Complications and Solutions in Propeller Flap Surgery

open7siPropeller perforator flaps (PPFs) have long been proven as valid reconstructive tools for a wide range of soft tissue defects in different body regions. During the last decade, despite their numerous advantages, many authors have thoroughly analyzed outcomes of these flaps, sometimes discouraging their use mainly because of a high failure rate. Accurate patient selection, adequate preoperative planning, and an appropriate dissection technique seem to potentially improve outcomes. Our study provides a review of the relevant literature related to PPF complications and of our experience, describing reasons for failure, measures for preventing them, and approaches for a prompt evaluation and management of complications.embargoed_20210801Cajozzo, M; Jiga, LP; Jandali, Z; Muradov, M; Pignatti, M; Cordova, A; D'Arpa, SCajozzo, M; Jiga, LP; Jandali, Z; Muradov, M; Pignatti, M; Cordova, A; D'Arpa,

Florintesa, a program agreement for the italian botanical gardens and the national floristic heritage.

OUR CLAIM: "The Botanical Gardens are, par excellence, responsible for carrying out the important mission of the conservation of our flora, through specific actions on live plants and their seeds, along with education and outreach aimed at spreading a new environmental culture, more careful and respectful of the essential needs of life, more sensible to the aesthetic and scientific value of the national flora" To overcome the isolation and strengthen their role in our society, the University Botanical Gardens have become promoters of national and European consortiums: examples are the working group "Botanical and Historic Gardens" of the Italian Botanical Society (1) and, on the global level, the Botanic Garden Conservation International (2). Aims and tasks of the Botanical Gardens in the second millennium have been the topic of a thorough debate, with specific references to the provisions of the United Nations Programme for a sustainable development. In particular, the Action Plan for Botanic Gardens in the European Union (3) identifies the following major assets: scientific research, conservation of plant diversity, public advisory services on it, environmental education related to it. To pursue these objectives, initiatives are constantly needed to enhance the visibility of the institutions involved and help them to perform their functions. in this contest was born FLORINTESA FLORINTESA is a program agreement, funded by the Italian Ministry of Education (MIUR) with identification code ACPR12_00201, involving as partners ENEA, Plinianum Forum and the Italian Botanical Society, which contributes to bridge the still existing gap between the scientific research, the technical action of conservation and preservation of plant diversity and the public awareness on such themes. The main objectives of the FLORINTESA can be summarized as follows: - Establishing an institutional network service for information and dissemination on the flora of Italy, with reference to the role of Botanical Gardens as centers of research and knowledge on the national flora, as well as on the assessment and conservation of its rarest species,; - Disseminating and publicizing the activities of the University Botanical Gardens for the flora of Italy; - Increasing the visibility of the Italian Botanical Society and of its working group on "Botanical and Historic Gardens"; - Disseminating the achievements and helpful assistance offered by the Botanical Gardens in the implementation of the National Strategy for Biodiversity (4) and the Natura 2000 Network (5), through initiatives such as the Italian Germplasm Banks Network (6), the International Foundation pro Herbario Mediterraneo (7), the pan-Mediterranean Genmeda network (8), the Horti Mediterranei Educational Network (9). The flora of Italy will be the leitmotif of the actions envisaged in FLORINTESA, highlighting the unique role of the University Botanical Gardens and their respective institutions as "engines of knowledge" on the national flora heritage, as "engines of awareness" on the important issue of conservation of flora and habitats, as "engines of passion" for the grateful acknowledgement of the role of plants as primary producers not only of resources in the natural ecosystems, but also of inspiring beauty in the human cultures. The kick-off meeting, open to all members of the Italian Botanical Society, will take place in Rome, at the Auditorium of the Accademia Nazionale dei Lincei, on January 23, 2014

Bronchoalveolar lavage, sputum and exhaled clinically relevant inflammatory markers: values in healthy adults.

11noBronchoalveolar lavage (BAL), induced sputum and exhaled breath markers (exhaled nitric oxide and exhaled breath condensate) can each provide biological insights into the pathogenesis of respiratory disorders. Some of their biomarkers are also employed in the clinical management of patients with various respiratory diseases. In the clinical context, however, defining normal values and cut-off points is crucial. The aim of the present review is to investigate to what extent the issue of defining normal values in healthy adults has been pursued for the biomarkers with clinical value. The current authors reviewed data from literature that specifically addressed the issue of normal values from healthy adults for the four methodologies. Most studies have been performed for BAL (n = 9), sputum (n = 3) and nitric oxide (n = 3). There are no published studies for breath condensate, none of whose markers yet has clinical value. In healthy adult nonsmokers the cut-off points (mean+2sd) for biomarkers with clinical value were as follows. BAL: 16.7% lymphocytes, 2.3% neutrophils and 1.9% eosinophils; sputum: 7.7 x 10(6).mL(-1) total cell count and 2.2% eosinophils; nitric oxide: 20.2 ppb. The methodologies differ concerning the quantity and characteristics of available reference data. Studies focusing on obtaining reference values from healthy individuals are still required, more evidently for the new, noninvasive methodologies.nonemixedBALBI B; PIGNATTI P; CORRADI M; BAIARDI P; BIANCHI L; BRUNETTI G; RADAELI A; MOSCATO G; MUTTI A; SPANEVELLO A; MALERBA MBalbi, B; Pignatti, P; Corradi, M; Baiardi, P; Bianchi, L; Brunetti, G; Radaeli, A; Moscato, G; Mutti, A; Spanevello, Antonio; Malerba, M

Effectiveness of a Pulmonary Rehabilitation Program on Persistent Asthma Stratified for Severity

BACKGROUND: Asthma is defined by airway inflammation associated with various respiratory symptoms, and pharmacologic treatment is based on inhaled corticosteroids and bronchodilators. Physical activity, educational training, nutritional support, and psychological counseling are considered part of non-pharmacologic treatment; however, studies so far have investigated the effect of single non-pharmacologic treatment. There are few studies that demonstrate the effect of comprehensive pulmonary rehabilitation, but no clear data are available regarding factors that can predict who could benefit the most. Our study aimed to assess the effect of a comprehensive 3-week pulmonary rehabilitation program on exercise tolerance and to identify baseline subject characteristics that may predict a better response to treatment. METHODS: This was a retrospective study. A team planned a pulmonary rehabilitation program: educational support; endurance training; and optional components, such as respiratory exercises and airway clearance techniques. The following data were collected before and after pulmonary rehabilitation: subject characteristics, smoking history, asthma severity, respiratory function and 6-min walk test (6MWT). RESULTS: We collected data on 515 subjects (202 males 39.2%), age, mean \ub1 SD 63.9 \ub1 10.4 y), with 413 (80.2%) having moderate-to-severe disease; and 455 (88.4%) with stable respiratory symptoms 455 (88.35%). At baseline, the percentage of predicted 6MWT in all subjects categorized by the Global Initiative for Asthma (GINA) steps was in the normal range, except for the subjects at step 5, for which it was significantly lower (P = .01). All subjects showed a significant improvement in exercise tolerance and oxygen saturation, together with a decrease in baseline dyspnea, muscle fatigue, and heart rate after pulmonary rehabilitation. Improvement of 6MWT was statistically significant, irrespective of the GINA categorization. The variables related to the improvement in 6MWT were age (P < .001), smoking habit (P = .034), and baseline 6MWT (P < .001). CONCLUSIONS: Subjects with asthma at any GINA step seemed to benefit from a pulmonary rehabilitation program; analysis of our data highlighted that pulmonary rehabilitation was more beneficial in younger subjects with a smoking history and worse baseline exercise tolerance

Type I and type II interferons inhibit both basal and tumor necrosis factor-α-induced CXCL8 secretion in primary cultures of human thyrocytes.

Interferons (IFNs) and tumor necrosis factor-α (TNF-α) cooperate in activating several inflammation-related genes, which sustain chronic inflammation in autoimmune thyroid disease (AITD). Much is known about the positive signaling of IFNs to activate gene expression in AITD, while the mechanisms by which IFNs negatively regulate genes remain less studied. While IFNs inhibit CXCL8 secretion in several human cell types, their effects on thyroid cells were not evaluated. Our aim was to study the interplay between TNF-α and type I or type II IFNs on CXCL8 secretion by human thyroid cells. CXCL8 was measured in supernatants of primary cultures of thyroid cells basally and after a 24-h incubation with TNF-α. CXCL8 was detected in thyroid cell supernatants in basal conditions (96.2±23.5 pg/mL) being significantly increased (784.7±217.3 pg/mL; PIFN-β>IFN-α. This study demonstrates that type I and type II IFNs downregulate both basal and TNF-α-induced CXCL8 secretion by human thyrocytes, IFN-γ being the most powerful inhibitor. Future studies aimed at a better comprehension of the interplay between CXCL8 and thyroid diseases appear worthwhile

Time course of exercise capacity in patients recovering from covid-19-associated pneumonia

Objective: High prevalences of muscle weakness and impaired physical performance in hospitalized patients recovering from COVID-19-associated pneumonia have been reported. Our objective was to determine whether the level of exercise capacity after discharge would affect long-term functional outcomes in these patients. Methods: From three to five weeks after discharge from acute care hospitals (T0), patients underwent a six-minute walk test (6MWT) and were divided into two groups according to the distance walked in percentage of predicted values: <75% group and ≥75% group. At T0 and three months later (T1), patients completed the Short Physical Performance Battery and the Euro Quality of Life Visual Analogue Scale, and pulmonary function and respiratory muscle function were assessed. In addition, a repeat 6MWT was also performed at T1. Results: At T0, 6MWD values and Short Physical Performance Battery scores were lower in the <75% group than in the ≥75% group. No differences were found in the Euro Quality of Life Visual Analogue Scale scores, pulmonary function variables, respiratory muscle function variables, length of hospital stay, or previous treatment. At T1, both groups improved their exercise capacity, but only the subjects in the <75% group showed significant improvements in dyspnea and lower extremity function. Exercise capacity and functional status values returned to predicted values in all of the patients in both groups. Conclusions: Four weeks after discharge, COVID-19 survivors with exercise limitation showed no significant differences in physiological or clinical characteristics or in perceived health status when compared with patients without exercise limitation. Three months later, those patients recovered their exercise capacity

Porcine model for gluteal artery perforator flap: Anatomy and technique

Although flap anatomy is well studied on cadavers and microsurgical techniques are well practiced on rats, still there are few training models for learning the techniques of perforator flap harvesting. The cadaver has no bloodstream, so accuracy of dissection cannot be evaluated and flap viability cannot be verified. Training on humans carries a high risk of flap damage. A living model for perforator flap harvest is needed to learn the technique before starting with its clinical application

Porcine model for deep superior epigastric artery perforator flap harvesting: Anatomy and technique

BACKGROUND Microsurgical training on rats before starting with clinical practice is a well-established routine. Animal model training is less widespread for perforator flaps, although these flaps represent a technical challenge. Unlike other flaps, they require specific technical skills that need to be adequately trained on a living model 1 : a cadaver is not enough because no bleeding, vessel damage, or vasospasm can be simulated. 2 The purpose of this study was to assess the suitability of the porcine abdomen as a training model for the deep inferior epigastric artery perforator (DIEAP) flap, commonly used in human breast reconstruction. METHODS A female swine (Sus scrofa domesticus, ssp; weight 25kg) was used. The procedure was performed with the pig under general anesthesia and in the supine position. A deep superior epigastric artery perforator (DSEAP) flap was harvested on the left side of the abdomen, including the 3 cranial nipples and stopping in the midline to spare the contralateral flap for another dissection (as in bilateral breast reconstructions in humans; Fig. 1). All steps of a DIEAP harvest were simulated: superficial vein harvest, suprafascial perforator dissection, intramuscular perforator harvest with preservation of the nerves, and flap isolation. Observation of capillary refill was used to confirm flap viability at the end of the dissection. The procedure was recorded by means of a GoPro camera and simultaneously with a head mounted (4 7 magnification) Loupecam system. Photographs were taken using 2 cameras during surgery at relevant time points. RESULTS At the end of the dissection, the flap was viable. The subcutaneous adipose tissue of the pig is less represented than in human and pigs have an additional muscular layer, the panniculus carnosus, which is the analogue of the human Scarpa's fascia. The rectus fascia is thinner. The perforators are lined in 2 rows: 1 lateral and 1 medial, as in the DIEAP, and the intercostal nerves cross the vessels, as happens in humans. The porcine rectus abdominis muscle is thinner than the human one, but vessels' branching faithfully reproduces the human model. 1 We identified 5 perforating vessels of more than 1mm in diameter (2 lateral and 3 medial). We isolated a lateral perforator first and a medial one last: the latter was eventually used to nourish the flap (Fig. 2). CONCLUSIONS The DSEAP flap allows one to closely reproduce all the steps of DIEAP flap harvesting and also to carry out the intramuscular dissection of 2 perforators for each side (up to 4 for each animal), confirming the adequacy of this pig model for microsurgical training. The deep superior epigastric artery is dominant in pigs. 3 Despite this anatomical difference, the DSEAP allows one to reproduce the main steps of DIEAP flap harvesting, providing an excellent training model. Moreover, the presence of double perforating rows allows simulating the dissection twice on each side