Un contributo alla sostenibilità ambientale: metano e territorio in Campania

IX Giornata Studio INU Infrastrutture blu e verdi, reti virtuali, culturali e social

Clinical Outcomes in Breast Cancer: Innovations and Ideas Commentary on "Expression of CDK13 was Associated with Clinical Outcomes and Expression of HIF-1 and Beclin1 in Breast Cancer Patients"

The oncogenes underlying the development of breast cancer are not fully understood and careful and rigorous research is still necessary in this area. Before considering the role of these molecules ..

Reconstruction of the nose. management of nasal cutaneous defects according to aesthetic subunit and defect size. a review

The nose represents the most common site for the presentation of cutaneous cancer, especially in sun-exposed areas: ala, dorsum, and tip. Even the smallest loss of substance can create aesthetic and psychosocial concerns for patients; therefore, surgeons who perform nasal reconstruction should be strictly confident with the pertinent surgical anatomy in order to tailor the procedure to the patient's condition and needs. Radical tumor excision and satisfactory aesthetic and functional results are primary targets. Restoring the original shape is the goal of any reconstruction: appropriate reshaping of three-dimensional geometry, proper establishment of symmetry, and excellent color and texture match to the adjacent structures are paramount features. Multiple options exist to re-establish functional and aesthetic integrity after surgical oncology; nevertheless, the management of nasal defects can be often challenging, and the gold standard is yet to be found. The current goal is to highlight some of the more common techniques used to reconstruct cutaneous defects of the nose with a specific focus on decision making based on the aesthetic subunit and defect size. The authors attempt to share common pitfalls and offer practical suggestions that they have found helpful in their clinical experience

Chronic constipation diagnosis and treatment evaluation: The "CHRO.CO.DI.T.E." study

Background: According to Rome criteria, chronic constipation (CC) includes functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C). Some patients do not meet these criteria (No Rome Constipation, NRC). The aim of the study was is to evaluate the various clinical presentation and management of FC, IBS-C and NRC in Italy. Methods: During a 2-month period, 52 Italian gastroenterologists recorded clinical data of FC, IBS-C and NRC patients, using Bristol scale, PAC-SYM and PAC-QoL questionnaires. In addition, gastroenterologists were also asked to record whether the patients were clinically assessed for CC for the first time or were in follow up. Diagnostic tests and prescribed therapies were also recorded. Results: Eight hundred seventy-eight consecutive CC patients (706 F) were enrolled (FC 62.5%, IBS-C 31.3%, NRC 6.2%). PAC-SYM and PAC-QoL scores were higher in IBS-C than in FC and NRC. 49.5% were at their first gastroenterological evaluation for CC. In 48.5% CC duration was longer than 10 years. A specialist consultation was requested in 31.6%, more frequently in IBS-C than in NRC. Digital rectal examination was performed in only 56.4%. Diagnostic tests were prescribed to 80.0%. Faecal calprotectin, thyroid tests, celiac serology, breath tests were more frequently suggested in IBS-C and anorectal manometry in FC. More than 90% had at least one treatment suggested on chronic constipation, most frequently dietary changes, macrogol and fibers. Antispasmodics and psychotherapy were more frequently prescribed in IBS-C, prucalopride and pelvic floor rehabilitation in FC. Conclusions: Patients with IBS-C reported more severe symptoms and worse quality of life than FC and NRC. Digital rectal examination was often not performed but at least one diagnostic test was prescribed to most patients. Colonoscopy and blood tests were the "first line" diagnostic tools. Macrogol was the most prescribed laxative, and prucalopride and pelvic floor rehabilitation represented a "second line" approach. Diagnostic tests and prescribed therapies increased by increasing CC severity

Improving perforator flaps vascularization reliability through a novel perforators assessment

The paramount principles of perforator flaps and perforasome had already been described through thoroughly conducted cadaveric studies. However, some questions remain unanswered. Most importantly, the amount of tissue being vascularized by a single perforator still needs to be defined as long as the importance of perforator diameter and distance of perforator from flap edges. The lack of vascular knowledge may explain partial necrosis rates, which can be as high as 11.3% after reconstruction with perforator flaps. In the present clinical study, we aimed at focus on filling the gap between a correctly planned perforator flap and the surgical outcomes that could be sometimes disappointing. To the best of our knowledge, this is the first clinical study that investigates the pertinent role of perforator caliber, distance of the perforator from flap edge, and whether the number of suitable perforators of a perforator flap has a key role in flap viability. Between December 2018 and February 2021, patients presenting at our Institution and in need for a soft tissue or combined soft and bony tissue reconstruction due to oncologic or traumatic reasons were assessed. Thirty-three patients meeting the inclusion criteria were enrolled. Four patients were excluded intraoperatively and three patients were lost to follow-up. A total of 26 oncologic patients were finally evaluated. Data of all the surgeries were prospectively collected in a digital database accounting for demographics and surgical characteristics, medical history, complications and outcomes. During every surgical operation, several parameters were measured including flap size, perforator caliber (right after irrigation with warm saline) and number of reliable perforators divided during the procedure; the position of the selected perforator was noted both preoperatively and intraoperatively. Both in case of a free or pedicled perforator flap, the perforating vessel was selected through preoperative imaging, and the choice was confirmed with doppler examination

Pianificazione fisica, questione ambientale e innovazione delle tecniche: il caso del Litorale Domitio-Flegreo

La Pianificazione urbanistica italiana, è strutturata attraverso un rigido sistema gerarchico, in base al quale le previsioni del livello sovra-ordinato ingabbiano le scelte del Piano sotto-ordinato. L'eccessiva prescrittività delle disposizioni, il lungo processo di redazione, adozione/approvazione fanno sì che, una volta giunti nella fase di attuazione, i piani si rivelano superati dalle esigenze reali nel frattempo maturate. Il caso-studio proposto del litorale Domitio-Flegreo rappresenta in modo emblematico una struttura naturale e antropica complessa, caratterizzata da delicati equilibri e viene proposta come caso paradigmatico per l’applicazione di una procedura innovativa di perimetrazione, capace di contribuire alla risoluzione delle criticità suesposte e finalizzata alla sperimentazione di una nuova tecnica di pianificazione. La proposta ha l’obiettivo di perimetrare più aree-problema (a geometria variabile) attraverso l’elaborazione di analisi finalizzate a individuare i detrattori ambientali e antropici che contribuiranno al riconoscimento del giusto confine pertinente all’efficacia dello specifico intervento di pianificazione

Editorial for the Special Issue “Vasorum Lymphaticorum: From the Discovery of the Lymphatic System to the New Perspectives in Microsurgical Reconstruction and Patient Rehabilitation”

Lymphedema is a complex clinical condition that appears as a result of the failure of the lymphatic system function, and it is characterized by edema, fibrosis, and adipose deposition [...