Graves-Basedow ophthalmopathy surgical approaches: Open vs Endoscopic.

Graves-Basedow's disease (GBD) is an autoimmune pathology that affects the thyroid and is characterized by the presence of goiter, hyperthyroidism, ophthalmopathy, and dermopathy. Graves-Basedow ophthalmopathy (GBO) is a set of inflammatory and infiltrative alterations of the orbital tissue that affects 40-90% of subjects suffering from GBD. Our study aims to investigate the differences in the clinical outcomes of patients treated with two different techniques: the classic open and the more modern endoscopic. A retrospective clinical study was carried out from the year 2011 until the year 2020 to evaluate the clinical outcomes of two different surgical techniques for the treatment of GBO. Eighteen patients were given surgical indications, 12 males and 6 females aged between 37 and 69 years (average age 48.5 years), for a total of 36 orbits. From the year 2011 to the year 2014, all patients were treated with the open orbital decompression technique; from 2015 onwards, patients were subjected to orbital decompression with the endoscopic transnasal approach. Pre- and postoperative ophthalmometry, reduction of proptosis, and reduction of oculo-orbital index were compared for the two techniques. As evidenced by the statistical analysis carried out on the sample before and after surgical treatment, there is a statistically significant difference between ophthalmometry and the Oculo-Orbital Index (IOO) values; this indicates that surgical orbital decompression with two walls (floor and medial wall) is effective in reducing exophthalmos. The positive result is also confirmed by the reduction of proptosis, measured in millimeters, averaging 1.7 mm. In the analysis of data relating to the two different patient groups, treated respectively with endoscopic orbital decompression (Technique 1) and classical open orbital decompression (Technique 2), the results obtained show that there is no statistically significant difference between the results of the two techniques. Therefore, the choice of surgical approach is at the discretion of the surgeon. It is our opinion that orbital decompression with the endoscopic transnasal technique should be an absolute indication in all patients who have clinical and radiographic signs of involvement of the optic nerve at the orbital apex (crowded apex syndrome) thanks to the ability of this technique to add and decompress the optical channel at the apex. For all other patients with GBO, the endoscopic technique of orbital decompression can be indicated as a first-line surgical approach considering the absence of skin scars and the best aesthetic results.

Robot-as-a-Service: From Cloud to Peering Technologies.

This article is devoted to the historical overview of the Robot-as-a-Service concept. Several major scientific publications on the development of Robot-as-a-Service systems based on a service-oriented paradigm are considered. Much attention is paid to the analysis of a centralized approach in the development using cloud computing services and the search for the limitations of this approach. As a result, general conclusions on the reviewed publications are given, as well as the authors' own vision of Robot-as-a-Service systems based on the concept of robot economics.

Long-term Follow-up after Extracapsular Dissection of Parotid Pleomorphic Adenomas - A Retrospective Study.

Introduction: Parotid pleomorphic adenoma (PPA) is the most common benign salivary gland neoplasm. Extracapsular dissection (ED) arose as a conservative surgical technique alternative to superficial parotidectomy to reduce complications. Materials and Methods: Patients who underwent ED for superficial, <3 cm, mobile parotid lumps (Quer I) between 2004 and 2008 were retrospectively analysed focusing on those with histological diagnosis of pleomorphic adenoma. A retrospective cohort study on 50 patients who accepted to undergo ultrasonography and clinical evaluation for at least 10 years since surgery was performed. Clinical data, surgical reports, and validated questionnaires for the assessment of complications, quality of life (QoL) and aesthetic satisfaction were analysed. Recurrence rate and complications after ED, with their QoL and aesthetic impact, were evaluated. Statistical analysis was performed setting α=0.05 as the level of significance. Results: Low occurrence of complications related to ED was seen. Overall QoL after ED was very good (range 1-7, mean 6,86), due to low complications incidence of complications and their low severity, as assessed by patients through Parotidectomy Outcome Inventory-8 questionnaire. Overall aesthetic satisfaction was high (range 1-10, mean 9,78). Aesthetic satisfaction and QoL was statistically related to onset of complications (P = 0.02504 and P = 0.001859). Tumour localization and dimension was not statistically related to onset of complications (P = 0.8207 and 0.7586). After a mean follow-up of 12.5 years, no recurrences were detected. Discussion: There is a lack of studies with a long-term follow-up after ED for the evaluation of recurrences and complications. Considering our results, the ED technique should be adopted as the first surgical approach for Quer I PPA without suspicion of malignancy.

Cystic lymphangioma in adult: a case report and a review of the literature.

Cystic lymphangioma (CL) in adult is a very rare pathology. Its etiology remains unclear, but it is supposed to be congenital or to be a result of obstruction and lymph fluid retention of developing lymphatic vessels. It generally occurs in the head and neck region, probably because of the rich lymphatics in this area. It can be easily misdiagnosed with other cervicofacial masses. We present the case of a 56-year-old-female presented with a right-sided painless cervical swelling. Ultrasonography and magnetic resonance imaging were performed and a surgical complete removal was carried out. Histological examination revealed that the mass was composed by a variety of dilated lymph vessels involved in a fibrovascular stroma. Diagnose of CL was done. With this article, we want to highlight the features of CL and its role in the differential diagnoses of adults' cervicofacial masses.

Trustable Environmental Monitoring by Means of Sensors Networks on Swarming Autonomous Marine Vessels and Distributed Ledger Technology.

The article describes a highly trustable environmental monitoring system employing a small scalable swarm of small-sized marine vessels equipped with compact sensors and intended for the monitoring of water resources and infrastructures. The technological foundation of the process which guarantees that any third party can not alter the samples taken by the robot swarm is based on the Robonomics platform. This platform provides encrypted decentralized technologies based on distributed ledger tools, and market mechanisms for organizing the work of heterogeneous multi-vendor cyber-physical systems when automated economical transactions are needed. A small swarm of robots follows the autonomous ship, which is in charge of maintaining the secure transactions. The swarm implements a version of Reynolds' Boids model based on the Belief Space Planning approach. The main contributions of our work consist of: (1) the deployment of a secure sample certification and logging platform based on the blockchain with a small-sized swarm of autonomous vessels performing maneuvers to measure chemical parameters of water in automatic mode; (2) the coordination of a leader-follower framework for the small platoon of robots by means of a Reynolds' Boids model based on a Belief Space Planning approach. In addition, the article describes the process of measuring the chemical parameters of water by using sensors located on the vessels. Both technology testing on experimental vessel and environmental measurements are detailed. The results have been obtained through real world experiments of an autonomous vessel, which was integrated as the "leader" into a mixed reality simulation of a swarm of simulated smaller vessels.The design of the experimental vessel physically deployed in the Volga river to demonstrate the practical viability of the proposed methods is shortly described.

Synchronous Ipsilateral Pleomorphic Adenomas of Parotid and Submandibular Glands: An Unusual Finding.

A rare case of synchronous ipsilateral pleomorphic adenomas (PA) of the left parotid and submandibular glands is reported. Simultaneous multiple PA in major salivary glands are a very rare entity, and merely few cases of ipsilateral synchronous PA involving parotid and submandibular glands are reported in the literature. The case of a 40-year-old female with a six-year history of asymptomatic growing lesion in both left parotid and left submandibular regions is presented. Left superficial parotidectomy and left submandibular gland excision at the same surgery have been performed. The aim of this article is to highlight the importance of an accurate head and neck presurgery examination both clinically and radiologically, keeping in mind the possibility of multiple tumor location.