Telematic solutions in plastic surgery during COVID-19 pandemic: Liability issues and risk management

During the COVID-19 pandemic, surgical elective procedures were stopped in our plastic surgery unit. Limitations for consultations and for follow-up of previous surgical procedures were imposed in order to minimize the risk of contagion in waiting rooms and outpatient clinics. We have identified telemedicine as an alternative way to follow patients during the lockdown. Nevertheless, we have experienced different difficulties. We have not had the possibility to use a secure teleconferencing software. In our unit we had not technological devices. Surgeons in our department were not able to use remote video technology for patient management. Guidelines for an appropriate selection of patients which could be served via telemedicine had to be created.Telemedicine must be regulated by healthcare organizations for legal, ethical, medico-legal and risk management aspects.Even if we have experienced an important need to use telematic solutions during the COVID-19 lockdown, liability and risk management issues has greatly limited this possibility in our unit. The need of telemedicine in the time of COVID-19 pandemic has encouraged us to implement future virtual encounters in order to reduce unnecessary in-person visits by taking into consideration all legal, ethical and medico-legal aspects

Synthesis of Glass Nanocomposite Powders: Structure, Thermal, and Antibacterial Study

The aim of the present study is to synthesize CaO•GeO2 glass nanocomposite powders. The samples are prepared at 1450°C, and to investigate the structure of the samples, differential thermal analysis (DTA), X-ray diffraction, and Fourier Transform Infrared (FTIR) spectroscopy are used. The main crystallizing phase is found to be CaGe2O5 crystals. Furthermore, the potential antibacterial properties of the materials towards the Gram-negative bacteria, Escherichia coli, are preliminarily studied

Determining the optimal piecewise constant approximation for the nonhomogeneous Poisson process rate of Emergency Department patient arrivals

Modeling the arrival process to an Emergency Department (ED) is the first step of all studies dealing with the patient flow within the ED. Many of them focus on the increasing phenomenon of ED overcrowding, which is afflicting hospitals all over the world. Since Discrete Event Simulation models are often adopted to assess solutions for reducing the impact of this problem, proper nonstationary processes are taken into account to reproduce time–dependent arrivals. Accordingly, an accurate estimation of the unknown arrival rate is required to guarantee the reliability of results. In this work, an integer nonlinear black–box optimization problem is solved to determine the best piecewise constant approximation of the time-varying arrival rate function, by finding the optimal partition of the 24 h into a suitable number of not equally spaced intervals. The black-box constraints of the optimization problem make the feasible solutions satisfy proper statistical hypotheses; these ensure the validity of the nonhomogeneous Poisson assumption about the arrival process, commonly adopted in the literature, and prevent mixing overdispersed data for model estimation. The cost function of the optimization problem includes a fit error term for the solution accuracy and a penalty term to select an adequate degree of regularity of the optimal solution. To show the effectiveness of this methodology, real data from one of the largest Italian hospital EDs are used

Cavity-Enhanced Two-Photon Interference using Remote Quantum Dot Sources

Quantum dots in cavities have been shown to be very bright sources of indistinguishable single photons. Yet the quantum interference between two bright quantum dot sources, a critical step for photon based quantum computation, has never been investigated. Here we report on such a measurement, taking advantage of a deterministic fabrication of the devices. We show that cavity quantum electrodynamics can efficiently improve the quantum interference between remote quantum dot sources: poorly indistinguishable photons can still interfere with good contrast with high quality photons emitted by a source in the strong Purcell regime. Our measurements and calculations show that cavity quantum electrodynamics is a powerful tool for interconnecting several devices.Comment: 5 pages, 4 figures (Supp. Mat. attached

Photo-Curing 3D Printing and Innovative Design of Porous Composite Structures for Biomedical Applications

Light-activated resins and composites are used in conjunction with a light curing unit and allow an on-demand process of polymerization. These kinds of materials usually represent the most popular choice in the restorative dental practice. Some works have already highlighted contemporary tendencies in the use of nondegradable scaffolds and mesenchymal stem cells in regenerative medicine. Accordingly, the aim of the current research is to develop 3D porous and light-activated composite structures with optimized functional properties. Preliminary mechanical and biological tests are carried out

Integrated Design Strategy for Additively Manufactured Scaffolds in Tissue Engineering

Additive manufacturing technologies allow for the direct fabrication of 3D scaffolds with improved properties for tissue regeneration. In this scenario, design strategies and 3D fiber deposition technique are considered to develop advanced scaffolds with different lay-down patterns, tailored mechanical and biological properties. 3D poly(ε-caprolactone) scaffolds are manufactured and surface-modified (i.e., aminolysis). The effect of surface modification on the mechanical and biological performances of the designed 3D scaffolds is assessed

Predicting the ecological impacts of an alien invader: experimental approaches reveal the trophic consequences of competition

1. Ecological theory on the trophic impacts of invasive fauna on native competitors is equivocal. While increased inter-specific competition can result in coexisting species having constricted and diverged trophic niches, the competing species might instead increase their niche sizes to maintain energy intakes. Empirical experiments can test invasion theory on competitive interactions and niche sizes across different spatial scales and complexity. 2. The consequences of increased inter-specific competition from a model alien fish Leuciscus idus were tested on two taxonomically and trophically similar native fishes, Squalius cephalus and Barbus barbus. Competitive interactions were tested in tank aquaria using comparative functional responses (CFRs) and cohabitation trials. The consequences of these competitive interactions for the trophic niche sizes and positions of the fishes were tested in pond mesocosms. 3. CFRs revealed that compared to B. barbus, L. idus had significantly higher attack and consumption rates; cohabitation trials revealed B. barbus growth rates were depressed in sympatry with L. idus. For L. idus and S. cephalus, differences in their functional response parameters and growth rates were not significant. 4. Pond mesocosms used stable isotope metrics to quantify shifts in the trophic niche sizes of the fishes between allopatry and sympatry using a substitutive experimental design. Isotopic niches were smaller and more divergent in sympatric paired species than predicted by their allopatric treatments, suggesting trophic impacts from inter-specific competition. However, an all-species sympatric treatment revealed similar niche sizes with allopatry. This maintenance of niche sizes in the presence of all species potentially resulted from the buffering of direct competitive effects of the species-pairs by indirect effects. 5. Experimental predictions from tank aquaria assisted the interpretation of the constricted and diverged trophic niches detected in the paired-species sympatric treatments of the pond mesocosms. However, the all-species sympatric treatment of this experiment revealed greater complexity in the outcomes of the competitive interactions within and between the species. These results have important implications for understanding how alien species integrate into food webs and influence the trophic relationships between native species

Laminin 332-Dependent YAP Dysregulation Depletes Epidermal Stem Cells in Junctional Epidermolysis Bullosa

Laminin 332-deficient junctional epidermolysis bullosa (JEB) is a severe genetic skin disease. JEB is marked by epidermal stem cell depletion, the origin of which is unknown. We show that dysregulation of the YAP and TAZ pathway underpins such stem cell depletion. Laminin 332-mediated YAP activity sustains human epidermal stem cells, detected as holoclones. Ablation of YAP selectively depletes holoclones, while enforced YAP blocks conversion of stem cells into progenitors and indefinitely extends the keratinocyte lifespan. YAP is dramatically decreased in JEB keratinocytes, which contain only phosphorylated, inactive YAP. In normal keratinocytes, laminin 332 and alpha 6 beta 4 ablation abolish YAP activity and recapitulate the JEB phenotype. In JEB keratinocytes, laminin 332-gene therapy rescues YAP activity and epidermal stem cells in vitro and in vivo. In JEB cells, enforced YAP recapitulates laminin 332-gene therapy, thus uncoupling adhesion from proliferation in epidermal stem cells. This work has important clinical implication for ex vivo gene therapy of JEB

Patient-specific image-based computer simulation for theprediction of valve morphology and calcium displacement after TAVI with the Medtronic CoreValve and the Edwards SAPIEN valve

AIMS: Our aim was to validate patient-specific software integrating baseline anatomy and biomechanical properties of both the aortic root and valve for the prediction of valve morphology and aortic leaflet calcium displacement after TAVI. METHODS AND RESULTS: Finite element computer modelling was performed in 39 patients treated with a Medtronic CoreValve System (MCS; n=33) or an Edwards SAPIEN XT (ESV; n=6). Quantitative axial frame morphology at inflow (MCS, ESV) and nadir, coaptation and commissures (MCS) was compared between multislice computed tomography (MSCT) post TAVI and a computer model as well as displacement of the aortic leaflet calcifications, quantified by the distance between the coronary ostium and the closest calcium nodule. Bland-Altman analysis revealed a strong correlation between the observed (MSCT) and predicted frame dimensions, although small differences were detected for, e.g., Dmin at the inflow (mean±SD MSCT vs. MODEL: 21.6±2.4 mm vs. 22.0±2.4 mm; difference±SD: -0.4±1.3 mm, p<0.05) and Dmax (25.6±2.7 mm vs. 26.2±2.7 mm; difference±SD: -0.6±1.0 mm, p<0.01). The observed and predicted calcium displacements were highly correlated for the left and right coronary ostia (R2=0.67 and R2=0.71, respectively p<0.001). CONCLUSIONS: Dedicated software allows accurate prediction of frame morphology and calcium displacement after valve implantation, which may help to improve outcome