Surgical management of Glioma Grade 4: technical update from the neuro-oncology section of the Italian Society of Neurosurgery (SINch®): a systematic review

Purpose: The extent of resection (EOR) is an independent prognostic factor for overall survival (OS) in adult patients with Glioma Grade 4 (GG4). The aim of the neuro-oncology section of the Italian Society of Neurosurgery (SINch®) was to provide a general overview of the current trends and technical tools to reach this goal. Methods: A systematic review was performed. The results were divided and ordered, by an expert team of surgeons, to assess the Class of Evidence (CE) and Strength of Recommendation (SR) of perioperative drugs management, imaging, surgery, intraoperative imaging, estimation of EOR, surgery at tumor progression and surgery in elderly patients. Results: A total of 352 studies were identified, including 299 retrospective studies and 53 reviews/meta-analysis. The use of Dexamethasone and the avoidance of prophylaxis with anti-seizure medications reached a CE I and SR A. A preoperative imaging standard protocol was defined with CE II and SR B and usefulness of an early postoperative MRI, with CE II and SR B. The EOR was defined the strongest independent risk factor for both OS and tumor recurrence with CE II and SR B. For intraoperative imaging only the use of 5-ALA reached a CE II and SR B. The estimation of EOR was established to be fundamental in planning postoperative adjuvant treatments with CE II and SR B and the stereotactic image-guided brain biopsy to be the procedure of choice when an extensive surgical resection is not feasible (CE II and SR B). Conclusions: A growing number of evidences evidence support the role of maximal safe resection as primary OS predictor in GG4 patients. The ongoing development of intraoperative techniques for a precise real-time identification of peritumoral functional pathways enables surgeons to maximize EOR minimizing the post-operative morbidity

The genus Dallocardia (Mollusca: Bivalvia: Cardiidae) in the Southwestern Atlantic Ocean

The taxonomy of the species assigned to the genus Dallocardia (Cardiidae: Trachycardiinae) recorded from the Argentinean and Magellanic biogeographical provinces was reviewed, revealing that two species are present: Dallocardia muricata (Linnaeus, 1758), well-known as widely distributed along the western Atlantic, and here considered as having its living southernmost limit of distribution in the southern Brazilian coast; and Dallocardia delicatula (EA Smith, 1915), a species resurrected as valid, to which D. manueli (Prado, 1993) is regarded as a junior synonym, occurring along southeastern and southern Brazil, Uruguay and in temperate waters of Argentina. The shells of both species are characterized in detail, differing in outline and rib morphology. Apart from this, a study of the functional anatomy of D. muricata was performed. This species is a moderately rapid shallow burrower from intertidal and subtidal regions in coarse, grassy and muddy sand bottoms, presenting adaptations to live in low-energy environments of sheltered bays and inlets. It has short siphons, with the incurrent crowned with simple, finger-like tentacles, which prevent, but do not block completely excess material and/or large particles from entering the pallial cavity. In addition to presenting a wide pedal gape and the two siphonal openings, D. muricata is the first known cardiid having a temporary fourth mantle gape, this acting as a supplementary incurrent opening, and also serving for expulsion of pseudofaeces. Compared to the labial palps, the ctenidia in this species are large and involved in processing the bulk of material entering the mantle cavity. The densely folded labial palps are indicative that D. muricata deals with moderate to considerable amounts of material. D. muricata is a hermaphroditic bivalve species.Fil: Signorelli, Javier Hernan. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto de Biología de Organismos Marinos; ArgentinaFil: Leme da Fonseca, Mauricio. Centro de Pesquisas e Desenvolvimento Leopoldo Américo Miguez de Mello (PETROBRAS), Cidade Universitária, Rio de Janeiro; BrasilFil: Scarabino, Fabrizio. Universidad de la Republica. Centro Universitario Regional del Este.; UruguayFil: Dias Passos, Flavio. Departamento de Biologia Animal, Instituto de Biologia—Universidade Estadual de Campinas (UNICAMP); Brasi

A reappraisal of macrophage polarization in glioblastoma: Histopathological and immunohistochemical findings and review of the literature

The survival rate in glioblastoma multiforme patients has scarcely improved in the last decades; however, many new therapeutic strategies have been theorized or developed for these neoplasias. Recently, the inverse correlation observed between patient prognosis and tumor-associated macrophages (TAMs) density in solid tumors has encouraged the development of anti-tumor strategies aiming to target TAMs. As expected, TAMs polarization is influenced by both macrophage localization and tumor microenvironment signals, resulting in a more complex scenario than the simple M1/M2 activation status. Macrophage polarization in glioblastoma has not yet been fully elucidated, and most results have been obtained in experimental non-human settings, with some apparent contradiction. The authors performed a histopathological and immunohistochemical study of 37 cases of glioblastoma in order to characterize the M1 and M2 macrophage populations within TAMs. A high prevalence of CD163+ M2-polarized macrophages was detected in this cohort, whereas iNOS+ macrophages were rarely found. The down-regulation of CD68 expression in microglia/macrophage infiltrating glioblastomas is also reported for the first time. Such a finding is associated with a specific location of TAMs within the lesion, as confirmed by the fact that CD68 staining was lower than CD163, mainly in perivascular areas. The authors discuss the recent literature about the global scenario of macrophage plasticity and polarization in glioblastoma, and suggest some pivotal points for therapeutic applications

14th International Congress on Antiphospholipid Antibodies Task Force Report on Catastrophic Antiphospholipid Syndrome

The 'Task Force on Catastrophic Antiphospholipid Syndrome (CAPS)' was developed on the occasion of the 14th International Congress on Antiphospholipid Antibodies. The objectives of this Task Force were to assess the current knowledge on pathogenesis, clinical and laboratory features, diagnosis and classification, precipitating factors and treatment of this condition in order to address recommendations for future research. This article summarizes the studies analyzed by the Task Force, its recommendations and the future research agenda. © 2014 Elsevier B.V. All rights reserved.The 'Task Force on Catastrophic Antiphospholipid Syndrome (CAPS)' was developed on the occasion of the 14th International Congress on Antiphospholipid Antibodies. The objectives of this Task Force were to assess the current knowledge on pathogenesis, clinical and laboratory features, diagnosis and classification, precipitating factors and treatment of this condition in order to address recommendations for future research. This article summarizes the studies analyzed by the Task Force, its recommendations and the future research agenda

A New Universal Simplified Adhesive: 6-Month Randomized multi-center clinical trial

The objective of this multi-centric, double-blind, randomized clinical trial was to evaluate the clinical performance of a new universal adhesive system (Futurabond U, Voco GbmH, Germany) when applied with different application strategies over a period of six months. For this, 200 restorations were performed on non-carious cervical lesions using the adhesive Futurabond U in the four adhesive strategies (n=50 per group): self-etch without previous conditioner (SEE); self-etch associated with selective enamel etching (SET); etch-and-rinse with dry dentin (ERDry) and; etch-and-rinse with wet dentin (ERWet). After the use of the adhesive system, the cavities were restored with Admira Fusion composite resin (Voco GmbH). After 6 months of clinical performance, these restorations were evaluated according to FDI criteria in the following items: retention/fracture, marginal adaptation, marginal staining, postoperative sensitivity and caries recurrence. Seven restorations were lost/fractured after six months of clinical evaluation (2 in the SEE group, 1 in the SET group, 1 in the ERDry group, and 3 in the ERWet group). The retention rates for six months (95% confidence interval) were 96% (86%-98%) for the SEE group, 98% (89%-99%) for the SET group, 98% (89%-99%) for the ERDry group and 94% (83%-97%) for the ERWet group, with no statistical difference identified between any pair of groups (p> 0.05). Twenty-four restorations presented small marginal adaptation defects at the six-months evaluation recall, and all of them were considered clinically acceptable. The clinical performance of the universal adhesive Futurabond U associated to Admira Fusion unidoses resin composite was found to be promise after 6-month of clinical evaluation when applied in noncarious cervical lesions and it was not depending on the bonding strategy employed

Associations Among Antiphospholipid Antibody Types, Isotypes, and Titers: An AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Study

Several antiphospholipid antibody (aPL) profiles ("triple" and lupus anticoagulant [LA] positivity) are associated with a higher risk for clinical manifestations of antiphospholipid syndrome (APS). Further risk is correlated with higher levels of anticardiolipin antibody (aCL) and anti -b2 glycoprotein-I antibody (ab2GPI), and with aPL persistence. Given that the 3 aPL tests detect partially overlapping sets of antibodies, the primary goal of this study was to characterize the associations among aPL tests using AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) core laboratory data. The APS ACTION Registry includes annually followed adult patients with positive aPL based on the Revised Sapporo Classification Criteria. We analyzed baseline and prospective core laboratory data of the registry for associations among aPL tests using the Spearman rank correlation with Bonferroni-adjusted significance level for multiple comparisons. An aPL Load was calculated based on 6 tests (aCL IgG/IgM/IgA and ab2GPI IgG/IgM/IgA); a receiver operating characteristic curve was used to evaluate the diagnostic performance of the aPL Load in predicting LA positivity. In 351 patients simultaneously tested for LA, aCL, and ab2GPI, the frequency of moderate-to-high (>= 40 U) titers of aCL and ab2GPI IgG/IgM/ IgA was higher in patients who were positive for LA vs those who were negative. An aPL Load was calculated for each patient to assess the overall aPL burden. For every 1-point increase in the aPL Load, the possibility of a positive LA test increased by 32% (odds ratio, 1.32; 95% CI, 1.2-1.5; P