“Spontaneous” ping-pong fracture in newborns: case report and review of the literature

“Ping-pong” fractures (PPF) are depressed skull fractures typical of newborns. PPF usually result from head injury and, rarely, may cause severe long-term neurological sequelae. The management of PPF is still controversial. The goal of this paper is to present a case of “spontaneous” ping-pong fracture and to review the pertinent literature of the last 20 years. We report on a newborn who presented with a “spontaneous” parietal depressed skull fracture at birth. Preoperative computed tomography (CT) scan confirmed the PPF and excluded brain injuries. Neurosurgical intervention was performed on day 3 with immediate lifting of the fracture; the postoperative course was uneventful. During the last 20 years, 22 cases of “spontaneous ping-pong” fractures in newborn have been reported, with different clinical pictures and management but, generally, with a good outcome. “Ping-pong” fractures can occur in uneventful pregnancies and after uncomplicated vaginal or cesarean deliveries. CT scan, with low-dose protocol for infants, is the gold standard examination to evaluate the fracture and any associated brain lesions. Treatment is selected according to fracture characteristics

Lipid Peroxidation and Antioxidant Consumption as Early Markers of Neurosurgery-Related Brain Injury in Children

BACKGROUND AND AIMS: Lipid peroxidation represents a marker of secondary brain injury both in traumatic and in non-traumatic conditions-as in major neurosurgical procedures-eventually leading to brain edema amplification and further brain damage. Malondialdehyde (MDA), a lipid peroxidation marker, and ascorbate, a marker of antioxidant status, can represent early indicators of this process within the cerebrospinal fluid (CSF). We hypothesized that changes in cerebral lipid peroxidation can be measured ex vivo following neurosurgery in children. METHODS: Thirty-six children (M:F = 19/17, median age 32.9 months; IQR 17.6-74.6) undergoing neurosurgery for brain tumor removal were admitted to the pediatric intensive care unit (PICU) in the postoperative period with an indwelling intraventricular catheter for intracranial pressure monitoring and CSF drainage. Plasma and CSF samples were obtained for serial measurement of MDA, ascorbate, and cytokines. RESULTS: An early brain-limited increase in lipid peroxidation was measured, with a significant increase from baseline of MDA in CSF (p = 0.007) but not in plasma. In parallel, ascorbate in CSF decreased (p = 0.05). Systemic inflammatory response following brain surgery was evidenced by plasma IL-6/IL-8 increase (p 0.0022 and 0.0106, respectively). No correlation was found between oxidative response and tumor site or histology (according to World Health Organization grading). Similarly, lipid peroxidation was unrelated to the length of surgery (mean 321 ± 73 min), or intraoperative blood loss (mean 20.9 ± 16.8% of preoperative volemia, 44% given hemotransfusions). Median PICU stay was 3.5 days (IQL range 2-5.5 d.), and postoperative ventilation need was 24 h (IQL range 20-61.5 h). The elevation in postoperative MDA in CSF compared with preoperative values correlated significantly with postoperative ventilation need (P = 0.05, r2 0168), while no difference in PICU stay was recorded. CONCLUSIONS: Our results indicate that lipid peroxidation increases consistently following brain surgery, and it is accompanied by a decrease in antioxidant defences; intraventricular catheterization offers a unique chance of oxidative process monitoring. Further studies are needed to evaluate whether monitoring post-neurosurgical oxidative stress in CSF is of prognostic utility

Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document

Malformació de Chiari 1; Nens; SiringomieliaMalformación de Chiari 1; Niños; SiringomieliaChiari 1 malformation; Children; SyringomyeliaBackground Chiari malformation type 1 (CM1) is a rare condition where agreed classification and treatment are still missing. The goal of this study is to achieve a consensus on the diagnosis and treatment of CM1 in children. Methods A multidisciplinary panel formulated 57 provisional statements based on a review of the literature. Thirty-four international experts (IE) participated in a Delphi study by independently rating each statement on a 4-point Likert scale (“strongly disagree,” “disagree,” “agree,” “strongly agree”). Statements that were endorsed (“agree” or “strongly agree”) by < 75% of raters were re-formulated, or new statements were added, and another Delphi round followed (up to a maximum of three). Results Thirty-five IE were contacted and 34 agreed to participate. A consensus was reached on 30/57 statements (52.6%) after round 1. Three statements were added, and one removed. After round 2, agreement was reached on 56/59 statements (94.9%). Finally, after round 3, which took place during the 2019 Chiari Consensus Conference (Milan, Italy), agreement was reached on 58/59 statements (98.3%) about four main sections (Definition and Classification, Planning, Surgery, Isolated Syringomyelia). Only one statement did not gain a consensus, which is the “definition of radiological failure 24 month post-surgery.” Conclusions The consensus document consists of 58 statements (24 on diagnosis, 34 on treatment), serving clinicians and researchers following children with CM1. There is a clear need for establishing an international network and registry and to promote collaborative studies to increase the evidence base and optimize the long-term care of this patient population.Open access funding provided by Università Cattolica del Sacro Cuore within the CRUI-CARE Agreement

Human BLCAP transcript: new editing events in normal and cancerous tissues

Bladder cancer-associated protein (BLCAP) is a highly conserved protein among species, and it is considered a novel candidate tumor suppressor gene originally identified from human bladder carcinoma. However, little is known about the regulation or the function of this protein. Here, we show that the human BLCAP transcript undergoes multiple A-to-I editing events. Some of the new editing events alter the highly conserved amino terminus of the protein creating alternative protein isoforms by changing the genetically coded amino acids. We found that both ADAR1 and ADAR2-editing enzymes cooperate to edit this transcript and that different tissues displayed distinctive ratios of edited and unedited BLCAP transcripts. Moreover, we observed a general decrease in BLCAP-editing level in astrocytomas, bladder cancer and colorectal cancer when compared with the related normal tissues. The newly identified editing events, found to be downregulated in cancers, could be useful for future studies as a diagnostic tool to distinguish malignancies or epigenetic changes in different tumors

Seasonal variations in the chemical composition of indoor and outdoor PM10 in university classrooms

In the VIEPI project (Integrated evaluation of the exposure to indoor particulate matter) framework, we carried out a 1-year study of the concentration and chemical composition of particulate matter (PM) in a 5 story building in the Sapienza University of Rome (Italy). Each sampling had a duration of 1 month and was carried out indoors and outdoors in six classrooms. The chemical analyses were grouped to obtain information about the main PM sources. Micro-elements in their soluble and insoluble fractions were used to trace additional sources. Indoor PM composition was dominated by soil components and, to a lesser extent, by the organics, which substantially increased when people crowded the sites. The penetration of PM components was regulated by their chemical nature and by the dimensions of the particles in which they were contained. For the first time in crowded indoor environments, three different chemical assays aimed to determine PM redox properties complemented chemical composition measurements. These preliminary tests showed that substantially different redox properties characterised atmospheric particles in indoor and outdoor sites. The innovative characteristics of this study (time duration, number of considered environments) were essential to obtain relevant information about PM composition and sources in indoor academic environments and the occupants’ role

Finite mixture model-based classification of a complex vegetation system

To propose a Finite Mixture Model (FMM) as an additional approach for classifying large datasets of georeferenced vegetation plots from complex vegetation systems. Study area: The Italian peninsula including the two main islands (Sicily and Sardinia), but excluding the Alps and the Po plain. Methods: We used a database of 5,593 georeferenced plots and 1,586 vascular species of forest vegetation, created in TURBOVEG by storing published and unpublished phytosociological plots collected over the last 30 years. The plots were classified according to species composition and environmental variables using a FMM. Classification results were compared with those obtained by TWINSPAN algorithm. Groups were characterized in terms of ecological parameters, dominant and diagnostic species using the fidelity coefficient. Interpretation of resulting forest vegetation types was supported by a predictive map, produced using discriminant functions on environmental predictors, and by a non\u2010metric multidimensional scaling ordination. Results: FMM clustering obtained 24 groups that were compared with those from TWINSPAN, and similarities were found only at a higher classification level corresponding to the main orders of the Italian broadleaf forest vegetation: Fagetalia sylvaticae, Carpinetalia betuli, Quercetalia pubescenti-petraeae and Quercetalia ilicis. At lower syntaxonomic level, these 24 groups were referred to alliances and sub-alliances. Conclusions: Despite a greater computational complexity, FMM appears to be an effective alternative to the traditional classification methods through the incorporation of modelling in the classificatory process. This allows classification of both the co-occurrence of species and environmental factors so that groups are identified not only on their species composition, as in the case of TWINSPAN, but also on their specific environmental niche

Syringomyelia and Chiari Syndrome Registry: advances in epidemiology, clinical phenotypes and natural history based on a North Western Italy cohort.

Background. Syringomyelia and Chiari Syndrome are classified as rare diseases, but current known occurrence in Europe is missing. The increased ability to diagnose these pathologies by magnetic resonance imaging and its widespread availability has led to an increase of reported cases, often asymptomatic, with the need to standardize definitions, diagnostic criteria and treatments.Aims. We present shared Interregional Recommendations developed with the primary aim to estimate Syringomyelia and Chiari Syndrome prevalence and incidence in North Western Italy, with special reference to symptomatic forms.Methods. An agreement for the standardization of definitions, classifications, diagnostic criteria and surgical Recommendations was reached by the multidisciplinary Interregional Piemonte and Valle d’Aosta Chiari-Syringomyelia Consortium (Delphi method); next, in 2011 a census for Syringomyelia and Chiari Malformation was performed through the Interregional Piemonte and Valle d’Aosta Rare Disease Registry, integrated by a dedicated form in order to estimate prevalence and incidence.Results. 436 patients, 292 females, met shared interregional diagnostic criteria. Syringomyelia prevalence was estimated in 4.84:100 000; Chiari Malformation prevalence was 7.74:100 000; incidence was 0.82:100 000 and 3.08:100 000 respectively. Demographics, neuroradiological parameters and aetiology were reported (in symptomatic and asymptomaticforms). Finally, symptoms and signs, familiar and natural history were analyzed.Conclusions. First Italian epidemiological data (prevalence, incidence) on Chiari and syringomyelia was collected, according to shared diagnostic Recommendations. Future perspectives include the adoption of these Recommendations at national level to standardize the access to diagnosis and care process and promote multicenter clinical trials

Safety and Efficacy of Subcutaneous Rituximab in Previously Untreated Patients with CD20+ Diffuse Large B-Cell Lymphoma or Follicular Lymphoma: Results from an Italian Phase IIIb Study

Subcutaneous (SC) rituximab may be beneficial in terms of convenience and tolerability, with potentially fewer and less severe administration-related reactions (ARRs) compared to the intravenous (IV) form. This report presents the results of a phase IIIb study conducted in Italy. The study included adult patients with CD20+ DLBCL or FL having received at least one full dose of IV RTX 375 mg/m2 during induction or maintenance. Patients on induction received ≥4 cycles of RTX SC 1400 mg plus standard chemotherapy and FL patients on maintenance received ≥6 cycles of RTX SC. Overall, 159 patients (73 DLBCL, 86 FL) were enrolled: 103 (54 DLBCL, 49 FL) completed induction and 42 patients with FL completed 12 maintenance cycles. ARRs were reported in 10 patients (6.3%), 3 (4.2%) with DLBCL and 7 (8.1%) with FL, all of mild severity, and resolved without dose delay/discontinuation. Treatment-emergent adverse events (TEAEs) and serious adverse events occurred in 41 (25.9%) and 14 patients (8.9%), respectively. Two patients with DLBCL had fatal events: Klebsiella infection (related to rituximab) and septic shock (related to chemotherapy). Neutropenia (14 patients, 8.9%) was the most common treatment-related TEAE. Two patients with DLBCL (2.8%) and 6 with FL (7.0%) discontinued rituximab due to TEAEs. 65.2% and 69.7% of patients with DLBCL and 67.9% and 73.6% of patients with FL had complete response (CR) and CR unconfirmed, respectively. The median time to events (EFS, PFS, and OS) was not estimable due to the low rate of events. At a median follow-up of 29.5 and 47.8 months in patients with DLBCL and FL, respectively, EFS, PFS, and OS were 70.8%, 70.8%, and 80.6% in patients with DLBCL and 77.9%, 77.9%, and 95.3% in patients with FL, respectively. The switch from IV to SC rituximab in patients with DLBCL and FL was associated with low risk of ARRs and satisfactory response in both groups. This trial was registered with NCT01987505

Sense of smell in chronic rhinosinusitis: A multicentric study on 811 patients

Introduction: The impairment of the sense of smell is often related to chronic rhinosinusitis (CRS) with or without nasal polyps (CRSwNP, CRSsNP). CRSwNP is a frequent condition that drastically worsens the quality of life of those affected; it has a higher prevalence than CRSsNP. CRSwNP patients experience severe loss of smell with earlier presentation and are more likely to experience recurrence of their symptoms, often requiring revision surgery. Methods: The present study performed a multicentric data collection, enrolling 811 patients with CRS divided according to the inflammatory endotype (Type 2 and non-Type 2). All patients were referred for nasal endoscopy for the assessment of nasal polyposis using nasal polyp score (NPS); Sniffin' Sticks olfactory test were performed to measure olfactory function, and SNOT-22 (22-item sinonasal outcome test) questionnaire was used to assess patients' quality of life; allergic status was evaluated with skin prick test and nasal cytology completed the evaluation when available. Results: Data showed that Type 2 inflammation is more common than non-type 2 (656 patients versus 155) and patients suffer from worse quality of life and nasal polyp score. Moreover, 86.1% of patients with Type 2 CRSwNP were affected by a dysfunction of the sense of smell while it involved a lesser percentage of non-Type 2 patients. Indeed, these data give us new information about type-2 inflammation patients' characteristics. Discussion: The present study confirms that olfactory function weights on patients' QoL and it represents an important therapeutic goal that can also improve patients' compliance when achieved. In a future - and present - perspective of rhinological precision medicine, an impairment of the sense of smell could help the clinician to characterize patients better and to choose the best treatment available