Nipple-Sparing Mastectomy in 99 Patients With a Mean Follow-up of 5 Years

Background. The safety and practicality of nipple-sparing mastectomy (NSM) are controversial. Methods. Review of a large breast center's experience identified 99 women who underwent intended NSM with subareolar biopsy and breast reconstruction for primary breast cancer. Outcome was assessed by biopsy status, postoperative nipple necrosis or removal, cancer recurrence, and cancer-specific death. Results. NSM was attempted for invasive cancer (64 breasts, 24 with positive lymph nodes), noninvasive cancer (35 breasts), and/or contralateral prophylaxis (50 breasts). Twenty-two nipples (14%) were removed because of positive subareolar biopsy results (frozen or permanent section). Seven patients underwent a pre-NSM surgical delay procedure because of increased risk for nipple necrosis. Reconstruction used transverse rectus abdominis myocutaneous flaps (56 breasts), latissimus flaps with expander (35 breasts), or expander alone (58 breasts). Of 127 retained nipples, 8 (6%) became necrotic and 2 others (2%) were removed at patient request. There was no nipple necrosis when NSM was performed after a surgical delay procedure. At a mean follow-up of 60.2 months, all 3 patients with recurrence had biopsy-proven subareolar disease and had undergone nipple removal at original mastectomy. There were no deaths. Conclusions. Five-year recurrence rate is low when NSM margins (frozen section and permanent) are negative. Nipple necrosis can be minimized by incisions that maximize perfusion of surrounding skin and by avoiding long flaps. A premastectomy surgical delay procedure improves nipple survival in high-risk patients. NSM can be performed safely with all types of breast reconstruction

Mapping deuterated methanol toward L1544: I. Deuterium fraction and comparison with modeling

The study of deuteration in pre-stellar cores is important to understand the physical and chemical initial conditions in the process of star formation. In particular, observations toward pre-stellar cores of methanol and deuterated methanol, solely formed on the surface of dust grains, may provide useful insights on surface processes at low temperatures. Here we analyze maps of CO, methanol, formaldehyde and their deuterated isotopologues toward a well-known pre-stellar core. This study allows us to test current gas-dust chemical models. Single-dish observations of CH$_3$OH, CH$_2$DOH, H$_2$CO, H_2\,^{13}CO, HDCO, D$_2$CO and C$^{17}$O toward the prototypical pre-stellar core L1544 were performed at the IRAM 30 m telescope. We analyze their column densities, distributions, and compare these observations with gas-grain chemical models. The maximum deuterium fraction derived for methanol is [CH$_2$DOH]/[CH$_3$OH] $\sim$ 0.08$\pm$0.02, while the measured deuterium fractions of formaldehyde at the dust peak are [HDCO]/[H$_2$CO] $\sim$ 0.03$\pm$0.02, [D$_2$CO]/[H$_2$CO] $\sim$ 0.04$\pm$0.03 and [D$_2$CO]/[HDCO] $\sim$ 1.2$\pm$0.3. Observations differ significantly from the predictions of models, finding discrepancies between a factor of 10 and a factor of 100 in most cases. It is clear though that to efficiently produce methanol on the surface of dust grains, quantum tunneling diffusion of H atoms must be switched on. It also appears that the currently adopted reactive desorption efficiency of methanol is overestimated and/or that abstraction reactions play an important role. More laboratory work is needed to shed light on the chemistry of methanol, an important precursor of complex organic molecules in space.Comment: Accepted for publication in A&

Endothelial Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

OBJECTIVES To review, analyze, and synthesize the literature on endothelial dysfunction in critically ill children with multiple organ dysfunction syndrome and to develop a consensus biomarker-based definition and diagnostic criteria. DATA SOURCES Electronic searches of PubMed and Embase were conducted from January 1992 to January 2020, using a combination of medical subject heading terms and key words to define concepts of endothelial dysfunction, pediatric critical illness, and outcomes. STUDY SELECTION Studies were included if they evaluated critically ill children with endothelial dysfunction, evaluated performance characteristics of assessment/scoring tools to screen for endothelial dysfunction, and assessed outcomes related to mortality, functional status, organ-specific outcomes, or other patient-centered outcomes. Studies of adults or premature infants (≤36 weeks gestational age), animal studies, reviews or commentaries, case series with sample size ≤10, and non-English language studies with the inability to determine eligibility criteria were excluded. DATA EXTRACTION Data were abstracted from each eligible study into a standard data extraction form along with risk of bias assessment. DATA SYNTHESIS We identified 62 studies involving 84 assessments of endothelial derived biomarkers indirectly linked to endothelial functions including leukocyte recruitment, inflammation, coagulation, and permeability. Nearly all biomarkers studied lacked specificity for vascular segment and organ systems. Quality assessment scores for the collected literature were low. CONCLUSIONS The Endothelial Subgroup concludes that there exists no single or combination of biomarkers to diagnose endothelial dysfunction in pediatric multiple organ dysfunction syndrome. Future research should focus on biomarkers more directly linked to endothelial functions and with specificity for vascular segment and organ systems

Theoretical knock-outs on biological networks

Peer reviewedPreprin

Amarelli's Industry 4.0 Transformation with IoT and Digital Advertisement: Optimizing Operations and Engaging Customers

This paper presents a vertical IoT solution for Amarelli, a licorice producing company, aiming to optimize their operations and enhance their customer engagement through the integration of IoT technology, Enterprice Resource Planning (EPR) system, e-commerce and social media advertising. The proposed solution includes several key components, such as IoT-enabled production monitoring, warehouse monitoring, RFID tracking, and real-time data analysis. The solution also integrates an ERP system, to provide business intelligence and e-commerce combination to enhance online presence and customer engagement through social media advertising. This vertical solution will enable Amarelli to improve efficiency, productivity, and profitability, while also providing valuable insights into customer preferences and purchasing behavior. The implementation of this solution will position Amarelli at the forefront of Industry 4.0, and help the company to stay competitive in today's rapidly evolving marketplace

Clypeogethes elongatus (Rosenhauer, 1856) in Sardinia (Coleoptera. Nitidulidae, Meligethinae)

Clypeogethes elongatus (Rosenhauer, 1856) is a pollen-beetle occurring in SW Mediterranean areas, from Southern Iberian Peninsula to most of the North Africa; in Italy, this uncommon species was thus far known only from the Island of Pantelleria (southern Sicily). Recent researches in S Sardinia allowed to find a small relic population of this species in Cagliari (San Michele hill), where it is cer-tainly associated with early-flowering Brassicaceae, on chalk-based rocks

Prenatal Diagnosis of Gómez-López-Hernández Syndrome.

Gómez-López-Hernández syndrome (GLHS), also known as cerebello-trigeminal-dermal dysplasia, is an extremely rare neurocutaneous disease, classically described by the triad of rhombencephalosynapsis (RES), bilateral focal alopecia, and trigeminal anesthesia. The clinical and radiographic spectrum of GLHS is now known to be broader, including craniofacial and supratentorial anomalies, as well as neurodevelopmental issues. Here, we present a case of antenatally diagnosed GLHS with RES, hydrocephaly, and craniofacial anomalies identified on ultrasound (low-set ears with posterior rotation, hypertelorism, midface hypoplasia, micrognathia, and anteverted nares) which were confirmed by autopsy after termination of pregnancy at 23 weeks of gestation. As no known genetic causes have been identified and the classical triad is not applicable to prenatal imaging, prenatal diagnosis of GLHS is based on neuroimaging and the identification of supporting features. In presence of an RES associated with craniofacial abnormalities in prenatal (brachycephaly, turricephaly, low-set ears, midface retrusion, micrognathia), GLHS should be considered as "possible" according to postnatal criteria

Novel TCAD Approach for the Investigation of Charge Transport in Thick Amorphous SiO2 Insulators

A TCAD approach for the investigation of charge transport in thick amorphous silicon dioxide is presented for the first time. Thick oxides are investigated representing the best candidates for integrated galvanic insulators in future power applications. The large electric fields, such devices experience and the preexisting defects in the amorphous material, give rise to a leakage current, which leads to degradation and failure. Hence, it is crucial to have a complete understanding of the main physical mechanisms responsible for the charge transport in amorphous silicon oxide. For this reason, metal-insulator-metal structures have been experimentally characterized at different high-field stress conditions and a TCAD approach has been implemented in order to gain insight into the microscopic physical mechanisms responsible for the leakage current. In particular, the role of charge injection at contacts and charge build-up due to trapping-detrapping mechanisms in the bulk of the oxide layer has been investigated and modeled to the purpose of understanding the oxide behavior under dc- and ac-stress conditions. Numerical simulations have been compared against experiments to quantitatively validate the proposed approach

Electronic structure of Nb-Mo alloys

Thermoreflectance measurements on NbxMo1−x alloys (x=0.2, 0.5, 0.8) have been carried out in the 0.5-5.0 eV energy region. Augmented-plane-wave (APW) calculations for Nb at two different lattice parameters and for Mo, as well as coherent-potential-approximation calculations (CPA), have been carried out and have been used in the interpretation of the experimental results. Several optical transitions [Σ1(EF)→Σ3, G4(EF)→G1,N2→N′1], have been identified, and their concentration dependence followed. These results contribute significantly toward putting the interpretation of the optical properties of Nb, Mo, and their alloys on a much more secure footing. In particular, it has been confirmed that while the lower conduction bands behave roughly as predicted by the rigid-band model, the higher-lying conduction bands show distinctly non-rigid-band-like behavior