Retrospective analysis in lower limb reconstruction : propeller perforator flaps versus free flaps

Background: Technical advancements and increasing experience in the management of soft tissue defects in lower extremities have led to the evolution of decisional reconstructive algorithms. Both propeller perforator flaps (PPFs) and free flaps (FFs) proved to be useful methods of reconstruction for lower extremities defects, offering alternative reconstructive tools. We present a case series of PPFs and FFs for reconstruction of lower limbs defects, analyzing and comparing treatment and outcomes. Methods: Through a retrospective analysis, we report our experience in performing PPFs or FFs for reconstruction of soft tissue defects of the lower extremities, in patients admitted between 2010 and 2015 at the Department of Plastic and Reconstructive Surgery, University of Palermo. In these patients, we evaluated location and causes of defects, types of flaps used, recipient vessels, complications, time to healing, and aesthetic outcome. Results: A primary healing rate was obtained in 13 patients for PPF and 16 cases for FF. Revision surgery for partial skin necrosis was required in eight cases (PPF: four and FF: four). Recovery time and hospitalization period were eventually shorter in patients with FFs, due to lower rate of complications and revision surgery. Conclusion: In the past years, our indications for reconstruction with PPFs in the lower limb have become more restricted, while we favor reconstruction with FFs. Recommendations are provided to orient surgical treatment in small, medium, and large lower limb defects

Molecular epidemiology of heteroresistant vancomycin-intermediate Staphylococcus aureus in Brazil

AbstractTo determine the epidemiological and molecular characteristics of 12 Staphylococcus aureus isolates presenting heteroresistance to vancomycin in laboratories of two cities in Santa Catarina, southern Brazil. Epidemiological data, including the city of isolation, health institution, and date of isolation were considered, as well as the associated clinical specimen. For molecular characterization, we analyzed the staphylococcal cassette chromosome types, the erm gene presence, and the genomic diversity of isolates using pulsed-field gel electrophoresis. The 12 isolates of S. aureus were previously confirmed as heteroresistance to vancomycin using the population analysis profile–area under curve. Regarding genetic variability, two clones were detected: the main one (clone A) composed of four isolates and the clones B, with two isolates. For clone A, two isolates presented identical band patterns and were related to the same hospital, with an interval of 57 days between their isolation. The other isolates of this clone showed no epidemiological link between them because they were isolated in different hospitals and had no temporal relationship. The other clone showed no detectable epidemiological relationship. The heteroresistance to vancomycin recovered in Santa Catarina State from 2009 to 2012 had, in general, heterogeneous genomic patterns based on pulsed-field gel electrophoresis results, which is in accordance with the fact that these isolates had little or no epidemiological relationship among them. Due to the characteristic phenotypic instability and often prolonged vancomycin therapy for selection, clonal spread is not as common as for other resistance mechanisms disseminated through horizontal gene transfer

Building urban climate resilience through public health: Identifying strategies for integrated public health governance in Duran, Ecuador

In the poster it is presented the Case Study of Duran, Ecuador, a coastal city of 235.000 inhabitants which are exposed to annual flooding events that increase the risk of vector-borne and other infectious diseases. Duran is an in-dustrial satellite city of Guayaquil, the largest city of Ecuador, with a rapid population growth that lead to a large area of informal settle-ments on the city. Applying an integrated climate risk management and urban health focus, it is assessed the Duran strategies for reducing vulnerability to flooding, landslides and heat waves through a collabo-rative inter-sectoral approach among the health, urban, and scientific actors. Stakeholder engagement between municipality and researchers are providing evidence and building knowledge to implement “low re-gret” adaptation strategies and community active participation

An Operational Framework for Urban Vulnerability to Floods in the Guayas Estuary Region: The Duran Case Study

Duran is a coastal city located in the Guayas Estuary region in which 24% of urban sectors suffers from the effects of chronic flooding. This study seeks to assess the causes of Duran’s vulnerability by considering exposure, population sensitivity and adaptive capacity to establish alternatives to reduce its vulnerability to flooding. An operational framework is proposed based on the vulnerability definition of the Intergovernmental Panel on Climate Change (IPCC) and applying a census-based Index of Vulnerability, a geographic information system and local knowledge of urban development. A Principal Component and equal weighting analysis were applied as well as a spatial clustering to explore the spatial vulnerability across the city. A total of 34% of the city area is mapped as having high and very high vulnerability, mostly occupied by informal settlements (e.g., 288 hectares). Underlying factors were poor quality housing, lack of city services and low adaptive capacity of the community. However, some government housing programs (e.g., El Recreo), with better housing and adaptive capacity were also highly vulnerable. Limited urban planning governance has led to the overloading of storm water and drainage infrastructure which cause chronic flooding. Understanding the underlying causes of vulnerability is critical in order develop integrated strategies that increase city resilience to climate change

By promoting cell differentiation, miR-100 sensitizes basal-like breast cancer stem cells to hormonal therapy

Basal-like breast cancer is an aggressive tumor subtype with a poor response to conventional therapies. Tumor formation and relapse are sustained by a cell subset of Breast Cancer Stem Cells (BrCSCs). Here we show that miR-100 inhibits maintenance and expansion of BrCSCs in basal-like cancer through Polo-like kinase1 (Plk1) down-regulation. Moreover, miR-100 favors BrCSC differentiation, converting a basal like phenotype into luminal. It induces the expression of a functional estrogen receptor (ER) and renders basal-like BrCSCs responsive to hormonal therapy. The key role played by miR-100 in breast cancer free-survival is confirmed by the analysis of a cohort of patients' tumors, which shows that low expression of miR-100 is a negative prognostic factor and is associated with gene signatures of high grade undifferentiated tumors. Our findings indicate a new possible therapeutic strategy, which could make aggressive breast cancers responsive to standard treatments