Carmustine Wafers Implantation in Patients With Newly Diagnosed High Grade Glioma: Is It Still an Option?

Background: The implantation protocol for Carmustine Wafers (CWs) in high grade glioma (HGG) was developed to offer a bridge between surgical resection and adjuvant treatments, such as radio- and chemotherapy. In the last years, however, a widespread use of CWs has been limited due to uncertainties regarding efficacy, in addition to increased risk of infection and elevated costs of treatment. Objective: The aims of our study were to investigate the epidemiology of patients that underwent surgery for HGG with CW implantation, in addition to the assessment of related complications, long-term overall survival (OS), and associated prognostic factors. Methods: Three different medical databases were screened for conducting a systematic review of the literature, according to the PRISMA statement guidelines, evaluating the role of BCNU wafer implantation in patients with newly diagnosed HGG. The search query was based on a combination of medical subject headings (MeSH): “high grade glioma” [MeSH] AND “Carmustine” [MeSH] and free text terms: “surgery” OR “BCNU wafer” OR “Gliadel” OR “systemic treatment options” OR “overall survival.” Results: The analysis of the meta-data demonstrated that there was a significant advantage in using CWs in newly diagnosed GBM in terms of OS, and a very low heterogeneity among the included studies [mean difference 2.64 (95% CI 0.85, 4.44); p = 0.004; I2149 = 0%]. Conversely, no significant difference between the two treatment groups in terms of PFS wad detected (p = 0.55). The analysis of complications showed a relatively higher rate in Carmustine implanted patients, although this difference was not significant (p = 0.53). Conclusions: This meta-analysis seems to suggest that CWs implantation plays a significant role in improving the OS, when used in patients with newly diagnosed HGG. To minimize the risk of side effects, however, a carful patient selection based mainly on patient age and tumor volume should be desirable

Proteome profile of peritoneal effluents in children on glucose- or icodextrin-based peritoneal dialysis

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Fusion imaging for intra-operative ultrasound-based navigation in neurosurgery

The major shortcoming of image-guided navigation systems is the use of presurgically acquired image data, which does not account for intra-operative changes such as brain shift, tissue deformation and tissue removal occurring during the surgical procedure. Intra-operative ultrasound (iUS) is becoming widely used in neurosurgery but they lack orientation and panoramic view. In this article, we describe our procedure for US-based real-time neuro-navigation during surgery. We used fusion imaging between preoperative magnetic resonance imaging (MRI) and iUS for brain lesion removal in 67 patients so far. Surgical planning is based on preoperative MRI only. iUS images obtained during surgery are fused with the preoperative MRI. Surgery is performed under intra-operative US control. Relying on US imaging, it is possible to recalibrate navigated MRI imaging, adjusting distortion due to brain shift and tissue resection, continuously updating the two modalities. Ultrasound imaging provides excellent visualization of targets, their margins and surrounding structures. The use of navigated MRI is helpful in better understanding cerebral ultrasound images, providing orientation and panoramic view. Intraoperative US-guided neuro-navigation adjustments are very accurate and helpful in the event of brain shift. The use of this integrated system allows for a true real-time feedback during surgery

Polymeric nanoparticles for nonviral gene therapy extend brain tumor survival in vivo

Biodegradable polymeric nanoparticles have the potential to be safer alternatives to viruses for gene delivery; however, their use has been limited by poor efficacy in vivo. In this work, we synthesize and characterize polymeric gene delivery nanoparticles and evaluate their efficacy for DNA delivery of herpes simplex virus type I thymidine kinase (HSVtk) combined with the prodrug ganciclovir (GCV) in a malignant glioma model. We investigated polymer structure for gene delivery in two rat glioma cell lines, 9L and F98, to discover nanoparticle formulations more effective than the leading commercial reagent Lipofectamine 2000. The lead polymer structure, poly(1,4-butanediol diacrylate-co-4-amino-1-butanol) end-modified with 1-(3-aminopropyl)-4-methylpiperazine, is a poly(\u3b2-amino ester) (PBAE) and formed nanoparticles with HSVtk DNA that were 138 \ub1 4 nm in size and 13 \ub1 1 mV in zeta potential. These nanoparticles containing HSVtk DNA showed 100% cancer cell killing in vitro in the two glioma cell lines when combined with GCV exposure, while control nanoparticles encoding GFP maintained robust cell viability. For in vivo evaluation, tumor-bearing rats were treated with PBAE/HSVtk infusion via convection-enhanced delivery (CED) in combination with systemic administration of GCV. These treated animals showed a significant benefit in survival (p = 0.0012 vs control). Moreover, following a single CED infusion, labeled PBAE nanoparticles spread completely throughout the tumor. This study highlights a nanomedicine approach that is highly promising for the treatment of malignant glioma

Design, construction, and test of the Gas Pixel Detectors for the IXPE mission

Due to be launched in late 2021, the Imaging X-Ray Polarimetry Explorer (IXPE) is a NASA Small Explorer mission designed to perform polarization measurements in the 2-8 keV band, complemented with imaging, spectroscopy and timing capabilities. At the heart of the focal plane is a set of three polarization-sensitive Gas Pixel Detectors (GPD), each based on a custom ASIC acting as a charge-collecting anode. In this paper we shall review the design, manufacturing, and test of the IXPE focal-plane detectors, with particular emphasis on the connection between the science drivers, the performance metrics and the operational aspects. We shall present a thorough characterization of the GPDs in terms of effective noise, trigger efficiency, dead time, uniformity of response, and spectral and polarimetric performance. In addition, we shall discuss in detail a number of instrumental effects that are relevant for high-level science analysis -- particularly as far as the response to unpolarized radiation and the stability in time are concerned.Comment: To be published in Astroparticle Physic

La fistola bilio-digestiva: nostra esperienza con coledoco-duodenostomia latero-laterale

La coledoco-duodenostomia è stata proposta e descritta da Riedel nel 1892. Gli AA. riportano la loro esperienza sulle anastomosi coledoco-duodenali latero-laterali e il loro orientamento sulle indicazioni a tale intervento. La casistica (1980-1989) è costituita da 51 pazienti cui è stata praticata una coledoco-duodenostomia derivativa di tipo latero-laterale, caratterizzata dall’esecuzione di una incisione longitudinale ed il successivo affrontamento con sutura monostrato a punti staccati in materiale a lento assorbimento, avendo cura che l’anastomosi abbia un diametro di 2 cm. ed ancora di ottenere il perfetto affrontamento della mucosa duodenale e coledocica. Sulla scorta dei risultati ottenuti, ovvero nessun caso di mortalità operatoria e bassa incidenza di morbilità, gli AA. ritengono che la C.D.S. latero-laterale rappresenti una tecnica di derivazione bilio digestiva tuttora attuale, di facile esecuzione a decorso post-operatorio semplice, con dei buoni risultati a distanza, purchè eseguita con tecnica corretta ed in base ad appropriate indicazioni

LARES is in orbit! Some aspects of the mission

LARES (LAser RElativity Satellite), a scientific satellite of the Italian Space Agency (ASI), has been accurately injected in the nominal orbit by the new ESA expendable launch vehicle, Vega during its qualification launch, on the 13th of February 2012. This was a very exciting result also because of the low success rate of qualification launches . Furthermore, several innovative technical solutions characterize the new European launch vehicle, such as the extensive use of carbon fiber reinforced plastic composites for the rocket structures. LARES program started on February 2008 when the Italian Space Agency awarded a contract to the prime contractor CGS (former Carlo Gavazzi Space). A peculiarity of the LARES program was the extensive involvement of universities in many aspects such as the technical design of the satellite and the innovative separation system. A strong cooperation between ASI and ESA about its respective programs, since the acceptance of the LARES mission for the Vega maiden flight, allowed to design a mission which satisfies the scientific requirements of the satellite along with the launcher qualification objectives. The trajectory itself was defined also taking into account the launch vehicle performance and trajectory constraints. The initial orbit envisaged for the maiden flight was a typical sun-synchronous orbit at about 750 km. However that was not acceptable for the science objectives, i.e., the measurement of the Lense-Thirring effect, an Einstein general relativity prediction. Therefore ESA and the launch vehicle authority, ELV (European Launch Vehicle) Prime Contractor of the VEGA development program, proposed a new orbit at 1200 km that later was changed to 1450 km along with small changes to the inclination in order to comply with all the safety constraints to the mission trajectory. In order to meet part of its qualification requirements, the VEGA upper-stage (AVUM) performed several maneuvers, especially during the ballistic phase, namely: the neutral axis maneuver, the barbeque, sun pointing, and spin axis maneuver. In this paper, an overview of the LARES mission and of its elements, including the payload ground segment, is given, together with the first results of the launch campaign and activities that brought the satellite in the final operative configuration