Invited response on: dual-plane retro-pectoral versus pre-pectoral dti breast reconstruction. An italian multicenter experience

Invited Response on: Dual-Plane Retro-Pectoral Versus Pre-pectoral DTI Breast Reconstruction: An Italian Multicenter Experienc

Acral lentiginous melanoma. A retrospective study

Background: Acral lentiginous melanoma (ALM) carries one of the worst prognoses among other subtypes. This malignant tumor is found on the distal limbs and is usually detected at late stages. Hereby, the authors present their experience on this melanoma subtype. Methods: A retrospective study was conducted. Data were extracted from patients’ medical records and from phone interviews. Results: A total of 43 patients were included in the study. The main signs and symptoms disclosed by the patients were bleeding (41.9%), size greater than 6 mm (41.9%), change in size (37.2%), change in shape (30.2%), rise above the surface of the skin (27.9%), change in color (20.9%), irregular borders (16.3%), and inflammation (16.3%). The first healthcare professional consulted was a general practitioner or a dermatologist in the majority of cases (88.3%). Only 44.2% of the patients were sent by their first physician for a biopsy, whereas 30.3% were sent by the 2nd physician. 14 patients underwent biopsy within 1 month from the first appointment with a physician, while 20 patients within 3 months and 9 patients within 6 months. Only 7 patients sought medical attention in the first 3 months; 21 patients sought medical care between 3 months and one year from the appearance of the lesion, while the remaining 15 patients waited more than a year. Conclusions: One of the major issues found in ALM is represented by the diagnostic delay; this may be due to either the patients or the physicians’ failure to recognize warning signs

Deep sternal wound infection following cardiac surgery. A comparison of the monolateral with the bilateral pectoralis major flaps

Deep sternal wound infections are a serious complication following sternotomy for cardiothoracic surgery. “Conventional” treatment provides debridement and secondary closure or closed catheter irrigation. The combination of the Negative Pressure Therapy with flap coverages is an accepted technique and one or both Pectoralis Major muscles could be chosen. A multistep protocol was adopted. One hundred and sixty seven patients were treated with the combination of Negative Pressure Therapy with the Pectoralis Major muscle flap: 86 monolateral flap and 81 bilateral flap reconstruction. The main complications (hematoma, seroma, dehiscence, and re-infection), the need for re-intervention, mortality rates, Intensive Care Unit, and hospitalisation time were assessed. The mono-pectoralis group had fewer complications and need for revision, with a shorter hospital stay. A statistically significant difference emerged for the hematoma rate (P =.0079). Monolateral flap should to be preferred because with the same coverage effectiveness, it guarantees the saving of controlateral muscle with its functionality and the possibility of its use in case of failure. Furthermore, as the technique is less invasive, it can be reserved for more fragile patients

Extended latissimus dorsi kite flap (eld-k flap). Revisiting an old place for a total autologous breast reconstruction in patients with medium to large breasts

Background: The latissimus dorsi (LD) flap represents one of the most reliable methods for autologous breast reconstruction. However, in many patients, the exclusive use of this technique may not guarantee the restoration of an adequate volume and projection. We report our experience with the extended latissimus dorsi kite flap (ELD-K flap), an alternative surgical approach to maximize the volume of the fleur-de-lis pattern LD flap, for total autologous breast reconstruction. Methods: Between 2016 and 2018, 23 patients were subjected to mastectomy and immediate autologous reconstruction with "extended latissimus dorsi kite flap" (ELD-K flap), technique that employs an extended version of the LD musculocutaneous flap, based on the skeletonized thoracodorsal pedicle and a trilobate skin incision with an inferiorly based vertical branch. The BREAST-Q questionnaire was administered preoperatively, and one year after surgery to evaluate the quality of life results of the patients. BREAST-Q latissimus dorsi module was also provided. Results: Average body mass index was 29.7 kg/m2 (range 25–40 kg/m2). Mild complications occurred in only six cases, and eight patients underwent treatment to improve the donor site scar outcome. Patients indicated high scores in quality of life measures with an increase in all BREAST domains from the preoperative to the postoperative period. A statistically significant increase (p < 0.05) was noted in: “overall satisfaction with breasts” (p < 0.05), “psychosocial well-being” (p < 0.05), “physical impact of the surgery” (p < 0.05). Within the LD module, participants reported a mean score of, respectively, 73.8 and 67.9 for “satisfaction with back” and “satisfaction with shoulder and back function” domains. Conclusions: The extended incision allows the recruitment of additional tissue to provide enough volume to complete the reconstruction without implants. The isolation of the vascular pedicle allows for extreme freedom and mobilization of the flap, ensuring adequate filling of the breast. ELD-K flap may expand the indications for a total autologous LD immediate breast reconstruction, representing an additional and reliable alternative in selected cohorts of patients. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

The effects of COVID-19 pandemic on elective post-bariatric surgery waiting list. A single plastic surgery center investigation

Objective: After massive weight loss, patients that meet specific criteria can be inserted in an ad-hoc post-bariatric surgery list in order to be subjected to body contouring procedures. During COVID-19 pandemic, the Italian National Health System has been overwhelmed by the continue load of life-threatening patients that needed medical assistance. Plastic surgery practice enormously scaled back during this period and this fact greatly affected elective procedures waiting lists. The aim of our study is to analyze how the lockdown and its related sanitary policies affected post-bariatric patients' behaviors towards the delay of their procedure. Patients and methods: A 7-item questionnaire was administered to all patients. Change in the desire to be subjected to body contouring procedures was recorded. Smoking status, level of training during quarantine and psychological co-morbidities were also evaluated. Results: 124 patients completed the questionnaire. Data analysis showed that none of them encountered a decrease of the desire to be subjected to post-bariatric plastic surgery procedures. Conclusions: The present study showed that all the patients in the waiting list did not modify their interest in being subjected to post-bariatric surgery procedures, even though the waiting time increased

Ocean circulation and Tropical Variability in the Coupled Model ECHAM5/MPI-OM

This paper describes the mean ocean circulation and the tropical variability simulated by the Max Planck Institute for Meteorology (MPI-M) coupled atmosphere–ocean general circulation model (AOGCM). Results are presented from a version of the coupled model that served as a prototype for the Intergovernmental Panel on Climate Change (IPCC) Fourth Assessment Report (AR4) simulations. The model does not require flux adjustment to maintain a stable climate. A control simulation with present-day greenhouse gases is analyzed, and the simulation of key oceanic features, such as sea surface temperatures (SSTs), large-scale circulation, meridional heat and freshwater transports, and sea ice are compared with observations. A parameterization that accounts for the effect of ocean currents on surface wind stress is implemented in the model. The largest impact of this parameterization is in the tropical Pacific, where the mean state is significantly improved: the strength of the trade winds and the associated equatorial upwelling weaken, and there is a reduction of the model’s equatorial cold SST bias by more than 1 K. Equatorial SST variability also becomes more realistic. The strength of the variability is reduced by about 30% in the eastern equatorial Pacific and the extension of SST variability into the warm pool is significantly reduced. The dominant El Niño–Southern Oscillation (ENSO) period shifts from 3 to 4 yr. Without the parameterization an unrealistically strong westward propagation of SST anomalies is simulated. The reasons for the changes in variability are linked to changes in both the mean state and to a reduction in atmospheric sensitivity to SST changes and oceanic sensitivity to wind anomalies

Higgs Low-Energy Theorem (and its corrections) in Composite Models

The Higgs low-energy theorem gives a simple and elegant way to estimate the couplings of the Higgs boson to massless gluons and photons induced by loops of heavy particles. We extend this theorem to take into account possible nonlinear Higgs interactions resulting from a strong dynamics at the origin of the breaking of the electroweak symmetry. We show that, while it approximates with an accuracy of order a few percents single Higgs production, it receives corrections of order 50% for double Higgs production. A full one-loop computation of the gg->hh cross section is explicitly performed in MCHM5, the minimal composite Higgs model based on the SO(5)/SO(4) coset with the Standard Model fermions embedded into the fundamental representation of SO(5). In particular we take into account the contributions of all fermionic resonances, which give sizeable (negative) corrections to the result obtained considering only the Higgs nonlinearities. Constraints from electroweak precision and flavor data on the top partners are analyzed in detail, as well as direct searches at the LHC for these new fermions called to play a crucial role in the electroweak symmetry breaking dynamics.Comment: 30 pages + appendices and references, 12 figures. v2: discussion of flavor constraints improved; references added; electroweak fit updated, results unchanged. Matches published versio

Flavour physics from an approximate U(2)^3 symmetry

The quark sector of the Standard Model exhibits an approximate U(2)^3 flavour symmetry. This symmetry, broken in specific directions dictated by minimality, can explain the success of the Cabibbo-Kobayashi-Maskawa picture of flavour mixing and CP violation, confirmed by the data so far, while allowing for observable deviations from it, as expected in most models of ElectroWeak Symmetry Breaking. Building on previous work in the specific context of supersymmetry, we analyze the expected effects and we quantify the current bounds in a general Effective Field Theory framework. As a further relevant example we then show how the U(2)^3 symmetry and its breaking can be implemented in a generic composite Higgs model and we make a first analysis of its peculiar consequences. We also discuss how some partial extension of U(2)^3 to the lepton sector can arise, both in general and in composite Higgs models. An optimistic though conceivable interpretation of the considerations developed in this paper gives reasons to think that new physics searches in the flavour sector may be about to explore an interesting realm of phenomena.Comment: 29 pages, 5 figure

Brane-bulk matter relation for a purely conical codimension-2 brane world

We study gravity on an infinitely thin codimension-2 brane world, with purely conical singularities and in the presence of an induced gravity term on the brane. We show that in this approximation, the energy momentum tensor of the bulk is strongly related to the energy momentum tensor of the brane and thus the gravity dynamics on the brane are induced by the bulk content. This is in contrast with the gravity dynamics on a codimension-1 brane. We show how this strong result is relaxed after including a Gauss-Bonnet term in the bulk.Comment: 12 pages, mistake corrected, references adde

A natural little hierarchy for RS from accidental SUSY

We use supersymmetry to address the little hierarchy problem in Randall-Sundrum models by naturally generating a hierarchy between the IR scale and the electroweak scale. Supersymmetry is broken on the UV brane which triggers the stabilization of the warped extra dimension at an IR scale of order 10 TeV. The Higgs and top quark live near the IR brane whereas light fermion generations are localized towards the UV brane. Supersymmetry breaking causes the first two sparticle generations to decouple, thereby avoiding the supersymmetric flavour and CP problems, while an accidental R-symmetry protects the gaugino mass. The resulting low-energy sparticle spectrum consists of stops, gauginos and Higgsinos which are sufficient to stabilize the little hierarchy between the IR scale and the electroweak scale. Finally, the supersymmetric little hierarchy problem is ameliorated by introducing a singlet Higgs field on the IR brane.Comment: 37 pages, 3 figures; v2: minor corrections, version published in JHE