Preoperative estimation of cosmetic outcomes after immediate breast reconstruction with extended latissimus dorsi flap: A simple prediction model

Background: The extended latissimus dorsi (ELD) flap can provide adequate volume for breast reconstruction without an implant. The aim of this study was to identify a simple method to estimate preoperatively if the ELD flap would provide enough volume for breast reconstruction and good cosmetic outcome. The proposed model was based on correlating the preoperative body mass index (BMI) and breast cup size. Methods: This retrospective cohort study included 64 patients who underwent immediate breast reconstruction with ELD at the National Cancer Institute, Cairo University, between January 2014 and January 2016. Preoperative breast cup size and patients' BMI were recorded. The primary end point was cosmetic outcome score assessed by three independent breast surgeons and the patients. Correlation analysis was performed between the preoperative factors and final cosmetic outcome. Results: Sixty-four patients underwent immediate reconstruction following skin-sparing mastectomy. BMI range was 23–38 kg/m2 with a median of 28. All patients with cup size A had aesthetically pleasing results. As the breast cup size increased, the favorable cosmetic outcomes were noted with lower BMI. All patients with BMI higher than 33 had unfavorable results. Conclusion: Favorable cosmetic outcomes are expected after ELD reconstruction in patients with cup size A regardless of the BMI. As the breast cup size increases, favorable cosmetic outcomes are expected in patients with lower BMI than in those with higher BMI. At a BMI of 34, no favorable cosmetic outcomes are expected. The prediction model will be validated in a prospective study

Radio-frequency ablation as primary management of well-tolerated sustained monomorphic ventricular tachycardia in patients with structural heart disease and left ventricular ejection fraction over 30%

Aims Patients with well-tolerated sustained monomorphic ventricular tachycardia (SMVT) and left ventricular ejection fraction (LVEF) over 30% may benefit from a primary strategy of VT ablation without immediate need for a ‘back-up' implantable cardioverter-defibrillator (ICD). Methods and results One hundred and sixty-six patients with structural heart disease (SHD), LVEF over 30%, and well-tolerated SMVT (no syncope) underwent primary radiofrequency ablation without ICD implantation at eight European centres. There were 139 men (84%) with mean age 62 ± 15 years and mean LVEF of 50 ± 10%. Fifty-five percent had ischaemic heart disease, 19% non-ischaemic cardiomyopathy, and 12% arrhythmogenic right ventricular cardiomyopathy. Three hundred seventy-eight similar patients were implanted with an ICD during the same period and serve as a control group. All-cause mortality was 12% (20 patients) over a mean follow-up of 32 ± 27 months. Eight patients (40%) died from non-cardiovascular causes, 8 (40%) died from non-arrhythmic cardiovascular causes, and 4 (20%) died suddenly (SD) (2.4% of the population). All-cause mortality in the control group was 12%. Twenty-seven patients (16%) had a non-fatal recurrence at a median time of 5 months, while 20 patients (12%) required an ICD, of whom 4 died (20%). Conclusion Patients with well-tolerated SMVT, SHD, and LVEF > 30% undergoing primary VT ablation without a back-up ICD had a very low rate of arrhythmic death and recurrences were generally non-fatal. These data would support a randomized clinical trial comparing this approach with others incorporating implantation of an ICD as a primary strateg

Oncoplastic breast surgery: A guide to good practice

Oncoplastic Breast Surgery has become standard of care in the management of Breast. Cancer Patents. These guidelines written by an Expert Advisory Group; convened by the Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), are designed to provide all members of the breast cancer multidisciplinary team (MDT) with guidance on the best breast surgical oncoplastic and reconstructive practice at each stage of a patient's journey, based on current evidence. It is hoped they will also be of benefit to the wide range of professionals and service commissioners who are involved in this area of clinical practice

Rare predicted loss-of-function variants of type I IFN immunity genes are associated with life-threatening COVID-19

Background: We previously reported that impaired type I IFN activity, due to inborn errors of TLR3- and TLR7-dependent type I interferon (IFN) immunity or to autoantibodies against type I IFN, account for 15–20% of cases of life-threatening COVID-19 in unvaccinated patients. Therefore, the determinants of life-threatening COVID-19 remain to be identified in ~ 80% of cases. Methods: We report here a genome-wide rare variant burden association analysis in 3269 unvaccinated patients with life-threatening COVID-19, and 1373 unvaccinated SARS-CoV-2-infected individuals without pneumonia. Among the 928 patients tested for autoantibodies against type I IFN, a quarter (234) were positive and were excluded. Results: No gene reached genome-wide significance. Under a recessive model, the most significant gene with at-risk variants was TLR7, with an OR of 27.68 (95%CI 1.5–528.7, P = 1.1 × 10−4) for biochemically loss-of-function (bLOF) variants. We replicated the enrichment in rare predicted LOF (pLOF) variants at 13 influenza susceptibility loci involved in TLR3-dependent type I IFN immunity (OR = 3.70[95%CI 1.3–8.2], P = 2.1 × 10−4). This enrichment was further strengthened by (1) adding the recently reported TYK2 and TLR7 COVID-19 loci, particularly under a recessive model (OR = 19.65[95%CI 2.1–2635.4], P = 3.4 × 10−3), and (2) considering as pLOF branchpoint variants with potentially strong impacts on splicing among the 15 loci (OR = 4.40[9%CI 2.3–8.4], P = 7.7 × 10−8). Finally, the patients with pLOF/bLOF variants at these 15 loci were significantly younger (mean age [SD] = 43.3 [20.3] years) than the other patients (56.0 [17.3] years; P = 1.68 × 10−5). Conclusions: Rare variants of TLR3- and TLR7-dependent type I IFN immunity genes can underlie life-threatening COVID-19, particularly with recessive inheritance, in patients under 60 years old

Agrobacterium vir-inducing activities of glycosylated acetosyringone, acetovanillone, syringaldehyde and syringic acid derivatives

International audienceExpression of theAgrobacterium tumefaciens virulence (vir) gene is known to be dependent on host plant phenolic compounds. TheA. tumefaciens strain A348 (pSM358) harbouring avirE::lacZ fusion plasmid was used to detect the ability of 13 synthetic acetosyringone, acetovanillone, syringaldehyde and syringic acid β-glycosides to induce virulence. The activity of the reporter β-galactosidase was detected by spectrofluorimetry using 4-methylumbelliferyl β-galactopyranoside as substrate. Acetosyringonyl β-l-fucopyranoside was the most active monoglycoside tested; even at high concentration this compound was devoid of toxic effects. However, monoglycosides were less activevir inducers than free acetosyringone. In contrast, the β-maltoside of syringaldehyde showed higher activity than the free phenol at high concentration. The activity of such glycosylated inducers may be related to specific sugar receptors on the bacterial cell surface

Impact of successive drought and re-watering cycles on growth and specific leaf area of two Populus X canadensis (Moench) clones, 'Dorskamp' and 'Luisa_Avanzo'

International audienceResponses to successive drought and re-watering cycles (1–3 cycles) were compared in greenhouse-grown cuttings of Populus × canadensis (Moench) clones, ‘Luisa_ Avanzo’ and ‘Dorskamp.’ Total leaf number increment rate, duration of leaf expansion, total and individual leaf area expansion rates and stomatal conductance were recorded periodically during the experiment. Soil water content (SWC) and predawn leaf water potential (ØWP) were measured four times during each drought cycle. In parallel, relative leaf water content (RWC) and specific leaf area (SLA) were estimated on leaves collected from the top to bottom of each cutting. Under well-watered conditions, ‘Luisa_Avanzo’and ‘Dorskamp’differed in their patterns of leaf area expansion. Although duration of leaf expansion was similar between clones, ‘Luisa_ Avanzo’exhibited higher total leaf number increment rates and individual leaf area increases than ‘Dorskamp.’ As a result, ‘Luisa_Avanzo’ cuttings reached larger individual and total leaf areas than ‘Dorskamp.’‘Dorskamp’leaves had lower SLA than ‘Luisa_Avanzo’ leaves. In response to successive drought cycles, both clones underwent decreases in total leaf number increment rates and in total leaf area expansion rates, but both whole-plant and individual leaf areas were drastically reduced only in ‘Luisa_Avanzo.’ ‘Dorskamp’ maintained a constant leaf area as a result of an increase in the duration of leaf expansion during drought and a significant stimulation of individual leaf area expansion rate and total leaf number increment rate in response to re-watering. Drought caused a greater decrease in SLA in ‘Luisa_Avanzo’ than in ‘Dorskamp.’ Expanded leaves of ‘Dorskamp’ were constitutively dense or thick, or both, whereas leaves of ‘Luisa_Avanzo’ became dense or thick, or both, only in response to drought. In both clones, re-watering caused partial recovery of SLA to control values. Our data confirm previous field and greenhouse observations that ‘Dorskamp’ is more tolerant to successive drought and re-watering cycles than ‘Luisa_Avanzo.’We conclude that this difference is mainly attributable to the plasticity of ‘Dorskamp’ after re-watering, rather than to clonal differences in drought responses

Impact of successive drought and re-watering cycles on growth and specific leaf area of two Populus X canadensis (Moench) clones, 'Dorskamp' and 'Luisa_Avanzo'

International audienceResponses to successive drought and re-watering cycles (1–3 cycles) were compared in greenhouse-grown cuttings of Populus × canadensis (Moench) clones, ‘Luisa_ Avanzo’ and ‘Dorskamp.’ Total leaf number increment rate, duration of leaf expansion, total and individual leaf area expansion rates and stomatal conductance were recorded periodically during the experiment. Soil water content (SWC) and predawn leaf water potential (ØWP) were measured four times during each drought cycle. In parallel, relative leaf water content (RWC) and specific leaf area (SLA) were estimated on leaves collected from the top to bottom of each cutting. Under well-watered conditions, ‘Luisa_Avanzo’and ‘Dorskamp’differed in their patterns of leaf area expansion. Although duration of leaf expansion was similar between clones, ‘Luisa_ Avanzo’exhibited higher total leaf number increment rates and individual leaf area increases than ‘Dorskamp.’ As a result, ‘Luisa_Avanzo’ cuttings reached larger individual and total leaf areas than ‘Dorskamp.’‘Dorskamp’leaves had lower SLA than ‘Luisa_Avanzo’ leaves. In response to successive drought cycles, both clones underwent decreases in total leaf number increment rates and in total leaf area expansion rates, but both whole-plant and individual leaf areas were drastically reduced only in ‘Luisa_Avanzo.’ ‘Dorskamp’ maintained a constant leaf area as a result of an increase in the duration of leaf expansion during drought and a significant stimulation of individual leaf area expansion rate and total leaf number increment rate in response to re-watering. Drought caused a greater decrease in SLA in ‘Luisa_Avanzo’ than in ‘Dorskamp.’ Expanded leaves of ‘Dorskamp’ were constitutively dense or thick, or both, whereas leaves of ‘Luisa_Avanzo’ became dense or thick, or both, only in response to drought. In both clones, re-watering caused partial recovery of SLA to control values. Our data confirm previous field and greenhouse observations that ‘Dorskamp’ is more tolerant to successive drought and re-watering cycles than ‘Luisa_Avanzo.’We conclude that this difference is mainly attributable to the plasticity of ‘Dorskamp’ after re-watering, rather than to clonal differences in drought responses

Physiological traits of two Populus x euramericana clones, Luisa Avanzo and Dorskamp, during a water stress and re-watering cycle

International audienceWe compared responses to drought and re-watering of greenhouse-grown cuttings of Populus × euramericana (Dode) Guinier clones, Luisa Avanzo and Dorskamp. Total leaf area, leaf number, leaf area increment and stomatal conductance were evaluated periodically during a 29-day drought period and for 16 days after re-watering. Soil water content and predawn leaf water potential (Øwp) were measured on Days 29 and 45. On the same days, relative water content (RWC), specific leaf area (SLA), nitrogen, chlorophyll, soluble sugars, total phenols, flavanols and antioxidant activity were determined for leaves taken from the bottom to the top of each cutting. Leaves of Luisa Avanzo cuttings grew more rapidly than leaves of Dorskamp and exhibited higher SLA, but lower concentrations of nitrogen, chlorophyll and soluble sugars and lower antioxidant activity per unit area. On Day 29, after withholding water, both clones had closed their stomata, reduced rates of leaf growth, and lower Øwp and RWC; however, the clones differed in their responses to soil water depletion. Compared to Dorskamp, Luisa Avanzo closed its stomata earlier and maintained higher Øwp, but lower RWC and leaf sugar concentrations. Antioxidant activity of leaf methanolic extracts decreased in response to water stress only in Luisa Avanzo. Leaf physiology and its modulation by water stress were age dependent in Luisa Avanzo