Effectiveness of Quinolone Prophylaxis in Pediatric Acute Leukemia and Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-analysis

The effectiveness of quinolone prophylaxis in high-risk hematological pediatric patients is controversial. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including studies that involved children and young adults undergoing chemotherapy for acute leukemia or hematopoietic stem cell transplantation (HSCT) who received quinolone prophylaxis compared with no prophylaxis. A meta-analysis was performed on bloodstream infections and neutropenic fever. Data regarding the impact of prophylaxis on overall survival, antibiotic exposure, antibiotic-related adverse effects, antibiotic resistance, Clostridium difficile infections, fungal infections, length of hospitalization, and costs were reviewed in the descriptive analysis. Sixteen studies were included in the qualitative analysis, and 10 of them met the criteria for quantitative analysis. Quinolone prophylaxis was effective in reducing the rate of bloodstream infections and neutropenic fever in pediatric acute leukemia compared with no prophylaxis, but it had no significant effect in HSCT recipients. Prophylaxis was associated with a higher rate of bacterial resistance to fluoroquinolones and higher antibiotic exposure

New neuroanatomy learning paradigms for the next generation of trainees: A novel literature-based 3D methodology

Background: An appreciation for complex three-dimensional relationships in neuroanatomy forms a fundamental tenet of neurosurgical education. The value of experience in the cadaver lab is indisputable; however, it is expensive and often inaccessible. The wide availability of 3D technologies has opened new possibilities, although scientific inaccuracy has hitherto limited their use. Objective: In the present study, we aim to describe a novel, literature-based process of scientific 3D modeling for the creation of neuroanatomical models adapted for mobile technology. Methods: A systematic literature review regarding current resources in neuroanatomy education was performed according to PRISMA guidelines. The composition of the team and the workflow behind the 3D Head Atlas app are also described. Results: A total of 101 manuscripts were reviewed, and 24 included. Cadaveric dissections improve the learning process, although high costs limit their availability. Digital advancements have partially overcome the limitations of dissection, and have been associated with improved knowledge retention. Nevertheless, 3D models are often inaccurate, poorly adapted to mobile hardware, and expensive. Recent technological advances provide a new way to widely disseminate complex 3D models, with a revolutionary impact on learning. The approach behind the 3D Head Atlas app, based on the synergistic work of scientific and development teams, facilitates the creation of interactive 3D scientific material with high accuracy and wide accessibility. Conclusion: The study of neuroanatomy is intimately related to the evolution of digital technology. Traditional methods (i.e. cadaveric dissections) have undisputed value but high costs. High-fidelity 3D scenarios and mobile devices may revolutionize learning if based on a sound evidence-based approach

Shape-specific microfabricated particles for biomedical applications: a review

The storied history of controlled the release systems has evolved over time; from degradable drug-loaded sutures to monolithic zero-ordered release devices and nano-sized drug delivery formulations. Scientists have tuned the physico-chemical properties of these drug carriers to optimize their performance in biomedical/pharmaceutical applications. In particular, particle drug delivery systems at the micron size regime have been used since the 1980s. Recent advances in micro and nanofabrication techniques have enabled precise control of particle size and geometry–here we review the utility of microplates and discoidal polymeric particles for a range of pharmaceutical applications. Microplates are defined as micrometer scale polymeric local depot devices in cuboid form, while discoidal polymeric nanoconstructs are disk-shaped polymeric particles having a cross-sectional diameter in the micrometer range and a thickness in the hundreds of nanometer range. These versatile particles can be used to treat several pathologies such as cancer, inflammatory diseases and vascular diseases, by leveraging their size, shape, physical properties (e.g., stiffness), and component materials, to tune their functionality. This review highlights design and fabrication strategies for these particles, discusses their applications, and elaborates on emerging trends for their use in formulations. GRAPHICAL ABSTRACT: [Image: see text

Combined presence of ophthalmic artery origin from anterior cerebral artery and meningolacrimal artery

In this study we describe a case of an ophthalmic artery (OphA) originating from the pre-communicating segment of the anterior cerebral artery (A1), associated with the presence of a meningolacrimal artery (MLA). The OphA has an anomalous origin in 1-3% of cases and rarely arises from A1, however, the combination of these anatomical variations is unique. Anomalous origins of the OphA are also correlated with a higher incidence of ICA aneurysm (1). Macroscopic and endonasal endoscopic dissections of a cadaver head, which formerly underwent a cone-beam CT scan, were performed. Bilateral samples of the ICA walls were collected and processed for standard hematoxylin-eosin staining and immunofluorescence analysis. The MLA was found on the right side by CT scan and its entrance in the superior orbital fissure was confirmed during head dissection. Hence, performing the endoscopic approach on the same side, the anomalous OphA, originating from the inferior surface of A1 segment and entering the optic canal above the optic nerve, was discovered. This arterial pattern could be explained by the embryological development of the orbital vascular system and it is referred to persistent ventral OphA (2). The histomorphological examination of ICA walls showed a significantly decreased thickness of the tunica media and adventitia on the right side compared to the left one. In addition, fluores- cence microscopy showed that type I and type III collagen were significantly lower in the tunicae media and adventitia of the right side. Since aneurysms of the ICA are related with a low content of collagen in the arterial wall, our results are consistent with current literature

Ethmoidal arteries variability: an anatomical and radiological study

Understanding the location of ethmoidal arteries (EAs) is crucial during endo- scopic sinus surgery or skull base surgery. The aim of this study was to evaluate the anatomical variability of EAs, considering their presence and position within the ethmoid bone and their position in relation to the skull base (SB) and the frontal sinus (FS). Fourteen human heads underwent a cone-beam CT scan and an endoscopic dissection was carried out to evaluate the anatomy of the EAs. Several features were assessed both radiologically and in the lab setting: presence; position according to the “5 doors theory” (1); position respect to the SB; distance from the SB; relation with the FS (2); dehiscence of the bony canal. Anterior EA and posterior EA were present in all cases, whereas the prevalence of the middle EA was 28.57±16.73%. Anterior EA was most frequently found (64.29%) in the basal lamella of the middle turbinate; it originated from the SB in 60.71% of cases and it was separated from the FS by a single bony lamella in 46.43%. Its canal was dehiscent in 46.43±18.47%. Posterior EA was almost equally found posterior to the basal lamella of the middle turbinate, in the basal lamella of the superior turbinate and posterior to it. It was found in the SB in 82.14% of the cases and its canal was dehiscent in the 28.57±16.73%. Middle EA was found posterior to the basal lamella of the middle turbinate in 62.50% of cas- es and it was found in the SB in 75.00% of the cases. These data demonstrate that, despite their constant presence, anterior and posterior EAs showed a variable position and relationship with the SB; in addition, the data showed a non-negligible number of cases in which the middle MEA was present. Therefore, because of these several anatomical variability in EAs, a high-spatial-resolution CT should be provided for the preoperative anatomical assessment

Morphometric analysis of Huguier’s canal by Cone Beam CT

The middle ear and the stomatognatic system are closely anatomically and functionally related. The anterior chordal canal of Huguier connects the temporomandibular joint (TMJ) and the middle ear. This canal is formed by the inferior process of tegment tympani and the sphenoid bone and it is located at the medial end of the petrotympanic fissure. To data, few studies aimed to describe Huguier’s canal morphology and its related structures (Toth et al., 2006; Sato et al., 2008; Aristeguieta et al., 2009). The aim of this study is to describe the radiological anatomy of the Huguier’s canal using cone beam CT (CBCT, Scanora 3D, Soredex). We measured 438 Huguier’s canals from 219 human skulls (Section of Anthropology and Ethnology, Museum of Natural History, Florence, Italy). The measurements were made at three levels: 1) near the TMJ (lateral-glenoidal side) that was 1.961 ± 0.472 mm; 2) the narrowest point of the middle area that was 0.494 ± 0.24 mm; 3) near the middle ear (medial, acoustic meatus side) that was 1.085 ± 0.354 mm. 21 on 439 Huguier’s canal (4.79%) were ossificated: 1 only in the medial side, 11 only in the middle area and 9 in all the three levels. Considering the high number of measurements, the values obtained were comparable, suggesting that CBCT can be useful to detect these anatomical details

Tumor Infiltrating Neutrophils Are Enriched in Basal-Type Urothelial Bladder Cancer

15noBackground: Urothelial bladder cancers (UBCs) are distinct in two main molecular subtypes, namely basal and luminal type. Subtypes are also diverse in term of immune contexture, providing a rationale for patient selection to immunotherapy. Methods: By digital microscopy analysis of a muscle-invasive BC (MIBC) cohort, we explored the density and clinical significance of CD66b(+) tumor-associated-neutrophils (TAN) and CD3(+) T cells. Bioinformatics analysis of UBC datasets and gene expression analysis of UBC cell lines were additionally performed. Results: Basal type BC contained a significantly higher density of CD66b(+) TAN compared to the luminal type. This finding was validated on TCGA, GSE32894 and GSE124305 datasets by computing a neutrophil signature. Of note, basal-type MIBC display a significantly higher level of chemokines (CKs) attracting neutrophils. Moreover, pro-inflammatory stimuli significantly up-regulate CXCL1, CXCL2 and CXCL8 in 5637 and RT4 UBC cell lines and induce neutrophil chemotaxis. In term of survival, a high density of T cells and TAN was significantly associated to a better outcome, with TAN density showing a more limited statistical power and following a non-linear predicting model. Conclusions: TAN are recruited in basal type MIBC by pro-inflammatory CKs. This finding establishes a groundwork for a better understanding of the UBC immunity and its relevance.openopenMandelli, Giulio Eugenio; Missale, Francesco; Bresciani, Debora; Gatta, Luisa Benerini; Scapini, Patrizia; Caveggion, Elena; Roca, Elisa; Bugatti, Mattia; Monti, Matilde; Cristinelli, Luca; Belotti, Sandra; Simeone, Claudio; Calza, Stefano; Melocchi, Laura; Vermi, WilliamMandelli, Giulio Eugenio; Missale, Francesco; Bresciani, Debora; Gatta, Luisa Benerini; Scapini, Patrizia; Caveggion, Elena; Roca, Elisa; Bugatti, Mattia; Monti, Matilde; Cristinelli, Luca; Belotti, Sandra; Simeone, Claudio; Calza, Stefano; Melocchi, Laura; Vermi, Willia

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

Risk of Hospitalization and Death for COVID-19 in People with Parkinson's Disease or Parkinsonism

The risk of COVID-19 and related death in people with Parkinson's disease or parkinsonism is uncertain. The aim of the study was to assess the risk of hospitalization for COVID-19 and death in a cohort of patients with Parkinson's disease or parkinsonism compared with a control population cohort, during the epidemic bout (March-May 2020) in Bologna, northern Italy