Are shipwrecks a real hazard for the ecosystem in the Mediterranean Sea?

The aim of the present study was to evaluate the hazard from shipwrecks on communities by a holistic approach taking into account different effects on biological communities. Multibeam and Remotely Operated Vehicles surveys recorded ecological assessment of fish and benthic species on three shipwrecks flooded during the Second World War on Maërl beds habitats in the strait of Sicily. Pollution levels of a wide range of chemicals of ecotoxicological concern were also measured in sediments and in fish species from different trophic levels. Statistical analysis evidenced significant differences among pollutant levels between both sediments and fish collected in shipwreck sites and controls. Concerning fish, significant effects due to the vessel's cargo type and flooding position are recorded. In spite of that, our results underline that shipwrecks are also a hotspots of biodiversity and a habitat for preservation strategies in marine ecosystems that need to be monitored.

Anisakis spp. larvae in three mesopelagic and bathypelagic fish species of the central Mediterranean Sea

In this work 437 fish samples of species belonging to the families Myctophidae (Electrona risso and Diaphus metopoclampus) and Phosichthyidae (Vinciguerria attenuata) were examined for the presence of Anisakidae larvae. The study was performed with fishes in the central Mediterranean Sea, particularly in the Strait of Sicily and in the Strait of Messina. The visual inspection and chloro-peptic analysis revealed the presence of nematode parasites with prevalence values between 2.9% in Electrona risso samples and 5.4% in Vinciguerria attenuata samples. A positive correlation was found between standard length (SL) and prevalence of infestation in D. metopoclampus samples (p<0.05). The larvae examined were morphologically ascribed, at genus level, to Anisakis morphotypes I and II and molecularly identified as Anisakis pegreffii, Anisakis ziphidarum and Anisakis physeteris, in 67%, 9% and 24% of the fish samples examined. Overall, A. pegreffii and A. ziphidarum larvae were isolated in 14 and 2 specimens of D. metopoclampus respectively, A. physeteris larvae were found in 3 E. risso and 2 V. attenuata. A positive correlation was found between standard length and prevalence of infestation in D. metopoclampus samples (p<0.05). First information is provided on the presence of Anisakis spp. larvae of the myctophid fish species E. risso, D. metopoclampus and V. attenuata from the Central Mediterranean. It is also confirmed the role of lanternfishes (Myctophidae) as paratenic hosts for Anisakis spp.

Septal flip flap for anterior skull base reconstruction after endoscopic resection of sinonasal cancers: preliminary outcomes

Over the past decade surgery for sinonasal malignancies encroaching into the anterior skull base (ASB) has evolved from open craniofacial resection to the use of minimally invasive transnasal endoscopic approaches. Using these techniques, ASB reconstruction is most often performed in a multilayer fashion with autologous free grafts (fascia lata or iliotibial tract) which leads to the production of abundant nasal crusting in the postoperative months and discomfort for patients. In carefully selected cases, we propose harvesting a flap from the contralateral nasal septum based on the septal branches of the anterior and posterior ethmoidal arteries (Septal Flip Flap, SFF), which can be rotated to resurface the ASB defect. The exclusion criteria for using the SFF were as follows: cases where the tumour extended to both ethmoid complexes; cases where there was nasal septum or planum spheno-ethmoidalis involvement by the disease; cases of sinonasal malignant tumour with multifocal histology. In our tertiary care referral centre, skull base reconstruction using the SFF was performed in four patients; one was affected by ethmoidal teratocarcinosarcoma, one by persistence of sinonasal undifferentiated carcinoma after radio-chemotherapy, another by olfactory cleft esthesioneuroblastoma and the fourth by ethmoidal squamous cell carcinoma. Successful skull base reconstruction was obtained in all four cases without any intra- or post-operative complications. Post-operatively, nasal crusting was significantly reduced with faster healing of the surgical cavity. No recurrences of disease have been observed after a mean follow-up of 15 months. The SFF can be considered as a safe and effective technique for ASB reconstruction with high success rates similar to those obtained with other pedicled flaps. This flap also ensured a faster healing process with reduction of nasal crusting and improvement in the quality of life of patients in the postoperative period. This technique appears to be a safe and effective option for ASB reconstruction after endonasal resection of sinonasal malignancies in selected cases. Larger case series with a longer follow-up are needed to validate the preliminary results obtained with such an innovative and promising surgical technique.

Changes in peripheral lymphocyte subpopulations following radiation therapy

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Background: Since ionizing radiation can affect the immune system, in this research we sought to analyze the changes of peripheral blood lymphocyte subpopulations (LS) in patients undergoing Radiation Therapy (RT). Methods: In 2015 we enrolled 58 patients, 97% with no systemic cancer (breast 47%, prostate 23%,head and neck 16%, abdomen-pelvis 11%, metastases 3%). The percentages of patients with lowered LS were determined prior to RT, and at different intervals in the patients’ history.The average dose of RT was 50Gy (+/-10 ) with 2 Gy/day fractions. Results: As baseline, total T lymphocytes, T helper, T suppressor, B lymphocytes and Natural Killer cells, were reduced vs. normal range in 24%, 33%, 24%, 59% and null of patients, respectively.A second blood sample was withdrawn after 14-58 days (mean 36) from starting RT, in which we found significantly increased the patients damaged up to 66%, 65%, 62%, 88% and 7% (p=< 0,0001 for each LS ). Compared with the nadir of LS depletion, at 44 (5-180) and 153 (43-130) days from the completion of RT, all the LS raised significantly, except for a weak value of T Helper category (p=0,0145 and 0,0226 respectively). Conclusions: After common RT regimens for solid tumors, all LS can be substantially impaired, and for the T Helper the recovery is particularly slow in the following months.

Transorbital endoscopic assisted management of intraorbital lesions: lessons learned from our first 9 cases

BACKGROUND

The management of intraorbital lesions is challenging and it is strongly dependent to their nature, position and biological behaviour. Traditionally, the superior and lateral compartments of the orbit are addressed via lateral orbitotomy or transcranial approaches. Herein we present our preliminary experience in the management of selected supero-lateral intraorbital lesion through an endoscopic-assisted superior-eyelid approach.

METHODOLOGY

All cases of intraorbital lesion treated in two Italian tertiary care referral centres using a superior eyelid endoscopic-assisted transorbital approach were retrospectively reviewed.

RESULTS

Nine patients have been analysed. The aim of surgery was diagnostic in 5 cases and curative in the remaining 4 patients. Significant tissue biopsy was obtained in all the five diagnostic procedures. Complete resection was obtained in 3/4 lesions. No major intra- or postoperative complications have been observed. Mean surgical time was 68 minutes. Mean hospitalization time was 4.4 days. All patients were satisfied about the surgical procedure, as emerged by the post-operative counselling. At present, the mean follow-up time is 18 months, ranging from 11 to 25 months.

CONCLUSIONS

Our preliminary results are promising with successful functional and cosmetic outcomes and reduced morbidity for the patient. This approach should be considered as an option for selected intraorbital lesions.

Fish Distribution and Habitat Complexity on Banks of the Strait of Sicily (Central Mediterranean Sea) from Remotely-Operated Vehicle (ROV) Explorations

The Strait of Sicily was recognized internationally as an "Ecologically or Biologically Significant Area" by the Contracting Parties of the Convention on Biological Diversity in 2014. However, basic aspects of its fish diversity are still unknown and most of the information comes from traditional trawl surveys. This paper provides the first detailed description, using a Remotely Operated Vehicle (ROV), of the composition and depth distribution of the demersal fish assemblages found on banks of the Strait of Sicily and the related habitat complexity from 35 to 240 m depth. A total of 24 families and 52 fish species were recorded and depth was consistently associated with a significant proportion of the variation of the fish assemblage. The highest species richness was observed at the shallowest depth layer (0-50 m) and significantly decreased, remaining almost constant, in deeper layers. Similarly the highest abundance was recorded at 0-50 m, where C. julis represented the most abundant species, and decreased progressively throughout the whole depth gradient. Although the factor habitat complexity explained only a small proportion of the fish assemblage variation, significant differences among different degrees of habitat complexity were observed, together with a general positive trend for species richness and abundance with increasing habitat complexity. The ROV also allowed us to observe some rare or poorly known fish species such as Scorpaenodes arenai, Hyporthodus haifensis, Myliobatis aquila, Gadella maraldi, Epinephelus caninus and Lappanella fasciata. These findings show that banks serve as reservoirs for fish abundance and biodiversity and that immediate environmental conservation and management actions represent a priority not only for Italy but also for other countries which share the same area.

PCB and OCP accumulation and evidence of hepatic alteration in the Atlantic bluefin tuna, T. thynnus, from the Mediterranean Sea

Persistent organic pollutants (POPs) are known to act as "obesogens", being fat-soluble and affecting lipid metabolism. The Atlantic bluefin tuna, Thunnus thynnus, are top pelagic predators prone to bioaccumulate and biomagnify environmental contaminants. This study aimed at evaluating POPs-induced ectopic lipid accumulation in liver of adult tuna from the Mediterranean Sea. PCBs and organochlorine pesticides were measured in tuna liver, and marked morphological changes observed, namely poorly compacted tissues, intense vacuolization, erythrocyte infiltration and presence of melanomacrophages. The expression of perilipin, a lipid-droplet marker, positively correlated with the gene expression of PPARγ, a master regulator of adipogenesis, and its heterodimeric partner, RXRα. Changes in metabolites involved in fatty acid biosynthesis and ketogenesis were also observed. Although male bluefin tuna appeared to be more sensitive than females to the adverse effects of environmental obesogens, the alterations observed in tuna liver of both sexes suggest a potential onset of hepatic steatosis.

Endoscopic endonasal management of non-functioning pituitary adenomas with cavernous sinus invasion: a 10- year experience

BACKGROUND

The management of Non-Functioning Pituitary Adenoma (NFPA) invading the cavernous sinus (CS) is currently a balancing act between the surgical decompression of neural structures, radiotherapy and a wait-and-see policy.

METHODS

We undertook a retrospective review of 56 cases of NFPA with CS invasion treated through an endoscopic endonasal approach (EEA) between 2000 and 2010. The Knosp classification was adopted to describe CS involvement using information from preoperative MRI and intraoperative findings. Extent of resection and surgical outcomes were evaluated on the basis of postoperative contrast-enhanced MRI. Endocrinological improvement and visual outcomes were assessed according to the most recent consensus criteria.

RESULTS

EEA was performed using direct para-septal, trans-ethmoidal-sphenoidal or trans-ethmoidal-pterygoidal-sphenoidal approach. Visual outcomes improved in 30 (81%) patients. Normalization or at least improvement of previous hypopituitarism was obtained in 55% of cases. A gross total resection was achieved in 30.3% of cases. The recurrence-free survival was 87.5%, with a mean follow-up of 61 months (range, 36-166 months). No major intraoperative or postoperative complications occurred.

DISCUSSION

EEA is a minimally-invasive, safe and effective procedure for the management of NFPA invading the CS. The extent of CS involvement was the main factor limiting the degree of tumor resection. The EEA was able to resolve the mass effect, preserving or restoring visual function, and obtaining adequate long-term tumor control.

Relationships between otolith size and fish length in some mesopelagic teleosts (Myctophidae, Paralepididae, Phosichthyidae and Stomiidae)

Length-mass relationships and linear regressions are given for otolith size (length and height) and standard length (LS ) of certain mesopelagic fishes (Myctophidae, Paralepididae, Phosichthyidae and Stomiidae) living in the central Mediterranean Sea. The length-mass relationship showed isometric growth in six species, whereas linear regressions of LS and otolith size fit the data well for all species. These equations represent a useful tool for dietary studies on Mediterranean marine predators.

Prevalence of occupational hazards in patients with different types of epithelial sinonasal cancers

BACKGROUND

Occupational exposure to carcinogens contributes greatly to the etiology of sinonasal cancer (SNC), but the role of different risk factors in determining different histological subtypes is disputed.

METHODOLOGY

All consecutive surgical epithelial SNC cases (case-series study) underwent a systematic occupational medicine examination to determine previous exposure to a wide range of work-related chemical hazards.

RESULTS

We investigated 65 SNC cases including intestinal-type adenocarcinoma [ITAC] squamous-cell carcinoma [SCC], and others. Occupational exposure was recognized for 39 cases. Occupational exposures were sensibly more frequent among ITAC than among SCC or other histotypes. Occupational exposure in ITAC cases was to leather or wood dust only, while among non-ITAC cases, we recognised exposure to formaldehyde, solvents and metal fumes. A high proportion of SNC with occupational exposure originated in the ethmoidal epithelium.

CONCLUSION

In our case-series of SNC, a very high frequency of previous occupational exposure to carcinogens was detected, suggesting that occupational hazards may be associated to the aetiopathogenesis, primarily for ITAC, but also for other histotypes. Besides leather or wood, other chemical agents must be recognized as occupational risk factors.

Combined transnasal transcervical robotic dissection of posterior skull base: feasibility in a cadaveric model

The current surgical trend is to expand the variety of minimally invasive approaches and, in particular, the possible application of robotic surgery in head and neck surgery. For this purpose, we explored the feasibility of a combined transcervical-transnasal approach to the posterior skull base, using the da Vinci Surgical System in 3 cadaver heads. Superb visualization of the sellar, suprasellar and clival regions was possible in all three specimens. The trocars` placement through a transcervical port made a more cephalad visualization possible, eliminating the need to split the palate. The advantages of robotic surgery applied to the posterior cranial fossa are similar to the ones already clinically experienced in other districts (oropharynx, tongue base), in terms of tremor-free, bimanual, precise dissection. The implementation of instruments for bony work will definitely increase the applicability of such a system in the forthcoming years.