Publications by authors named "Vincenzo Ricci"

75 Publications

Clinical and Ultrasound Examination of the Thoracolumbar Fascia: The Hands and the Probe Together.

Am J Phys Med Rehabil 2021 10;100(10):e157-e158

From the Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy (CP, CS); Physical and Rehabilitation Medicine Unit, "Luigi Sacco" University Hospital, A.S.S.T Fatebenefratelli-Sacco, Milan, Italy (VR); and Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (LÖ).

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http://dx.doi.org/10.1097/PHM.0000000000001728DOI Listing
October 2021

Diagnosing sarcopenia: Functional perspectives and a new algorithm from the ISarcoPRM.

J Rehabil Med 2021 Jun 21;53(6):jrm00209. Epub 2021 Jun 21.

Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey. E-mail:

Sarcopenia is an important public health problem, characterized by age-related loss of muscle mass and muscle function. It is a precursor of physical frailty, mobility limitation, and premature death. Muscle loss is mainly due to the loss of type II muscle fibres, and progressive loss of motor neurones is thought to be the primary underlying factor. Anterior thigh muscles undergo atrophy earlier, and the loss of anterior thigh muscle function may therefore be an antecedent finding. The aim of this review is to provide an in-depth (and holistic) neuromusculoskeletal approach to sarcopenia. In addition, under the umbrella of the International Society of Physical and Rehabilitation Medicine (ISPRM), a novel diagnostic algorithm is proposed, developed with the consensus of experts in the special interest group on sarcopenia (ISarcoPRM). The advantages of this algorithm over the others are: special caution concerning disorders related to the renin-angiotensin system at the case finding stage; emphasis on anterior thigh muscle mass and function loss; incorporation of ultrasound for the first time to measure the anterior thigh muscle; and addition of a chair stand test as a power/performance test to assess anterior thigh muscle function. Refining and testing the algorithm remains a priority for future research.
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http://dx.doi.org/10.2340/16501977-2851DOI Listing
June 2021

From histo-anatomy to sonography in lymphedema: EURO-MUSCULUS/USPRM approach.

Eur J Phys Rehabil Med 2021 04 16. Epub 2021 Apr 16.

Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey.

Lymphedema is a disorder characterized by the accumulation of protein-rich lymphatic fluid in the cutaneous and subcutaneous tissue. Based on the underlying causes, it is classified into primary and secondary forms. The use of ultrasound has recently become widespread in the field of lymphedema - especially for its diagnosis and treatment planning. In this sense/paper, we briefly review the anatomy and histology of the skin and subcutaneous tissue - in an attempt to propose a standardized ultrasound assessment of the superficial tissues in patients with upper/lower limb lymphedema. We believe that identification of the sono-histological patterns of the dermoepidermal complex and subcutaneous tissue has place to serve as a simple and reproducible strategy to evaluate their edema diseases that are often subject to an inaccurate diagnosis in daily clinical practice.
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http://dx.doi.org/10.23736/S1973-9087.21.06853-2DOI Listing
April 2021

Ultrasound Imaging of Abdominal Wall Endometriosis: A Pictorial Review.

Diagnostics (Basel) 2021 Mar 29;11(4). Epub 2021 Mar 29.

Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, 66100 Chieti, Italy.

Endometriosis is a debilitating disease characterized by endometrial glands and stroma outside the endometrial cavity. Abdominal wall endometriosis (AWE) indicates the presence of ectopic endometrium between the peritoneum and the skin, including subcutaneous adipose tissue and muscle layers, often following obstetric and gynecological surgical procedures. AWE is a not infrequent gynecological surgical complication, due to the increasing number of cesarean sections worldwide. In this pictorial review, we discuss the importance of medical history and physical examination, including the main ultrasound features in the diagnosis of AWE.
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http://dx.doi.org/10.3390/diagnostics11040609DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065386PMC
March 2021

Cytokine Profiling of End Stage Cancer Patients Treated with Immunotherapy.

Vaccines (Basel) 2021 Mar 8;9(3). Epub 2021 Mar 8.

Translational Oncology, ARCO Foundation, 12100 Cuneo, Italy.

Published data suggest that immunotherapy plays a role even in patients with very advanced tumours. We investigated the immune profile of end-stage cancer patients treated with immunotherapy to identify changes induced by treatment. Breast, colon, renal and prostate cancer patients were eligible. Treatment consisted of metronomic cyclophosphamide, low-dose interleukin-2 (IL-2) and a single radiation shot. A panel of 16 cytokines was assessed using automated ELISA before treatment (T0), after radiation (RT; T1), at cycle 2 (T2) and at disease progression (TPD). Receiving operating characteristic (ROC) analysis was used to identify cytokine cut-off related to overall survival (OS). Principal component analysis (PCA) was used to identify the immune profile correlating better with OS and progression-free survival. Twenty-three patients were enrolled. High IL-2, low IL-8 and CCL-2 correlated with OS. The PCA identified a cluster of patients, with high IL-2, IL-12 and IFN-γ levels at T0 having longer PFS and OS. In all cohorts, IL-2 and IL-5 increased from T0 to T2; a higher CCL-4 level compared to T2 and a higher IL-8 level compared to T0 were found at TPD. The progressive increase of the IL-10 level during treatment negatively correlated with OS. Our data suggested that baseline cytokine levels may predict patients' outcome and that the treatment may affect their kinetic even in end-stage patients. Cytokine profiling of end-stage patients might offer a tool for medical decisions (EUDRACT: 2016-000578-39).
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http://dx.doi.org/10.3390/vaccines9030235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999072PMC
March 2021

Injecting the Trigger Finger: Target (With Ultrasound), Then Shoot!

J Prim Care Community Health 2021 Jan-Dec;12:21501327211000237

Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1177/21501327211000237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7975485PMC
June 2021

Type-1 neurofibromatosis mimicking multiple mononeuropathy: the help of nerve ultrasound.

Neurol Sci 2021 Jul 1;42(7):3007-3009. Epub 2021 Mar 1.

Unit of Neurology, San Luca Hospital, Lucca, Italy.

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http://dx.doi.org/10.1007/s10072-021-05140-2DOI Listing
July 2021

Ultrasound Imaging and Guidance in Common Wrist/Hand Pathologies.

Am J Phys Med Rehabil 2021 06;100(6):599-609

From the Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic (KM, YA); Physical and Rehabilitation Medicine Unit, "Luigi Sacco" University Hospital, A.S.S.T. Fatebenefratelli-Sacco, Milan, Italy (VR); Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic (JJ, KS); Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic (ON); and Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (LÖ).

Abstract: Wrist/hand pain is a prevalent musculoskeletal condition with a great spectrum of etiologies (varying from overuse injuries to soft tissue tumors). Although most of the anatomical structures are quite superficial and easily evaluated during physical examination, for several reasons, the use of ultrasound imaging and guidance has gained an intriguing and paramount concern in the prompt management of relevant patients. In this aspect, the present review aims to illustrate detailed cadaveric wrist/hand anatomy to shed light into better understanding the corresponding ultrasonographic examinations/interventions in carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, rhizarthrosis, and the radiocarpal joint arthritis. In addition, evidence from the literature supporting the rationale why ultrasound guidance is henceforth unconditional in musculoskeletal practice is also exemplified.
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http://dx.doi.org/10.1097/PHM.0000000000001683DOI Listing
June 2021

Rewinding sarcopenia: a narrative review on the renin-angiotensin system.

Aging Clin Exp Res 2021 Sep 4;33(9):2379-2392. Epub 2021 Jan 4.

Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey.

Background And Aims: The purpose of this review was two-fold. First, we aimed to provide an in-depth glance on the relationship between renin-angiotensin system (RAS) dysregulation and sarcopenia. Second, we aimed to touch upon potential treatments of sarcopenia (including RAS blockers, vitamin D, and exercise) in light of the pertinent literature.

Methods: Currently available research regarding the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers on knee extensor strength, grip strength, chair stand test, gate speed together with the effects of exercise on muscle mass, strength, physical performance, blood pressure and cognitive tests (particularly in older adults) was reviewed.

Results: Although some studies have shown favorable effects of ACEIs on muscle strength and/or physical function tests, some studies have reported no/negative association in between. The favorable impact of exercise on reducing blood pressure is shown, and exercise treatment is widely recommended in the relevant literature. Different types of exercises (aerobic, resistance, dancing, music movement, water-based, golf, knitting activities or multicomponent exercises) have shown improvement in cognitive functions as well.

Conclusion: Classical RAS activity results in deleterious effects not only on the cardiovascular but also on the neuromusculoskeletal system. Therefore, treatments targeting inhibition of the classical RAS activity seem to be important in the management of several age-related pathologies, including sarcopenia. As such, ACEIs, vitamin D, exercise, and healthy diet can have prominent effects not only on the modulation of RAS but also on physical and cognitive functions and sarcopenia as well.
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http://dx.doi.org/10.1007/s40520-020-01761-3DOI Listing
September 2021

Reassessing Sarcopenia in Hypertension: STAR and ACE Inhibitors Excel.

Int J Clin Pract 2021 Mar 20;75(3):e13800. Epub 2020 Nov 20.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

Background: Hypertension and sarcopenia are commonly seen in older adults. The renin-angiotensin system and the therapeutic use of angiotensin-converting enzyme (ACE) inhibitors have been on the agenda of sarcopenia in different perspectives. Our aim was to explore the frequency of sarcopenia in patients with hypertension and to investigate the association between the use of ACE inhibitors and sarcopenia.

Methods: A total of 272 community-dwelling adults were recruited. Anterior thigh muscle thickness was measured by ultrasound. Handgrip strength, gait speed, and chair stand test were evaluated. Low muscle mass was diagnosed in the presence of low sonographic thigh adjustment ratio (STAR) values and sarcopenia was diagnosed if low STAR values were coupled with low functional tests.

Results: 136 subjects (50.0%) had no comorbid disease; 102 (37.5%) had one, 21 (7.7%) had two, nine (3.3%) had three and four (1.5%) had four comorbid diseases. Both low muscle mass (41.9% vs 13.2%) and sarcopenia (32.2% vs 7.8%) were more commonly seen in hypertensive when compared with normotensive older adults. Subgroup analysis of older adults with hypertension revealed that sarcopenia was less prevalent (P = .003) in patients using ACE inhibitors (8.7%) than those using angiotensin II receptor blockers (48.7%) and other antihypertensive drugs (46.4%). After binary logistic regression analyses; only the presence of hypertension seemed to independently predict the development of sarcopenia in older adults [OR = 6.5 (95% CI: 2.4-17.8, P < .001)].

Conclusions: Sarcopenia is highly prevalent in hypertensive older adults. Amongst many antihypertensive medications, ACE inhibitors seem to have favourable effects on both disorders.
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http://dx.doi.org/10.1111/ijcp.13800DOI Listing
March 2021

Treatments after progression to first-line FOLFOXIRI and bevacizumab in metastatic colorectal cancer: a pooled analysis of TRIBE and TRIBE2 studies by GONO.

Br J Cancer 2021 01 7;124(1):183-190. Epub 2020 Oct 7.

Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.

Background: FOLFOXIRI/bevacizumab (bev) is a first-line regimen of proven activity and efficacy in metastatic colorectal cancer. The upfront exposure to three cytotoxics raises concerns about the efficacy of treatments after progression.

Methods: We performed a pooled analysis of treatments after progression to upfront FOLFOXIRI/bev in patients enrolled in two randomised Phase 3 studies (TRIBE and TRIBE2) that compared FOLFOXIRI/bev to doublets (FOLFOX or FOLFIRI)/bev. Response rate, progression-free survival (2nd PFS) and overall survival (2nd OS) during treatments after progression were assessed. The RECIST response in first line and the oxaliplatin and irinotecan-free interval (OIFI) were investigated as potential predictors of benefit from FOLFOXIRI ± bev reintroduction.

Results: Longer 2nd PFS was reported in patients receiving FOLFOXIRI ± bev reintroduction compared to doublets ± bev or other treatments (6.1 versus 4.4 and 3.9 months, respectively, P = 0.013), and seems limited to patients achieving a response during first line (6.9 versus 4.2 and 4.7 months, respectively, P = 0.005) and an OIFI ≥ 4 months (7.2 versus 6.5 and 4.6 months, respectively, P = 0.045).

Conclusions: First-line FOLFOXIRI/bev does not impair the administration of effective second-line therapies. First-line response and longer OIFI seem associated with improved response and 2nd PFS from FOLFOXIRI ± bev reintroduction, without impacting 2nd OS.
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http://dx.doi.org/10.1038/s41416-020-01089-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7782547PMC
January 2021

Sonography of abdominal wall vascular malformation: a case report and review of the literature.

J Ultrasound 2020 Dec 4;23(4):481-485. Epub 2020 Sep 4.

Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. D'Annunzio" University, Chieti, Italy.

Vascular anomalies are classified as vascular tumors (VT) and vascular malformations (VM). VTs are divided according to their clinical behavior, while VMs are classified according to their flow characteristics, histopathologic features, and associations with other anomalies. Sonography emerges as the diagnostic imaging method of first choice for assessing abdominal wall disorders and masses, thus representing a valuable tool for the diagnosis and follow-up of abdominal wall VMs. In this review, we report a case of abdominal wall arteriovenous malformation (AVM) in a 17-year old and briefly discuss the cases of abdominal wall VMs.
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http://dx.doi.org/10.1007/s40477-020-00523-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588565PMC
December 2020

Artifacts in Musculoskeletal Ultrasonography: From Physics to Clinics.

Diagnostics (Basel) 2020 Aug 27;10(9). Epub 2020 Aug 27.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey.

Ultrasound appears to be the most useful imaging tool in the diagnosis and guided treatment of musculoskeletal disorders. However, ultrasonography has been criticized for being user dependent. Therefore, medical professionals should be familiar with the basic principles of ultrasound imaging (e.g., physics and technical skills) to diminish artifacts and avoid misinterpretation. In this review, we focused on the physics of common artifacts, their clinical significance, and the ways to tackle them in daily practice during musculoskeletal imaging. In particular, artifacts pertaining to the focal zone, beam attenuation, path and side lobe of the beam, speed of the sound, and range ambiguity were described.
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http://dx.doi.org/10.3390/diagnostics10090645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7555047PMC
August 2020

Ultrasound imaging and guidance in the management of post-injection sciatic neuropathy: Love, loss and space.

Turk J Phys Med Rehabil 2020 Jun 18;66(2):225-226. Epub 2020 May 18.

Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.5606/tftrd.2020.5897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7401677PMC
June 2020

Treating patients with cancer amidst the COVID-19 pandemic: experience of a regional hospital in the Piedmont region in northern Italy.

Tumori 2020 Oct 23;106(5):427-431. Epub 2020 Jul 23.

Medical Oncology, Azienda Ospedaliera S. Croce e Carle Ospedale di Insegnamento, Cuneo, Italy.

Background: The coronavirus disease 2019 (COVID-19) pandemic is posing an unprecedented dilemma to oncologists worldwide, forcing them to decide whether to continue or suspend treatments in order to protect their most vulnerable patients from infection. After the first report from China, the outbreak spread rapidly worldwide. To, date no clear indications on how to treat patients with cancer with COVID-19 infection are available.

Methods: We report data on 21 patients with cancer referred to a single medical oncology unit of a general hospital from mid-March to April 23, 2020.

Results: Nine patients were on active cancer therapy during the infection and all stopped medical treatments. Overall 8 patients developed pneumonia and 6 patients died of COVID-19.

Conclusion: The management of patients with cancer during the pandemic should be carefully balanced and discussed among oncologists and other key professionals involved in the treatment of this vulnerable group of patients, in order to balance the risk of treatment and the risk of infection.
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http://dx.doi.org/10.1177/0300891620942313DOI Listing
October 2020

Sarcopenia and COVID-19: A Manifold Insight on Hypertension and the Renin Angiotensin System.

Am J Phys Med Rehabil 2020 10;99(10):880-882

From the Department of Physical Medicine and Rehabilitation, Türkmenbaşi Medical Center, Adana, Turkey (TE); Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (MK, LÖ); Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey (FÖ); and Physical and Rehabilitation Medicine Unit, Department of Biomedical and Neuromotor Science, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy (VR).

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http://dx.doi.org/10.1097/PHM.0000000000001528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375181PMC
October 2020

Obstructive sleep apnea syndrome-related hypertension and sarcopenia: a brief glance on the renin-angiotensin-aldosterone system.

Sleep Breath 2021 Jun 11;25(2):1159-1161. Epub 2020 Jun 11.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1007/s11325-020-02119-9DOI Listing
June 2021

Sonographic Pearls for Imaging the Brachial Plexus and Its Pathologies.

Diagnostics (Basel) 2020 May 20;10(5). Epub 2020 May 20.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey.

The brachial plexus (BP) is a complicated neural network, which may be affected by trauma, irradiation, neoplasm, infection, and autoimmune inflammatory diseases. Magnetic Resonance Imaging is the preferred diagnostic modality; however, it has the limitations of high cost and lack of portability. High-resolution ultrasound has recently emerged as an unparalleled diagnostic tool for diagnosing postganglionic lesions of the BP. Existing literature describes the technical skills needed for prompt ultrasound imaging and guided injections for the BP. However, it remains particularly challenging for beginners to navigate easily while scanning its different parts. To address this, we share several "clinical pearls" for the sonographic examination of the BP as well as its common pathologies.
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http://dx.doi.org/10.3390/diagnostics10050324DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7277999PMC
May 2020

Ultrasound-Guided Hydrodilatation of the Shoulder Capsule at the Rotator Interval: Technical Tips and Tricks.

Pain Pract 2020 11 12;20(8):948-949. Epub 2020 Jun 12.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

Adhesive capsulitis and disorders of the intra-articular portion of the long head of the biceps brachii tendon are common causes of shoulder pain. Sonographic findings, coupled with clinical evaluation and medical history, are paramount for prompt diagnosis. Herewith, either to precisely confirm the pain generator(s) or to appropriately treat relevant cases, ultrasound-guided interventions are often required in daily clinical practice. Targeting the anatomical structures involved in the aforementioned pathological conditions, we briefly describe some technical tips and tricks as regards ultrasound-guided hydrodilatation of the shoulder capsule at the rotator interval.
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http://dx.doi.org/10.1111/papr.12920DOI Listing
November 2020

'Scientific Strabismus' or two related pandemics: coronavirus disease and vitamin D deficiency.

Br J Nutr 2020 10 12;124(7):736-741. Epub 2020 May 12.

Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey.

The WHO has announced the novel coronavirus disease (COVID-19) outbreak to be a global pandemic. The distribution of community outbreaks shows seasonal patterns along certain latitude, temperature and humidity, that is, similar to the behaviour of seasonal viral respiratory tract infections. COVID-19 displays significant spread in northern mid-latitude countries with an average temperature of 5–11°C and low humidity. Vitamin D deficiency has also been described as pandemic, especially in Europe. Regardless of age, ethnicity and latitude, recent data showed that 40 % of Europeans are vitamin D deficient (25-hydroxyvitamin D (25(OH)D) levels <50 nmol/l), and 13 % are severely deficient (25(OH)D < 30 nmol/l). A quadratic relationship was found between the prevalences of vitamin D deficiency in most commonly affected countries by COVID-19 and the latitudes. Vitamin D deficiency is more common in the subtropical and mid-latitude countries than the tropical and high-latitude countries. The most commonly affected countries with severe vitamin D deficiency are from the subtropical (Saudi Arabia 46 %; Qatar 46 %; Iran 33·4 %; Chile 26·4 %) and mid-latitude (France 27·3 %; Portugal 21·2 %; Austria 19·3 %) regions. Severe vitamin D deficiency was found to be nearly 0 % in some high-latitude countries (e.g. Norway, Finland, Sweden, Denmark and Netherlands). Accordingly, we would like to call attention to the possible association between severe vitamin D deficiency and mortality pertaining to COVID-19. Given its rare side effects and relatively wide safety, prophylactic vitamin D supplementation and/or food fortification might reasonably serve as a very convenient adjuvant therapy for these two worldwide public health problems alike.
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http://dx.doi.org/10.1017/S0007114520001749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300194PMC
October 2020

High ankle sprain: sonographic demonstration of a posterior inferior tibiofibular ligament avulsion.

J Ultrasound 2020 Sep 4;23(3):431-433. Epub 2020 Apr 4.

Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Bologna, Italy.

Syndesmotic injuries, also referred as high ankle sprains, may cause significant ankle instability and chronic pain. Ultrasound (US) is a well-proven imaging modality to evaluate the ligaments of the ankle, due to its high spatial resolution and the possibility to perform dynamic examinations. However, considering the syndesmosis complex, the sonographic appearance of the posterior inferior tibiofibular ligament (PITFL) is not well described in the pertinent literature and, to the best of our knowledge, we found no report of PITFL avulsion demonstrated at US, as in the case presented.
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http://dx.doi.org/10.1007/s40477-020-00455-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441094PMC
September 2020

Circulating cytokines and outcome in metastatic colorectal cancer patients treated with regorafenib.

World J Gastrointest Oncol 2020 Mar;12(3):301-310

Medical Oncology and Laboratory of Translational Oncology, Oncology Department, S. Croce and Carle Teaching Hospital Cuneo, Cuneo 12100, Italy.

Background: Regorafenib is an oral small-molecule multikinase inhibitor approved in third or later line of treatment for patients with metastatic colorectal cancer (mCRC). Regorafenib has shown significant benefits in overall survival and progression free survival in two phase III trials compared to placebo in patients with mCRC who had progressed on previous therapy.

Aim: To identify an immune profile that might specifically correlate with the outcome in patients treated with regorafenib.

Methods: Blood samples were collected from 17 patients before treatment with regorafenib and from 6 healthy volunteers. The proteins evaluated (TNF-α, TGF-β, VEGF, CCL-2, CCL-4, and CCL-5) were selected on the basis of their roles in angiogenesis and colorectal cancer pathogenesis.

Results: We found that TNF-α basal level was significantly higher in mCRC patients compared to healthy individuals. Non Responder (NR) patients showing progression of disease ( = 12) had higher basal level of TGF-β, TNF-α, VEGF, CCL-2 and CCL-5 compared to Responder (R) patients (complete response CR, = 1; partial response PR, = 1; Stable Disease SD, = 3). On the contrary, plasma basal level of CCL-4 was higher in R compared to NR patients. High values of TGF-β and TNF-α negatively correlated with progression free survival.

Conclusion: These results suggest a cytokine signature potentially able to discriminate between R and NR patients to treatment with regorafenib.
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http://dx.doi.org/10.4251/wjgo.v12.i3.301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081116PMC
March 2020

Dynamic ultrasound imaging of the posterior capsule in the shoulder: Tips and tricks.

Kaohsiung J Med Sci 2020 06 12;36(6):471-472. Epub 2020 Feb 12.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1002/kjm2.12190DOI Listing
June 2020

Ultrasound-Guided Hydrodissection of the Median Nerve in Pronator Syndrome: Where Is the "Pronator Tunnel"?

J Ultrasound Med 2020 Jul 20;39(7):1463-1464. Epub 2020 Jan 20.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1002/jum.15221DOI Listing
July 2020

Sonographic diagnosis of clinically unsuspected thrombosis of the medial marginal vein and dorsal arch of the foot.

J Ultrasound 2020 Jan 9. Epub 2020 Jan 9.

Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Bologna, Italy.

Foot pain is common in daily clinical practice but thrombosis of the foot veins is rarely considered as a differential diagnosis. Several cases of plantar veins thrombosis are reported in literature but a detailed description of ultrasonographic findings in case of thrombosis of the dorsal venous arch of the foot is lacking. We report a case of ours with a thrombosis of the medial marginal vein and dorsal venous arch of the foot, showing its close anatomical relation with the extensor hallucis longus tendon.
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http://dx.doi.org/10.1007/s40477-019-00421-1DOI Listing
January 2020

Ultrasound follow-up of spontaneous tears of the plantar fascia treated with conservative therapies: Two case reports.

Medicine (Baltimore) 2019 Dec;98(52):e18428

Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti.

Rationale: The plantar fascia (PF) is an important anatomical structure that stabilizes the longitudinal arch of the foot. While plantar fasciitis is a common pathology affecting the foot, tears of the PF are uncommon injuries characterized by acute pain in the plantar aspect of the foot. The main purpose of this paper was to describe, in detail, how the ultrasonographic pattern of PF rupture can be combined with the clinical features to define the prognosis and promptly plan the therapeutic approach.

Patient Concerns: In the first case, a 39-year-old male patient was seen due to acute pain in the mid plantar foot which appeared 3 days after a tennis match. The pain was accompanied by a "snap" noise and intense pain. In the second case, a 44-year-old male patient was seen due to pain in the heel region which appeared 2 days after a running session.

Diagnosis: One case of noninsertional complete tear of the central bundle of the PF with retraction of the 2 stumps and 1 case of partial tear of the central bundle of the PF at the level of the insertional region.

Interventions: Both patients were treated with conservative therapies including load management, oral nonsteroidal anti-inflammatory drugs, foot orthosis, and restriction of sport activities.

Outcomes: At follow-up, the patient with spontaneous complete tear of the PF (noninsertional area) showed a small fibrous bridge between the 2 stumps, with partial alignment of the proximal and distal portions, the ability to walk for a medium to long-distance, and difficulty going up and downstairs. The patient with the spontaneous partial tear (insertional area) showed complete fibrous scar tissue with restoration of the fascial continuity, and the ability to walk for a long-distance and go up and downstairs without pain.

Lessons: Based on the clinical and ultrasonographic findings, we suggest that partial tear of the PF in the insertional region presents a favorable prognosis with complete recovery, both clinically and anatomically, while a complete tear in the noninsertional region is associated with partial functional and histological recovery when managed with a conservative approach. Therefore, coupling the clinical findings with the sonohistologic pattern is a valuable approach to plan the most suitable treatment for patients with spontaneous PF tear.
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http://dx.doi.org/10.1097/MD.0000000000018428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946576PMC
December 2019

Ultrasound Imaging of the Subcoracoid Space in the Shoulder: Brachial Plexus Nearby?

Pain Pract 2020 06 29;20(5):564-565. Epub 2020 Jan 29.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1111/papr.12869DOI Listing
June 2020
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