Autologous fat grafting: Harvesting techniques

Autologous fat grafting is widely used for soft-tissue augmentation and replacement in reconstructive and aesthetic surgery providing a biocompatible, natural and inexpensive method. Multiple approaches have been developed in the past years, varying in the location of adipose tissue donor-sites, use of wetting solutions, harvesting, processing and placing techniques. Despite many advances in this subject, the lack of standardization in the protocols and the unpredictability of the resorption of the grafted tissue pose a significant limitation for graft retention and subsequent filling. In this review, we discuss several approaches and methods described over the last years concerning the harvesting of autologous fat grafts. We focus on contents such as the best donor-site, differences between existing harvesting techniques (namely tissue resection, hand aspiration or liposuction techniques), recommended harvesting cannula diameters, pressure application and volume of wetting solution injected prior aspiration. Results and comparisons between methods tend to vary according to the outcome measured, thus posing a limitation to pinpoint the most efficient methods to apply in fat grafting. Additionally, the lack of a standard assay to determine viability or volume augmentation of fat grafting remains another limitation to obtain universally accepted grafting procedures and protocols.This work was supported by FEDER – Fundo Europeu de Desenvolvimento Regional, through NORTE 2020 Programa Operacional Regional do Norte - NORTE-01-0145-FEDER-000012 and Instituto de Investigação e Inovação em Saúde (Projeto Estratégico UID/BIM/04293/2013 )

Delay in hospital admission of patients with cerebral vein and dural sinus thrombosis

Factors influencing early hospital admission have been described for several stroke types but not for cerebral vein and dural sinus thrombosis (CVT). CVT is more difficult to diagnose than arterial stroke; delay in hospital admission may postpone CVT treatment. The purposes of this study were: (1) to describe the delay between the onset of symptoms and hospital admission of patients with CVT, and (2) to identify the variables that influence that delay. We registered the interval (days) between the onset of symptoms and hospital admission in 91 consecutive patients admitted to 20 Portuguese hospitals between June 1995 and June 1998. We also studied the impact of admission delay on treatments (prescription of anticoagulants and the number of days elapsed between the onset of symptoms and start of anticoagulation and admission). Median admission delay was 4 days. Twenty-two (25%) patients were admitted within 24 h. Two thirds of the patients were admitted within 7 days and 75% within 13 days. In multiple logistic regression analysis, admission within 24 h was positively associated with mental status disorder (delirium or abulia; OR = 4.59; 95% CI = 1.41-14.89) and negatively associated with headache (OR = 0.03; 95% CI = 0.00-0.32). Presentation as isolated intracranial hypertension was associated with admission delay of more than 4 days (OR = 2.63; 95% CI = 0.97-7.14). Papilloedema was associated with an admission delay of more than 13 days (OR = 4.69; 95% CI = 1.61-13.61). There was no association between admission delay and the proportion of anticoagulated patients. The interval between onset of symptoms and start of anticoagulation was shorter in patients admitted earlier (p = 0.0001, for either admission within 24 h, 4 or 13 days). There is a considerable delay until the clinical picture associated with CVT is recognised as justifying hospital admission, especially when patients present with symptoms identical to isolated intracranial hypertension syndrome

The impact of the coronavirus disease 2019 pandemic on the diagnosis and treatment of cancer in Northern Portugal

Objectives The coronavirus disease 2019 (COVID-19) pandemic has affected the availability of healthcare resources, and adjustments to cancer care have been necessary considering the risk of morbidity by COVID-19 and of cancer progression. This study aims to quantify the impact of the COVID-19 pandemic on the care of patients with cancer by comparing a period of 4 months after the outbreak began (2 March 2020) with an equal period from 2019. Methods Cancer cases of the esophagus, stomach, colon and rectum, pancreas, lung, skin-melanoma, breast, cervix, prostate, non-Hodgkin lymphoma, and leukemia from the Portuguese Oncology Institute of Porto, and diagnosed between 2 March and 1 July 2019 (before COVID-19) and 2020 (after COVID-19) were identified. Those with the first treatment outside the Portuguese Oncology Institute of Porto were excluded. Sociodemographic, clinical and treatment characteristics were obtained from the cancer registry database and clinical files. Results The absolute number of new cancer cases decreased nearly 40% after the COVID-19 pandemic (from 1430 to 866). The largest decreases were observed for cervical (-74.3%) and prostate (-71.7%) cancers. Cases were more often diagnosed at more advanced stages in 2020 (P = 0.001), and the proportion of patients not starting any treatment until 1 July was just under 20% in 2019 and nearly 40% in 2020. The median times from symptoms onset, first medical exam and first appointment to diagnosis, and from diagnosis to first appointment, multidisciplinary tumor board meeting and first treatment were shorter after COVID-19. Conclusions There was a notable overall decrease in cancer diagnoses after COVID-19, with changes in the characteristics of incident cases. © 2022 Lippincott Williams and Wilkins. All rights reserved.This study was funded by the Foundation for Science and Technology – FCT (Portuguese Ministry of Science, Technology and Higher Education) in collaboration with the Agency for Clinical Research and Biomedical Innovation (AICIB), under the scope of the project “Impacto da pandemia COVID-19 nos cuidados prestados a doentes oncológicos” (Research 4 COVID 174_596850546), and national funding from FCT, under the Unidade de Investigação em Epidemiologia – Instituto de Saúde Pública da Universidade do Porto (EPIUnit; UIDB/04750/2020). SM was funded under the scope of the project “NEON-PC - Neuro-oncological complications of prostate cancer: longitudinal study of cognitive decline” (POCI-01-0145-FEDER-032358; ref. PTDC/SAU-EPI/32358/2017), which is funded by the European Regional Development Fund through the Operational Programme Competitiveness and Internationalization, and national funding from FCT. The funding sources had no involvement in the conduct of the research or preparation of the article

The impact of the COVID-19 pandemic on cancer screening

Letter to the editorThis study was funded by the Foundation for Science and Technology – FCT (Portuguese Ministry of Science, Technology and Higher Education) in collaboration with the Agency for Clinical Research and Biomedical Innovation (AICIB), under the scope of the project ‘Impacto da pandemia COVID-19 nos cuidados prestados a doentes oncológicos’ (Research 4 COVID 174_596850546), and national funding from FCT, under the Unidade de Investigação em Epidemiologia – Instituto de Saúde Pública da Universidade do Porto (EPIUnit; info:eu-repo/grantAgreement/FCT/6817 - DCRRNI ID/UIDB/04750/2020/PT). SM was also funded under the scope of the project ‘NEON-PC - Neuro-oncological complications of prostate cancer: longitudinal study of cognitive decline’ (POCI-01-0145-FEDER-032358; ref. PTDC/SAU-EPI/32358/2017), which is funded by FEDER through the Operational Programme Competitiveness and Internationalization, and national funding from FCT. The funding sources had no involvement in the conduct of the research and/or preparation of the article

Risk and Survival of Third Primary Cancers in a Population-Based Cohort of Breast Cancer Patients

Introduction: The growing number of women diagnosed with breast cancer (BCa) together with high survival has resulted in an increasing population of survivors at risk of subsequent primary cancers. This study aimed to estimate the long-term risk and survival of third primary cancers (TPCs) among females with a first primary BCa. Methods: Breast first primary cancers (FPCs) from the Portuguese North Region Cancer Registry, diagnosed between 2000 and 2010 (n = 15,981), were followed for a TPC (December 31, 2015) and death from any cause (June 30, 2021). The cumulative incidence of and mortality among TPCs were estimated. To compare survival, female patients with a TPC were matched (1:1, by age group, years between FPC and second primary cancer [SPC] diagnosis, and SPC location) to FPC + SPC patients without a TPC. Results: Overall, 67 (0.4% of FPCs and 5.4% of SPCs) TPCs were diagnosed. The most common TPC sites were digestive, breast, and female genital organs. Among all FPCs, the 15-year cumulative incidence (95% confidence interval [CI]) of a TPC was 0.69% (0.47–0.90%) and among SPCs, 7.21% (4.99–9.43%). The 15-year cumulative mortality of TPCs and matched patients was 70.0% and 51.5%, respectively. For TPCs, compared to matched SPC only patients, the age-adjusted hazard ratio (95% CI) for death was 2.86 (1.61–5.07). Discussion/Conclusion: The most common TPC sites were digestive, breast, and female genital organs, with a 15-year cumulative incidence of 0.69% among FPCs. TPCs had a worse long-term survival compared to patients with an SPC only.This work was supported by national funds from the Foundation for Science and Technology – FCT (Portuguese Ministry of Science, Technology and Higher Education), under the Unidade de Investigação em Epidemiologia – Instituto de Saúde Pública da Universidade do Porto (EPIUnit; UIDB/04750/2020). S.M. was funded by FEDER through the Operational Program Competitiveness and Internationalization and national funding from FCT under the scope of the project “NEON-PC – Neuro-oncological complications of prostate cancer: longitudinal study of cognitive decline” (POCI-01-0145-FEDER-032358; ref. PTDC/SAU-EPI/32358/2017) and received funding from the EPIUnit – Junior Research – Prog Financing (UIDP/04750/2020). The funding sources had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication

Immunodeficiency and Autoimmunity Coming Together: a Nearly Missed Diagnosis

The coexistence of human immunodeficiency virus (HIV) and systemic lupus erythematosus (SLE) appears to be unusual and the prevalence of patients who carry the dual diagnosis is currently unknown. We hereby present a case of a C4 deficient HIV-1 positive Caucasian female under highly active antiretroviral therapy for the past eight years, admitted to hospital with an aggressive and potentially fatal clinical presentation of SLE. There was a favorable outcome despite a significant diagnostic delay. Despite its rarity, the case highlights that this association is remarkable and may be overlooked by clinicians familiar with either condition.info:eu-repo/semantics/publishedVersio

Five-Year Outcome in Stroke Patients Submitted to Thrombolysis

BACKGROUND AND PURPOSE: Little is known on long-term follow-up after thrombolysis in ischemic stroke patients because the majority of studies evaluated outcome at 3 to 12 months. We aimed to assess 5-year outcome after intravenous thrombolysis (IVT). METHODS: Cohort study based on the prospective registry of all consecutive ischemic stroke patients submitted to IVT in our Stroke Unit. Five-year outcome, including living settings, functional outcome, stroke recurrence, and mortality, was ascertained by telephonic interviews and additional review of clinical records. Multivariate analyses were performed to identify predictors of outcome and mortality. Excellent outcome was defined as modified Rankin scale 0 to 1. RESULTS: Five-year outcome was available for 155/164 patients submitted to IVT. At 5 years, 32.9% of patients had an excellent outcome (95% confidence interval (CI) =25.5-43.3) and mortality was 43.9% (95%CI=36.1-51.7). Increasing age (odds ratio =0.93, 95% CI =0.90-0.97) and increasing National Institute of Health Stroke Scale (NIHSS) 24 h after thrombolysis (odds ratio =0.81, 95% CI =0.74-0.90) were independently associated with a lower likelihood of an excellent 5-year outcome. Age (hazards ratio =1.07, 95% CI =1.03-1.11) and excellent functional outcome 3 months after thrombolysis (hazards ratio =0.28, 95%CI=0.12-0.66) were independently associated with mortality during follow-up. CONCLUSIONS: One third of ischemic stroke patients have excellent 5-year outcome after IVT. Younger age, lower NIHSS 24 h after IVT, and excellent 3-month functional outcome are independent predictors of excellent 5-year outcome

Neonatal Auditory Screening in 17 732 Neonates

Introdução: A surdez infantil representa uma das anomalias congénitas mais frequentes. Em Portugal, foi desenvolvido o Grupo de Rastreio e Intervenção na Surdez Infantil (GRISI), cujo principal objetivo é implementar um programa de rastreio nacional através da aplicação de técnicas e métodos definidos e semelhantes nos vários hospitais. Objetivos: Analizar a polupação de recém-nascidos rastreados num hospital periférico, no que concerne à presença de fatores de risco para surdez e resultados dos testes de rastreio. Material e métodos: Foram consultados os processos das crianças nascidas no Hospital Professor Doutor Fernando Fonseca, entre 2010 e 2015. Foram analisados os fatores de risco para surdez e os resultados dos testes de rastreio. Foram calculados a efetividade do rastreio assim como o índice de referenciação para consulta de Otorrinolaringologia. Os dados foram analizados através do programa informático SPSS®, atribuindo-se validade estatística a valores de p<0.05. Resultados: Verificou-se o nascimento de 18019 crianças. O programa de rastreio foi efetuado em 17732 recém-nascidos. A efetividade do rastreio foi de 98,7%. O índice de referenciação para consulta foi de 2,3%. 402 crianças não passaram o rastreio. 354 crianças possuiam fatores de risco para surdez. Discussão: O programa de rastreio foi considerado efetivo e o índice de referenciação foi inferior a 4%. Os principais fatores de risco foram: muito baixo peso ao nascer, baixo índice Apgar e consumo de fármacos ototóxicos. Conclusão: Os autores consideram importante a consciencialização dos resultados do programa de rastreio, para que este possa ser melhorado.info:eu-repo/semantics/publishedVersio

Kothe dual of Banach lattices generated by vector measures

We study the Kothe dual spaces of Banach function lattices generated by abstract methods having roots in the theory of interpolation spaces. We apply these results to Banach spaces of integrable functions with respect to Banach space valued countably additive vector measures. As an application we derive a description of the Banach dual of a large class of these spaces, including Orlicz spaces of integrable functions with respect to vector measuresThe first author was supported by the Foundation for Polish Science (FNP). The second author was supported by the Ministerio de Economia y Competitividad (Spain) under Grant #MTM2012-36740-C02-02.Mastylo, M.; Sánchez Pérez, EA. (2014). Kothe dual of Banach lattices generated by vector measures. Monatshefte fur Mathematik. 173(4):541-557. https://doi.org/10.1007/s00605-013-0560-8S5415571734Aronszajn, N., Gagliardo, E.: Interpolation spaces and interpolation methods. Ann. Mat. Pura. Appl. 68, 51–118 (1965)Bartle, R.G., Dunford, N., Schwartz, J.: Weak compactness and vector measures. Canad. J. Math. 7, 289–305 (1955)Brudnyi, Yu.A., Krugljak, N.Ya.: Interpolation functors and interpolation spaces $$I$$ I . North-Holland, Amsterdam (1991)Curbera, G.P.: Operators into $$L^1$$ L 1 of a vector measure and applications to Banach lattices. Math. Ann. 293, 317–330 (1992)Curbera, G.P., Ricker, W.J.: The Fatou property in $$p$$ p -convex Banach lattices. J. Math. Anal. Appl. 328, 287–294 (2007)Delgado, O.: Banach function subspaces of $$L^1$$ L 1 of a vector measure and related Orlicz spaces. Indag. Math. 15(4), 485–495 (2004)Diestel, J., Jr., Uhl, J.J.: Vector measures, Amer. Math. Soc. Surveys 15, Providence, R.I. (1977)Fernández, A., Mayoral, F., Naranjo, F., Sánchez-Pérez, E.A.: Spaces of $$p$$ p -integrable functions with respect to a vector measure. Positivity 10, 1–16 (2006)Ferrando, I., Rodríguez, J.: The weak topology on $$L_p$$ L p of a vector measure. Topol. Appl. 155, 1439–1444 (2008)Ferrando, I., Sánchez Pérez, E.A.: Tensor product representation of the (pre)dual of the $$L_p$$ L p -space of a vector measure. J. Aust. Math. Soc. 87, 211–225 (2009)Galaz-Fontes, F.: The dual space of $$L^p$$ L p of a vector measure. Positivity 14(4), 715–729 (2010)Kamińska, A.: Indices, convexity and concavity in Musielak-Orlicz spaces, dedicated to Julian Musielak. Funct. Approx. Comment. Math. 26, 67–84 (1998)Kantorovich, L.V., Akilov, G.P.: Functional analysis, 2nd edn. Pergamon Press, New York (1982)Krein, S.G., Petunin, Yu.I., Semenov, E.M.: Interpolation of linear operators. In: Translations of mathematical monographs, 54. American Mathematical Society, Providence, R.I., (1982)Lewis, D.R.: Integration with respect to vector measures. Pacific. J. Math. 33, 157–165 (1970)Lewis, D.R.: On integrability and summability in vector spaces. Ill. J. Math. 16, 583–599 (1973)Lindenstrauss, J., Tzafriri, L.: Classical Banach spaces II. Springer, Berlin (1979)Lozanovskii, G.Ya.: On some Banach lattices, (Russian). Sibirsk. Mat. Z. 10, 419–430 (1969)Musielak, J.: Orlicz spaces and modular spaces. In: Lecture Notes in Math. 1034, Springer-Verlag, Berlin (1983)Okada, S.: The dual space of $$L^1(\mu )$$ L 1 ( μ ) of a vector measure $$\mu$$ μ . J. Math. Anal. Appl. 177, 583–599 (1993)Okada, S., Ricker, W.J., Sánchez Pérez, E.A.: Optimal domain and integral extension of operators acting in function spaces, operator theory. Adv. Appl., vol. 180, Birkhäuser, Basel (2008)Rao, M.M., Zen, Z.D.: Applications of Orlicz spaces. Marcel Dekker, Inc., New York (2002)Rivera, M.J.: Orlicz spaces of integrable functions with respect to vector-valued measures. Rocky Mt. J. Math. 38(2), 619–637 (2008)Sánchez Pérez, E.A.: Compactness arguments for spaces of $$p$$ p -integrable functions with respect to a vector measure and factorization of operators through Lebesgue-Bochner spaces. Ill. J. Math. 45(3), 907–923 (2001)Sánchez Pérez, E.A.: Vector measure duality and tensor product representation of $$L_p$$ L p spaces of vector measures. Proc. Amer. Math. Soc. 132, 3319–3326 (2004)Zaanen, A.C.: Integration. North Holland, Amsterdam (1967