Anaesthetic challenging in microsurgical flap reconstruction: a systematic review

Background: Anaesthetic management for microvascular reconstructive surgery is challenging and clearly affects the risk of major complications such as flap hypo-perfusion. In this systematic review we explore recent (last 7 years) clinical evidences related to perioperative management and anaesthetic controversy of patients undergoing microvascular reconstructive surgery, especially focused on head and neck surgery with free flaps (FF) and breast reconstructive surgery with deep inferior epigastric perforator flap (DIEP-flap). Methods: A literature search of published clinical studies between 2011 and 2018 was conducted, yielding a total of 4307 papers. Only 150 were eligible, according inclusion and exclusion criteria. Results: 62 studies were selected for this review and categorized in 3 groups: preoperative-intraoperative- postoperative anaesthetic management and areas of controversy for patients undergoing head and neck surgery with FF and breast reconstructive surgery with DIEP-flap. Discussion: Anaesthetic management for flap reconstructive surgery remains an open field of interest with limited evidences regarding a standard care. Main components of research currently are: the need to join standard multidisciplinary enhanced recovery pathways, as well as the necessity to develop a standard intraoperative management. In theatre, the recent hemodynamic parameter “Hypotension Probability Indicator” (HPI) is promising: the advantage to predict a drop in the mean arterial pressure can be more effective than a fluid therapy titrated to maintain SVV less than 13%. Prospective studies are necessary to clarify

The timing of maternal depressive symptoms and child cognitive development: a longitudinal study.

Background: Maternal depression is known to be associated with impairments in child cognitive development, although the effect of timing of exposure to maternal depression is unclear. Methods: Data collected for the Avon Longitudinal Study of Parents and Children, a longitudinal study beginning in pregnancy, included self-report measures of maternal depression the Edinburgh Postnatal Depression Scale, completed on 6 occasions up to 3 years of age, and IQ of the index child (WISC) measured at aged 8 years. We used these data to assign women to 8 groups according to whether depression occurred in the antenatal, postnatal, preschool period, any combination of these times, or not at all. We compared a model comprising all patterns of depression (saturated model) with models nested within this to test whether there is a relationship between depression and child cognitive development and, if so, whether there is a sensitive period. We then investigated the relationship with child IQ for each model, following adjustment for confounders. Results: Six thousand seven hundred and thirty-five of 13,615 children from singleton births (49.5%, of eligible core sample) attended a research clinic at 8 years and completed a WISC with a score ≥ 70. A total of 5,029 mothers of these children had completed mood assessments over the 3 time periods. In unadjusted analyses, all three sensitive period models were as good as the saturated model, as was an accumulation model. Of the sensitive period models, only that for antenatal exposure was a consistently better fit than the accumulation model. After multiple imputation for missing data (to n = 6,735), there was no effect of postnatal depression on child IQ independent of depression at other times [-0.19 IQ points, 95% confidence interval (CI) -1.5 to 1.1 points]. There was an effect of antenatal depression (-3.19 IQ points, 95% CI: -4.33 to -2.06) which attenuated following adjustment (-0.64 IQ points, 95% CI: -1.68 to 0.40). Conclusions: The postnatal period is not a sensitive one for the effect of maternal depression on child cognitive development. © 2011 The Authors. Journal of Child Psychology and Psychiatry

Play in rats: association across contexts and types, and analysis of structure

Play has been proposed as a promising indicator of positive animal welfare. We aimed to study play in rats across contexts (conspecific/heterospecific) and types (social: pinning, being pinned; solitary: scampering), and we investigated its structure using behavioral sequence analysis. Group-housed (three per cage) adolescent male Lister Hooded rats (n = 21) were subjected to a Play-In-Pairs test: after a 3 hour isolation period, a pair of cage-mates was returned to the home cage and both social and solitary play were scored for 20 min. This procedure was repeated for each pair combination across three consecutive days, and individual play scores were calculated. Heterospecific play was measured using a Tickling test: rats were individually tickled by the experimenter through bouts of gentle, rapid finger movements on their underside, and the number of positive 50 kHz frequency modulated vocalizations and experimenter-directed approach behaviors were recorded. Both of the above tests were compared with social play in the home cage. While conspecific play in both the Play-In-Pairs test and home cage were correlated, both seemed to be unrelated to heterospecific play in the Tickling test. During the Play-In-Pairs test, although both solitary and social play types occurred, they were unrelated, and solitary locomotor play of one rat did not predict the subsequent play behavior of its cage mate. Analysis of play structure revealed that social play occurred more often in bouts of repeated behaviors while solitary play sequences did not follow a specific pattern. If play is to be used as an indicator of positive welfare in rats, context, type and structure differences should be taken into account

Natural and synthetic pigments used in the pink-red coloration of salmon flesh: methodology of quali-quantitative assessments and sampling results

In Europe Atlantic salmon leads the first position in the farmed species contest with more than 763,000t (FES, 2007). In the year 2006, Norway produced alone beyond 603,000t followed by the United Kingdom with 128,000t. In these last years, the demand of organic salmon is gradually increased both in domestic and foreign markets. In these fish the pink-red coloration of flesh is obtained by supplementing the feed with shrimp waste meal. In Italy, Coop Italia since three years has started the commercialization in the context of "prodotti a marchio" of Atlantic salmon farmed following prescriptions reported in terms of specification that prohibits the use of synthetic and GM pigments in the feeds. In collaboration with this supermarket company, the Faculty of Veterinary Medicine of Camerino University carried out the quali-quantitative assessments on the presence of molecules and relative isomers that distinguish the natural carotenoid pigment from the synthetic one. Skinned portion of fillet (10g) were collected from dorsal muscle (retro-cranial, central and caudal region), mixed and homogenized and repeatedly extracted with acetone until they were colourless. The pooled extract were filtered and an aliquot (10ml) was centrifugated (2200xg, 5min). The astaxanthin content in the supernatant was determined by HPLC using a Varian ProStar instrument equipped with UV/vis detector using an external astaxanthin standard at detection wavelength 470nm. Analysis was performed on a Varian Kromasil 100 C 18 250x0.3 mm according to Bjerkeng et al. (1997). Identification and determination of stereoisomers were carried out by means of a Sumichiral a-phenylglicine 250x4.6mm column following Abu-Lafi and Turujman method (1999). The analysis performed on all the organic fish have demonstrated the exclusive content of natural pigment. In this group (b.w.=3.9-4.4kg), C-Card for salmonids ranged between 26±1 in 2004 and 21.5±1.3 in 2005 and 21.5±2.1 in 2006. Astaxanthin and isomers decreased from 5.6±0.3mg/kg in 2004 to 2.9±1.1mg/kg in 2006. The low-cost non organic salmon group (b.w.=4.5-4.6kg) resulted pigmented only with synthetic carotenoids and C-card for salmonids ranged between 27.3 in 2004 and 23.7 in 2005 whereas in 2006 it was observed equal to 27. Also in this batch, astaxanthin and isomers decreased passing from 6.5mg/kg in 2004 to 4.9mg/kg in 2006

Reducing the False Positive Rate Using Bayesian Inference in Autonomous Driving Perception

Object recognition is a crucial step in perception systems for autonomous and intelligent vehicles, as evidenced by the numerous research works in the topic. In this paper, object recognition is explored by using multisensory and multimodality approaches, with the intention of reducing the false positive rate (FPR). The reduction of the FPR becomes increasingly important in perception systems since the misclassification of an object can potentially cause accidents. In particular, this work presents a strategy through Bayesian inference to reduce the FPR considering the likelihood function as a cumulative distribution function from Gaussian kernel density estimations, and the prior probabilities as cumulative functions of normalized histograms. The validation of the proposed methodology is performed on the KITTI dataset using deep networks (DenseNet, NasNet, and EfficientNet), and recent 3D point cloud networks (PointNet, and PintNet++), by considering three object-categories (cars, cyclists, pedestrians) and the RGB and LiDAR sensor modalities.Comment: This paper has been submitted to the journal Pattern Recognition Letter

Cutaneous sarcoid-like reaction in a patient treated with target therapy for metastatic melanoma: the hue is the clue

Cutaneous sarcoid-like reaction in a patient treated with target therapy for metastatic melanoma: the hue is the clu

Comparison of zootechnical performances, welfare condition and quality traits of hybrid striped bass (Morone chrysops x Morone saxatilis) reared in different Italian farms.

Growth performances of sunshine bass (initial m.b.w.=200\ub150 g) were examined in 3 different rearing conditions: concrete square basins (HSB-1); raceways (HSB-2); natural ponds (HSB-3). Fish received the same extruded feed (prot. 48.8%; lip. 17.8%). The trial lasted 16 months in HSB-1 and HSB-2 and 12 months in HSB-3 due to unfavourable welfare status and low growth performances. At harvest (16 months), sunshine bass reached a satisfactory mean weight without significant differences between groups. HSB-2 fish were longer with a smaller circumference, probably due to different hydrodynamics of the raceway. Glucose, cholesterol, triglycerides, protein, lactic dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), creatine kinase (CK), glycogen of plasma or tissue were not affected by rearing conditions as well as the proximate composition and the fatty acid profile of the fillet

Effect of temperature on the p50 value for human blood

We investigated the effect of temperature (19, 30, 37, and 42\ub0C) on the p50 value for normal human blood at p(CO2) = 5.72 kPa (43 mmHg), at various pHs (range 7.0 to 7.6) and molar ratios of [2,3-diphosphoglycrate]/[Hb4] (range 0.4 to 2.4). The d(log p50)/d(pH) coefficient varied from 0.39 at 19\ub0C to 0.35 at 43\ub0 C. The relationship between log p50 and 1/T (T = degrees Kelvin) was linear under the experimental conditions used, and the d(log p50)/d(1/T) coefficient varied between -2138 at pH 7.0 and -2162 at pH 7.6, independent of the concentration of 2,3-diphosphoglycerate. Assuming that the effect of p(CO2) on the p50 value is the same at 19, 30, and 43\ub0C as at 37\ub0C, one can use the reported coefficients to calculate the p50 value for normal human blood under conditions of temperature, pH, p(CO2), and 2,3-diphosphoglycerate concentrations prevailing under physiological and pathological conditions. The p50 value calculated by empirical equations, taking into account the effect of temperature, correlated well with the values for p50 determined experimentally (y = 0.9774x + 0.453; r = 0.998; n = 60), with an SD of 52 Pa (0.39 mmHg)

Pre-operative evaluation of dna methylation profile in oral squamous cell carcinoma can predict tumor aggressive potential

Background: Prognosis of oral squamous cell carcinoma (OSCC) is difficult to exactly assess on pre-operative biopsies. Since OSCC DNA methylation profile has proved to be a useful pre-operative diagnostic tool, the aim of the present study was to evaluate the prognostic impact of DNA methylation profile to discriminate OSCC with high and low aggressive potential. Methods: 36 OSCC cases underwent neoplastic cells collection by gentle brushing of the lesion, before performing a pre-operative biopsy. The CpG islands methylation status of 13 gene (ZAP70, ITGA4, KIF1A, PARP15, EPHX3, NTM, LRRTM1, FLI1, MiR193, LINC00599, MiR296, TERT, GP1BB) was studied by bisulfite Next Generation Sequencing (NGS). A Cox proportional hazards model via likelihood-based component-wise boosting was used to evaluate the prognostic power of the CpG sites. Results: The boosting estimation identified five CpGs with prognostic significance: EPHX3-24, EPHX3-26, ITGA4-3, ITGA4-4, and MiR193-3. The combination of significant CpGs provided promising results for adverse events prediction (Brier score = 0.080, C-index = 0.802 and AUC = 0.850). ITGA4 had a strong prognostic power in patients with early OSCC. Conclusions: These data confirm that the study of methylation profile provides new insights into the molecular mechanisms of OSCC and can allow a better OSCC prognostic stratification even before surgery

Peritoneal carcinomatosis

Several gastrointestinal and gynecological malignancies have the potential to disseminate and grow in the peritoneal cavity. The occurrence of peritoneal carcinomatosis (PC) has been shown to significantly decrease overall survival in patients with liver and/or extraperitoneal metastases from gastrointestinal cancer. During the last three decades, the understanding of the biology and pathways of dissemination of tumors with intraperitoneal spread, and the understanding of the protective function of the peritoneal barrier against tumoral seeding, has prompted the concept that PC is a loco-regional disease: in absence of other systemic metastases, multimodal approaches combining aggressive cytoreductive surgery, intraperitoneal hyperthermic chemotherapy and systemic chemotherapy have been proposed and are actually considered promising methods to improve loco-regional control of the disease, and ultimately to increase survival. The aim of this review article is to present the evidence on treatment of PC in different tumors, in order to provide patients with a proper surgical and multidisciplinary treatment focused on optimal control of their locoregional disease. (C) 2013 Baishideng Publishing Group Co., Limited. All rights reserved