Minimally invasive procedure for removal of infected ventriculoatrial shunts

Background: Ventriculoatrial shunts were one of the most common treatments of hydrocephalus in pediatric and adult patients up to about 40 years ago. Thereafter, due to the widespread recognition of the severe cardiac and renal complications associated with ventriculoatrial shunts, they are almost exclusively implanted when other techniques fail. However, late infection or atrial thrombi of previously implanted shunts require removal of the atrial catheter several decades after implantation. Techniques derived from management of central venous access catheters can avoid cardiothoracic surgery in such instances. Methods: We retrospectively investigated all the patients requiring removal of a VA shunt for complications treated in the last 5 years in our institution. Results: We identified two patients that were implanted 28 and 40 years earlier. Both developed endocarditis with a large atrial thrombus and were successfully treated endovascularly. The successful percutaneous removal was achieved by applying, for the first time in this setting, the endoluminal dilation technique as proposed by Hong. After ventriculoatrial shunt removal and its substitution with an external drainage, both patients where successfully weaned from the need for a shunt and their infection resolved. Conclusion: Patients carrying a ventriculoatrial shunt are now rarely seen and awareness of long-term ventriculoatrial shunt complications is decreasing. However, these complications must be recognized and treated by shunt removal. Endovascular techniques are appropriate even in the presence of overt endocarditis, atrial thrombi, and tight adherence to the endocardial wall. Moreover, weaning from shunt dependence is possible even decades after shunting

Pneumocephalus due to granulomatosis with polyangiitis

A 67-year-old woman affected by granulomatosis with polyangiitis (GPA) presented with a flare of lung disease and ulceration of the lower limb without active sinusitis. She had a 9-year history of GPA with pulmonary and ENT involvement, the latter leading to left eye enucleation (histological findings suggestive of GPA). She had initially been treated with CYC (6 months) and was currently on steroids and MTX. Laboratory studies revealed raised inflammatory markers and cANCA (PR3) positivity. Thoracic CT showed progression of bilateral ground-glass opacities; bronchoalveolar lavage excluded infections. Methylprednisolone 1 mg/kg was introduced with clinical improvement. However, she gradually developed episodic headache and a mild, fluctuant altered mental status with confusion and delayed verbal response without other neurological features. A coronal T2-weighted MRI (Fig. 1)revealed a previously known, unmodified ischaemic lesion and the presence of extensive pneumocephalus secondary to cerebrospinal fluid leakage through multiple discontinuities in the ethmoid bone due to chronic localization of GPA to the anterior skull base (without other risk factors for development of pneumocephalus). Pneumocephalus due to cerebrospinal fluid fistula is usually secondary to trauma or surgery [1], but to our knowledge has never been reported as a complication of skull base involvement in GPA

The right to food and food diversity in the Italian Constitution

Il contributo analizza la tutela apprestata dalla Costituzione italiana al diritto al cibo che, pur non essendo espressamente menzionato, viene ricavato attraverso l'analisi di principi ed azioni sottese alla nostra Carta che ne riconoscono il valore: il principio lavorista, la lotta alla povertà, la retribuzione del lavoratore...

REST Controls Self-Renewal and Tumorigenic Competence of Human Glioblastoma Cells

The Repressor Element 1 Silencing Transcription factor (REST/NRSF) is a master repressor of neuronal programs in non-neuronal lineages shown to function as a central regulator of developmental programs and stem cell physiology. Aberrant REST function has been associated with a number of pathological conditions. In cancer biology, REST has been shown to play a tumor suppressor activity in epithelial cancers but an oncogenic role in brain childhood malignancies such as neuroblastoma and medulloblastoma. Here we examined REST expression in human glioblastoma multiforme (GBM) specimens and its role in GBM cells carrying self-renewal and tumorigenic competence. We found REST to be expressed in GBM specimens, its presence being particularly enriched in tumor cells in the perivascular compartment. Significantly, REST is highly expressed in self-renewing tumorigenic-competent GBM cells and its knock down strongly reduces their self-renewal in vitro and tumor-initiating capacity in vivo and affects levels of miR-124 and its downstream targets. These results indicate that REST contributes to GBM maintenance by affecting its self-renewing and tumorigenic cellular component and that, hence, a better understanding of these circuitries in these cells might lead to new exploitable therapeutic targets

Network analysis of human glaucomatous optic nerve head astrocytes

<p>Abstract</p> <p>Background</p> <p>Astrocyte activation is a characteristic response to injury in the central nervous system, and can be either neurotoxic or neuroprotective, while the regulation of both roles remains elusive.</p> <p>Methods</p> <p>To decipher the regulatory elements controlling astrocyte-mediated neurotoxicity in glaucoma, we conducted a systems-level functional analysis of gene expression, proteomic and genetic data associated with reactive optic nerve head astrocytes (ONHAs).</p> <p>Results</p> <p>Our reconstruction of the molecular interactions affected by glaucoma revealed multi-domain biological networks controlling activation of ONHAs at the level of intercellular stimuli, intracellular signaling and core effectors. The analysis revealed that synergistic action of the transcription factors AP-1, vitamin D receptor and Nuclear Factor-kappaB in cross-activation of multiple pathways, including inflammatory cytokines, complement, clusterin, ephrins, and multiple metabolic pathways. We found that the products of over two thirds of genes linked to glaucoma by genetic analysis can be functionally interconnected into one epistatic network via experimentally-validated interactions. Finally, we built and analyzed an integrative disease pathology network from a combined set of genes revealed in genetic studies, genes differentially expressed in glaucoma and closely connected genes/proteins in the interactome.</p> <p>Conclusion</p> <p>Our results suggest several key biological network modules that are involved in regulating neurotoxicity of reactive astrocytes in glaucoma, and comprise potential targets for cell-based therapy.</p

Disorders of Consciousness

Disorders of Consciousness are a big challenge for the entire process of rehabilitation: assessment, diagnosis, pharmacological, and rehabilitation programs, including conventional treatments and the use of new technologies