Coverage of exposed hardware after lower leg fractures with free flaps or pedicled flaps

Abstract. – OBJECTIVE: The placement of osteosynthetic materials in the leg may be complicated by hardware exposure. Successful soft tissue reconstruction often provides a critical means for limb salvage in patients with hardware exposure in the leg. Free flaps are currently considered the standard surgical procedure for soft tissue coverage of the wounds with internal hardware exposure. However, to date, no conclusive literature shows the superiority of a specific type of flap. MATERIALS AND METHODS: The current review compares data from the literature concerning outcomes and complications of free and pedicled flaps for exposed osteosynthetic material preservation in the leg. RESULTS: A total of 81 cases from twelve different articles presenting internal hardware exposure of the leg were analyzed in our study. Thirty-two patients underwent immediate reconstructive surgery with pedicled flaps, while forty-nine patients underwent free flap reconstruction. The overall survival rate for pedicled flaps was 96.77%, while for free flaps it was 97.77%. The overall implant preservation rate was 78.12% for pedicled flaps and 53.33% for free flaps. With reference to postoperative complications, the overall complication rate was 46.87% for pedicled flaps and 10.20% for free flaps. CONCLUSIONS: No significant difference was found in terms of overall flap survival. However, a significant difference was found regarding successful implant preservation (78.12% in the pedicled flap group vs. 53.33% in the free flap group). In particular, the first observation appears to be in contrast with the current trend of considering the free flaps the first choice procedure for soft tissue coverage of the wounds with internal hardware exposure. Nevertheless, a higher occurrence of postoperative complications was observed in the pedicled flap group (46.87% vs. 10.20%). The choice of the most appropriate reconstructive procedure should take into account several issues including the size of the wounds with internal hardware exposure, the possibility of soft tissue coverage with pedicled flaps, the availability of recipient vessels, general conditions of the patients (such as age, diabetes, smoking history), patients’ preference and presence of a microsurgical team. However, according to the results of this review, we believe that pedicled flap reconstruction should be reconsidered as a valid alternative procedure for skin tissue loss with hardware exposure whenever it is possible

Precision measurement of gravity with cold atoms in an optical lattice and comparison with a classical gravimeter

We report on a high precision measurement of gravitational acceleration using ultracold strontium atoms trapped in a vertical optical lattice. Using amplitude modulation of the lattice intensity, an uncertainty $\Delta g /g \approx 10^{-7}$ was reached by measuring at the 5$^{th}$ harmonic of the Bloch oscillation frequency. After a careful analysis of systematic effects, the value obtained with this microscopic quantum system is consistent with the one we measured with a classical absolute gravimeter at the same location. This result is of relevance for the recent interpretation of related experiments as tests of gravitational redshift and opens the way to new tests of gravity at micrometer scale.Comment: 4 pages, 4 figure

High-precision spectroscopy of ultracold molecules in an optical lattice

The study of ultracold molecules tightly trapped in an optical lattice can expand the frontier of precision measurement and spectroscopy, and provide a deeper insight into molecular and fundamental physics. Here we create, probe, and image microkelvin $^{88}$Sr$_2$ molecules in a lattice, and demonstrate precise measurements of molecular parameters as well as coherent control of molecular quantum states using optical fields. We discuss the sensitivity of the system to dimensional effects, a new bound-to-continuum spectroscopy technique for highly accurate binding energy measurements, and prospects for new physics with this rich experimental system.Comment: 12 pages, 4 figure

Oncoplastic conservative surgery for breast cancer: long-term outcomes of our first ten years experience

The main goal of oncoplastic breast surgery (OBS) is to optimize cosmetic outcomes and reduce patient morbidity, while still providing an oncologically-safe surgical outcome and extending the target population of conservative surgery. Although the growing number of reported experiences with oncoplastic surgery, few studies account for the long-term outcomes

Oncological safety of stromal vascular fraction enriched fat grafting in two-stage breast reconstruction after nipple sparing mastectomy: long-term results of a prospective study

OBJECTIVE: Autologous fat transfer (AFT) is commonly used to treat implant palpability and prevent fibrosis and thinning in mastectomy skin flaps. A major limit to this procedure is volume retention over time, leading to the introduction of fat enrichment with stromal vascular fraction (SVF+AFT). Oncological concerns have been raised over the injection of an increased concentration of progenitors cells (ASCs) in the SVF. The aim of the study is to evaluate the long-term cancer recurrence risk of SVF+AFT cases compared to AFT, in patients undergoing Nipple Sparing Mastectomy (NSM). PATIENTS AND METHODS: A prospective study was designed to compare three groups of patients undergoing NSM followed by SVF+AFT, AFT or none (control group), after a two-stage breast reconstruction. Patients were strictly followed-up for at least 5-years from the second stage reconstructive procedure. Loco-regional and systemic recurrence rate were evaluated over time as the primary outcome. Logistic regression was used to investigate which factors were associated with recurrence events and independent variables of interest were: surgical technique, age above 50 years old, lympho-vascular invasion, oncological stage, adjuvant or neoadjuvant chemotherapy, adjuvant radiotherapy and adjuvant hormone therapy. RESULTS: 41 women were included in G1 (SVF+AFT), 64 in G2 (AFT), and 64 in G3 (control group). Loco-regional recurrence rate was 2.4% for G1, 4.7% for G2, and 1.6% for G3. Systemic recurrence was 7.3%, 3.1%, and 3.1%, respectively. Among the variables included, there were no significant risk factors influencing a recurrence event, either loco-regional or systemic. In particular, SVF+AFT (G1) did not increase the oncological recurrence. CONCLUSIONS: Our data suggest that both centrifuged and SVF-enhanced fat transfer have a similar safety level in comparison to patients who did not undergo fat grafting in breast reconstruction after NSM

Analysis of spin-squeezing generation in cavity-coupled atomic ensembles with continuous measurements

We analyze the generation of spin-squeezed states via coupling of three-level atoms to an optical cavity and continuous quantum measurement of the transmitted cavity field in order to monitor the evolution of the atomic ensemble. Using analytical treatment and microscopic simulations of the dynamics, we show that one can achieve significant spin squeezing, favorably scaling with the number of atoms N. However, contrary to some previous literature, we clarify that it is not possible to obtain Heisenberg scaling without the continuous feedback that is proposed in optimal approaches. In fact, in the adiabatic cavity removal approximation and large N limit, we find the scaling behavior N - 2 / 3 for spin squeezing and N - 1 / 3 for the corresponding protocol duration. These results can be obtained only by considering the curvature of the Bloch sphere, since linearizing the collective spin operators tangentially to its equator yields inaccurate predictions. With full simulations, we characterize how spin-squeezing generation depends on the system parameters and departs from the bad cavity regime, by gradually mixing with cavity-filling dynamics until metrological advantage is lost. Finally, we discuss the relevance of this spin-squeezing protocol to state-of-the-art optical clocks

An accurate approach for computational pKa determination of phenolic compounds

Computational chemistry is a valuable tool, as it allows for in silico prediction of key parameters of novel compounds, such as pKa. In the framework of computational pKa determination, the literature offers several approaches based on different level of theories, functionals and continuum solvation models. However, correction factors are often used to provide reliable models that adequately predict pKa. In this work, an accurate protocol based on a direct approach is proposed for computing phenols pKa. Importantly, this methodology does not require the use of correction factors or mathematical fitting, making it highly practical, easy to use and fast. Above all, DFT calculations performed in the presence two explicit water molecules using CAM-B3LYP functional with 6-311G+dp basis set and a solvation model based on density (SMD) led to accurate pKa values. In particular, calculations performed on a series of 13 differently substituted phenols provided reliable results, with a mean absolute error of 0.3. Furthermore, the model achieves accurate results with -CN and -NO2 substituents, which are usually excluded from computational pKa studies, enabling easy and reliable pKa determination in a wide range of phenols

On the usability of augmented reality devices for interactive risk assessment

The use of Augmented Reality (AR) technologies is the new challenge of management models born under the “Industry 4.0” paradigm. The aim of the work is to evaluate the usability of two types of AR devices (tablet and see-through) employed in the training and information activities of workers according to the ISO/IEC 9126 and ISO 9241 standards. Starting from the state of the art, evaluating market and competitors and developing different concepts of interfaces, a dedicated application was programmed and, then, the usability of such devices for the professional figures involved was evaluated through experimental tests. Two reference scenarios were defined, the Department of Industrial Engineering of University of Naples Federico II and INAIL (National Institute for Insurance against Accidents at Work) laboratories, an user interface was designed and developed, as an aid in the drafting of the document for risk evaluation and subsequent training of workers. The activity is part of the IDEE Project (Interactive Design for Ergonomics), born by the collaboration between Joint Lab IDEAS and Contarp-INAIL-Regional Management for Campania. The data analysis allowed to evaluate the goodness of the devices and the degree of satisfaction in their use on the basis of the sample of users who conducted the tests. The use of AR devices produces better results than paperwork in terms of efficiency and effectiveness, but not all devices produce appreciable results in terms of user satisfaction. Although AR technologies are mature, the tasks need to be carefully defined to avoid rejection phenomena. The strong expectation, that they generate in potential users, risks to remain disappointed today for some usability limits found in currently available devices. It is necessary to start testing in pilot applications in various industrial fields in order to capture in time and adequately support this opportunity of innovation in Italy