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Background Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. Methods The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. Results The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. Conclusions This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.

Herbicides with glyphosate (GLY) as an active ingredient (a.i.) are increasingly used, and GLY is currently the most used herbicide in the world. Consequently, its residues have often been found in aquatic ecosystems. Investigating how this substance affects aquatic species is a priority in ecotoxicology research, especially in fish, as they can absorb and concentrate toxins. In this sense, a critical review was performed, synthesizing data from the peer-reviewed bibliography, reporting on the toxicity of exposure to pure GLY and glyphosate-based herbicides (GBHs), using zebrafish as an animal model. The concentrations of this herbicide that induced toxic effects are highly variable, with some exceeding the limits determined by regulatory agencies. Globally, relevant toxic effects have been reported in zebrafish, namely, teratogenic effects incompatible with life, which translates directly into an increase in reported zebrafish mortality. Neurotoxicity, genotoxicity, changes in energy metabolism and oxidative stress, and immune and hormonal system dysfunction with an impact on fish reproduction were also described. In conclusion, both GLY and GBHs may induce damage to zebrafish, compromising their survival, reproduction, and maintenance. These results may be valid and applied to other fish species and aquatic ecosystems.

Thymol (THY) and 24-epibrassinolide (24-EPI) are two examples of plant-based products with promising therapeutic effects. In this study, we investigated the anti-inflammatory, antioxidant and anti-apoptotic effects of the THY and 24-EPI. We used zebrafish (Danio rerio) larvae transgenic line (Tg(mpxGFP)i114) to evaluate the recruitment of neutrophils as an inflammatory marker to the site of injury after tail fin amputation. In another experiment, wild-type AB larvae were exposed to a well known pro-inflammatory substance, copper (CuSO4), and then exposed for 4 h to THY, 24-EPI or diclofenac (DIC), a known anti-inflammatory drug. In this model, the antioxidant (levels of reactive oxygen species—ROS) and anti-apoptotic (cell death) effects were evaluated in vivo, as well as biochemical parameters such as the activity of antioxidant enzymes (superoxide dismutase, catalase and glutathione peroxidase), the biotransformation activity of glutathione-S-transferase, the levels of glutathione reduced and oxidated, lipid peroxidation, acetylcholinesterase activity, lactate dehydrogenase activity, and levels of nitric acid (NO). Both compounds decreased the recruitment of neutrophils in Tg(mpxGFP)i114, as well as showed in vivo antioxidant effects by reducing ROS production and anti-apoptotic effects in addition to a decrease in NO compared to CuSO4. The observed data substantiate the potential of the natural compounds THY and 24-EPI as anti-inflammatory and antioxidant agents in this species. These results support the need for further research to understand the molecular pathways involved, particularly their effect on NO.

Increasing awareness regarding fossil fuel dependence, waste valorization, and greenhouse gas emissions have prompted the emergence of new solutions for numerous markets over the last decades. The tire industry is no exception to this, with a global production of more than 1.5 billion tires per year raising environmental concerns about their end-of-life recycling or disposal. Pyrolysis enables the recovery of both energy and material from end-of-life tires, yielding valuable gas, liquid, and solid fractions. The latter, known as recovered carbon black (rCB), has been extensively researched in the last few years to ensure its quality for market applications. These studies have shown that rCB quality depends on the feedstock composition and pyrolysis conditions such as type of reactor, temperature range, heating rate, and residence time. Recent developments of activation and demineralization techniques target the production of rCB with specific chemical, physical, and morphological properties for singular applications. The automotive industry, which is the highest consumer of carbon black, has set specific targets to incorporate recycled materials (such as rCB) following the principles of sustainability and a circular economy. This review summarizes the pyrolysis of end-of-life tires for the production of syngas, oil, and rCB, focusing on the process conditions and product yield and composition. A further analysis of the characteristics of the solid material is performed, including their influence on the rCB application as a substitute of commercial CB in the tire industry. Purification and modification post-treatment processes for rCB upgrading are also inspected.

The current study tested the hypothesis that magnesium sulfate after reversal with sugammadex causes recurarization. A single-center, prospective, randomized, double-blind, controlled trial. Terciary care hospital in Rio de Janeiro, Brazil. Included 60 patients undergoing for elective otolaryngological surgery. All patients received total intravenous anesthesia and a single dose of rocuronium (0.6 mg/kg). In 30 patients, the neuromuscular blockade was reversed with sugammadex (4 mg/kg) at the reappearance of one or two posttetanic counts (deep-blockade series). In 30 other patients, sugammadex (2 mg/kg) was administered at the reappearance of the second twitch of the train-of-four (moderate-blockade series). After the normalized train-of-four ratio recovered to ≥0.9, the patients in each series were randomized to receive intravenous magnesium sulfate (60 mg/kg) or placebo for 10 min. Neuromuscular function was measured by acceleromyography. The primary outcome was the number of patients who exhibited recurarization (normalized train-of-four ratio < 0.9). The secondary outcome was rescue with an additional dose of sugammadex after 60 min. In the deep-blockade series, a normalized train-of-four ratio < 0.9 occurred in 9/14 (64%) patients receiving magnesium sulfate and 1/14 (7%) receiving placebo, RR 9.0 (95% CI: 62–1.30), and (p = 0.002), with four rescues with sugammadex. In the moderate-blockade series, neuromuscular blockade recurred in 11/15 (73%) patients receiving magnesium sulfate and in 0/14 (0%) receiving placebo (p < 0.001), with two rescues. The absolute differences in recurarization were 57% and 73% in the deep-blockade and moderate-blockade, respectively. Single-dose magnesium sulfate led to a normalized train-of-four ratio < 0.9, 2 min after recovery from rocuronium-induced deep and moderate neuromuscular blockade using sugammadex. Additional sugammadex reversed prolonged recurarization.

An increase in blood-brain barrier (BBB) permeability after subarachnoid haemorrhage (SAH) has been described in humans and has been correlated with delayed cerebral ischemia and poor clinical outcome. Few studies examined in the laboratory the relationship between SAH and BBB, with contrasting results due to limitations in experimental probes adopted and in timing of observation. The aim of this study was to quantify the time-course of BBB changes after experimental SAH. Groups of eight rats received injections of 400 microl of autologous arterial blood into the cisterna magna. BBB was assessed 6, 12, 24, 36, 48, 60, and 72 hours after SAH and in sham-operated animals separately for cerebral cortex, i.e. frontal, temporal, parietal, occipital, subcortical gray matter (Caudate-Putamen-Thalamus), cerebellar cortex and nuclei, and brain stem by a spectrophotofluorimetric evaluation of Evans Blue dye extravasation. As compared to sham-operated controls, SAH determined a significant BBB permeability change beginning 36 hours after SAH, peaking at 48 hours, and normalizing on day 3. This study provides a quantitative description of the temporal progression and recovery of BBB dysfunction after SAH. These results have implications for the management of aneurysm patients and for assessing the rationale and the therapeutic window of new pharmacological approaches.

Purpose Vancomycin is commonly used for the management of severe infections; however, vancomycin dosing may be challenging in critically ill patients. This observational study aims to describe the population pharmacokinetics of vancomycin in adult patients with sepsis or septic shock. Methods A single-centre retrospective review of adult patients with sepsis or septic shock receiving vancomycin with therapeutic drug monitoring was undertaken. Blood samples taken 1 h after the vancomycin infusion cessation and 30 min prior to the next dose were assayed using the Vitros Crea Slide method. Vancomycin concentrations determined on different days were included. A pharmacokinetic model was developed using Pmetrics for R. Monte Carlo dosing simulations were performed using the final model. Results Vancomycin concentrations were available for 27 adult patients admitted to the intensive care unit with sepsis or septic shock. A one-compartment pharmacokinetic model with inter-occasion variability of clearance and volume of distribution before and after 72 h adequately described the data. Creatinine clearance normalized to body surface area was included as a covariate on vancomycin clearance. The clearance and volume of distribution within 72 h of admission were 7.29 L/h and 54.20 L, respectively. Monte Carlo simulations suggested that for patients with a creatinine clearance of ≥ 80 mL/min/1.73 m 2 , vancomycin doses of ≥ 2 g every 8 h are required to consistently achieve key therapeutic targets. Conclusions Vancomycin doses ≥ 2 g every 8 h in adult patients with sepsis or septic shock with a creatinine clearance ≥ 80 mL/min/1.73 m 2 are likely needed to achieve an optimal therapeutic exposure.

Multilayer plastic packaging waste (MPPW) represents a major challenge for waste management due to its widespread use in single-use applications and its complex, heterogeneous structure. Variations in polymer composition, layer thickness and number of layers significantly hinder conventional recycling processes, leading most MPPW to be disposed of through landfilling or incineration. This study presents the development and optimization of a dissolution–precipitation process using toluene to recover polyethylene (PE) from MPPW. The proposed method successfully produced PE with less than 5 wt% polypropylene (PP), meeting common recycling quality requirements. Design of experiments (DoEs) combined with response surface methodology (RSM) was applied to evaluate the influence of key operating parameters, including temperature, dissolution time, solvent to waste ratio and agitation speed, to identify optimal processing conditions. The results demonstrated that temperature had the most significant influence on both dissolution yield and polymer purity. Optimal conditions of 100 °C, 30 min, 400 rpm, and a solvent-to-waste ratio of 15 mL/g resulted in a total recovery yield of 39.1% with a polymer composition of 97.7 wt% PE and 2.3 wt% PP. Owing to the use of established and scalable unit operations, the process shows strong potential for industrial-scale implementation without requiring complex or specialized infrastructure.

In the recent decades many studies have been addressed in the literature to assess specific factors related to glioblastoma multiforme (GBM) invasion. However, few studies have evaluated tumour cell's interaction with specific extracellular matrix (ECM) components, and, moreover, there is a lack of information regarding the occurrence of these phenomena in paediatric GBM. ECM proteins were evaluated in six cases of paediatric GBM assessing the immunohistochemical expression of laminin, fibronectin, and type IV collagen. We used a semiquantitative scale, ranging from not detected (zero) to marked (3). Laminin expression was minimal in three cases, moderate in one case, marked and generalised in one patient and marked and focal in the last case. Fibronectin expression was minimal in three patients; moderate immunoreactivity was documented in one case. Conversely, one case was classified as marked with generalised distribution and the remaining case as marked with focal immunostaining. Type IV collagen expression was minimal in three cases, moderate in one, marked with focal reaction in one and marked with generalised reaction in the remaining case. This study provides additional insights into tumour invasion features of paediatric GBM, as ECM plays a pivotal role in numerous cellular functions during normal and pathological processes. Although based on a limited number of patients, this investigation may serve as a challenge for the management of paediatric GBM, stimulating trials with larger patient numbers aimed at documenting specific factors influencing GBM prognosis.

Mutism is an infrequent and transitory complication observed following posterior fossa surgery. Patients become mute in the immediate postoperative period, with restoration of speech within a few weeks in the absence of additional neurological alterations. The anatomical structures thought to be involved are the connections between the cerebellar dentate nucleus, the ventrolateral nucleus of the contralateral thalamus and the supplementary motor area. In an attempt to understand the pathophysiology of this syndrome, and to depict the perfusion of different brain areas semiquantitatively, in two children who had become mute after posterior fossa surgery we performed a Tc99M-HM-PAO SPECT study during the period of mutism and again when normal speech had returned. In one patient, who had a left cerebellar astrocytoma, the SPECT study showed a marked reduction of cerebral perfusion in the right fronto-parietal region, and in the other, who had a medulloblastoma, a left fronto-temporo-parietal perfusion alteration was observed. When the patients regained normal speech, the follow-up SPECT studies revealed normalization of the cerebral perfusion. This study demonstrates the occurrence of a focal dysfunction of cerebral perfusion in children with cerebellar mutism after posterior fossa surgery. These observations are useful in extending our understanding of the pathophysiology of this postoperative clinical syndrome.