Autologous Fat Grafting Reduces Pain in Irradiated Breast: A Review of Our Experience

Introduction. Pain syndromes affect women after conservative and radical breast oncological procedures. Radiation therapy influences their development. We report autologous fat grafting therapeutical role in treating chronic pain in irradiated patients. Materials and Methods. From February 2006 to November 2014, we collect a total of 209 patients who meet the definition of "Postmastectomy Pain Syndrome" (PMPS) and had undergone mastectomy with axillary dissection (113 patients) or quadrantectomy (96 patients). Both procedures were followed by radiotherapy. We performed fat grafting following Coleman's procedure. Mean amount of adipose tissue injected was 52\u2009cc (\ub18.9\u2009cc) per breast. Seventy-eight in 209 patients were not treated surgically and were considered as control group. Data were gathered through preoperative and postoperative VAS questionnaires; analgesic drug intake was recorded. Results. The follow-up was at 12 months (range 11.7-13.5 months). In 120 treated patients we detected pain decrease (mean \ub1 SD point reduction, 3.19 \ub1 2.86). Forty-eight in 59 patients stopped their analgesic drug therapy. Controls reported a mean \ub1 SD decrease of pain of 1.14 \ub1 2.72. Results showed that pain decreased significantly in patients treated (p < 0.005, Wilcoxon rank-sum test). Conclusion. Our 8-year experience confirms fat grafting effectiveness in decreasing neuropathic pain

Autologous Fat Grafting in the Treatment of Painful Postsurgical Scar of the Oral Mucosa

Background. Persistent pain as a consequence of surgical treatment has been reported for several common surgical procedures and represents a clinical problem of great magnitude. Material and Methods. We describe the case of a 47-year-old female who presented a retractile scar that adhered to deep planes at the upper right of the vestibule due to surgical removal of maxillary exostosis, which determined important pain symptoms extending till the right shoulder during both chewing and rest. We subsequently treated her with autologous fat grafting according to Coleman’s technique. Results. Clinical assessments were performed at 5 and 14 days, 1, 3, and 6 months, and 1 year after surgical procedure. We observed a progressive release of scar retraction together with an important improvement of pain symptoms. Conclusion. The case described widens the possible application of autologous fat grafting on a new anatomical site as buccal vestibule and in one specific clinical setting confirming its promising biological effects

Charakterisierung des Adhäsivsystems von Euprymna scolopes Berry, 1913 (Cephalopoda)

Adhäsion ist ein weitverbreiterter und (über-)lebenswichtiger Prozess in der Natur, der bei den verschiedensten Spezies von Bedeutung ist. Er spielt bei Abwehr, Beutefang und Schlüpfen, sowie bei Tarnung und Verankerung der Lebewesen eine tragende Rolle. Vier Gattungen von Cephalopoden, zu vier verschiedenen Familien gehörend (Euprymna, Sepiolidae; Idiosepius, Idiosepiidae; Nautilus, Nautilidae und Sepia, Sepiidae), produzieren biologische Klebstoffe für temporäre Anheftung von Substrat oder zur Verankerung. Euprymna scolopes Berry, 1913 lebt in küstennahen, benthischen Gewässern des Indopazifischen Ozeans (Singley, 1982; Shears, 1988). Die Tiere sind nachtaktiv und verbringen die Tagesstunden im Meeresboden vergraben (Moynihan, 2002). Ultrastrukturelle Untersuchungen zeigen, dass die adhäsiven Zellen bei Euprymna scolopes nur in der dorsalen Epidermis liegen. Das epitheliale Sekretionssystem produziert einen schleimartigen Adhäsivkleber, der es den Tintenfischen ermöglicht, während der Fortbewegung Sand und anderes Bodenmaterial an ihre dorsale Körperoberfläche zu heften. Diese tarnende Schutzschicht kann bei Gefahr blitzschnell abgestoßen werden und soll als sinkender “Köder” nahende Räuber ablenken (Shears, 1988; Norman, 2000). In der dorsalen Adhäsivregion finden sich vier verschiedene Arten von Drüsenzellen, ventral hingegen nur zwei. Alle diese Zelltypen erstrecken sich über die gesamte Breite des Epithels und setzen Sekretionsmaterial an der Oberfläche frei. Das Mantelepithel misst zwischen 34 und 60 μm und wird von einer 0.3 μm dicken Basalmembran abgegrenzt. Singley (1982) vermutete, dass aus “goblet” Zellen (Becherzellen) sekretierte Mukopolysaccharide verantwortlich für die Adhäsion seien, während aus “ovate” (ovalen) Zellen stammende, saure Mukoproteine einen gegenteiligen Effekt auslösen. Neue histochemische Beobachtungen belegen, dass das Sekretionsmaterial von “ovate” Zellen keine starke Reaktion bei Tests für saure Gruppen zeigen. Unter dem Drüsenpithel von Euprymna scolopes befinden sich verschieden orientierte Dermal- und Mantelmuskelschichten, Dies deutet darauf hin, dass das Abwerfen der körperbedeckenden Sandschicht mechanisch induziert wird- und nicht chemisch, wie von Singley (1982) vorgeschlagen.Bio-adhesion is a common and crucial process in nature and is used by several different species for camouflage, prey capture, hatching or to avoid drifting. Four genera of cephalopods belonging to four different families (Euprymna, Sepiolidae; Idiosepius, Idiosepiidae; Nautilus, Nautilidae and Sepia, Sepiidae) produce glue for temporary attachment (von Byern and Klepal, 2006). Euprymna live in near-shore benthal habitats of the Indo-Pacific Ocean (Singley, 1982; Shears, 1988). They are noctual active and bury into the seafloor during the day (Moynihan, 2002). The animals secrete glue to coat themselves totally with sand. In case of danger they release the adhesive glue as a sinking decoy instantaneously to deflect predators (Shears, 1988; Norman, 2000). Ultrastructural observations show that the adhesive structures of Euprymna scolopes are located in the dorsal epidermis. The epithelial secretory system produces a mucous coat and gives the squid the ability to fix sand and other bottom material to the dorsal surface of it´s body while moving. Presumably the coat acts as camouflage over the matching substrate. Four types of gland cells occur in the dorsal adhesive region, whereby only two of them are present ventrally. All cell types span the full thickness of the epithelium and release secretory material to the surface. The thickness of the mantle epidermis ranges dorsally from 34 to 60 μm and is delimited by a 0.3 μm thick basement membrane. Singley (1982) assumed that neutral mucopolysaccharides, secreted from the goblet cells, were responsible for adhesion, whereas de-adhesion was caused by acidic mucoproteins released from the ovate cells. New histochemical observations showed that the secretory material of ovate cells does not display a strong reaction to tests for acidic groups. Beneath the epithelium variously oriented dermal and mantle muscle layers were found. This makes a mechanically related release of sand particles more likely than chemically induced de-adhesion, as suggested earlier (Singley, 1982)

The evolution of autologous breast reconstruction.

With breast cancer (BC) becoming more treatable, breast reconstruction has become an integral part of BC treatment. Nowadays, implant-based breast reconstruction is more common. However, there is a growing interest in autologous breast reconstruction due to the increasing awareness of implant-related complications. This work provides a comprehensive overview of the evolution of autologous reconstruction techniques of the breast and the nipple-areolar complex (NAC)

Love is the triumph of the imagination: daydreams about significant others are associated with increased happiness, love and connection

Social relationships and interactions contribute to daily emotional well-being. The emotional benefits that come from engaging with others are known to arise from real events, but do they also come from the imagination during daydreaming activity? Using experience sampling methodology with 101 participants, we obtained 371 reports of naturally occurring daydreams with social and non-social content and self-reported feelings before and after daydreaming. Social, but not non-social, daydreams were associated with increased happiness, love and connection and this effect was not solely attributable to the emotional content of the daydreams. These effects were only present when participants were lacking in these feelings before daydreaming and when the daydream involved imagining others with whom the daydreamer had a high quality relationship. Findings are consistent with the idea that social daydreams may function to regulate emotion: imagining close others may serve the current emotional needs of daydreamers by increasing positive feelings towards themselves and others

Autologous fat grafting efficacy in treating PostMastectomy pain syndrome: A prospective multicenter trial of two Senonetwork Italia breast centers.

Postmastectomy pain syndrome (PMPS) represents a common complication following breast surgery defined as a chronic neuropathic pain located in the front of the chest, in the axilla and in the upper arm that for more than 3 months after surgery. Several medications prove to be ineffective while autologous fat grafting revealed to be an innovative solution in the treatment of neuropathic pain syndromes based on retrospective studies. For this reason, we performed a prospective multicenter trial to reduce the memory bias and further increase the evidence of the results. From February 2018 to March 2019, 37 female patients aged between 18 and 80 years, underwent mastectomy or quadrantectomy with pathologic scarring and chronic persistent neuropathic pain, compatible with PMPS, are been included in the study and treated with autologous fat grafting. During the enrollment phase, patients were asked to estimate pain using the Visual Analogue Scale (VAS) and POSAS questionnaire in order to evaluate scar outcomes. The VAS scale, starting from 6.9 (1.3), decreased in the first month by 3.10 (1.59), continuing to fall by 0.83 (1.60) to 3 months and by 0.39 (2.09) at 6 months. Statistical analysis showed a significant reduction after 1 month (P < .0001) and 3 months (P < .005). All POSAS grades documented a statistically significant reduction (P < .0001) of the scores by both observers and patients. We observed that no significant association was found between age, BMI, menopausal status of patients, days from oncologic surgery to autologous fat grafting and reduction of VAS values over time while both smoking and axillary dissection were observed as the main factor significantly associated with a reduced clinical efficacy (respectively, P = .0227 and P = .0066). Our prospective multicenter trial confirms the efficacy of fat grafting in the treatment of PMPS based on the principle of regenerative medicine with a satisfactory response in terms of pain reduction and improvement of the quality of the treated tissues. Clinical questionnaires show that the cicatricial areas improve in terms of color, thickness, skin pliability, and surface irregularities. Regenerative effect is based also on the adoption of needles. The combined effect of fat grafting and needles determines a clinical full response

Immediate direct-to-implant breast reconstruction: A single center comparison between different procedures

BackgroundThe increased incidence of conservative mastectomy operations (nipple- and skin- sparing) has increased the frequency of immediate breast reconstructions (IBR). In order to guarantee patients the best possible aesthetic outcome, the least chance of complications and moreover, the least postoperative pain, the technique with prepectoral prosthetic pocket was recently reconsidered with the use of ADM. This is the first study using Fortiva® in prepectoral breast reconstruction, and it compares the outcomes of three different patient populations (undergoing retromuscular, prepectoral and prepectoral reconstruction with ADM). The authors suggest that prepectoral breast reconstruction with ADM may bring benefits compared to the current standard technique (retromuscular) as well as compared to the prepectoral reconstruction without ADM.MethodsRetrospective data analysis of patients who underwent mastectomy followed by immediate breast reconstruction with silicone implants (DTI), performed by a team of breast surgeons and plastic surgeons. Logistic factor regressions were performed in order to investigate the effects of the three different intervention techniques on the incidence of complications. Fisher's exact test was used to analyze the differences in the occurrence of each complication. Mann Whitney test was used to compare the averages of referred pain. A p value &lt;0.05 was considered significant.ResultsA total of 67 patients underwent DTI reconstruction, of which 43 with retromuscular prosthesis, 13 prepectoral and 11 prepectoral with ADM. We found a significantly lower incidence of surgical complications with ADM, exclusively in comparison with retromuscular reconstruction (p = 0.028). It emerges prepectoral reconstruction with ADM involves significantly less visibility of the implant than both the prepectoral surgery without ADM (p = 0.013) and the retromuscular technique (p = 0.029). Finally, postoperative pain referred at twelfth month is significantly less relevant in the group with prepectoral prosthesis and ADM, both in the group with retromuscular (p &lt; 0.001) and prepectoral without ADM (p = 0.001).ConclusionsThis study demonstrates that immediate prepectoral breast reconstruction with ADM is a safe and reliable technique, able to exceed some type of limits imposed by prepectoral reconstruction. Moreover, it provides benefits if compared to the current standard technique. In the future, this technique could also be added to it, after a proper selection of patients in pre- and intraoperative time

Chlamydia pneumoniae Hides inside Apoptotic Neutrophils to Silently Infect and Propagate in Macrophages

BACKGROUND: Intracellular pathogens have developed elaborate strategies for silent infection of preferred host cells. Chlamydia pneumoniae is a common pathogen in acute infections of the respiratory tract (e.g. pneumonia) and associated with chronic lung sequelae in adults and children. Within the lung, alveolar macrophages and polymorph nuclear neutrophils (PMN) are the first line of defense against bacteria, but also preferred host phagocytes of chlamydiae. METHODOLOGY/PRINCIPAL FINDINGS: We could show that C. pneumoniae easily infect and hide inside neutrophil granulocytes until these cells become apoptotic and are subsequently taken up by macrophages. C. pneumoniae infection of macrophages via apoptotic PMN results in enhanced replicative activity of chlamydiae when compared to direct infection of macrophages, which results in persistence of the pathogen. Inhibition of the apoptotic recognition of C. pneumoniae infected PMN using PS- masking Annexin A5 significantly lowered the transmission of chlamydial infection to macrophages. Transfer of apoptotic C. pneumoniae infected PMN to macrophages resulted in an increased TGF-ss production, whereas direct infection of macrophages with chlamydiae was characterized by an enhanced TNF-alpha response. CONCLUSIONS/SIGNIFICANCE: Taken together, our data suggest that C. pneumoniae uses neutrophil granulocytes to be silently taken up by long-lived macrophages, which allows for efficient propagation and immune protection within the human host

The evolution of breast prostheses.

Every year approximately 1.5 million prostheses are implanted worldwide for breast augmentation and reconstructive indications. The modern breast implant as we know was released to the open market in 1963. It has gone through intense phases of development which have improved the initially primitive and limited devices to current-day devices, which exhibit a tremendous range of surface textures, sizes, gel consistencies, and anatomical shapes. This article explores the evolution of breast implants providing historical facts and technical details

Late Recognition of SARS in Nosocomial Outbreak, Toronto

Late recognition of severe acute respiratory syndrome (SARS) was associated with no known SARS contact, hospitalization before the nosocomial outbreak was recognized, symptom onset while hospitalized, wards with SARS clusters, and postoperative status. SARS is difficult to recognize in hospitalized patients with a variety of underlying conditions in the absence of epidemiologic links