Predictive and Protective Factors for Partial Necrosis in DIEP Flap Breast Reconstruction. Does Nulliparity Bias Flap Viability?

Although success rate of deep inferior epigastric perforator (DIEP) flap breast reconstruction has greatly improved, complications still occasionally occur. Perfusion-related complications (PRCs) (ie, fat necrosis and partial flap necrosis) are the most frequent concern, affecting aesthetic final result of the reconstructed breast.The aim of our study was to retrospectively investigate 287 consecutive DIEP flap breast reconstructions to investigate predictive and protective factors for PRCs.From May 2004 to February 2012, 287 DIEP flap breast reconstructions were performed on 270 patients; 247 unilateral flaps, including Holm vascular zones I to III, were retrospectively selected and analyzed. Tobacco use, mean blood pressure over the first postoperative 48 hours, superficial epigastric vein drainage, medial/lateral row perforator, nulliparity, crystalloid versus combined crystalloid/colloid intravenous fluid infusion therapy, and learning curve were evaluated by univariate and multivariate logistic regression analyses.Perfusion-related complications occurred 32 (12.9%) times, 79 (31.9%) patients were smokers, 48 (19.4%) showed postoperative mean blood pressure less than 75 mm Hg, 29 (11.7%) were nulliparous, and 173 (70%) had superficial epigastric vein drainage. Selected perforators were 110 (44.5%) from lateral row, 137 (55.5%) from medial row; 91 (36.8%) received crystalloid fluid infusion, whereas 156 (63.2%) combined crystalloid/colloid fluid infusion. From univariate analysis emerged significance of nulliparity, perforator row and intravenous fluid infusion for PRC. Nevertheless, multivariate model confirmed only nulliparity as a significant risk factor (P = 0.029), although variable correlations to other predictors were found: both medial row perforator and combined crystalloid/colloid fluid infusion potentially decrease the PRC risk of 11.6% and 27.6%, respectively. Learning curve did not show significant decrease of PRC risk over time.Our study first proved nulliparity as a statistically significant predictor for PRCs in DIEP flap breast reconstruction, possibly due to different superficial abdominal perfusion between pluriparous and nulliparous women, with potential weaker pattern of perforators and smaller angiosomes in the latter. The choice of medial row perforators and combined crystalloid/colloid fluid infusion might reduce PRC risk

Public Reporting as a Communication Tool to Aid Vulnerable Consumers in Healthcare Decisions: What Do We Know?

Background/Introduction: There is tremendous variation in quality, healthcare service utilization and disparities experienced by the poor, certain minorities, and other priority populations. Public reporting is identified as one method of bringing these differences to light and by informing consumers through documented comparison of provider performance to influence change and encourage improvement in healthcare. The federal Accountable Care Act has the stated mandate “to improve the dissemination of measures of healthcare quality and resource use, (and) to build the science of public reporting.” However, early studies on the design and use of consumer reports cite the public’s confusion and lack of understanding regarding the utility of such reports. Objectives: 1. Determine if public reporting is being utilized in making healthcare decisions: by vulnerable consumers defined as African American, Latino and White populations who are Medicare beneficiaries by vulnerable consumers with chronic diseases such as diabetes 2. Determine the gaps in knowledge of healthcare public reports utilization by vulnerable populations 3. Identify barriers and facilitators to help vulnerable diabetic populations make informed decisions about personal healthcare services Methods: A systematic review of the literature was conducted of relevant databases, reports, books, websites, and grey literature. Conclusions/Lessons Learned: While consumer reports are designed for consumers, consumers rarely use them and seem unaware of the availability of such reports. Little evidence that reports are designed for vulnerable populations. Much work needed to assist consumers in using consumer reports

Narrazioni affettive nella gestione del diabete di tipo 1. Studio pilota di una triade familiare

Il diabete mellito tipo 1 è una malattia cronica dovuta ad un disordine metabolico ad eziologia multipla. Definita da Bury (2005) come una “discordanza biografica”, il suo trattamento si basa sul coinvolgimento attivo delle famiglie e rende necessario una riorganizzare della vita quotidiana del paziente e della famiglia. Lo studio ha lo scopo di analizzare le interazioni di una triade familiare in termini di modalità enabling (facilitante) e constraining (ostacolante) e l’influenza sulla salute del ragazzo di queste modalità comunicative. Gli strumenti self report, come la Scala degli ambiti di discussione familiari (Gambini, 2008) per il tema scelto e il Sample Diabetes Questionnaire (SDQ) dello Stanford Patient Education Research Center (2007), per la salute del paziente, hanno affiancato lo strumento Constraining and Enabling Coding System (CECS; Hauser, et al.1991 adattato da Chiarolanza, et al. 2016) per le analisi dell’interazione videoregistrata di una triade familiare. Dall’analisi delle interazioni emerge che le forme comunicative nella triade si orientano verso modalità comunicative della dimensione cognitiva vincolante. Questo sembra interferire sul monitoraggio della glicemia e sul rapporto del figlio col medico. La modalità con cui i membri di una triade riescono a coordinarsi o non, dunque, durante un’interazione sembra avere effetti sulla salute dell’adolescente sia declinata come qualità delle relazioni familiari che di benessereThe type 1 diabetes mellitus is a chronic disease caused by a metabolic disorder with multiple etiologies. Defined by Bury (2005) as a "biographical disagreement ", its treatment is based on the active involvement of families and makes it necessary to reorganize both patient daily life and his/her family one. This paper aims to analyze the interactions of a family triad in terms of enabling and constraining style and how this type of communication has an impact on the child health. We utilized for this study self-report questionnaires and Constraining and Enabling Coding System (CECS; Hauser, et al.,1991 adapted by Chiarolanza, et al., 2016) for analysis of a family triad interaction. Results showed that interactive communication in the triad are oriented towards constraining cognitive dimension. This could interfere with blood glucose monitoring and the patient relationship with integrated team care. Members of a triad can coordinate or not during a family interaction and this could have effects on adolescent health in terms of quality of family relationships and well bein

THE EMOTIONAL IMPACT OF THE OPERATOR IN THE CARE OF PATIENTS WITH MENTAL DISORDERS DURING THE PANDEMIC: AND BURN-OUT

Background: The continuation of the health emergency due to the management of COVID-19 is having a profound effect on all aspects of society, including mental health and physical health. This observational study examined practitioners of psychiatric rehabilitation and therapeutic communities, focusing on the emotional aspects of patient care, in particular the fatigue of compassion, empathy and lack of hope, aspects that could be directly linked to the burnout of health professionals, as found in other similar studies. Method: In this study, self-administered scale data was collected in 87 healthcare professionals recruited from 3 different psychiatric rehabilitation communities. In particular, we assessed the fatigue of compassion, vicarious trauma, burnout and hope (hopeless), empathy and depressive symptoms in the two months of May and June 2021. Results: The results obtained after the administration of the following rating scales, ProQOL, BHS, SAVE-9, BDI-II and BEES, showed an overall increase in scores in all professional figures, a significant fatigue of compassion, while the percentage burnout is not present in several groups. The presence of high levels of hope, satisfaction of compassion is indicative of a moderate level of empathy in some professional figures; these high levels can protect workers from the risk of developing work-related stress and depressive symptoms. Conclusions: The data obtained with this study are not similar to those of previous studies, although they may indicate the importance of factors such as hope, empathy in the care of the patient with psychic disorders in rehabilitation communities, underlining the need for interventions aimed at the emotional management of the care relationship as a tool to improve care and prevent burnout even during times of high stress, such as managing a pandemic

THE EMOTIONAL IMPACT OF THE OPERATOR IN THE CARE OF PATIENTS WITH MENTAL DISORDERS DURING THE PANDEMIC: AND BURN-OUT

Background: The continuation of the health emergency due to the management of COVID-19 is having a profound effect on all aspects of society, including mental health and physical health. This observational study examined practitioners of psychiatric rehabilitation and therapeutic communities, focusing on the emotional aspects of patient care, in particular the fatigue of compassion, empathy and lack of hope, aspects that could be directly linked to the burnout of health professionals, as found in other similar studies. Method: In this study, self-administered scale data was collected in 87 healthcare professionals recruited from 3 different psychiatric rehabilitation communities. In particular, we assessed the fatigue of compassion, vicarious trauma, burnout and hope (hopeless), empathy and depressive symptoms in the two months of May and June 2021. Results: The results obtained after the administration of the following rating scales, ProQOL, BHS, SAVE-9, BDI-II and BEES, showed an overall increase in scores in all professional figures, a significant fatigue of compassion, while the percentage burnout is not present in several groups. The presence of high levels of hope, satisfaction of compassion is indicative of a moderate level of empathy in some professional figures; these high levels can protect workers from the risk of developing work-related stress and depressive symptoms. Conclusions: The data obtained with this study are not similar to those of previous studies, although they may indicate the importance of factors such as hope, empathy in the care of the patient with psychic disorders in rehabilitation communities, underlining the need for interventions aimed at the emotional management of the care relationship as a tool to improve care and prevent burnout even during times of high stress, such as managing a pandemic

Phenotype and genotype variation in primary carnitine deficiency

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Serum Metabolic Profile in Multiple Sclerosis Patients

Multiple sclerosis (MS) is a progressive demyelinating process considered as an autoimmune disease, although the causes of this pathology have not been yet fully established. Similarly to other neurodegenerations, MS is characterized by a series of biochemical changes affecting to different extent neuronal functions; great attention has been given to oxidative/nitrosative stress and to alterations in mitochondrial functions. According to previous data, MS patients show significant changes in the circulating concentrations of different metabolites, although it is still unclear whether uric acid undergoes to decrease, increase, or no change under this pathological condition. In this study, we report the serum metabolic profile in terms of purines, pyrimidines, creatinine, malondialdehyde, ascorbic acid, nitrite, and nitrate in a group of 170 MS patients. The results show increase in circulating uric acid and other oxypurines (hypoxanthine and xanthine), as well as in uridine and β-pseudouridine. The concomitant increase in circulating creatinine, malondialdehyde, nitrite, and nitrate, and decrease in ascorbic acid, demonstrates that MS induces alteration in energy metabolism and in oxidants/antioxidants balance that can be monitored in serum of MS patients

SGSI project at CNAF

The Italian Tier1 center is mainly focused on LHC and physics experiments in general. Recently we tried to widen our area of activity and established a collaboration with the University of Bologna to set-up an area inside our computing center for hosting experiments with high demands of security and privacy requirements on stored data. The first experiment we are going to host is Harmony, a project part of IMI's Big Data for Better Outcomes programme (IMI stands for Innovative Medicines Initiative). In order to be able to accept this kind of data we had to make a subset of our computing center compliant with the ISO 27001 regulation. In this article we will describe the SGSI project (Sistema Gestione Sicurezza Informazioni, Information Security Management System) with details of all the processes we have been through in order to become ISO 27001 compliant, with a particular focus on the separation of the project dedicated resources from all the others hosted in the center. We will also describe the software solutions adopted to allow this project to accept in the future any experiment or collaboration in need for this kind of security procedures

ProNGF Induces p75-Mediated Death of Oligodendrocytes following Spinal Cord Injury

AbstractThe neurotrophin receptor p75 is induced by various injuries to the nervous system, but its role after injury has remained unclear. Here, we report that p75 is required for the death of oligodendrocytes following spinal cord injury, and its action is mediated mainly by proNGF. Oligodendrocytes undergoing apoptosis expressed p75, and the absence of p75 resulted in a decrease in the number of apoptotic oligodendrocytes and increased survival of oligodendrocytes. ProNGF is likely responsible for activating p75 in vivo, since the proNGF from the injured spinal cord induced apoptosis among p75+/+, but not among p75−/−, oligodendrocytes in culture, and its action was blocked by proNGF-specific antibody. Together, these data suggest that the role of proNGF is to eliminate damaged cells by activating the apoptotic machinery of p75 after injury