Tocilizumab administration in COVID-19 patients: Water on the fire or gasoline?

Tocilizumab is widely being used to treat COVID-19. Although reducing systemic inflammation, it also increases the risk for secondary infections as a result of the immunosuppression produced. We report the case of a 69-year-old patient admitted to the ICU with severe respiratory distress caused by COVID-19 pneumonia who developed pulmonary aspergillosis. On the basis of these findings, we suggest early testing for pulmonary aspergillosis in COVID-19 patients treated with tocilizumab

Cervico-mediastinal schwannoma of the vagus nerve: resection with intraoperative nerve monitoring.

Schwannomas are usually benign, single, encapsulated, slow-growing tumours originating from cranial or spinal nerve sheaths. The vagus nerve involvement at the mediastinal inlet is very uncommon. For anatomical reasons, the resection of cervical and mediastinal schwannoma of the vagus nerve has a high risk of vocal fold paralysis. We describe the case of a 67-year-old female with a cervico-mediastinal schwannoma of the vagus nerve that we removed using the intraoperative neuromonitoring technique. The patient presented with mild hoarseness and complained of discomfort behind the jugular notch. Neck and chest computerized tomography described a 35 9 30 mm solid lesion behind the left clavi-sternal junction; preoperative fine needle aspiration cytology revealed schwannoma. Resection of the mass was performed with a cervical approach and the vagus nerve tumour was completely removed under continuous neuromonitoring (NIM-3 System), preserving the vagus and the recurrent laryngeal nerve function. Pathology on the resected mass documented A-type schwannoma with \u2018\u2018ancient schwannoma\u2019\u2019 areas. The intraoperative neurostimulation and neuromonitoring approach for the resection of vagus schwannoma are recommended because it may reduce the risk of injury to the vagus and to the recurrent laryngeal nerve

Aggregative cycles evolve as a solution to conflicts in social investment

Multicellular organization is particularly vulnerable to conflicts between different cell types when the body forms from initially isolated cells, as in aggregative multicellular microbes. Like other functions of the multicellular phase, coordinated collective movement can be undermined by conflicts between cells that spend energy in fuelling motion and ‘cheaters’ that get carried along. The evolutionary stability of collective behaviours against such conflicts is typically addressed in populations that undergo extrinsically imposed phases of aggregation and dispersal. Here, via a shift in perspective, we propose that aggregative multicellular cycles may have emerged as a way to temporally compartmentalize social conflicts. Through an eco-evolutionary mathematical model that accounts for individual and collective strategies of resource acquisition, we address regimes where different motility types coexist. Particularly interesting is the oscillatory regime that, similarly to life cycles of aggregative multicellular organisms, alternates on the timescale of several cell generations phases of prevalent solitary living and starvation-triggered aggregation. Crucially, such self-organized oscillations emerge as a result of evolution of cell traits associated to conflict escalation within multicellular aggregates

Single tracks data obtained by selective laser melting of Ti6Al4V with a small laser spot diameter

Nowadays, advanced metal components with high geometrical complexity can be 3D printed by using the Selective Laser Melting (SLM) technology. Despite SLM resolution and accuracy are generally limited to some tenths of mm, it should be possible to produce finer and more precise details by applying lasers with a small spot diameter. However, to present date the data collected with small laser spot diameters are poor. In this work, experimental data describing the effects of laser power and scan speed on single track formation when applying a small laser spot diameter of 50 \ub5m on Ti6Al4V powder are reported. SEM images and the extracted geometrical data characterizing the obtained single tracks are provided here, as well as their microstructural analysis and microhardness measurements

Left pneumonectomy for rapidly growing lung metastasis from phyllodes tumor

Distant metastases occur in 10-25% of malignant phyllodes tumors of the breast, heralding fatal outcome within few months. Only four cases of successful resection of solitary pulmonary metastases from phyllodes tumor are described in the literature. We report the case of a 67-year-old woman who developed rapidly growing metastases (volume doubling time: 25 days) in the left lung, two years after mastectomy for malignant phyllodes tumor. The left lung was the only site of 18-FDG uptake at total-body PET scan and the patient was successfully treated by left pneumonectomy

Unravelling main- and side-chain motions in polymers with NMR spectroscopy and relaxometry: The case of polyvinyl butyral

Polyvinyl butyral (PVB) is an amorphous polymer employed in many technological applications. In order to highlight the relationships between macroscopic properties and dynamics at a microscopic level, motions of the main-chain and of the propyl side-chains were investigated between Tg − 288◦ C and Tg + 55◦ C, with Tg indicating the glass transition temperature. To this aim, a combination of solid state Nuclear Magnetic Resonance (NMR) methods was applied to two purposely synthesized PVB isotopomers: one fully protonated and the other perdeuterated on the side-chains.1 H time domain NMR and1 H field cycling NMR relaxometry experiments, performed across and above Tg, revealed that the dynamics of the main-chain corresponds to the α-relaxation associated to the glass transition, which was previously characterized by dielectric spectroscopy. A faster secondary relaxation was observed for the first time and ascribed to side-chains. The geometry and rate of motions of the different groups in the side-chains were characterized below Tg by2 H NMR spectroscopy

Learning from the italian experience during covid-19 pandemic waves: Be prepared and mind some crucial aspects

COVID-19 pandemic has rapidly spread worldwide causing a serious challenge to the global medical community. Italy was struck hard during the first wave earlier this year and several weaknesses as well as general unpreparedness of the national healthcare system were acknowledged. Learning essential lessons from the past, we realized how implementing contingency response measures, human resources and social dynamics could have changed the outcome if promptly adopted. This review translates the previous experience into strategic actions that has to be considered when developing appropriate national and regional operational plans to respond to a pandemic

Functional consequences of mutations in CDKL5, an X-linked gene involved in infantile spasms and mental retardation

Mutations in the X-linked cyclin-dependent kinase-like 5 (CDKL5) gene have been identified in patients with Rett syndrome, West syndrome, and X-linked infantile spasms sharing the common features of generally intractable early seizures and mental retardation. Disease-causing mutations are distributed in both the catalytic domain and in the large COOH terminus. In this report, we examine the functional consequences of some Rett mutations of CDKL5 together with some synthetically designed derivatives useful to underline the functional domains of the protein. The mutated CDKL5 derivatives have been subjected to in vitro kinase assays and analyzed for phosphorylation of the TEY (Thr-Glu-Tyr) motif within the activation loop, their subcellular localization, and the capacity of CDKL5 to interact with itself. Whereas wild-type CDKL5 autophosphorylates and mediates the phosphorylation of the methyl-CpG-binding protein 2 (MeCP2) in vitro, Rett-mutated proteins show both impaired and increased catalytic activity suggesting that a tight regulation of CDKL5 is required for correct brain functions. Furthermore, we show that CDKL5 can self-associate and mediate the phosphorylation of its own TEY (Thr-Glu-Tyr) motif. Eventually, we show that the COOH terminus regulates CDKL5 properties; in particular, it negatively influences the catalytic activity and is required for its proper sub-nuclear localization. We propose a model in which CDKL5 phosphorylation is required for its entrance into the nucleus whereas a portion of the COOH-terminal domain is responsible for a stable residency in this cellular compartment probably through protein-protein interactions