement of gadolinium. Hence an extensive laminectomy and total removal of the mass was done. Peroperative impression confirms arachnoid cyst. After operation there was dramatic improvement of signs and symptoms; patient was able to walk without support during discharge from the hospital after one week. Mediscope 2021;8(2): 128-130

Pediatric meningioma with rhabdoid features developed at the site of skull fracture: illustrative case

BACKGROUND Pediatric meningiomas are rare, and only a few cases attributed to trauma and characterized by development at the site of bone fracture have been reported. Both pediatric and traumatic meningiomas have aggressive characteristics. OBSERVATIONS An 11-year-old boy who sustained a head injury resulting from a left frontal skull fracture 8 years previously experienced a convulsive attack. Imaging revealed a meningioma in the left frontal convexity. Total removal of the tumor with a hyperostotic section was successfully achieved. Intraoperative investigation showed tumor invasion into the adjacent frontal cortex. Histologically, the surgical specimen revealed a transitional meningioma with brain invasion and a small cluster of rhabdoid cells. This led to a final pathological diagnosis of an atypical meningioma with rhabdoid features. The postoperative course was uneventful, and no recurrence of the tumor was found after 2 years without adjuvant therapy. LESSONS This is the first report of a pediatric meningioma with rhabdoid features occurring at the site of a skull fracture. Meningiomas that contain rhabdoid cells without malignant features are not considered to be as aggressive as rhabdoid meningiomas. However, the clinical course must be carefully observed for possible long-term tumor recurrence.

The nature and origin of cratons constrained by their surface geology

To the memory of Nicholas John (Nick) Archibald (1951−2014), master of cratonic geology. Cratons, defined by their resistance to deformation, are guardians of crustal and lithospheric material over billion-year time scales. Archean and Proterozoic rocks can be found in many places on earth, but not all of them represent cratonic areas. Some of these old terrains, inappropriately termed “cratons” by some, have been parts of mobile belts and have experienced widespread deformations in response to mantle-plume-generated thermal weakening, uplift and consequent extension and/or various plate boundary deformations well into the Phanerozoic. It is a common misconception that cratons consist only of metamorphosed crystalline rocks at their surface, as shown by the indiscriminate designation of them by many as “shields.” Our compilation shows that this conviction is not completely true. Some recent models argue that craton formation results from crustal thickening caused by shortening and subsequent removal of the upper crust by erosion. This process would expose a high-grade metamorphic crust at the surface, but greenschist-grade metamorphic rocks and even unmetamorphosed supracrustal sedimentary rocks are widespread on some cratonic surfaces today, showing that craton formation does not require total removal of the upper crust. Instead, the granulitization of the roots of arcs may have been responsible for weighing down the collided and thickened pieces and keeping their top surfaces usually near sea level. In this study, we review the nature and origin of cratons on four well-studied examples. The Superior Province (the Canadian Shield), the Barberton Mountain (Kaapvaal province, South Africa), and the Yilgarn province (Western Australia) show the diversity of rocks with different origin and metamorphic degree at their surface. These fairly extensive examples are chosen because they are typical. It would have been impractical to review the entire extant cratonic surfaces on earth today. We chose the inappropriately named North China “Craton” to discuss the requirements to be classified as a craton.

Ethical Issues in the Deactivation of Total Artificial Heart Support – A Systematic Review

"Introduction: In the context of a relatively constant heart donation rate, the effort to satisfy the needs, has led to the development of mechanical devices that can replace the cardiac function. Estimating an annual potential of 100,000 artificial heart implants in the United States alone, there is an increased interest in these devices, which is why it is appropriate to explore the situations where its inactivation may be ethically appropriate. Method: We performed a systematic review, which includes all the studies regarding the dilemma of artificial hearts inactivation from the beginning until 2020, published in PubMed, Embase and Scopus. The searched keywords were “totally artificial heart and ethics”; the duplicate studies and those referring to other cardiac support devices were excluded. Results: Following the selection, 12 articles were included in the review. The conflict between the principle of discontinuity and the prohibition generated by the indispensability of the artificial heart was emphasized. The decision to inactivate the support dependent on the patient’s declared level of happiness or clinical evolution over time was reviewed. The dilemma of self-inactivation of artificial cardiac support as suicide versus the acceptance of death caused by the underlying heart condition, as well as the impact of total removal of the native heart were included in the ethical analysis. Conclusions: Requests for withdrawal of TAH support are not uncommon among patients, their discontinuation being ethically acceptable when it does not serve the patient’s interests, even though they may still be capable to prolong their life. "