Coverage of exposed hardware after lower leg fractures with free flaps or pedicled flaps

Abstract. – OBJECTIVE: The placement of osteosynthetic materials in the leg may be complicated by hardware exposure. Successful soft tissue reconstruction often provides a critical means for limb salvage in patients with hardware exposure in the leg. Free flaps are currently considered the standard surgical procedure for soft tissue coverage of the wounds with internal hardware exposure. However, to date, no conclusive literature shows the superiority of a specific type of flap. MATERIALS AND METHODS: The current review compares data from the literature concerning outcomes and complications of free and pedicled flaps for exposed osteosynthetic material preservation in the leg. RESULTS: A total of 81 cases from twelve different articles presenting internal hardware exposure of the leg were analyzed in our study. Thirty-two patients underwent immediate reconstructive surgery with pedicled flaps, while forty-nine patients underwent free flap reconstruction. The overall survival rate for pedicled flaps was 96.77%, while for free flaps it was 97.77%. The overall implant preservation rate was 78.12% for pedicled flaps and 53.33% for free flaps. With reference to postoperative complications, the overall complication rate was 46.87% for pedicled flaps and 10.20% for free flaps. CONCLUSIONS: No significant difference was found in terms of overall flap survival. However, a significant difference was found regarding successful implant preservation (78.12% in the pedicled flap group vs. 53.33% in the free flap group). In particular, the first observation appears to be in contrast with the current trend of considering the free flaps the first choice procedure for soft tissue coverage of the wounds with internal hardware exposure. Nevertheless, a higher occurrence of postoperative complications was observed in the pedicled flap group (46.87% vs. 10.20%). The choice of the most appropriate reconstructive procedure should take into account several issues including the size of the wounds with internal hardware exposure, the possibility of soft tissue coverage with pedicled flaps, the availability of recipient vessels, general conditions of the patients (such as age, diabetes, smoking history), patients’ preference and presence of a microsurgical team. However, according to the results of this review, we believe that pedicled flap reconstruction should be reconsidered as a valid alternative procedure for skin tissue loss with hardware exposure whenever it is possible

remarks on a computational estimator for the barrier option pricing in an iot scenario

Abstract The importance of derivatives in financial markets has known an exponential growth in the last decades, especially in risk management and speculation fields: this explains researchers' interest in answering questions about this kind of contracts. In particular, in this paper we restrict our attention on European vanilla and barrier options, and we propose a statistical procedure to solve efficiently the problem of determining the no arbitrage price of this type of derivatives in an IoT context: starting form an Internet of Things (IoT) data flow, an IoT system takes information from several sources and stores it into a suitable database; this information is used in our estimation problem. Our scheme is based on some strong assumptions about the market model, in particular the completeness of the market, the log-normality of the underlying asset with a constant volatility. We conclude this paper with an application of our framework to a real case

Costruzione di un Simulatore Orbitale in ambiente Matlab

Nel presente lavoro ci siamo proposti di creare un simulatore di volo satellitare. Per fare ciò è stato necessario affrontare e risolvere il problema della determinazione e quantificazione delle perturbazioni a cui è soggetto un satellite operante in atmosfera terrestre. Da queste, per integrazione, si è ottenuta la traiettoria reale e si è valutato di quanto la stessa si discosta da quella Kepleriana ideale, basata su un semplice modello a due corpi (Terra e satellite) in cui l'unica forza agente è quella dovuta all'attrazione gravitazionale. La stima del discostamento dalla situazione ideale è stata fatta in termini di variazione dei sei elementi orbitali classici: semiasse maggiore, eccentricità, inclinazione, argomento del perigeo, ascensione retta del nodo ascendente, anomalia vera. Infine tra le configurazioni possibili ne sono state scelte tre, più significative, sulle quali abbiamo testato il nostro simulatore: Orbita bassa (LEO), Orbita di tipo "Molnya", Orbita Geostazionaria

Lithium limits trimethyltin-induced cytotoxicity and proinflammatory response in microglia without affecting the concurrent autophagy impairment

Trimethyltin (TMT) is a highly toxic molecule present as an environmental contaminant causing neurodegeneration particularly of the limbic system both in humans and in rodents. We recently described the occurrence of impairment in the late stages of autophagy in TMT-intoxicated astrocytes. Here we show that similarly to astrocytes also in microglia, TMT induces the precocious block of autophagy indicated by the accumulation of the autophagosome marker, microtubule associated protein light chain 3. Consistent with autophagy impairment we observe in TMT-treated microglia the accumulation of p62/SQSTM1, a protein specifically degraded through this pathway. Lithium has been proved effective in limiting neurodegenerations and, in particular, in ameliorating symptoms of TMT intoxication in rodents. In our in vitro model, lithium displays a pro-survival and anti-inflammatory action reducing both cell death and the proinflammatory response of TMT-treated microglia. In particular, lithium exerts these activities without reducing TMT-induced accumulation of light chain 3 protein. In fact, the autophagic block imposed by TMT is unaffected by lithium administration. These results are of interest as defects in the execution of autophagy are frequently observed in neurodegenerative diseases and lithium is considered a promising therapeutic agent for these pathologies. Thus, it is relevant that this cation can still maintain its pro-survival and anti-inflammatory role in conditions of autophagy bloc

The impact of endodontic anatomy on clinical practice: a micro-CT study and tribute to Prof. Francesco Riitano

Aim: To evaluate the quality of root canal preparation using two different mechanical NiTi systems. Methodology: 40 maxillary and mandibular molars were selected. Specimens were randomly assigned to two groups and were scanned using a micro-computed tomography scanner before and after root canal preparation that was performed using ProFile instrument sequence and Reciproc single file technique. Each system was used to obtain an optimal apical size for each specimen, following common clinical guidelines. 3D models were reconstructed and evaluated for volume, areas and root canal axis. The total volume of dentine removed and the volume of the coronal, middle and apical thirds of each root canal were calculated, as well as the average deviation of the root canal axis at different levels and the values compared. Student t-test was used to determine the difference between the two experimental groups (P < 0.05). A qualitative evaluation of root canal preparation was also performed. Results: No statistically significant differences were noted between the groups in the volume of dentine removed after root canal preparation, except for the volume of the coronal third (P < 0.05) and the volume of the apical third (P < 0.05) of the disto-buccal canal of maxillary molars and in the mesial canals of mandibular molars, where ProFile instruments produced significantly less enlarged canal volume in the apical third and more enlarged canal volume in the coronal third (P < 0.05). No statistically significant differences were found in the root canal axis deviation. Conclusions: Under the conditions of this study, both the systems analyzed were able to prepare molar teeth with similar amount of dentine removal and a relatively low risk of procedural errors

A new approach to antiglaucoma drugs: carbonic anhydrase inhibitors with or without NO donating moieties. Mechanism of action and preliminary pharmacology.

The clinically used sulfonamide carbonic anhydrase (CA, EC 4.2.1.1) inhibitor dorzolamide (DRZ), a new sulfonamide CA inhibitor also incorporating NO-donating moieties, NCX250, and isosorbide mononitrate (ISMN) (an NO-donating compound with no CA inhibitory properties) were investigated for their intraocular pressure (IOP) lowering effects in rabbits with carbomer-induced glaucoma. NCX250 was more effective than DRZ or ISMN on lowering IOP, increasing ocular hemodynamics, decreasing the inflammatory processes and ocular apoptosis in this animal model of glaucoma. NO participate to the regulation of IOP in glaucoma, having also antiapoptotic and anti-inflammatory effects. The ophthalmic artery, both systolic and diastolic velocities, were significantly reduced in NCX250-treated eyes in comparison to DRZ treated ones, suggesting thus a beneficial effect of NCX250 on the blood supply to the optic nerve. Combining CA inhibition with NO-donating moieties in the same compound offers an excellent approach for the management of glaucoma

Conditioning of root canal anatomy on static and dynamics of nickel-titanium rotary instruments

Abstract Aim Aim of this study is to analyze the real movement, influenced by anatomical difficulties, of nickel-titanium rotary instruments within root canal systems; then the objective is to point out the physical and geometrical characteristics of an ideal instrument, able to overcome the most complex anatomies. Methodology At first, observation of the behavior of nickel-titanium rotary instruments within root canal systems and of the influence on them of root canal anatomy. Then, attempt to avoid the anatomical obstructions exploiting, with manual rotation, the advantages of a zero/low torque. Results Given that, in some root canals the severity of the curves prevents instruments to advance in rotation, we obtained significant results by manually advancing and rotating NiTi rotary instruments. Conclusions Therefore, in some cases, we would need an instrument that can reconcile efficiency with a reduction of mass and torque; the ideal instrument should have a very contained working part, combining efficiency with the decrease of mass and, consequently, of torsional stresses too