Lateral-type posterior fossa ependymomas in pediatric patients: a national collaborative study.

PURPOSE: To review a multicentric series of lateral-type posterior fossa ependymomas operated in the last ten years and to analyze the factors related to clinical evolution and tumor survival. METHODS: Descriptive, retrospective study. Active members of the Spanish Society of Pediatric Neurosurgery were invited to participate in this multicentric study. Clinical and radiological data were incorporated to an open database. The role of histologic grade, grade of resection, postoperative morbidities, and clinical follow-up was evaluated through bivariate associations (chi-square), Kaplan-Meier's curves (log-rank test), and multivariate analysis (binary logistic regression). RESULTS: Fourteen centers entered the study, and 25 cases with a minimum follow-up of 6 months were included. There were 13 boys and 12 girls with a mean age close to 3 years. Mean tumor volume at diagnosis was over 60 cc. A complete resection was achieved in 8 patients and a near-total resection in 5 cases. Fifteen tumors were diagnosed as ependymoma grade 2 and ten as ependymoma grade 3. Major morbidity occurred postoperatively in 14 patients but was resolved in twelve within 6 months. There were six cases of death and 11 cases of tumor progression along the observation period. Mean follow-up was 44.8 months. Major morbidity was significantly associated with histologic grade but not with the degree of resection. Overall and progression-free survival were significantly associated with complete surgical resection. At the last follow-up, 16 patients carried a normal life, and three displayed a mild restriction according to Lansky's scale. CONCLUSIONS: Lateral-type posterior fossa ependymomas constitute a specific pathologic and clinical tumor subtype with bad prognosis. Gross total resection is the goal of surgical treatment, for it significantly improves prognosis with no additional morbidity. Neurological deficits associated to lower cranial nerve dysfunction are common, but most are transient. Deeper genetic characterization of these tumors may identify risk factors that guide new treatments and stratification of adjuvant therapies.

Sustainable Nanomagnetism: Investigating the Influence of Green Synthesis and pH on Iron Oxide Nanoparticles for Enhanced Biomedical Applications.

This study comprehensively analyzed green nanomagnetic iron oxide particles (GNMIOPs) synthesized using a green method, investigating their size, shape, crystallinity, aggregation, phase portions, stability, and magnetism. The influence of pH and washing solvents on the magnetic properties of the nanoparticles and their incorporation into PCL membranes was examined for biomedical applications. Polyphenols were utilized at different pH values (1.2, 7.5, and 12.5), with washing being performed using either ethanol or water. Characterization techniques, including XRD, SEM, TEM, FTIR, and VSM, were employed, along with evaluations of stability, magnetic properties, and antioxidant activity. The findings indicate that both pH levels and the washing process exert a substantial influence on several properties of NMIOPs. The particle sizes ranged from 6.6 to 23.5 nm, with the smallest size being observed for GNMIOPs prepared at pH 12.5. Higher pH values led to increased crystallinity, cubic Fe3O4 fractions, and reduced crystalline anisotropy. SEM and TEM analyses showed pH-dependent morphological variations, with increased aggregation being observed at lower pH values. GNMIOPs displayed exceptional magnetic behavior, with the highest saturation magnetization being observed in GNMIOPs prepared at pH 7.5 and 12.5 and subsequently washed with ethanol. The zeta potential measurements indicated a stability range for GNMIOPs spanning from -31.8 to -41.6 mV, while GNMIOPs synthesized under high-pH conditions demonstrated noteworthy antioxidant activity. Furthermore, it was explored how pH and washing solvent affected the morphology, roughness, and magnetic properties of GNMIOP-infused nanofiber membranes. SEM showed irregularities and roughness due to GNMIOPs, varying with pH and washing solvent. TEM confirmed better dispersion with ethanol washing. The magnetic response was stronger with ethanol-washed GNMIOPs, highlighting the influence of pH and washing solvent on membrane characteristics.

Quantifying the Structure and Properties of Nanomagnetic Iron Oxide Particles for Enhanced Functionality through Chemical Synthesis.

This comprehensive study investigates the properties of chemical nanomagnetic iron oxide particles (CNMIOPs) synthesized through a chemical method. The primary objective is to examine how pH levels and washing solvents affect the magnetism properties of these nanoparticles. Three different pH levels (1.2, 7.5, and 12.5) using NaOH and two washing solvents (ethanol and water) are employed. The characterization techniques include FTIR, SEM, TEM, XRD, ZSP, and VSM. Furthermore, the study incorporates two specific pH- and solvent-dependent CNMIOPs into PCL electrospun materials to analyze their performance in a targeted application. The results show that pH and the washing process significantly affect the CNMIOPs' properties. Higher pH levels result in smaller particles with higher crystallinity and reduce crystalline anisotropy. SEM and TEM analysis confirm different morphologies, including cubic, spherical, and elongated shapes. Ethanol-washed CNMIOPs exhibit superior magnetic behavior, with the highest magnetization saturation at pH 12.5 (Ms = 58.3 emu/g). The stability of the CNMIOPs ranges from -14.7 to -23.8 mV, and higher pH levels exhibit promising antioxidant activity. Furthermore, the study explores the effects of pH and washing solvents on CNMIOP-infused nanofiber membranes, with better dispersion observed with ethanol washing. Overall, this research provides valuable insights into the properties and behavior of CNMIOPs under varying pH and washing conditions.

Effect of Calcination Temperature and Time on the Synthesis of Iron Oxide Nanoparticles: Green vs. Chemical Method.

Nowadays, antioxidants and antibacterial activity play an increasingly vital role in biosystems due to the biochemical and biological reactions that involve free radicals and pathogen growth, which occur in many systems. For this purpose, continuous efforts are being made to minimize these reactions, including the use of nanomaterials as antioxidants and bactericidal agents. Despite such advances, iron oxide nanoparticles still lack knowledge regarding their antioxidant and bactericidal capacities. This includes the investigation of biochemical reactions and their effects on nanoparticle functionality. In green synthesis, active phytochemicals give nanoparticles their maximum functional capacity and should not be destroyed during synthesis. Therefore, research is required to establish a correlation between the synthesis process and the nanoparticle properties. In this sense, the main objective of this work was to evaluate the most influential process stage: calcination. Thus, different calcination temperatures (200, 300, and 500 °C) and times (2, 4, and 5 h) were studied in the synthesis of iron oxide nanoparticles using either Phoenix dactylifera L. (PDL) extract (green method) or sodium hydroxide (chemical method) as the reducing agent. The results show that calcination temperatures and times had a significant influence on the degradation of the active substance (polyphenols) and the final structure of iron oxide nanoparticles. It was found that, at low calcination temperatures and times, the nanoparticles exhibited small sizes, fewer polycrystalline structures, and better antioxidant activities. In conclusion, this work highlights the importance of green synthesis of iron oxide nanoparticles due to their excellent antioxidant and antimicrobial activities.

Personal exposimeter coupled to a drone as a system for measuring environmental electromagnetic fields.

Personal exposimeters are currently used in studies assessing human exposure to electromagnetic fields. These devices are usually carried by an individual, but vehicles such as bicycle or car are also used. The aim of the present study was to propose a personal exposimeter attached to a drone to perform environmental radio-frequency measurements. Trials were carried out to determine whether: (i) the wireless communication between the remote controller and the drone affects the downlink mobile telephony bands by a cross-talk effect, and (ii) the structure of the drone alters the measurements of the exposimeter compared to when the meter is on a tripod. To apply this system to a real scenario, a 3D representation of the electric field in a building was obtained, and the attenuation due to the building of radiation from outside was estimated. Measurements of the electromagnetic field with this system will make it possible to monitor without risk the emissions of antennas in their close vicinity, and to validate propagation models experimentally.

Green Synthesis of FexOy Nanoparticles with Potential Antioxidant Properties.

Iron oxide nanoparticles (FexOy-NPs) are currently being applied in numerous high-tech sectors, such as in chemical sectors for catalysis and in the medical sector for drug delivery systems and antimicrobial purposes, due to their specific, unique and magnetic properties. Nevertheless, their synthesis is under continuous investigation, as physicochemical methods are considered expensive and require toxic solvents. Thus, green nanotechnology has shown considerable promise in the eco-biogenesis of nanoparticles. In the current study, FexOy-NPs were synthesized by two different methods: via green synthesis through the use of polyphenols, which were extracted from Phoenix dactylifera L.; and via chemical synthesis, in which the reducing agent was a chemical (NaOH), and iron chloride was used as a precursor. Thus, polyphenol extraction and its ability to produce nanoparticles were evaluated based on the drying temperature used during the Phoenix dactylifera L. recollection, as well as the extraction solvent used. The results highlight the potential of polyphenols present in Phoenix dactylifera L. for the sustainable manufacture of FexOy-NPs. Finally, green and chemical syntheses were compared on the basis of physicochemical characteristics and functional properties.

Gelatin-Based Biofilms with FexOy-NPs Incorporated for Antioxidant and Antimicrobial Applications.

Currently, gelatin-based films are regarded as promising alternatives to non-environmentally friendly plastic films for food packaging. Nevertheless, although they have great biodegradability, their weak mechanical properties and high solubility limit their applications. In this way, the use of nanoparticles, such as FexOy-NPs, could improve the properties of gelatin-based biofilms. Thus, the main objective of this work was to include different concentrations of FexOy-NPs (0.25 and 1.0%) manufactured by green synthesis (GS) and chemical synthesis (CS) into gelatin-based biofilms in order to improve their properties. The results show that FexOy-NPs can be distributed throughout the biofilm, although with a greater concentration on the upper surface. In addition, the incorporation of FexOy-NPs into the biofilms improves their physicochemical, mechanical, morphological, and biological properties. Thus, it is possible to achieve suitable gelatin-based biofilms, which can be used in several applications, such as functional packaging in the food industry, antioxidant and antimicrobial additives in biomedical and pharmaceutical biomaterials, and in agricultural pesticides.

Marine Collagen-Based Antibacterial Film Reinforced with Graphene and Iron Oxide Nanoparticles.

It has become more widely available to use biopolymer-based films as alternatives to conventional plastic-based films due to their non-toxic properties, flexibility, and affordability. However, they are limited in application due to deficiencies in their properties. The marine collagen was the specimen for the present study. Thus, the main objective was to reinforce marine collagen-based films with 1.0% (w/w of the dry polymer weight) of iron oxide nanoparticles (IO-NPs), graphene oxide nanoparticles (GO-NPs), or a combination of both oxides (GO-NPs/IO-NPs) as antibacterial and antioxidant additives to overcome some of the limitations of the film. In this way, the nanoparticles were incorporated into the film-forming solution (2% w/v in acetic acid, 0.05 M) and processed by casting. Thereafter, the films were dried and analyzed for their physicochemical, mechanical, microstructural, and functional properties. The results show that the effective combination of GO-NPs/IO-NPs enhanced the physicochemical properties by increasing the water contact angle (WCA) of the films from 77.2 to 84.4° and their transparency (T) from 0.5 to 5.2. Furthermore, these nanoparticles added antioxidant and antibacterial value to the films, with free radical inhibition of up to 95.8% and 23.8 mm of bacteria growth inhibition (diameter). As a result, both types of nanoparticles are proposed as suitable additives to be incorporated into films and enhance their different properties.

Evolution of corneal epithelial remodeling after myopic laser in situ keratomileusis surgery measured by anterior segment optical coherence tomography combined with Placido disk.

PURPOSE: To investigate patterns of short- and long-term variations in corneal epithelial thickness (CET) after myopic laser in situ keratomileusis (LASIK) using anterior segment optical coherence tomography (AS-OCT) combined with Placido disk-based topography. METHODS: In this retrospective study, 36 subjects (72 eyes) who underwent LASIK myopic surgery and 53 healthy subjects (106 eyes) who served as controls were enrolled. AS-OCT (MS-39) was performed in all patients before, 1 day, 1 month, and 6 months after surgery. Statistical analysis was performed to analyze CET changes over time after LASIK and to detect patterns of definitive CET remodeling compared to healthy subjects. Multivariate analysis was performed to look for possible predictors of final CET. RESULTS: There was no statistically significant difference between groups in terms of demographic and anterior segment parameters (all P > 0.05). After LASIK, all sectors and rings got thicker over time (1.62-8.32 µm; P < 0.01). Except for the central sector, all areas achieved the thickest CET value one day after surgery with a progressive epithelial thinning between 1 and 6 months of follow-up. Changes on CET occurred independently of the grade of myopia before LASIK or final refraction (P > 0.05). None of the clinical variables studied, including diopters corrected, were found to be correlated with final CET (P > 0.05). CONCLUSION: Independent of anterior segment parameters and diopters corrected, CET becomes thicker after LASIK surgery. Central and inner ring sectors thicken more than those more peripheral. CET remodeling after myopic LASIK should be taken into consideration when planning refractive surgery.

Hepatocellular carcinoma risk in hepatitis C stage-3 fibrosis after sustained virological response with direct-acting antivirals.

BACKGROUND & AIMS: Patients with chronic hepatitis C and stage 3 fibrosis are thought to remain at risk of hepatocellular carcinoma after sustained virological response. We investigated this risk in a large cohort of patients with well-defined stage 3 fibrosis. METHODS: We performed a multicentre, ambispective, observational study of chronic hepatitis C patients with sustained virological response after treatment with direct-acting antivirals started between January and December 2015. Baseline stage 3 was defined in a two-step procedure: we selected patients with transient elastography values of 9.5-14.5 kPa and subsequently excluded those with nodular liver surface, splenomegaly, ascites or collaterals on imaging, thrombopenia or esophago-gastric varices. Patients were screened twice-yearly using ultrasound. RESULTS: The final sample comprised 506 patients (median age, 57.4 years; males, 59.9%; diabetes, 17.2%; overweight, 44.1%; genotype 3, 8.9%; HIV coinfection, 18.4%; altered liver values, 15.2%). Median follow-up was 33.7 (22.1-39.1) months. Five hepatocellular carcinomas and 1 cholangiocarcinoma were detected after a median of 29.4 months (95% CI: 26.8-39.3), with an incidence of 0.47/100 patients/year (95% CI: 0.17-1.01). In the multivariate analysis, only males older than 55 years had a significant higher risk (hazard ratio 7.2 [95% CI: 1.2-41.7; P = .029]) with an incidence of 1.1/100 patients/year (95% CI: 0.3-2.8). CONCLUSIONS: In a large, well-defined cohort of patients with baseline hepatitis C stage-3 fibrosis, the incidence of primary liver tumours was low after sustained virological response and far from the threshold for cost-effectiveness of screening, except in males older than 55 years.

Physical activity and risk of Parkinson's disease and parkinsonism in a prospective population-based study (NEDICES).

To investigate whether physical activity (PA) is a protective factor for the incidence of Parkinson's disease (PD) and parkinsonism after three years of follow-up. All participants of this study were obtained from the Neurological Disorders in Central Spain (NEDICES), a prospective population-based cohort survey of older subjects (≥65 years) that comprised 5278 census-based participants at baseline (1994-1995). A modified version of Rosow-Breslau questionnaire was applied to categorize PA into active versus sedentary group. The final diagnosis of PD and parkinsonism was made by an expert neurologist. Cox regression models (CRM) adjusted for several covariates (sex, age, education, alcohol consumption, tobacco, stroke, hypertension and body mass index) were used to calculate the association between PA (active group vs. sedentary) and risk of PD and parkinsonism after three years. 22 incident PD and 25 incident parkinsonism cases were identified among 2943 participants with available PA information (57.1% female; mean age = 73.28 ± 6.24 years) after three years of follow-up. The CRM showed that the active group (vs. sedentary) showed a lower risk of parkinsonism (Hazard ratio (HR) = 0.18; 95% CI [0.07-0.51]; p = 0.0001). However, this effect was restricted to men (HR = 0.34; 95% CI [0.11-0.99], p < 0.05) for incident PD. PA may be a protective factor for incident parkinsonism, whereas this effect was only significant for men in the case of PD. The mechanisms implicated for brain maintenance in active individuals and the neurophysiological differences behind the role of sex on PD are discussed.

An Immunologic Compatibility Testing Was Not Useful for Donor Selection in Fecal Microbiota Transplantation for Ulcerative Colitis.

Fecal microbiota transplantation (FMT) is an effective procedure against Clostridioides difficile infection (CDI), with promising but still suboptimal performance in other diseases, such as ulcerative colitis (UC). The recipient's mucosal immune response against the donor's microbiota could be relevant factor in the effectiveness of FMT. Our aim was to design and validate an individualized immune-based test to optimize the fecal donor selection for FMT. First, we performed an in vitro validation of the test by co-culturing lymphocytes obtained from the small intestine mucosa of organ donor cadavers (n=7) and microbe-associated molecular patterns (MAMPs) obtained from the feces of 19 healthy donors. The inflammatory response was determined by interleukin supernatant quantification using the Cytometric Bead Array kit (B&D). We then conducted a clinical pilot study with 4 patients with UC using immunocompetent cells extracted from rectal biopsies and MAMPs from 3 donor candidates. We employed the test results to guide donor selection for FMT, which was performed by colonoscopy followed by 4 booster instillations by enema in the following month. The microbiome engraftment was assessed by 16S rDNA massive sequencing in feces, and the patients were clinically followed-up for 16 weeks. The results demonstrated that IL-6, IL-8, and IL-1ß were the most variable markers, although we observed a general tolerance to the microbial insults. Clinical and colonoscopy remission of the patients with UC was not achieved after 16 weeks, although FMT provoked enrichment of the Bacteroidota phylum and Prevotella genus, with a decrease in the Actinobacteriota phylum and Agathobacter genus. The most relevant result was the lack of Akkermansia engraftment in UC. In summary, the clinical success of FMT in patients with UC appears not to be influenced by donor selection based on the explored recipient's local immunological response to FMT, suggesting that this approach would not be valid for FMT fecal donor optimization in such patients.

Radiological response to nivolumab in patients with hepatocellular carcinoma: A multicenter analysis of real-life practice.

BACKGROUND AND AIMS: Immune-checkpoint inhibitors are effective in many advanced tumors. However, there is scarce information regarding the radiological response to these agents in hepatocellular carcinoma outside clinical trials. We aimed to describe the radiological response in a retrospective cohort of hepatocellular carcinoma patients treated with nivolumab and to analyze the radiological evolution according to tumor response at first post-treatment radiological assessment. METHODS: We reviewed pre-treatment and post-treatment images (CT or MRI) obtained at different time-points in patients with hepatocellular carcinoma treated with nivolumab outside clinical trials at seven Spanish centers, assessing the response according to RECIST 1.1 and iRECIST and registering atypical responses. We also analyzed the imaging findings on subsequent assessments according to tumor status on the first posttreatment imaging assessment. RESULTS: From the 118 patients with hepatocellular carcinoma treated with nivolumab, we finally analyzed data from 31 patients (71 % Child-Pugh A; 74 % BCLC-C). Median follow-up was 8.39 months [IQR 5.00-10.92]; median overall survival was 12.82 months (95 %CI 10.92-34.79). According to RECIST 1.1, the objective response rate was 16 % and according to iRECIST, the objective response rate was 22.6 %. Findings at the first post-treatment assessment varied, showing stable disease in 44.8 % of patients; findings during follow-up also varied widely, including 4 hyperprogressions and 3 pseudoprogressions. CONCLUSION: Imaging findings during nivolumab treatment are heterogeneous between and within patients. Progression of disease does not always signify treatment failure, and surrogate end-points may not reflect survival outcomes, making the management of hepatocellular carcinoma patients under immunotherapy challenging.

Hepatocellular carcinoma after Fontan surgery: A systematic review.

AIM: Fontan surgery is often the procedure of choice for patients with congenital single effective ventricle. In the long term, elevated systemic venous pressure and chronic ischemia following this procedure could lead to advanced chronic liver disease and there is also a risk of hepatocellular carcinoma (HCC). This review systematically summarizes the characteristics and outcomes of this rare condition. METHODS: PubMed and Embase databases were searched from inception to January 2020 for studies reporting on HCC after Fontan surgery. The factors analyzed were clinical presentation, histology, imaging findings, treatments, and survival. Our primary analysis was based on biopsy-proven HCC. RESULTS: The records selected were 26 observational studies (19 case reports/case series and seven cohort studies) including 65 biopsy-proven HCC. Age at the time of HCC diagnosis ranged from 12 to 52 years, and 62% of the patients were female. Only one case occurred earlier than 10 years after Fontan surgery. Twenty patients had no imaging or histological evidence of liver cirrhosis and 78.3% had elevated α-fetoprotein levels. Advanced stage was the most common at diagnosis. The most frequent treatments were transarterial chemoembolization (n = 18) and surgery (n = 12). One-year survival was 50% and only four patients (6.2%) were under liver imaging surveillance. We also analyzed 17 patients with non-biopsy-proven HCC. CONCLUSIONS: After Fontan surgery, HCC usually occurs at least 10 years later and can develop in the absence of cirrhosis. Biopsy is mandatory to confirm the diagnosis. Patients were diagnosed at a late stage and survival outcomes were poor, highlighting a need for liver surveillance.

Dietary Intervention through Flipped Learning as a Techno Pedagogy for the Promotion of Healthy Eating in Secondary Education.

Technological progress in the educational field has led to the application of active and innovative teaching methods, such as flipped learning, including in the field of dietary education. This is considered a mixed formative approach that combines face-to-face and outside the classroom education. The objective of this research was to analyze the effectiveness of flipped learning methodology on a traditional training practice in dietary training, both in the sixth grade of primary education and in the fourth level of secondary education. A quasi-experimental design was adopted with two experimental groups, two control groups and only posttest. The final sample was composed of 115 students divided into four groups, two of each educational stage mentioned. A didactic unit consisting of six sessions in all groups was applied. Two different training methodologies were followed according to the nature of the group (control-traditional; experimental-flipped learning). The results reveal that flipped learning is effective both in primary education and in secondary education, being more influential in student development in this last stage. It is concluded that the flipped learning approach has meant an improvement of the academic indicators evaluated after a diet education program.

Influence of pH value on microstructure of oil-in-water emulsions stabilized by chickpea protein flour.

Food industry is highly interested in the development of healthier formulations of oil-in-water emulsions, stabilized by plant proteins instead of egg or milk proteins. These emulsions would avoid allergic issues or animal fat. Among other plant proteins, legumes are a cost-competitive product. This work evaluates the influence of pH value (2.5, 5.0 and 7.5) on emulsions stabilized by chickpea-based emulsions at two different protein concentration (2.0 and 4.0 wt%). Microstructure of chickpea-based emulsions is assessed by means of backscattering, droplet size distributions and small amplitude oscillatory shear measurements. Visual appearances as well as confocal laser scanning microscopy images are obtained to provide useful information on the emulsions structure. Interestingly, results indicate that the pH value and protein concentration have a strong influence on emulsion microstructure and stability. Thus, the system which contains protein surfaces positively charged shows the highest viscoelastic properties, a good droplet size distribution profile and non-apparent destabilization phenomena. Interestingly, results also reveal the importance of rheological measurements in the prediction of protein interactions and emulsion stability since this technique is able to predict destabilization mechanisms sooner than other techniques such as backscattering or droplet size distribution measurements.

Pseudotumor cerebri in kaposiform lymphangiomatosis: a case report and pathogenetic hypothesis.

CASE REPORT: A 4-year-old boy with kaposiform lymphangiomatosis (KLA) developed progressive headaches and papilloedema and was diagnosed with pseudotumor cerebri initially treated with acetazolamide. Clinical deterioration prompted placement of a ventriculoperitoneal shunt. After the surgery, the child's condition has markedly improved. DISCUSSION AND CONCLUSIONS: A network of intracranial lymphatics is presently being investigated. Neuroimaging excluded KLA infiltration of the skull and/or meninges, leaving as the most plausible explanation for the child's pseudotumor cerebri the existence of an increase in intracranial venous pressure by venous compression at the thorax. To our knowledge, our case constitutes the first report of pseudotumor cerebri occurring in the context of KLA.