Letter by Rustemi et al Regarding Article, "Flow Diverters for Intracranial Aneurysms: The DIVERSION National Prospective Cohort Study"

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Surgical Brain Metastases: Management and Outcome Related to Prognostic Indexes: A Critical Review of a Ten-Year Series

Brain metastasis are the most common neoplastic lesions of the nervous system. Many cancer patients are diagnosed on the basis of a first clinical presentation of cancer on the basis of a single or multiple brain lesions. Brain metastases are manifestations of primary disease progression and often determine a poor prognosis. Not all patients with a brain metastases undergo surgery: many are submitted to alternative or palliative treatments. Management of patients with brain metastases is still controversial, and many studies have been developed to determine which is the best therapy. Furthermore, management of patients operated for a brain metastasis is often difficult. Chemotherapy, stereotactic radiosurgery, panencephalic radiation therapy, and surgery, in combination or alone, are the means most commonly used. We report our experience in the management of a ten-year series of surgical brain metastasis and discuss our results in the preoperative and postoperative management of this complex condition

Mineralogical, petrographic and physical-mechanical study of Roman construction materials from the Maritime Theatre of Hadrian's Villa (Rome, Italy)

This paper presents the study of various Roman materials used in the construction of the Maritime Theatre, one of the main buildings in the Hadrian’s Villa complex, a designated UNESCO World Heritage Site located in Tivoli (Rome, Italy), dating to the first half of the II century A.D. The plaster layers (arriccio and intonachino) and overlying original Roman paintings that form the concave wall of the portico as well as some bedding mortars of the pyramidal stone elements (i.e. cubilia) of the circular masonry have been studied in particular. In addition, the acid volcanic rocks of the cubilia have been investigated, aiming to understand their state of alteration and geological origin. By mineralogical-petrographic microscopy (OM), diffractometry (XRPD), Raman spectroscopy, Point Load Tests (PLT), helium pycnometry, and particle size analysis, the composition and granulometric distribution of the aggregate, type and characteristics of the binder, and various physical-mechanical properties (density, porosity, water absorption, imbibition and saturation indices, mechanical resistance) of mortars and stones were defined. In addition, through digital image analysis of thin sections, the binder/aggregate ratio and some geometric characteristics of the aggregates (e.g. circularity) were determined. The research aims to improve the knowledge of the constructive technologies of the Maritime Theatre through the analysis of its materials

Apyrase-mediated amplification of secretory IgA promotes intestinal homeostasis.

Secretory immunoglobulin A (SIgA) interaction with commensal bacteria conditions microbiota composition and function. However, mechanisms regulating reciprocal control of microbiota and SIgA are not defined. Bacteria-derived adenosine triphosphate (ATP) limits T follicular helper (Tfh) cells in the Peyer's patches (PPs) via P2X7 receptor (P2X7R) and thereby SIgA generation. Here we show that hydrolysis of extracellular ATP (eATP) by apyrase results in amplification of the SIgA repertoire. The enhanced breadth of SIgA in mice colonized with apyrase-releasing Escherichia coli influences topographical distribution of bacteria and expression of genes involved in metabolic versus immune functions in the intestinal epithelium. SIgA-mediated conditioning of bacteria and enterocyte function is reflected by differences in nutrient absorption in mice colonized with apyrase-expressing bacteria. Apyrase-induced SIgA improves intestinal homeostasis and attenuates barrier impairment and susceptibility to infection by enteric pathogens in antibiotic-induced dysbiosis. Therefore, amplification of SIgA by apyrase can be leveraged to restore intestinal fitness in dysbiotic conditions

Imaging features and ultraearly hematoma growth in intracerebral hemorrhage associated with COVID-19

Purpose: Intracerebral hemorrhage (ICH) is an uncommon but deadly event in patients with COVID-19 and its imaging features remain poorly characterized. We aimed to describe the clinical and imaging features of COVID-19-associated ICH. Methods: Multicenter, retrospective, case-control analysis comparing ICH in COVID-19 patients (COV19\u2009+) versus controls without COVID-19 (COV19\u2009-). Clinical presentation, laboratory markers, and severity of COVID-19 disease were recorded. Non-contrast computed tomography (NCCT) markers (intrahematoma hypodensity, heterogeneous density, blend sign, irregular shape fluid level), ICH location, and hematoma volume (ABC/2 method) were analyzed. The outcome of interest was ultraearly hematoma growth (uHG) (defined as NCCT baseline ICH volume/onset-to-imaging time), whose predictors were explored with multivariable linear regression. Results: A total of 33 COV19\u2009+\u2009patients and 321 COV19\u2009-\u2009controls with ICH were included. Demographic characteristics and vascular risk factors were similar in the two groups. Multifocal ICH and NCCT markers were significantly more common in the COV19\u2009+\u2009population. uHG was significantly higher among COV19\u2009+\u2009patients (median 6.2 mL/h vs 3.1 mL/h, p\u2009=\u20090.027), and this finding remained significant after adjustment for confounding factors (systolic blood pressure, antiplatelet and anticoagulant therapy), in linear regression (B(SE)\u2009=\u20090.31 (0.11), p\u2009=\u20090.005). This association remained consistent also after the exclusion of patients under anticoagulant treatment (B(SE)\u2009=\u20090.29 (0.13), p\u2009=\u20090.026). Conclusions: ICH in COV19\u2009+\u2009patients has distinct NCCT imaging features and a higher speed of bleeding. This association is not mediated by antithrombotic therapy and deserves further research to characterize the underlying biological mechanisms

Acute subdural hematoma in the elderly: outcome analysis in a retrospective multicentric series of 213 patients

OBJECTIVE: The objective of this study was to analyze the risk factors associated with the outcome of acute subdural hematoma (ASDH) in elderly patients treated either surgically or nonsurgically.METHODS: The authors performed a retrospective multicentric analysis of clinical and radiological data on patients aged ≥ 70 years who had been consecutively admitted to the neurosurgical department of 5 Italian hospitals for the management of posttraumatic ASDH in a 3-year period. Outcome was measured according to the Glasgow Outcome Scale (GOS) at discharge and at 6 months' follow-up. A GOS score of 1-3 was defined as a poor outcome and a GOS score of 4-5 as a good outcome. Univariate and multivariate statistics were used to determine outcome predictors in the entire study population and in the surgical group.RESULTS: Overall, 213 patients were admitted during the 3-year study period. Outcome was poor in 135 (63%) patients, as 65 (31%) died during their admission, 33 (15%) were in a vegetative state, and 37 (17%) had severe disability at discharge. Surgical patients had worse clinical and radiological findings on arrival or during their admission than the patients undergoing conservative treatment. Surgery was performed in 147 (69%) patients, and 114 (78%) of them had a poor outcome. In stratifying patients by their Glasgow Coma Scale (GCS) score, the authors found that surgery reduced mortality but not the frequency of a poor outcome in the patients with a moderate to severe GCS score. The GCS score and midline shift were the most significant predictors of outcome. Antiplatelet drugs were associated with better outcomes; however, patients taking such medications had a better GCS score and better radiological findings, which could have influenced the former finding. Patients with fixed pupils never had a good outcome. Age and Charlson Comorbidity Index were not associated with outcome. CONCLUSIONS: Traumatic ASDH in the elderly is a severe condition, with the GCS score and midline shift the stronger outcome predictors, while age per se and comorbidities were not associated with outcome. Antithrombotic drugs do not seem to negatively influence pretreatment status or posttreatment outcome. Surgery was performed in patients with a worse clinical and radiological status, reducing the rate of death but not the frequency of a poor outcome

Roman mortars and raw materials from the Maritime Theater of Roman Hadrian's Villa (Rome, Italy)

The work addressed to the study of the Roman mortars used in the construction of the Maritime Theater of Villa Adriana, located in Tivoli (Rome), dating to the II sec. A.D. and UNESCO Cultural Heritage since 1999. By mineralogical-petrographic, XRPD, SEM-EDS and physical analysis, the granulometric composition and distribution of the aggregate, type and characteristics of the binder, and various physical-mechanical properties of mortars (density, porosity, water absorption, imbibition and saturation indexes, mechanical resistance) were defined. In addition, through thin section digital image analysis, the binder / aggregate ratio and some geometric characteristics of the aggregates (e.g. circularity) were determined. The value of the binder / aggregate ratio has been very useful in defining the compositional standards in relation to the function of the mortars in the analysed building, the technical quality of the mortar production and any inomogeneities resulting from the production processes or from the construction phases of the building. The layers (arriccio and intonachino) of some plasters used in the interior wall of the porch and some bedding mortars of the truncated-pyramidal bricks (i.e. cubilia) of the circular bearing masonry have been studied in particular. In addition, the petrographic characteristics of cubilia bricks made with acid volcanic rocks have been studied, aiming to understand their state of alteration and geological origin. In addition, by raman analysis, the coloured layers of some painting samples from the porch wall were studied to analyse their composition, thickness and raw materials used in the pigments. The purpose of the research is to contribute to understanding the constructive technologies of the Roman Theater of the Maritime Theater through the identification of materials

Petrographic and mineralogical characterization of volcanic rocks and surface-depositions on Romanesque monuments

The stone used on the monuments, especially if they come from ancient times (e.g. medieval period), when exposed to the atmosphere, they are frequently affected by weathering and bio-deterioration processes. Thus, these latter produce various chemical and mineralogical transformations of substrate at the interface with the atmospheric agents as function of intrinsic compositional and physical characteristics of the material. Moreover, if there also are ancient treatments on the surface of geomaterials, the investigation field is further complicated. This research aims to analyse the surfaces of different volcanic lithology (basalts, andesite, pyroclastic rocks) used in the medieval Romanesque churches of Sardinia (XI-XIV cent.) having high historical- architectural and cultural relevance. By mineralogical and petrographic analysis (OM) and other different analytical methods (XRPD, colorimetry) the investigations addressed to define: i) petrographic features of volcanic rocks substrate; ii) chemical and mineralogical composition of coatings/crusts and any salt fanoand cryptoefflorescence; iii) compositional and microstratigraphic characterization of ancient treatments (i.e., Ca-oxalate films) on the surface of facades; iv) chromatic modifications of surface with respect to the substrate due to the alteration processes. The results show the incidence of several factors in the alteration process, as function of the occurred time, petrophysical features and composition of geomaterials, their position in the monument structure, exposition to the weathering processes, microclimatic characteristics, environmental conditions