Voriconazole treatment of Candida tropicalis meningitis: persistence of (1,3)-b-D-glucan in the cerebrospinal fluid is a marker of clinical and microbiological failure

Introduction: Infections are still the most common complications of cerebral shunt procedures. Even though fungal etiologies are considered to be rare, they are associated with significant morbidity and mortality. Due to their uncommonness, diagnostic procedures and optimal therapy are poorly defined. We report a case of Candida tropicalis infection of ventriculo-peritoneal cerebrospinal fluid (CSF) shunt in a 49-year-old immune competent male treated with voriconazole (VOR). Methods: Microbiological and CSF markers (1,3-b-D-glucan-BDG) of fungal infection, biofilm production capacity, sensitivity of serial isolates of the pathogen, and the concentration of the antifungal drug have been monitored and related to the clinical course of this infection. Results: Despite appropriate treatment with VOR, in terms of adequate achieved CSF drug concentrations and initial effective therapeutic response, loss of VOR susceptibility of the C tropicalis and treatment failure were observed. Conclusion: Biofilm production of the C. tropicalis isolate might have had a significant role in treatment failure. Of interest, clinical and microbiological unfavorable outcome was anticipated by persistence of BDG in CSF. Rising titers of this marker were associated with relapse of fungal infection

Behavioral Event Management: una proposta di applicazione della prospettiva behaviorista alla progettazione e organizzazione di eventi culturali

Obiettivi. In questo paper si prover\ue0 ad applicare i principali risultati delle ricerche di matrice behaviorista allo specifico ambito della gestione degli eventi. Obiettivo del lavoro \ue8 dunque vedere quali suggerimenti l\u2019approccio behaviorista pu\uf2 offrire per migliorare l\u2019efficacia degli eventi culturali e della loro gestione.Metodologia. Questo paper segue una impostazione metodologica di fondo di tipo deduttivo. All\u2019interno di questo percorso, l\u2019orientamento \ue8 di tipo prescrittivo ovvero si propone di individuare alcune modalit\ue0 di comportamento da suggerire agli organizzatori di eventi.Risultati. Seguendo il percorso descritto, gli insight behavioristi presi in considerazione sono i seguenti: peak-end rule; sequence in pain and pleasure; vorfreude; build commitment through choice; rituals; felicit\ue0 esperita vs. felicit\ue0 ricordata. Ciascuno di essi viene illustrato secondo un framework predefinito, articolato in: descrizione dell\u2019insight a livello generale; forme di applicazione nel contesto degli eventi; casi esemplificativi; problemi o aspetti critici.Limiti della ricerca. Sinteticamente, essi consistono nella focalizzazione sui soli eventi di genere culturale; nell\u2019esame ristretto soltanto ad alcuni insight behavioristi; nella considerazione esclusivamente della dimensione soggettiva e non collettiva; nella mancata analisi degli eventuali risvolti etici connessi all\u2019applicazione dell\u2019approccio behaviorista.Implicazioni pratiche. L\u2019impiego della prospettiva behaviorista costringe a pensare all\u2019evento ponendosi dal punto di vista dello spettatore nel senso della considerazione della sua dimensione psicologica, del \u201cvissuto\u201d che l\u2019evento va a creare nella sua esperienza e memoria. I soggetti impegnati nell\u2019attivit\ue0 di organizzazione di eventi potranno senz\u2019altro beneficiare, cos\uec, di una serie di conoscenze utili per ottimizzare gli effetti della loro azione.Originalit\ue0 del lavoro. Il presente lavoro costituisce, a quanto risulta, una delle prime applicazioni dell\u2019approccio behaviorista alla gestione degli eventi culturali

Mechanisms of altered bone remodeling in children with type 1 diabetes

Bone loss associated with type 1 diabetes mellitus (T1DM) begins at the onset of the disease, already in childhood, determining a lower bone mass peak and hence a greater risk of osteoporosis and fractures later in life. The mechanisms underlying diabetic bone fragility are not yet completely understood. Hyperglycemia and insulin deficiency can affect the bone cells functions, as well as the bone marrow fat, thus impairing the bone strength, geometry, and microarchitecture. Several factors, like insulin and growth hormone/insulin-like growth factor 1, can control bone marrow mesenchymal stem cell commitment, and the receptor activator of nuclear factor-kappa B ligand/osteoprotegerin and Wnt-b catenin pathways can impair bone turnover. Some myokines may have a key role in regulating metabolic control and improving bone mass in T1DM subjects. The aim of this review is to provide an overview of the current knowledge of the mechanisms underlying altered bone remodeling in children affected by T1DM

Versatility of Capsular Flaps in the Salvage of Exposed Breast Implants

Summary: Breast implant exposure due to poor tissue coverage or previous irradiation represents a surgical challenge both in the reconstructive and aesthetic plastic surgery practice. In case of implant extrusion or incipient exposure, the commonly suggested strategies, such as targeted antibiotic therapy, drainage and lavage of the cavity, fistulectomy, and primary closure, may be ineffective leading the surgeon to an unwanted implant removal or to adopt more invasive flap coverage procedures. Breast implant capsule, in its physiological clinical behavior, can be considered as a new reliable source of tissue, which can be used in a wide range of clinical situations. In our hands, capsular flaps proved to be a versatile solution not only to treat breast contour deformities or inframammary fold malpositions but also to salvage exposed breast implants. In this scenario, the use of more invasive surgical techniques can be avoided or simply saved and delayed for future recurrences.(Plast Reconstr Surg Glob Open 2015;3:e340; doi:10.1097/GOX.0000000000000307; Published online 30 March 2015.

Tattoo preservation during surgical procedures

Stefania Tenna, Pietro Francesco Delle Femmine, Alfonso Luca Pendolino, Beniamino Brunetti, Paolo Persichetti Plastic Surgery Unit, University Campus Bio-Medico of Rome, University of Rome, Rome, Italy Abstract: In recent years, the number of people getting tattoos has continued to increase. Tattoos are much more than cultural fads and cosmetic complements, and nowadays often represent events that express the patient's personality without words. The presence of a tattoo in the surgical field may be a problem for both the patient and the surgeon. However, the relevant literature is mostly based on complications related to application of tattoos or methods used to remove them. To date, few reports have focused on the importance of preserving a tattoo during a surgical procedure, and no organized studies could be found. The aim of this paper is to provide an overview of the range of solutions that surgeons can use to preserve tattoos during surgery. A PubMed database search was done to assess other surgeons' experience. The terms "tattoo" in combination with "incision", "surgery", "surgical", or "operative" were used as key words. Following a review of the literature, photographs of patients presenting with a tattoo in the last 5 years at University Campus Bio-Medico of Rome were identified in order to determine the frequency of patients presenting with tattoos in our department. The patients were classified according to sex, age, type of surgery, number of tattoos, and tattoo location. Specific requests to preserve tattoos were recorded. Finally, an algorithm of treatment according to tattoo dimension and location is proposed. Knowledge of all the strategies available for saving tattoos is important for plastic and cosmetic surgeons. If a tattooed area needs to be operated on, surgeons should attempt, when possible, to avoid altering the tattoo in order to maximize the final cosmetic result. Keywords: tattoo incision, body contouring, surgery, complication

Graminex pollen: phenolic pattern, colorimetric analysis and protective effects in immortalized prostate cells (PC3) and rat prostate challenged with LPS

Prostatitis, a general term describing prostate inflammation, is a common disease that could be sustained by bacterial or non-bacterial infectious agents. The efficacy of herbal extracts with antioxidant and anti-inflammatory effects for blunting the burden of inflammation and oxidative stress, with possible improvements in clinical symptoms, is under investigation. Pollen extracts have been previously reported as promising agents in managing clinical symptoms related to prostatitis. The aim of the present work was to evaluate the protective effects of Graminex pollen (GraminexTM, Deshler, OH, USA), a commercially available product based on standardized pollen extracts, in rat prostate specimens, ex vivo. In this context, we studied the putative mechanism of action of pollen on multiple inflammatory pathways, including the reduction of prostaglandin E2 (PGE2), nuclear factor kappa-light-chain-enhancer of activated B cells (NFB), and malondialdehyde (MDA), whose activities were significantly increased by inflammatory stimuli. We characterized by means of chromatographic and colorimetric studies the composition of Graminex pollen to better correlate the activity of pollen on immortalized prostate cells (PC3), and in rat prostate specimens challenged with Escherichia coli lipopolysaccharide (LPS). We found that Graminex pollen was able to reduce radical oxygen species (ROS) production by PC3 cells and MDA, NFB mRNA, and PGE2 levels, in rat prostate specimens. According to our experimental evidence, Graminex pollen appears to be a promising natural product for the management of the inflammatory components in the prostate

Toxicity of citrate-capped AuNPs: an in vitro and in vivo assessment

In this study, we show that 15 nm citrate-capped AuNPs exert a remarkable toxicity in living systems. The assessment was performed by using well-characterized AuNPs, the combination of in vitro and in vivo models (namely two different cell lines and Drosophila melanogaster), exposure to low dosages of nanoparticles (in the sub-nanomolar concentration range), along with the application of several biological assays to monitor different aspects of the toxic effects, such as viability, genotoxicity, and molecular biomarkers

Paracetamol and antibiotics in childhood and subsequent development of wheezing/asthma: association or causation?

Several studies found an association between early administration of paracetamol and antibiotics and development of wheezing. This could be due to confounding: wheeze and asthmatic symptoms in early childhood are difficult to distinguish from respiratory tract infections that are widely treated with these drugs; in case of persistence of symptoms up to school age, this could explain the observed relationship

Effects of Cell Culture Media on the Dynamic Formation of Protein−Nanoparticle Complexes and Influence on the Cellular Response

The development of appropriate in vitro protocols to assess the potential toxicity of the ever expanding range of nanoparticles represents a challenging issue, because of the rapid changes of their intrinsic physicochemical properties (size, shape, reactivity, surface area, etc.) upon dispersion in biological fluids. Dynamic formation of protein coating around nanoparticles is a key molecular event, which may strongly impact the biological response in nanotoxicological tests. In this work, by using citrate-capped gold nanoparticles (AuNPs) of different sizes as a model, we show, by several spectroscopic techniques (dynamic light scattering, UV−visible, plasmon resonance light scattering), that proteins−NP interactions are differently mediated by two widely used cellular media (i.e., Dulbecco Modified Eagle's medium (DMEM) and Roswell Park Memorial Institute medium (RPMI), supplemented with fetal bovine serum). We found that, while DMEM elicits the formation of a large time-dependent protein corona, RPMI s..

Mutagenic effects of gold nanoparticles induce aberrant phenotypes in Drosophila melanogaster

Abstract The peculiar physical/chemical characteristics of engineered nanomaterials have led to a rapid increase of nanotechnology-based applications in many fields. However, before exploiting their huge and wide potential, it is necessary to assess their effects upon interaction with living systems. In this context, the screening of nanomaterials to evaluate their possible toxicity and understand the underlying mechanisms currently represents a crucial opportunity to prevent severe harmful effects in the next future. In this work we show the in vivo toxicity of gold nanoparticles (Au NPs) in Drosophila melanogaster , highlighting significant genotoxic effects and, thus, revealing an unsettling aspect of the long-term outcome of the exposure to this nanomaterial. After the treatment with Au NPs, we observed dramatic phenotypic modifications in the subsequent generations of Drosophila , demonstrating their capability to induce mutagenic effects that may be transmitted to the descendants. Noteworthy, we were able to obtain the first nanomaterial-mutated organism, named NM-mut. Although these results sound alarming, they underline the importance of systematic and reliable toxicology characterizations of nanomaterials and the necessity of significant efforts by the nanoscience community in designing and testing suitable nanoscale surface engineering/coating to develop biocompatible nanomaterials with no hazardous effects for human health and environment. From the Clinical Editor While the clinical application of nanomedicine is still in its infancy, the rapid evolution of this field will undoubtedly result in a growing number of clinical trials and eventually in human applications. The interactions of nanoparticles with living organisms determine their toxicity and long-term safety, which must be properly understood prior to large-scale applications are considered. The paper by Dr. Pompa's team is the first ever demonstration of mutagenesis resulting in clearly observable phenotypic alterations and the generation of nano-mutants as a result of exposure to citrate-surfaced gold nanoparticles in drosophila. These groundbreaking results are alarming, but represent a true milestone in nanomedicine and serve as a a reminder and warning about the critical importance of "safety first" in biomedical science