Medial Sural Perforator "Nerve through Flap": Anatomical Study and Clinical Application

Background: Nerve recovery after a complex trauma is affected by many factors and a poorly vascularized bed is often the cause of failure and perineural scar. Many techniques have been devised to avoid this problem and the possibility to transfer a nerve with a surrounding viable sliding tissue could help in this purpose; Methods: We performed an anatomic study on 8 injected specimens to investigate the possibility to raise a medial sural artery perforator (MSAP) flap including the sural nerve within its vascularized sheath; Results: In anatomic specimens, a visible direct nerve vascularization was present in 57% of legs (8 out of 14). In 43% a vascular network was visible in the fascia layer. There were no vascular anomalies. In one patient the MSAP flap was raised including the sural nerve with its proximal tibial and peroneal components within the deep sheath. The tibial and peroneal component of the sural nerve were anastomized independently with the common digital nerve of 4th and 5th fingers and with the collateral nerve for the ulnar aspect of the 5th. After 9 months, the patient showed an improving nerve function both clinically and electromyographically without any problem due to nerve adherence; Conclusions: Given the still debated advantage of a vascularized nerve graft versus a non-vascularized one, this flap could be useful in those cases of composite wounds with nerve lesions acting as a "nerve through flap", in order to reduce nerve adherence with a viable surrounding gliding tissue

Outdoor Comfort: The ENVI-BUG tool to Evaluate PMV Values Output Comfort Point by Point

Abstract Studies on Outdoor Comfort in urban open spaces adopt several tools and software to simulate microclimate models, energy performances and the fluid-dynamics of winds. Air temperature, wind speed, relative humidity are the typical input data used by the software to evaluate comfort indexes such as the Predicted Mean Vote [PMV], the Physiological Effective Temperature [PET] or the Universal Thermal Climate Index [UTCI]. Among the available software, Envi-met provides accurate outputs as well as the PMV index space distribution starting from a three-dimensional microclimate model. However it is affected by some limitations for what concerns a user centered approach including the changes in human metabolic activity (met) or clothes (clo). This paper offers a synthesis of a study performed on ENVI-BUG, an Envi-met algorithmic app, to obtain a fast calculation and distribution of local PMV point-by-point displayed with mannequin representation

Global second-order estimates in anisotropic elliptic problems

We deal with boundary value problems for second-order nonlinear elliptic equations in divergence form, which emerge as Euler-Lagrange equations of integral functionals of the Calculus of Variations built upon possibly anisotropic norms of the gradient of trial functions. Integrands with non polynomial growth are included in our discussion. The $W^{1,2}$-regularity of the stress-field associated with solutions, namely the nonlinear expression of the gradient subject to the divergence operator, is established under the weakest possible assumption that the datum on the right-hand side of the equation is a merely $L^2$-function. Global regularity estimates are offered in domains enjoying minimal assumptions on the boundary. They depend on the weak curvatures of the boundary via either their degree of integrability or an isocapacitary inequality. By contrast, none of these assumptions is needed in the case of convex domains. An explicit estimate for the constants appearing in the relevant estimates is exhibited in terms of the Lipschitz characteristic of the domains, when their boundary is endowed with H\"older continuous curvatures

Transient spectroscopy of the reaction of cyanide with ferrous myoglobin: Effect of distal side residues

The reaction of cyanide metmyoglobin with dithionite conforms to a two-step sequential mechanism with formation of an unstable intermediate, identified as cyanide bound ferrous myoglobin. This reaction was investigated by stopped-flow time resolved spectroscopy using different myoglobins, i.e. those from horse heart, Aplysia limacina buccal muscle, and three recombinant derivatives of sperm whale skeletal muscle myoglobin (Mb) (the wild type and two mutants). The myoglobins from horse and sperm whale (wild type) have in the distal position (E7) a histidyl residue, which is missing in A. limacina Mb as well as the two sperm whale mutants (E7 His----Gly and E7 His----Val). All these proteins in the reduced form display an extremely low affinity for cyanide at pH less than 10. The differences in spectroscopy and kinetics of the ferrous cyanide complex of these myoglobins indicate a role of the distal pocket on the properties of the complex. The two mutants of sperm whale Mb are characterized by a rate constant for the decay of the unstable intermediate much faster than that of the wild type, at all pH values explored. Therefore, we envisage a specific role of the distal His (E7) in controlling the rate of cyanide dissociation and also find that this effect depends on the protonation of a single ionizable group, with pK = 7.2, attributed to the E7 imidazole ring. The results on A. limacina Mb, which displays the slowest rate of cyanide dissociation, suggests that a considerable stabilizing effect can be exerted by Arg E10 which, according to Bolognesi et al. (Bolognesi, M., Coda, A., Frigerio, F., Gatti, C., Ascenzi, P., and Brunori, M. (1990) J. Mol. Biol. 213, 621-625), interacts inside the pocket with fluoride bound to the ferric heme iron. A mechanism of control for the rate of dissociation of cyanide from ferrous myoglobin, involving protonation of the bound anion, is discussed

On the Implementation of a regional X-bandweather radar network

In the last few years, the number of worldwide operational X-band weather radars has rapidly been growing, thanks to an established technology that offers reliability, high performance, and reduced efforts and costs for installation and maintenance, with respect to the more widespread C- and S-band systems. X-band radars are particularly suitable for nowcasting activities, as those operated by the LaMMA (Laboratory of Monitoring and Environmental Modelling for the sustainable development) Consortium in the framework of its institutional duties of operational meteorological surveillance. In fact, they have the capability to monitor precipitation, resolving very local scales, with good spatial and temporal details, although with a reduced scanning range. The Consortium has recently installed a small network of X-band weather radars that partially overlaps and completes the existing national radar network over the north Tyrrhenian area. This paper describes the implementation of this regional network, detailing the aspects related with the radar signal processing chain that provides the final reflectivity composite, starting from the acquisition of the signal power data. The network performances are then qualitatively assessed for three case studies characterised by different precipitation regimes and different seasons. Results are satisfactory especially during intense precipitations, particularly regarding what concerns their spatial and temporal characterisation

COVID-19 Vaccination Campaign Among Migrants in Rome and the Emilia-Romagna Region: Intercultural mediation and vaccine hesitancy

The migrant1 population in Italy constantly increased in the first two decades of the 21st century, reaching 5 million on 1 January 20202 . Italian legislation guarantees foreign residents full access to vaccines, as the right to health is enshrined in the sistema sanitario nazionale universalistico, universal access national healthcare system. Vaccine equality is linked to legal residency (Law 40/1998) not citizenship status. However, on 3 February 2021, the Agenzia Italiana del Farmaco (AIFA, Italian Medicines Agency) stated that vaccination rights extended to all residents regardless of their migrant or residency status. Therefore, the 2021-2022 COVID-19 vaccination campaign targeted everybody living in Italy, national and foreign residents. The principle of equal healthcare access, however, was not easy to implement in practice. For migrants to be able to fully benefit from healthcare, they also need reliable medical information in a language, format, and channel of communication to which migrants have access3 . Across Europe, migrant languages have been considered among the factors contributing to low rates of vaccine uptake4. In Italy, local health authorities at regional level (azienda, or azienda unità sanitaria locale) adopted different approaches to disseminate information about the COVID-19 vaccination campaign to members of migrant communities (including irregular migrants). On 12 May 2021, the Società Italiana di Medicina delle Migrazioni (SIMM, Italian Society of Migration Medicine) denounced serious issues on several regional online platforms that were used to book the vaccination. Online booking forms demanded proof of residency defined as ‘regularly present’ (stabilmente presenti) even though, in February, AIFA had reiterated that healthcare codes assigned to migrants who were ‘temporarily present’ (STP, stranieri temporanemente presenti) were legally sufficient to access COVID-19 vaccination. On the platform, the rule of law was contradicted by the bureaucratic requests. Practical issues and confusing information created vaccine inequality at point of access, and may have contributed to increasing vaccine hesitancy among migrants in Italy. Combined with limited proficiency in Italian, which may have prevented many from navigating these bureaucratic issues, there was a concrete risk of exclusion from the vaccination campaign. Other factors, such as distrust in the authorities and/or medical communities, or the influx of scientifically inaccurate information in their native language through social media, led some migrants to opt out of vaccination. The STRIVE project, whose findings are reported here, aimed to understand whether effective translation practices can contribute to reducing the impact of linguistic differences as factors determining lower rates of vaccine uptake among migrants in Italy. To address the research question, the STRIVE team carried out 33 interviews. Interviewees included personnel of civil society organisations and personnel of local health authorities (ASLs, AUSLs) who organised language mediation for local migrant communities, as well as translators, interpreters, and intercultural mediators. The researchers analysed language access policies, and evaluated quantitative data on migrants’ preferred languages, as distributed in Rome and the Emilia-Romagna Region. Information about language distribution was necessary to compare and contrast local language needs, provision, and budgeting issues with the language mediation.5 Rome and the Emilia Romagna region host similar numbers of migrant residents; their migrant population combined adds up to over 1 million and represents 20% of the national total. The STRIVE team was able to evaluate and compare approaches in rural, semi-urban, and urban areas, which have shown different levels of testing, infection, and vaccine hesitancy.