The “Sombrero-Shape” Super-Thin Pedicled ALT Flap for Complete Scrotal Reconstruction Following Fournier’s Gangrene

When the scrotal sac is entirely debrided following a Fournier gangrene, testes exposure poses unique challenges for the reconstructive surgeon. Despite the anterolateral thigh (ALT) flap is considered a workhorse in such context, aesthetic results are often suboptimal because of the lack of natural ptosis and patchwork appearance. We describe the use of a super-thin pedicled ALT flap for total scrotal reconstruction, modified according to a peculiar flap design and inset technique. A 42-year-old man was referred to our department for delayed total scrotal reconstruction 8 months after a Fournier gangrene extensive debridement. A super-thin pedicled ALT flap from the right thigh was designed: in the central portion of the ALT, a lateral skin paddle extension was marked to guarantee adequate posterior anchorage during insetting and ptosis of the scrotal sac. This particular flap arrangement has inspired the name “sombrero” as the shape is akin to the famous hat. No secondary refinements were needed, and the patient showed satisfying aesthetic and functional results at 12 months’ follow-up. The ALT flap design “sombrero” modification proposed in this article can improve scrotum cosmesis and patient satisfaction in a single-stage single-flap procedure

Automotive leathers – evaluating the performance limits (part II)

Content: Consumers perceive leather as a durable and natural product. To support this positive image, car manufacturers have set demanding performance profiles addressing wear, emissions and sustainable manufacture. Poor performance of auto leather becomes visible as the polymeric finishing coat wears off or cracks over time. Therefore ageing property is seen as a representative key performance parameter and is determined by checking how flexible and strong a polymer coating remains after leather has been exposed to light, heat and humidity for a given time. Ageing of leather is complex to determine and depends on various parameters and requires a full system approach . In a first step different type of crusts (wet-blue, wet-white) were prepared and finished with a standard polyurethane coating. It turned out that the selection of the right fat liquors and tanning agents as well as the presence of vegetable tannins play an important role. On top of this the effective use of proper protective chemicals like anti-oxidants is needed. In a second approach the polymer coating itself was studied and optimized with regard to aged flexing and abrasion. Parameters like polymer type, crosslinking, application technology, coating thickness and impact of additives were investigated and tested when applied on the best crust leathers selected from part 1 of this work. Results show that not only is the right selection of polymers critical but also so is the way the coat is being applied . Furthermore coating thickness greatly defines wear (abrasion), lightfastness and ageing properties. Additives like dulling agents, levelers, feel agents, waxes ,fillers although needed can weaken the integrity of the polymer matrix and consequently reduce physical and chemical fastness properties. This may also apply to a certain extent to protective additives such as anti-oxidants and UV stabilizers, but when used properly their advantages outweigh the potential disadvantages. As to application, special emphasis is given to transfer coating technology which can provide advantages in application and quality consistency but also with regards to fastness properties such as wear and ageing. Take-Away: - crust leather has a critical impact on performance of finishing coat of automotive leathers and requires careful selction of products and use of protective chemical - polymer selection and use of protective chemical play an important role for achieving good aged flexing performance - type of application of finishing coat on auto leather further determines the performance of coatin

Gamma-ray diagnostics of Type Ia supernovae: Predictions of observables from three-dimensional modeling

Besides the fact that the gamma-ray emission due to radioactive decays is responsible for powering the light curves of Type Ia supernovae (SNe Ia), gamma rays themselves are of particular interest as a diagnostic tool because they provide a direct way to obtain deeper insights into the nucleosynthesis and the kinematics of these explosion events. Focusing on two of the most broadly discussed SN Ia progenitor scenarios - a delayed detonation in a Chandrasekhar-mass white dwarf (WD) and a violent merger of two WDs - we use three-dimensional explosion models and perform radiative transfer simulations to obtain synthetic gamma-ray spectra. Both chosen models produce the same mass of 56Ni and have similar optical properties that are in reasonable agreement with the recently observed supernova SN 2011fe. In contrast to the optical regime, the gamma-ray emission of our two chosen models proves to be rather different. The almost direct connection of the emission of gamma rays to fundamental physical processes occuring in SNe Ia permits additional constraints concerning several explosion model properties that are not easily accessible within other wavelength ranges. Proposed future MeV missions such as GRIPS will resolve all spectral details only for nearby SNe Ia, but hardness ratio and light curve measurements still allow for a distinction of the two different models at 10 and 16 Mpc for an exposure time of 10^6 s, respectively. The possibility to detect the strongest line features up to the Virgo distance will offer the opportunity to build up a first sample of SN Ia detections in the gamma-ray energy range and underlines the importance of future space observatories for MeV gamma rays.Comment: 10 pages, 8 figures, accepted for publication by A&

Neutrophils, Crucial, or Harmful Immune Cells Involved in Coronavirus Infection: A Bioinformatics Study

The latest member of the Coronaviridae family, called SARS-CoV-2, causes the Coronavirus Disease 2019 (COVID-19). The disease has caused a pandemic and is threatening global health. Similar to SARS-CoV, this new virus can potentially infect lower respiratory tract cells and can go on to cause severe acute respiratory tract syndrome, followed by pneumonia and even death in many nations. The molecular mechanism of the disease has not yet been evaluated until now. We analyzed the GSE1739 microarray dataset including 10 SARS-positive PBMC and four normal PBMC. Co-expression network analysis by WGCNA suggested that highly preserved 833 turquoise module with genes were significantly related to SARS-CoV infection. ELANE, ORM2, RETN, BPI, ARG1, DEFA4, CXCL1, and CAMP were the most important genes involved in this disease according to GEO2R analysis as well. The GO analysis demonstrated that neutrophil activation and neutrophil degranulation are the most activated biological processes in the SARS infection as well as the neutrophilia, basophilia, and lymphopenia predicted by deconvolution analysis of samples. Thus, using Serpins and Arginase inhibitors during SARS-CoV infection may be beneficial for increasing the survival of SARS-positive patients. Regarding the high similarity of SARS-CoV-2 to SARS-CoV, the use of such inhibitors might be beneficial for COVID-19 patients

Adipose Derived Stem Cells Reduce Fibrosis and Promote Nerve Regeneration in Rats.

Peripheral nerve regeneration is critical and challenging in the adult humans. High level of collagen infiltration (i.e., scar tissue), in the niche of injury, impedes axonal regeneration and path finding. Unfortunately, studies focusing on the modulation of scar tissue in the nerves are scarce. To address part of this problem, we have evaluated the differentiated adipose derived stem cells (dASCs) for their antifibrotic and regenerative effects in a 10 mm nerve gap model in rats. Three different animal groups (N = 5) were treated with fibrin nerve conduits (empty), or seeded with dASCs (F + dASCs) and autograft, respectively. Histological analysis of regenerated nerves, at 12 weeks postoperatively, reveled the high levels of collagen infiltration (i.e., 21.5% ± 6.1% and 24.1% ± 2.9%) in the middle and distal segment of empty conduit groups in comparison with stem cells treated (16.6% ± 2.1% and 12.1% ± 2.9%) and autograft (15.0% ± 1.7% and 12.8% ± 1.0%) animals. Thus, the dASCs treatment resulted in significant reduction of fibrotic tissue formation. Consequently, enhanced axonal regeneration and remyelination was found in the animals treated with dASCs. Interestingly, these effects of dASCs appeared to be equivalent to that of autograft treatment. Thus, the dASCs hold great potential for preventing the scar tissue formation and for promoting nerve regeneration in the adult organisms. Future experiments will focus on the validation of these findings in a critical nerve injury model. Anat Rec, 301:1714-1721, 2018. © 2018 Wiley Periodicals, Inc

How to better exploit the use of LCA analysis for Ultra High Performance Concrete (UHPC) through a constitutive law which integrates chloride and sulfate attack

Structural applications of advanced cementitious materials such as Ultra High Performance Concrete (UHPC) have been already assessed in harsh exposure conditions with presence of chlorides or sulfates. Nevertheless, the limited availability of design standards has not favoured so far a widespread use of these materials. Moreover, previous studies employed a constitutive model only partially representative of the real behavior of such materials when exposed to aggressive conditions. Therefore, this work, employing a “scenario dependent” constitutive law, estimates the serviceability limit state in correspondence of which it is needed to carry out the maintenance activities and investigates, through the Life Cycle Assessment (LCA) methodology, the ecological and economic profile of a UHPC water basin structure subjected to chloride and sulfate attack. The CML impact assessment method has been employed for the specific purpose to compare such structure to one made with ordinary reinforced concrete (ORC) using as system boundary the A1-B7 stages indicated in EN 15804

The unresolved case of sacral chordoma: from misdiagnosis to challenging surgery and medical therapy resistance.

PURPOSE: A sacral chordoma is a rare, slow-growing, primary bone tumor, arising from embryonic notochordal remnants. Radical surgery is the only hope for cure. The aim of our present study is to analyse our experience with the challenging treatment of this rare tumor, to review current treatment modalities and to assess the outcome based on R status. METHODS: Eight patients were treated in our institution between 2001 and 2011. All patients were discussed by a multidisciplinary tumor board, and an en bloc surgical resection by posterior perineal access only or by combined anterior/posterior accesses was planned based on tumor extension. RESULTS: Seven patients underwent radical surgery, and one was treated by using local cryotherapy alone due to low performance status. Three misdiagnosed patients had primary surgery at another hospital with R1 margins. Reresection margins in our institution were R1 in two and R0 in one, and all three recurred. Four patients were primarily operated on at our institution and had en bloc surgery with R0 resection margins. One had local recurrence after 18 months. The overall morbidity rate was 86% (6/7 patients) and was mostly related to the perineal wound. Overall, 3 out of 7 resected patients were disease-free at a median follow-up of 2.9 years (range, 1.6-8.0 years). CONCLUSION: Our experience confirms the importance of early correct diagnosis and of an R0 resection for a sacral chordoma invading pelvic structures. It is a rare disease that requires a challenging multidisciplinary treatment, which should ideally be performed in a tertiary referral center

One-Stage Coverage of Leg Region Defects with STSG Combined with VAC Dressing Improves Early Patient Mobilisation and Graft Take: A Comparative Study

Lower limb skin defects are very common and can result from a wide range of aetiologies. Split thickness skin graft (STSG) is a widely used method to address these problems. The role of postoperative dressing is primary as it permits one to apply a uniform pressure over the grafted area and promote adherence. Focusing on lower limb reconstruction, our clinical study compares the application of V.A.C. (Vacuum Assisted Closure) Therapy vs. conventional dressing in the immediate postoperative period following skin grafting. We included in the study all patients who received skin grafts on the leg region between January 2015 and December 2018, despite the aetiology of the defect. Only reconstructions with complete preoperative and postoperative follow-up data were included in the study. Patients were divided into two groups depending on if they received a traditional compressive dressing or a VAC dressing in the immediate postoperative period. We could retain 92 patients, 23 in the No VAC group and 69 in the VAC group. The patients included in the VAC group showed a statistically significant higher rate of graft take together with a lower immobilisation time (p < 0.05). Moreover, a lower rate of postoperative infection was recorded in the VAC group. This study represents the largest in the literature to report in detail surgical outcomes comparing the use of VAC therapy vs. conventional dressing after STSG in the postoperative management of lower limb reconstruction using skin grafts. VAC therapy was used to secure the grafts in the leg region, increasing the early graft take rate while at the same time improving patient mobilisation

The Genetic Germline Background of Single and Multiple Primary Melanomas

Background: Melanoma has a complex molecular background and multiple genes are involved in its development and progression. The advent of next generation sequencing platforms has enabled the evaluation of multiple genes at a time, thus unraveling new insights into the genetics of melanoma. We investigated a set of germline mutations able to discriminate the development of multiple primary melanomas (MPM) vs. single site primary melanomas (SPM) using a targeted next generation sequencing panel. Materials and Methods: A total of 39 patients, 20 with SPM and 19 with MPM, were enrolled in our study. Next generation analysis was carried out using a custom targeted sequencing panel that included 32 genes known to have a role in several carcinogenic pathways, such as those involved in DNA repair, pigmentation, regulation of kinases, cell cycle control and senescence. Results: We found a significant correlation between PIK3CA:p.I391M and MPMs, compared to SPMs, p = 0.031 and a trend for the association between CYP1B1: p.N453S and SPMs, compared to MPMs (p = 0.096). We also found that both subgroups shared a spectrum of 9 alterations in 8 genes (CYP1B1: p.N453S, BAP1: p.C39fs, PIK3CA: p.I391M, CDKAL1: c.1226_1227TG, POLE: p.V1161fs, OCA2: p.R419Q, OCA2: p.R305W, MC1R: p.V60L, MGMT: p.L115F), which suggested that these genes may play a role in melanoma development. Conclusions: In conclusion, despite the small cohort of patients, we found that germline mutations, such as those of PIK3CAand CYP1B1, might contribute to the differential development of SPM and MPM

Anxiety-like behavior of prenatally stressed rats is associated with a selective reduction of glutamate release in the ventral hippocampus

Abnormalities of synaptic transmission and plasticity in the hippocampus represent an integral part of the altered programming triggered by early life stress. Prenatally restraint stressed (PRS) rats develop long-lasting biochemical and behavioral changes, which are the expression of an anxious/depressive-like phenotype. We report here that PRS rats showed a selective impairment of depolarization- or kainate-stimulated glutamate and 3HD-aspartate release in the ventral hippo campus, a region encoding memories related to stress and emotions. GABA release was un affected in PRS rats. As a consequence of reduced glutamate release, PRS rats were also highly resistant to kainate-induced seizures. Abnormalities of glutamate release were associated with large reductions in the levels of synaptic vesicle-related proteins, such as VAMP (synaptobrevin), syntaxin-1, synaptophysin, synapsin Ia/b and IIa, munc-18, and Rab3A in the ventral hippocampus of PRS rats. Anxiety-like behavior in male PRS (and control) rats was inversely related to the extent of depolarization-evoked glutamate release in the ventral hippocampus. A causal relationship between anxiety-like behavior and reduction in glutamate release was demonstrated usingamixtureofthemGlu2/3 receptor antagonist, LY341495, and the GABAB receptor antagonist, CGP52432, which was shown to amplify depolarization-evoked 3HD-aspartate release in the ventral hippocampus. Bilateral micro infusion of CGP52432 plus LY341495 in the ventral hippocampus abolished anxiety-like behavior in PRS rats. These findings indicate that an impairment of glutamate release in the ventral hippocampus is a key component of the neuro plastic program induced by PRS, and that strategies aimed at enhancing glutamate release in the ventral hippocampus correct the "anxious phenotype" caused by early life stress