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The loss of support of beam elements in Italian precast buildings is one of the main vulnerabilities recorded in past earthquakes. The reason for beam falling is due to the absence of adequate structural details in the beam-column joints, which were typically relying on friction for buildings located in regions previously classified as non-seismic prone. To guarantee the structural safety of the whole existing building stock, this collapse mechanism must be further investigated; in this regard, it could be interesting to evaluate the level of safety achieved by simple beam-column friction connections to allow, for instance, the prioritization of the retrofit interventions to guarantee a minimum level of safety in a wide range of structures. The paper investigates the influence of the parameters governing the beam-column relative displacements in the case of friction connections to establish criteria for evaluating the seismic loss of support probability in existing precast buildings. A simplified analytical model is introduced to describe single and double portal frames with and without the presence of stiff masonry infills. The influence of the epicentral distance on the results obtained is also preliminary addressed. Nonlinear time history analyses are carried out on a 2D finite element model to validate the effectiveness of the simplified model taking as reference a building that experienced the loss of support of a main beam during a past earthquake.

OBJECTIVE The goals of this study were to evaluate the extent of resection (EOR) obtained with an occipital interhemispheric transtentorial approach (OITA) in a series of pediatric patients with pineal region tumors and to define preoperative radiological factors predictive of the EOR. METHODS This is a retrospective cohort study of a series of pediatric patients with pineal tumors who underwent surgery through a microsurgical OITA performed by the senior author during the period from January 2006 to January 2020. The tumor volume was measured preoperatively, and then on sagittal midline cuts the authors identified the most cranial point of the torcular Herophili (defined as the “Herophilus point”) and the lowest point of the inferior profile of the vein of Galen (defined as the “Galen point”). The line joining these two points (defined as the "Herophilus-Galen line" [H-G line]) was used to identify the "Herophilus-Galen plane" (H-G plane) perpendicular to the sagittal plane. Tumor volumes located below and above this plane were measured. EOR was evaluated by measuring residual tumor volume visible on T1 volumetric injected sequences of immediate postoperative MRI. RESULTS Thirty patients were selected for study inclusion. The preoperative mean tumor volume was 15.120 cm3 (range 0.129–104.3 cm3). The mean volumes were 2.717 cm3 (range 0–31 cm3) above the H-G plane and 12.40 cm3 (median 5.27 cm3, range 0.12–72.87 cm3) below the H-G plane. Three patients underwent only biopsy. Of the remaining 27 patients, gross-total resection (GTR; 100% tumor volume) was achieved in 20 patients (74%). In the remaining 7 patients, the mean residual tumor volume was 7.3 cm3 (range 0.26–17.88 cm3). In 3 of these patients, GTR was accomplished after further surgical procedures (1 in 2 patients, 3 in 1 patient) for an overall GTR rate of 85.18%. Larger tumor volume was significantly associated with incomplete resection (p < 0.001). A tumor volume ≤ 2 cm3 above the H-G plane (p = 0.003), linear extension ≤ 1 mm above the H-G line, and pineal histology were predictive of GTR at first OITA procedure (p = 0.001). CONCLUSIONS The H-G line is an intuitive, easy-to-use, and reliable indicator of the superior anatomical limit of visibility during the microsurgical OITA. This anatomical landmark may be useful as a predictor of EOR for pineal tumors performed through this approach. The main limitations of this study are the small number of patients and the exclusively pediatric age of the patient population.

Objective : Chronic subdural hematoma (CSDH) is one of the most common pathology in daily neurosurgical practice and incidence increases with age. The aim of this study was to evaluate the prognostic factors and surgical outcome of CSDH in patients aging over 90 years compared with a control group of patients aging under 90 years.Methods : This study reviewed 25 patients with CSDH aged over 90 years of age treated in our department. This group was compared with a younger group of 25 patients aged below their eighties. At admission past medical history was recorded concerning comorbidities (hypertension, dementia, ictus cerebri, diabetes, and heart failure or attack). History of alcohol abuse, anticoagulant and antiplatelet therapy, head trauma and seizures were analyzed. Standard neurological examination and Markwalder score at admission, 48 hours after surgery and 1–6 months follow-up, radiologic data including location and CSDH maximum thickness were also evaluated.Results : Their mean age was 92.8 years and the median was 92.4 years (range, 90–100 years). In older group, the Markwalder evaluation at one month documented the complete recovery of 24 patients out of 25 without statistical difference with the younger group. This data was confirmed at 6-month follow-up. One patient died from cardiovascular failure 20 days after surgery. The presence of comorbidities, risk factors (antiplatelet therapy, anticoagulant therapy, history of alcohol abuse, and head trauma), preoperative symptoms, mono or bilateral CSDH, maximum thickness of hematoma, surgical time and recurrence were similar and statistically not significant in both groups.Conclusion : In this study, we demonstrate that surgery for very old patients above 90 years of age affected by CSDH is safe and allows complete recovery. Comparing two groups of patients above and under 90 years old we found that complication rate and recovery were similar in both groups.

Pin-supported (PS) walls represent a possible solution for the seismic retrofit of existing reinforced concrete (RC) buildings, enabling linearization of the frame deformation along its height and consequently inhibiting soft storey collapse mechanisms. The effectiveness of this rehabilitation technology is strongly related to the characteristics of the existing frames, especially to the vertical distribution of the frame storey lateral stiffness. Since a larger 1st storey lateral stiffness may lead to a detrimental structural response of the retrofitted system, an alternative solution obtained from removing the connecting link between the 1st floor of the existing building and the pin-supported wall is investigated in this paper. An analytical method is proposed to derive the distribution of the internal actions in a dual 2D RC frame-PS wall system without the link at the 1st floor level, considering both a linear and nonlinear behaviour of the frame. It emerges that some parameters describing the structure type can provide straightforward information on the suitability of this solution in the seismic retrofit of existing RC buildings. As a result, a simplified procedure has been derived to preliminarily define the retrofit system configuration and evaluate the maximum demand in the PS wall. Such a procedure is finally applied with reference to a frame representing a RC building and finite element model analyses are carried out for validation purposes.

Introduction: Bathing in the Blue Lagoon (BL) in Iceland benefits patients with psoriasis. Accordingly, the BL water contains algae with biological activities that improve skin barrier function and affect T-cell responses relevant for psoriasis. Bathing in the BL is also becoming increasingly popular among healthy individuals and anecdotal evidence suggests positive effects on uneven skin pigmentation. Objective: The aim of the study was to address the impact of BL algae on skin pigmentation. Methods: In this work, in vitro gene expression studies in melanocytes and a noninvasive in vivo study were conducted. Results: We here report that normal human epidermal melanocytes, which had been treated with nontoxic concentrations of BL algae, show a significantly reduced expression of α melanocyte-stimulating hormone-induced expression of genes important for melanin synthesis, such as tyrosinase, tyrosinase-related protein 1, dopachrome tautomerase, melan A protein, and pre-melanosome protein. This in vitro observation prompted us to conduct a randomized, double-blind, intra-individual, comparative split-face in vivo study, in which 60 volunteers with pre-existing facial pigment spots were treated twice daily with a BL algae containing serum or a vehicle control. We found that constitutive skin pigmentation as determined by colorimetry (individual typology angle and luminescence) did not differ significantly between vehicle- and serum-treated skin sites. In marked contrast, digital photography under cross-polarized lighting and RBX technology (VISIA CR) revealed that the number of pigment spots in the serum-treated face decreased significantly compared to the vehicle-treated side. Conclusion: Thus, BL algae can affect human melanocyte function in vitro and reduce uneven facial skin pigmentation in vivo.

The decarbonization of the construction sector, which is one of the most impactful sectors worldwide, requires a significant paradigm shift from a linear economy to a circular, future-proofed and sustainable economy. In this transition, the role of designers and structural engineers becomes pivotal, and new design objectives and principles inspired by Life Cycle Thinking (LCT) should be defined and included from the early stages of the design process to allow for a truly sustainable renovation of the built environment. In this paper, an overview of LCT-based objectives and principles is provided, critically analyzing the current state of the art of sustainability and circularity in the construction sector. The effectiveness of applying such design principles from the early stages of the design of retrofit interventions is then demonstrated with reference to a case study building. Four seismic retrofit alternatives made of timber, steel and concrete, conceived according to either LCT principles or traditional, were designed and compared to a demolition and reconstruction scenario on the basis of five common environmental impact indicators. The indicators were calculated adopting simplified LCA analyses based on Environmental Product Declarations (EPDs), considering the product and End of Life stages of the building. The results of the comparative analyses confirm that LCT-based retrofit solutions are less impactful than both the traditional seismic retrofit interventions and the demolition and reconstruction scenario.

Background Chronic subdural hematoma associated with dural calcifications in previously pediatric shunted patients is a rare condition. The inner dural membrane opening can lead to progressive brain herniation into the subdural space due to brain reexpansion. Case Description A 15-year-old boy, previously shunted at birth for congenital hydrocephalus, presented with a giant chronic right hemispheric subdural hematoma. After 2 surgical procedures in which the subdural calcified neomembrane was opened and a subdural shunt was implanted, he developed a cortical brain herniation into the subdural space, resulting in brain ischemia and upper limb weakness and vomiting. The final surgical treatment consisted of an extensive wide peeling of visceral calcified membrane mutually to programmable valve placement along the subduroperitoneal shunt, in order to create a positive gradient between the subdural space and the ventricles. The patient experienced a prompt clinical improvement. Conclusions This case illustrates a rare complication of the treatment of a chronic subdural hematoma caused by insufficient opening of the calcified inner mambrane of the hematoma and encouraged by gradient pressure between the ventricular and subdural compartments. To avoid this complication, it is preferable to not open a thick, calcified, unelastic inner membrane. However, in case of lack of clinical and radiologic improvement, it may become necessary to open it: a wide opening should be attempted, in order to prevent brain strangulation.

We present an uncommon case of holocord, "rosary bead-like," multiloculated syringomyelia consistent with a fourth ventricle outlet obstruction in a 2-month-old infant who was previously shunted for posthemorrhagic hydrocephalus of prematurity. The shunt malfunction resulted in a syringomyelia because of the simultaneous obstruction of the 3 outlets of the fourth ventricle, resulting in an enlargement of the central canal of the spinal cord. The syringomyelia resolved with shunt revision, avoiding further complex surgical procedures.

The seismic retrofit of the existing building heritage represents an urgent issue to be faced and innovative solutions which allow to overcome renovation barriers are needed. In this scenario, pin-supported (PS) walls represent an eligible solution, enabling linearization of the deformation of the frame along its height and inhibiting soft storey collapse mechanisms. The PS wall can be connected to the existing building from outside, thereby avoiding disruption to occupants or their relocation, which are acknowledged as the main barriers to the renovation nowadays. Suitability of PS wall solutions in the seismic retrofit of the existing building stock has been investigated herein, particularly in the case of existing reinforced concrete (RC) buildings, preliminarily focusing on 2D RC frames. The paper shows the weaknesses and strengths of the PS wall solution in relation to the specific features of the considered buildings. An analytical closed-form formulation is proposed and applied as a preliminary tool to evaluate the load distribution in the existing frame and in the PS wall after the retrofit considering the first mode of vibration of the retrofitted system. The results show that, in some conditions, the application of PS walls may be detrimental to the structural response. Along with the evaluation of the effectiveness of the retrofit solution, the proposed formulation allows a preliminary design of the retrofit system. Finally, a series of finite element model analyses have been carried out for validation purposes showing a good agreement between the proposed analytical formulation and the numerical results.

A growing attention has been paid to the deep renovation of RC buildings, particularly focusing on their structural vulnerability and on the development of retrofit strategies; however, the issue of the in-plane diaphragm action and the capacity of existing floors has rarely been addressed. Although floor capacity does not seem critical for the seismic capacity of existing structures, commonly affected by greater vulnerabilities, it may become critical when an additional lateral force resisting system is introduced. This paper investigates the in-plane capacity of beam and hollow-clay-block floor system, typical of the European post-WWII RC buildings. Considering the diaphragm action as associated with an in-plane tied-arch mechanism developing within the floor thickness, the main failure mechanisms are discussed, and some simplified equations are provided to preliminary estimate the maximum capacity of floors. Experimental and numerical analyses are than carried out to validate the simplified analytical model. The relevant influence of possible staircase openings on the in-plane load paths and on diaphragm flexibility and capacity are also considered. Finally, the influence of the floor capacity on the seismic vulnerability assessment and in the conceptual design of a seismic retrofit intervention is discussed. This preliminary study shows that only some of the beam-and-block floor systems have a reliable in-plane capacity, while other typologies cannot serve as floor diaphragms. When the diaphragm action can be relied upon, the diaphragms often exhibit a fairly stiff behaviour up to a brittle failure, which is commonly associated with the ultimate capacity at the tied-arch supports.

Introduction: Skin ageing involves senescent fibroblast accumulation, disturbance in extracellular matrix (ECM) homeostasis, and decreased collagen synthesis. Objective: to assess a cell therapy product for aged skin (RCS-01; verum) consisting of ~25 × 106 cultured, autologous cells derived from anagen hair follicle non-bulbar dermal sheath (NBDS). Methods: For each subject in the verum group, 4 areas of buttock skin were injected intradermally 1 or 3 times at monthly intervals with RCS-01, cryomedium, or needle penetration without injection; in the placebo group RCS-01 was replaced by cryomedium. The primary endpoint was assessment of local adverse event profiles. As secondary endpoints, expression of genes related to ECM homeostasis was assessed in biopsies from randomly selected volunteers in the RCS-01 group taken 4 weeks after the last injection. ­Results: Injections were well tolerated with no severe adverse events reported 1 year after the first injection. When compared with placebo-treated skin, a single treatment with RCS-01 resulted in a significant upregulation of TGFβ1, CTGF, COL1A1, COL1A2, COL3A1, and lumican mRNA expression. Limitations: The cohort size was insufficient for dose ­ranging evaluation and subgroup analyses of efficacy. Conclusions: RCS-01 therapy is well tolerated and associated with a gene expression response consistent with an improvement of ECM homeostasis.

Background: Our previous double-blinded, placebo-controlled cross-over study indicated that a nutritional supplement named lycopene-rich tomato nutrient complex (TNC) can protect from UVA1-induced (340–400 nm) and UVA- (320–400 nm)/UVB-induced (280–320 nm) upregulation of molecular markers associated with oxidative stress, inflammation, and ageing. Objectives: in the current double-blind, randomized, placebo-controlled multicenter study, we analyze whether a similar, synergistic carotenoid-rich TNC can protect from broadband UVB-induced threshold erythema formation assessed as increase in minimal erythemal dose (MED) reading, the intensity of erythema formation, and the upregulation of molecular markers associated with inflammation and immunosuppression, and whether this correlates with carotenoid blood levels. Methods: One hundred and forty-nine healthy volunteers were randomized to two groups and subjected to a 5-week washout phase, followed by a 12-week treatment phase receiving either 15 mg lycopene, 5.8 mg phytoene and phytofluene, 0.8 mg β-carotene, 5.6 mg tocopherols from tomato extract, and 4 mg carnosic acid from rosemary extract per day or placebo made from medium-chain triglycerides. At the end of each phase, MED determination, UVB irradiation, chromametry, biopsies, and blood samples were undertaken. Results: The active supplement was well tolerated. Interestingly, no significant difference was seen in the MED between the active-supplement and placebo groups, as determined by visual grading by expert assessors. Of note, the carotenoid-containing supplement significantly protected against UVB-induced erythema formation measured as Δa* after the intervention minus Δa* after the washout phase as compared to the placebo. Moreover, intake of the active supplement significantly protected against UVB-induced upregulation of IL6 and TNFα as compared with the intake of placebo. Lastly, carotenoid plasma levels were significantly increased. Conclusion: This well-tolerated carotenoid-containing supplement significantly protected against UVB-induced erythema formation and upregulation of proinflammatory cytokines in healthy volunteers.

Objective Ventriculoperitoneal (VP) shunt is the most common neurosurgical procedure to treat obstructive and communicating hydrocephalus, but failures are frequent. The most common causes of shunt failure are malpositioning and obstruction of the ventricular catheter by debris or blood clothes. The knowledge of the relationship between ventricular catheter tip position, etiology of hydrocephalus and patient’s age with shunt malfunction may be useful to avoid shunt failure. Patients and Methods We retrospectively analyze 89 adult patients affected by obstructive and communicating hydrocephalus operated with Ventriculoperitoneal shunt at our Institute. Patients with evident abdominal shunt malfunction were excluded from this study. Statistical analysis was performed in the group of patients with intracranial catheter malfunction in order to correlate shunt malfunction with the position of the catheter tip in brain ventricles, etiology of hydrocephalus and patient’s age. Results Shunt revision was performed in 26 patients out of 89 and cranial catheter malfunction was documented in 11 patients out of 26. Tip position in Monro foramen, lateral ventricles and third ventricle (“good position”) had a lower rate of surgical shunt revision compared to septum pellucidum and wall of lateral ventricle (“bad position”) p value = 0,049. No statistical significant association was observed between shunt malfunction and etiology of the hydrocephalus or patient’s age. Conclusions Ventricular catheter tip position is one the most important factor for shunt function.

In this video, the authors present an interhemispheric transcallosal transchoroidal approach to a pineal mass in a 15-year-old boy. He received emergency endoscopic third ventriculostomy (ETV), then an endoscopic biopsy that revealed an immature teratoma. Surgical removal was selected. The mass was located very high in the posterior third ventricle, hidden behind the splenium of the corpus callosum and the vein of Galen, so an interhemispheric transcallosal approach followed by a complete dissection of the whole choroidal fissure was chosen and allowed complete removal of the tumor. Microsurgical dissection is presented, showing clearly in detail all the neurovascular structures encountered. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2126.

The authors present a pediatric case of a pineoblastoma treated with gross-total removal through an occipital interhemispheric transtentorial approach (OITA). The child presented with acute hydrocephalus that was treated by endoscopic third ventriculostomy (ETV) and tumor biopsy through a single burr hole. Histology revealed a pineoblastoma. Microsurgical total removal was performed 3 months after neoadjuvant chemotherapy. OITA was chosen on the basis of the tumor’s location below the Herophilus-Galen line of sight. In this video, the authors show the positioning, the operating devices, the approach, and the microsurgical dissection, indicating all the neurovascular structures encountered. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2122.

Tumours of the infratemporal fossa (ITF) are rare and include primary tumours, contiguity lesions and metastases. Surgical resection is the gold standard. The fronto-orbito-zygomatic (FOZ) approach is commonly used in order to obtain safe access to the lateral skull base and ITF to resect intra- and extra-cranial tumours. We here describe our series of ITF lesions extending to the middle cranial fossa and/or orbit, treated by single- or two piece FOZ.All cases of single- or two-piece FOZ approach for an infratemporal fossa lesion extending to the middle cranial fossa operated at our Institution from January 2014 to January 2018 were retrospectively reviewed. The follow-up was for a minimum of four months and a maximum of 60 months. The inclusion criteria were lesions involving the ITF with an extension to the middle cranial fossa and/or orbit. Baseline characteristics of patients, tumour localisation, tumour extension, diffusion route, histology, extent of tumour resection, postoperative treatment, and post-operative complications were evaluated.Nine patients underwent a surgical procedure with a FOZ approach, two of them with a single-piece approach and the remainder with a two-piece one. All patients had an ITF localisation. Gross total removal (GTR) was achieved in 7/9 patients. Only one patient, with non-total removal (NTR), underwent radiotherapy.For the treatment of ITF fossa tumours extending to the orbit and or middle cranial fossa, we believe that both FOZ techniques are effective and allow a good medial extension toward the cavernous sinus and parasellar region. But a two-piece craniotomy may ensure a more medial extension and a wider angle of work compared to a one-piece craniotomy.

Introduction Several hematological factors, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutrition index (PNI) and albumin-to-globulin ratio (AGR), have been highlighted as systemic worse prognostic parameters for the outcome in gliomas. The aim of this study is to identify some pre-operative routinely blood tests as predictive parameters for the Overall Survival (OS) and Progression Free Survival (PFS) in glioblastoma (GBM). Materials and methods From January 2013 to April 2019, 124 patients operated for glioblastoma were analyzed. Data were collected regarding age, sex, Karnofsky performance status (KPS), IDH status, the extent of resection (EOR) and adjuvant therapy. The hematological parameters were collected at admission: neutrophils, lymphocytes and platelets, hemoglobin, lactate dehydrogenase, albumin, NLR, PLR, AGR and PNI. The OS and the PFS were considered as the end-point for the evaluation of the predictive factors. Results A pre-operative neutrophil count > 7 × 109/L was a worse prognostic factor for OS and PFS at univariate analysis (p = 0.004 and p = 0.025), as well as hypo-albuminemia. Thrombocytosis, lymphopenia and NLR > 4 were associated to a worse OS, at uni- and multivariate analysis, resulting as poor predictive parameters, independently to EOR, the IDH mutation and the adjuvant therapy. Conclusions Still nowadays there are no sensitive or specific hematological markers which are routinely applied for detecting and monitoring the treatment-response and the prognosis of glioblastoma. In our study, a pre-operative low cost and widely used blood markers, such as NLR, lymphocytes and platelets could be predictable prognostic factors for the Overall Survival of patients affected by glioblastomas.

INTRODUCTION: Atypical meningiomas (AMs) are characterized by a high rate of recurrence and a lesser Overall Survival (OS), compared to grade I meningioma. Nowadays, it is still controversial which are the predictive parameters for OS and the Recurrence free survival (RFS). METHODS: Data regarding age, gender, localization of the tumor, pre-operative symptoms, tumor localization, size, Simpson grade, postoperative complications, the extent of the resection (EOR), the number of mitoses, the proliferation index (MIB1), the brain invasion, the post-operative Radiotherapy (RT) treatment and clinical outcome (Karnofsky performance status, KPS, post- operatively and long-time follow-up) were evaluated. In addition, data regarding the recurrence rate, the mortality, OS and RFS at 1- year, 3-year and 5-year follow-up were collected. The median follow-up was 76 months, all patients had at least 3-year follow- up. RESULTS: Between 2007 and 2017, 73 patients underwent a surgical procedure for AMs (WHO grade II) in Ospedali Riuniti Center of Ancona and Sestre Milosrdnice University Hospital Centre. A preoperative KPS> 80 resulted to be related to a better OS, also at the one-month follow-up, six- month and one-year follow-up KPS. The post- operative complications did not modify the OS and the RFS. A Gross total removal (GTR, Simpson grade I, II) was achieved in the 80, 8% of patients. The RFS was statistically influenced by the EOR (p=0, 002). A MIB-1>8 was a negative predictive factor for recurrence at univariate and multivariate analysis (p=0, 001, p=0, 021). RT was statistically related to a worse outcome. The incidence of recurrence was 38%. The RFS was 98, 6% at 1-year follow-up, 81, 1% at 3-year and, only 57, 5% at 5-year follow-up. All patients were alive after 1-year follow-up. The OS at 3-year follow-up was 90, 5% and 78, 8 % at 5-year follow- up. CONCLUSIONS: Despite some limitations, our study demonstrate that an aggressive surgical treatment, achieving a GTR is a positive predictive parameter for the RFS, as well as a good clinical outcome (KPS > 80) is related to a longer overall survival.

Dura mater repair represents a final and crucial step in cranial surgery: an inadequate dural reconstruction determines dreadful consequences that significantly increase morbidity and mortality rates. Different dural substitutes have been used with poor results. To overcome this issue, in previous studies we proposed a laser-based approach to the bonding of porcine dura mater, evidencing the feasibility of the laser assisted procedure. In this work, we present the optimization of the laser bonding approach ex vivo in porcine dura mater and in vivo in rats. An 810 nm cw laser was used to weld the ICG stained chitosan patch to the dura. The ex vivo tests enabled to optimize the laser parameters, using histology and leak pressure evaluation to study the bonding effect. The in vivo tests were performed on 32 adult Wistar rats: laser bonding was carried out in 16 rats, while a collagen matrix was used for duroplasty in the control group. After the treatment, the animals were left to recover and were observed in a 15 and 90 days follow up study. At sacrifice, the rats were anesthetized for fluid leakage pressure test; treated tissue was harvested and underwent standard histology. The results of this study pointed out that the laser bonding procedure can be used to close the dura mater, both ex vivo and in vivo. The thermal effect is limited and spatially confined. The technique can thus be proposed as a valid alternative to standard method for the closuring of dura mater in cranial surgery.

Objective Study of mortality rate and clinical outcomes in octogenarians patients operated for intracranial meningiomas. Patients and methods Clinical, radiological and surgical data of 25 elderly patients aging over 80 years old operated at our Department from 2013 to 2016 for intracranial meningiomas have been recorded and analyzed. One-month mortality and clinical outcome at six-months after surgery were evaluated. Logistic regression was used for detecting the risk factors influencing mortality and neurological functions. Results The median age at diagnosis was 8185 years (range 80–87). Meningiomas were gross-total removed in 18 cases out of 25 (72%) and partially resected in 7 (28%). One-month post-operative mortality occurred in 2 pts out of 25 (8%). A close correlation was found between operative duration over 240 min and mortality (p = 0,0421). There was a significantly lower mortality in patients with ASA II rather than in patients with ASA III (p = 0,038). The median pre-operative KPS value was 743 (range 50–90) while at six-month follow-up was 82. The surgical time (p = 00,006) and size of the lesion >4 cm (p = 002) were a significant prognostic factors for clinical improvement at six-month follow-up. Conclusions The operative time and the ASA score are the most important prognostic factors for the mortality and neurological outcome of elderly patients over 80 years old operated for intracranial meningioma. Even if the number of patients is limited, our findings suggest that, after a careful preoperative stratification in elderly patients, it is possible to remove an intracranial meningioma with good results.

AimsThe presence of cold agglutinin in blood samples can cause a spontaneous agglutination of red blood cells (RBCs) when low temperature occurs. This phenomenon causes a spurious lowering of RBC count on the automated haematological analysers that are detected by incongruous values (≥370 g/L) of the mean cellular haemoglobi concentration (MCHC). A preheating at 37°C can remove the RBC agglutination generally resulting in a reliable count. It has been reported that the same result can be reached by using the optical reticulocyte (RET) channel of Sysmex analysers where the RBC count is not influenced by the presence of cold agglutinin. This study aims to evaluate these data in a larger population, with regard to environmental conditions on Sysmex analysers. We have also evaluated the influence of different thermal pretreatments on the RBC count.MethodsThis study was performed on 96 remnants of peripheral blood samples (48 with MCHC in normal range and 48 with MCHC>370 g/L) which have been analysed in different preanalytical conditions on the Sysmex analysers.ResultsA preheating of samples at 41°C for 1 min leads to a reversibility of the cold agglutination comparable to the one observed in the RET channel and yields better results compared with 37°C for 2 hours.ConclusionsNone of described procedures assure the complete cold agglutination reversibility in every case. Consequently, since the haematological analysers not yet provide reliable parameters to confirm the complete resolution of agglutination, further verification of RBC count accuracy needs to be performed.

SummaryBackground Increasing evidence suggests photo-protection by oral supplementation with s-carotene and lycopene. Objectives We examined the capacity of lycopene rich tomato nutrient complex (TNC) and lutein, to protect against UVA/B- and UVA1 radiation at a molecular level. Methods In a placebo-controlled, double blinded, randomized cross over study two actives containing either TNC or lutein were assessed for their capacity to decrease the expression of UVA1 radiation-inducible genes including heme oxygenase-1 (HO-1), intercellular adhesion molecule-1 (ICAM-1) and matrix metalloproteinase-1 (MMP-1). 65 healthy volunteers were allocated to 4 treatment groups and subjected to a 2-weeks wash-out phase, followed by two 12-weeks treatment phases separated by another 2-weeks wash-out. Volunteers started either with active and switched then to placebo or vice versa. At the beginning and at the end of each treatment phase skin was irradiated and 24 hours later biopsies were taken from untreated, UVB/A- and UVA1 irradiated skin for subsequent RT-PCR analysis of gene expression. Moreover, blood samples were taken after the wash out and the treatment phases for assessment of carotenoids. Results TNC completely inhibited UVA1 as well as UVA/B induced upregulation of HO-1, ICAM-1 and MMP1 mRNA no matter of sequence (ANOVA, p

Background: This study identified risk factors and postoperative indicators for recurrent lumbar disc herniations (rLDH) following microdiscectomy. Methods: We retrospectively reviewed the 1-year recurrence rate for LDH in 209 consecutive patients undergoing microdiscectomy (2013–2018). Results: Utilizing a multivariate analysis, higher body mass index (BMI) and postsurgery Oswestry disability index (ODI) were significantly associated with an increased risk of rLDH. Conclusion: Elevated postsurgery ODI and higher BMI were significantly associated with increased risk of rLDH.

Mammalian sirtuins are involved in the control of metabolism and life-span regulation. Here, we link the mitochondrial sirtuin SIRT4 with cellular senescence, skin aging, and mitochondrial dysfunction. SIRT4 expression significantly increased in human dermal fibroblasts undergoing replicative or stress-induced senescence triggered by UVB or gamma-irradiation. In-vivo, SIRT4 mRNA levels were upregulated in photoaged vs. non-photoaged human skin. Interestingly, in all models of cellular senescence and in photoaged skin, upregulation of SIRT4 expression was associated with decreased levels of miR-15b. The latter was causally linked to increased SIRT4 expression because miR-15b targets a functional binding site in the SIRT4 gene and transfection of oligonucleotides mimicking miR-15b function prevented SIRT4 upregulation in senescent cells. Importantly, increased SIRT4 negatively impacted on mitochondrial functions and contributed to the development of a senescent phenotype. Accordingly, we observed that inhibition of miR-15b, in a SIRT4-dependent manner, increased generation of mitochondrial reactive oxygen species, decreased mitochondrial membrane potential, and modulated mRNA levels of nuclear encoded mitochondrial genes and components of the senescence-associated secretory phenotype (SASP). Thus, miR-15b is a negative regulator of stress-induced SIRT4 expression thereby counteracting senescence associated mitochondrial dysfunction and regulating the SASP and possibly organ aging, such as photoaging of human skin.

AIM Postoperative surgical site infections (SSI) are complication of spinal surgery. These complications may lead to a poor outcome with neurological deficits, spinal deformity and chronic pain. The purpose of this study is to explore the statistical value of diagnostic parameters and the proper therapy. METHOD We retrospectively reviewed 550 patients who underwent spinal instrumentation at our department from January 2011 to December 2015. The SSI was present in 16 patients out of 550 operated. Diagnostic criteria of SSI were the positivity of the surgical wound swab or blood culture, the clinical findings, positivity of laboratory tests and radiological elements. All patients had peri-operative antibiotic prophylaxis. Diagnostic laboratory findings were compared with a homogeneous control group of 16 patients and analyzed by univariate statistical analysis with Chi-square test for the discrete variables. P

Nutritional strategies to benefit skin health are of growing importance. Current approaches mainly involve nutritional supplements containing antioxidants which were initially designed to protect human skin against ultraviolet radiation-induced damage. Within recent years, however, a growing number of studies suggests that the beneficial effects of these products clearly extend beyond photoprotection. In this review we take the nutritional supplement Pycnogenol®, which is based on an extract prepared from French marine pine bark extract, as an example to illustrate this development. Accordingly, the existing data provide compelling evidence that Pycnogenol® intake does not only provide photoprotection, but may be used to (i) reduce hyperpigmentation of human skin and (ii) improve skin barrier function and extracellular matrix homeostasis.

Stunting is a silent killer. It deprives a child of its right to grow, to thrive and to prosper. Today, stunting snatches away the opportunity of 156 million children to reach their full potential worldwide. It holds back the development of children, communities and countries. The price of stunting can be measured in cents and centimeters. The inexcusably high rates of childhood stunting in middle-and-low-income countries are one of the most serious threats to humankind that has escaped the world’s attention for far too long. How will countries compete in what will certainly be a more digitalized global economy in the future when one out of four of their children do not have as many neuronal connections in their brains as children in other countries that they must compete with? Peru has shown to the world that the reduction in stunting can be accelerated through a country-wide engagement. And accelerating the reduction in stunting globally is what we need to ensure a bright future for all children. This report details how Peru’s strong political commitment and good policies, coupled with economic growth, were the recipe behind breaking the cycle of poverty perpetuated by stunting. This experience demonstrates that investing in nutrition in the first 1,000 days of a child is critical to crack the world’s stunting crisis.

Photoprotection of human skin by means of sunscreens or daily skin-care products is traditionally centered around the prevention of acute (e.g. sunburn) and chronic (e.g. skin cancer and photoaging) skin damage that may result from exposure to ultraviolet rays (UVB and UVA). Within the last decade, however, it has been appreciated that wavelengths beyond the ultraviolet spectrum, in particular visible light and infrared radiation, contribute to skin damage in general and photoaging of human skin in particular. As a consequence, attempts have been made to develop skin care/sunscreen products that not only protect against UVB or UVA radiation but provide photoprotection against visible light and infrared radiation as well. In this article, we will briefly review the current knowledge about the mechanisms responsible for visible light/infrared radiation-induced skin damage and then, based on this information, discuss strategies that have been successfully used or may be employed in the future to achieve photoprotection of human skin beyond ultraviolet radiation. In this regard we will particularly focus on the use of topical antioxidants and the challenges that result from the task of showing their efficacy.