The Expander-Implant Breast Reconstruction in the COVID Era: Which is the “Unhappy” Tissue Expander Priority?

Breast surgeons seem to agree on the fact that a same-day surgery (mastectomy and breast reconstruction) protocol provides appropriate cancer treatment during times of unprecedented resource limitations, such as in the COVID era. In this scenario, pre-pectoral implant-based breast reconstruction can be definitively considered a sustainable technique. Nevertheless, the authors focus on the management of patients who had already undergone a same day procedure with two-stage breast reconstruction, implanting a breast tissue expander during the last two-year period and have been progressively delayed according to a surgical care based on priority. We coined the expression “unhappy tissue expander” to define all those symptomatic patients for which surgery should not be delayed even during an epidemic context. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

Tumor type M2-pyruvate-kinase levels in pleural fluid versus plasma in cancer patients: a further tool to define the need for invasive procedures

Pleural effusion is a common diagnostic problem and a challenge to the thoracic surgeon. The analysis of serum and body fluids for tumor markers is an established diagnostic procedure. Among various markers, tumors are linked to the overexpression of a glycolytic isoenzyme, M2-pyruvate-kinase (M2-PK). This preliminary study evaluated this enzyme as a tumor marker to differentiate malignant from benign pleural effusion

Spitzer-MIPS survey of the young stellar content in the Vela Molecular Cloud-D

A new, unbiased Spitzer-MIPS imaging survey (~1.8 square degs) of the young stellar content of the Vela Molecular Cloud-D is presented. The survey is complete down to 5mJy and 250mJy at 24micron (mu) and 70mu, respectively. 849 sources are detected at 24mu and 52 of them also have a 70mu counterpart. The VMR-D region is one that we have already partially mapped in dust and gas millimeter emission, and we discuss the correlation between the Spitzer compact sources and the mm contours. About half of the 24mu sources are located inside the region delimited by the 12CO(1-0) contours (corresponding to only one third of the full area mapped with MIPS) with a consequent density increase of about 100% of the 24mu sources [four times for 70mu ones] moving from outside to inside the CO contours. About 400 sources have a 2MASS counterpart. So we have constructed a Ks vs. Ks-[24] diagram and identified the protostellar population. We find an excess of Class I sources in VMR-D in comparison with other star forming regions. This result is reasonably biased by the sensitivity limits, or, alternatively, may reflect a very short lifetime (<=10^6yr) of the protostellar content in this cloud. The MIPS images have identified embedded cool objects in most of the previously identified starless cores; in addition, there are 6 very young, possibly Class 0 objects identified. Finally we report finding of the driving sources for a set of five out of six very compact protostellar jets previously discovered in near-infrared images.Comment: 29 pages, 14 figures. To appear in Ap.

Massive star-formation toward G28.87+0.07 (IRAS 18411-0338) investigated by means of maser kinematics and radio to infrared, continuum observations

We used the Very Long Baseline Array (VLBA) and the European VLBI Network (EVN) to perform phase-referenced VLBI observations of the three most powerful maser transitions associated with the high-mass star-forming region G28.87+0.07: the 22.2 GHz H$_{2}$O, 6.7 GHz CH$_{3}$OH, and 1.665 GHz OH lines. We also performed VLA observations of the radio continuum emission at 1.3 and 3.6 cm and Subaru observations of the continuum emission at 24.5 $\mu$m. Two centimeter continuum sources are detected and one of them (named "HMC") is compact and placed at the center of the observed distribution of H$_{2}$O, CH$_{3}$OH and OH masers. The bipolar distribution of line-of-sight (l.o.s) velocities and the pattern of the proper motions suggest that the water masers are driven by a (proto)stellar jet interacting with the dense circumstellar gas. The same jet could both excite the centimeter continuum source named "HMC" (interpreted as free-free emission from shocked gas) and power the molecular outflow observed at larger scales -- although one cannot exclude that the free-free continuum is rather originating from a hypercompact \ion{H}{2} region. At 24.5 $\mu$m, we identify two objects separated along the north-south direction, whose absolute positions agree with those of the two VLA continuum sources. We establish that $\sim$90% of the luminosity of the region ($\sim$\times10^{5} L_\sun$) is coming from the radio source "HMC", which confirms the existence of an embedded massive young stellar object (MYSO) exciting the masers and possibly still undergoing heavy accretion from the surrounding envelope.Comment: Accepted for publication in Ap

The Genetic Germline Background of Single and Multiple Primary Melanomas

Background: Melanoma has a complex molecular background and multiple genes are involved in its development and progression. The advent of next generation sequencing platforms has enabled the evaluation of multiple genes at a time, thus unraveling new insights into the genetics of melanoma. We investigated a set of germline mutations able to discriminate the development of multiple primary melanomas (MPM) vs. single site primary melanomas (SPM) using a targeted next generation sequencing panel. Materials and Methods: A total of 39 patients, 20 with SPM and 19 with MPM, were enrolled in our study. Next generation analysis was carried out using a custom targeted sequencing panel that included 32 genes known to have a role in several carcinogenic pathways, such as those involved in DNA repair, pigmentation, regulation of kinases, cell cycle control and senescence. Results: We found a significant correlation between PIK3CA:p.I391M and MPMs, compared to SPMs, p = 0.031 and a trend for the association between CYP1B1: p.N453S and SPMs, compared to MPMs (p = 0.096). We also found that both subgroups shared a spectrum of 9 alterations in 8 genes (CYP1B1: p.N453S, BAP1: p.C39fs, PIK3CA: p.I391M, CDKAL1: c.1226_1227TG, POLE: p.V1161fs, OCA2: p.R419Q, OCA2: p.R305W, MC1R: p.V60L, MGMT: p.L115F), which suggested that these genes may play a role in melanoma development. Conclusions: In conclusion, despite the small cohort of patients, we found that germline mutations, such as those of PIK3CAand CYP1B1, might contribute to the differential development of SPM and MPM

The Genetic Germline Background of Single and Multiple Primary Melanomas

Background: Melanoma has a complex molecular background and multiple genes are involved in its development and progression. The advent of next generation sequencing platforms has enabled the evaluation of multiple genes at a time, thus unraveling new insights into the genetics of melanoma. We investigated a set of germline mutations able to discriminate the development of multiple primary melanomas (MPM) vs. single site primary melanomas (SPM) using a targeted next generation sequencing panel. Materials and Methods: A total of 39 patients, 20 with SPM and 19 with MPM, were enrolled in our study. Next generation analysis was carried out using a custom targeted sequencing panel that included 32 genes known to have a role in several carcinogenic pathways, such as those involved in DNA repair, pigmentation, regulation of kinases, cell cycle control and senescence. Results: We found a significant correlation between PIK3CA:p.I391M and MPMs, compared to SPMs, p = 0.031 and a trend for the association between CYP1B1: p.N453S and SPMs, compared to MPMs (p = 0.096). We also found that both subgroups shared a spectrum of 9 alterations in 8 genes (CYP1B1: p.N453S, BAP1: p.C39fs, PIK3CA: p.I391M, CDKAL1: c.1226_1227TG, POLE: p.V1161fs, OCA2: p.R419Q, OCA2: p.R305W, MC1R: p.V60L, MGMT: p.L115F), which suggested that these genes may play a role in melanoma development. Conclusions: In conclusion, despite the small cohort of patients, we found that germline mutations, such as those of PIK3CAand CYP1B1, might contribute to the differential development of SPM and MPM

Not as gloomy as we thought Reassessing how the public understands probability of precipitation forecasts

Prior research asking people to interpret probability of precipitation (PoP) forecasts showed that many of them wrongfully believe that PoP forecasts are derived from a percentage of time, a percentage of a region or the strength of agreement among forecasters. We posit that the wording of PoP interpretation tasks matters, because it is associated with different metacognitive feelings used as cues in situations of uncertainty. We hypothesised that the fluency of the correct PoP interpretation is lower than the fluency of the incorrect interpretations and will, in turn, increase preference for the incorrect interpretations. We assessed the role of fluency in correctness perception (Study 1) and reassessed PoP interpretations with a more fluent correct interpretation (Study 2). Fluency perception was positively related with perception of correctness. Furthermore, participants selected the correct fluent interpretation more often than the correct disfluent one. We have drawn a more optimistic picture of people’s PoP forecasts understanding than that shown before and have discussed the methodological and applied implications

The ketogenic diet increases in vivo glutathione levels in patients with epilepsy

The Ketogenic Diet (KD) is a high-fat, low-carbohydrate diet that has been utilized as the first line treatment for contrasting intractable epilepsy. It is responsible for the presence of ketone bodies in blood, whose neuroprotective effect has been widely shown in recent years but remains unclear. Since glutathione (GSH) is implicated in oxidation-reduction reactions, our aim was to monitor the effects of KD on GSH brain levels by means of magnetic resonance spectroscopy (MRS). MRS was acquired from 16 KD patients and seven age-matched Healthy Controls (HC). We estimated metabolite concentrations with linear combination model (LCModel), assessing differences between KD and HC with t-test. Pearson was used to investigate GHS correlations with blood serum 3-B-Hydroxybutyrate (3HB) concentrations and with number of weekly epileptic seizures. The results have shown higher levels of brain GSH for KD patients (2.5 ± 0.5 mM) compared to HC (2.0 ± 0.5 mM). Both blood serum 3HB and number of seizures did not correlate with GSH concentration. The present study showed a significant increase in GSH in the brain of epileptic children treated with KD, reproducing for the first time in humans what was previously observed in animal studies. Our results may suggest a pivotal role of GSH in the antioxidant neuroprotective effect of KD in the human brain

Beam Test Performance and Simulation of Prototypes for the ALICE Silicon Pixel Detector

The silicon pixel detector (SPD) of the ALICE experiment in preparation at the Large Hadron Collider (LHC) at CERN is designed to provide the precise vertex reconstruction needed for measuring heavy flavor production in heavy ion collisions at very high energies and high multiplicity. The SPD forms the innermost part of the Inner Tracking System (ITS) which also includes silicon drift and silicon strip detectors. Single assembly prototypes of the ALICE SPD have been tested at the CERN SPS using high energy proton/pion beams in 2002 and 2003. We report on the experimental determination of the spatial precision. We also report on the first combined beam test with prototypes of the other ITS silicon detector technologies at the CERN SPS in November 2004. The issue of SPD simulation is briefly discussed.Comment: 4 pages, 5 figures, prepared for proceedings of 7th International Position Sensitive Detectors Conference, Liverpool, Sept. 200

Strangeness enhancements at central rapidity in 40 A GeV/c Pb-Pb collisions

Results are presented on neutral kaon, hyperon and antihyperon production in Pb-Pb and p-Be interactions at 40 GeV/c per nucleon. The enhancement pattern follows the same hierarchy as seen in the higher energy data - the enhancement increases with the strangeness content of the hyperons and with the centrality of collision. The centrality dependence of the Pb-Pb yields and enhancements is steeper at 40 than at 158 A GeV/c. The energy dependence of strangeness enhancements at mid-rapidity is discussed.Comment: 15 pages, 10 figures and 3 tables. Presented at International Conference on Strangeness in Quark Matter (SQM2009), Buzios, Rio de Janeiro, Brazil, 27 Sept - 2 Oct 2009. Submitted to J.Phys.G: Nucl.Part.Phys, one reference adde