Early and long-term results of pectoralis muscle flap reconstruction vs sternal rewiring following failed sternal closure.

OBJECTIVES: The aim of the study was to compare early and long-term results of pectoralis muscle flap reconstruction with those of sternal rewiring following failed sternal closure. Primary outcomes of the study were survival and failure rate. Respiratory function, chronic pain and quality of life were also evaluated. METHODS: In a propensity-score matching analysis, of 94 patients who underwent sternal reconstruction, 40 were selected; 20 underwent sternal reconstruction with bilateral pectoralis muscle flaps (Group 1) and 20 underwent sternal rewiring (Group 2). Survival and failure rates were evaluated by in-hospital records and at follow-up. Respiratory function measures, including vital capacity (VC), were evaluated both by spirometry and computed tomography (CT) volumetry. Chronic pain was evaluated by the visual analogue pain scale. RESULTS: At 85 ± 24 months of follow-up, survival and procedure failure were 95 and 90% in Group 1 and 60 and 55% in Group 2, respectively (P < 0.01, for both comparisons). Based on CT-scan volumetry, in Group 1, severe non-union and hemisternal paradoxical movement occurred less frequently (2 vs 7, P = 0.01). At spirometry assessment, postoperative VC was greater in Group 1 (3220 ± 290 vs 3070 ± 290 ml, P = 0.04). The same trend was detected by CT-scan in-expiratory measures (4034 ± 1800 vs 3182 ± 862 mm3, P < 0.05). Correspondingly, in Group 1, less patients presented in NYHA Class III (P < 0.05), and both chronic persistent pain score and physical health quality-of-life score were significantly better in the same group. CONCLUSIONS: In our study, muscle flap reconstruction guaranteed better early and late-term results as shown by lower rates of mortality, procedure failure and hemisternum stability. Moreover, Group 1 patients had greater postoperative VC, lower NYHA class and better quality of life. These results suggest that, in patients with multiple bone fracture, the rewiring approach does not promote physiological bone consolidation, whereas the muscle flap reconstruction can assure more physiological ventilatory dynamics

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P &lt; .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

The biocultural evolution in the Osmore valley. Morphological dental traits in pre-inca populations

The Osmore (Moquegua) Valley, in the South Central Andes, has an extremely varied history of human occupation that goes back at least 12,000 years (Rice, 1989). The discovery, over the past decades, of a considerable number of Chinchorro, Tiwanaku, and Chiribaya mummies has triggered an extensive investigation of the cultural and genetic changes that took place in the valley in pre-Inca times (Blom, 2005; Blom et al., 1998; Lozada, 1998; Moraga et al., 2005; Sutter, 1997, 2000, 2005; Sutter and Mertz, 2004). These studies resulted in the formulation of different hypotheses that were aimed at accounting for the diversity and diffusion of the material culture throughout the region (Rostworowsky, 1977; Browman, 1980, 1984; Dillehay and Nuñez, 1988; Sutter, 2000). The most widely accepted hypothesis is the spread of ethnically diverse colonists from the Tiwanaku Empire, which occupied many areas of the Upper Osmore Valley, establishing permanent settlements like Chen Chen and Omo (Goldstein, 2013; Sutter and Sarrat, 2010). Archaeological evidence seems to indicate that the culturally and ethnically diverse Tiwanaku colonists had established relationships with the valley’s indigenous populations (Goldstein, 2013). Conversely, the fewer Wari outposts in the valley, such as Cerro Baul (Nash and Williams, 2005; Williams, 2001), seem not to have instituted cultural relationships with their neighboring communities

INFLUENCE OF CHEMOSENSORY IMPAIRMENT ON INTAKE AND LIKING OF A FUNCTIONAL DRINK IN UNDERNOURISHED INSTITUTIONALIZED ELDERLY PEOPLE

Age-related chemosensory impairments (i.e., reduction of taste and smell acuity) affect a large proportion of the population older than 65 years. These conditions can affect overall health, quality of life and influence food appreciation and intake. The knowledge about the relation between chemosensory perception and hedonic food liking in older people might facilitate the development of effective strategies aiming to improve their nutritional wellbeing. Objectives: The key objective of this study is to test the influence of a sensory compensatory strategy on liking and intake of a functional red fruit drink in undernourished nursing home elderly people. Design: The research consisted of three main phases. In the first step the enrolled subjects were classified on the basis of their taste and olfaction sensitivity; in the second step the sensory compensatory strategy, aiming to counteract age-associated sensory losses and increase product pleasantness, was identified; the last step consisted of 14 days of exposure to each drink variant (standard and enhanced) to observe the effects of sensory modifications on liking and intake. Setting: “Villa delle Querce” Clinical Rehabilitation Institute of Nemi (Rome- Italy). Participants: 76 elderly people (64-97 years). Results: Overall the prevalence of measured chemosensory impairments in this sample of institutionalized older adults was very high (81%). The sensory modification strategy did influence significantly neither the intake nor liking in the elderly people. Consistent with the findings of previous studies (3, 6, 24, 25) no significant correlation was found between sensory capabilities and hedonic responses. Conclusion: These findings highlight that, in accordance to other studies (2, 3, 6-8), the role of sensory compensatory strategies in increasing products appreciation and intake of institutionalized elderly people have been overestimated