Skin/nipple sparing mastectomies and implant-based breast reconstruction in patients with large and ptotic breast: oncological and reconstructive results.

In this study we performed 77 procedures on 65 patients fulfilling the oncological criteria for skin-sparing mastectomy and presenting with large or medium size breasts. All the operations were performed as a single-stage procedure with an anatomical prosthesis allocated into a compound pouch, made up of the pectoralis major, serratus anterior fascia, and a lower dermal adipose flap. The medium size of the anatomical implants employed was 444.3 cc. The implant removal rate was 14.2%. At a median follow-up of 36 months we reported a 0.5% local recurrence rate per year. The overall specific survival rate was 98.2%. This study confirms the safety and effectiveness of this technical variation of skin and nipple-sparing mastectomies. All breast, irrespective of mammary shape and size, can be reconstructed with medium size implants and, if required, contralateral adjustments. The overall complication rate is in keeping with previous studies

Critical factors and guidelines for 3D surveying and modelling in Cultural Heritage

The 3D digitization of sites or objects, normally referred to “realitybased 3D surveying and modelling”, is based on 3D optical instruments able to deliver accurate, detailed and realistic 3D results. Nowadays many non-experts are facing the 3D world and its technologies (hardware and software) due to their easiness of use but a not correct use leads to wrong results and conclusions. The goal of the article is to critically report the 3D digitization pipeline with some Cultural Heritage examples. Based on our experiences, some guidelines are drawn as best practices for non-experts and to clearly point out the right approach for every goal and project

Extreme Energy Cosmic Rays (EECR) Observation Capabilities of an "Airwatch from Space'' Mission

The longitudinal development and other characteristics of the EECR induced atmospheric showers can be studied from space by detecting the fluorescence light induced in the atmospheric nitrogen. According to the Airwatch concept a single fast detector can be used for measuring both intensity and time development of the streak of fluorescence light produced by the atmospheric shower induced by an EECR. In the present communication the detection capabilities for the EECR observation from space are discussed.Comment: 3 pages (LaTeX). To appear in the Proceedings of TAUP'9

Determination of parameters for the evaluation of Phosphorus/Calcium metabolism in adult normal dogs

Diseases that facilitate alterations in the metabolism of calcium (Ca) and phosphorus (Pi) are\ndiverse. Knowing and interpreting normal parameters is fundamental to making a diagnosis.\nIn this study both minerals were evaluated in the blood and urine of 52 healthy adult dogs in\nthree age ranges in years old (group A: from 1 to 5, group B: from 6 to 10, and group C: older\nthan 10).\nCalcium levels exhibited no significant difference across age groups. A significant increase (p = 0.03)\nin phosphorus was found in group C in relation to the other two groups.\nBased on the elimination of both minerals through the urine, evaluated from the fractional\nexcretion (DIP and DICa) and the relation Ca or Pi / Creatinine, a non-significant tendency\nof a lower elimination of Pi through urine was observed, according to DIP values of group C\n(p = 0.055).\nThe values of DIP and DICa were correlated with the ones in Pi or Ca/Cr in urine (r = 0.9, p < 0.0001).\nThese results allow us to infer that the mineral/Cr relation can be used when evaluating\nelimination by urine. The age range must be taken into account when interpreting results of\nphosphorus in blood and urine, since groups older than 10 years old have higher minimum\nand maximum threshold levels than the other two groups.Fil: Martiarena, B. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Clínica Médica de Pequeños Animales; ArgentinaFil: Castillo, V. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Hospital Escuela de Pequeños Animales. Unidad de Endocrinología; ArgentinaFil: Regonat, M. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Patología Clínica; ArgentinaFil: Regonat, M. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Hospital Escuela de Pequeños Animales. Unidad de Laboratorio; ArgentinaFil: Quintana, H. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Nutrición; ArgentinaFil: Quintana, H. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Hospital Escuela de Pequeños Animales. Unidad de Nutrición; ArgentinaFil: Brandi, G. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Patología Clínica; ArgentinaFil: Brandi, G. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Hospital Escuela de Pequeños Animales. Unidad de Laboratorio; ArgentinaFil: Lamarca, G. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Clínica Médica de Pequeños Animales; ArgentinaFil: Molina, E. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Hospital Escuela de Pequeños Animlaes. Unidad de Nefrología y Urología; ArgentinaFil: Ruidiaz, V. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Clínica Médica de Pequeños Animales; ArgentinaFil: Visintini, A. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Clínica Médica de Pequeños Animales; ArgentinaLas enfermedades que alteran el metabolismo fósforo (Pi)/calcio (Ca) son variadas. Para\ndiagnosticarlas es necesario conocer e interpretar parámetros normales. Se estudiaron ambos\nminerales, en sangre y orina, en 52 perros adultos sanos, agrupados según rango etario en años:\nGA de 1 a 5; GB de 6 a 10 y GC ? de 10.\nNo se encontraron diferencias significativas para la calcemia entre los grupos. Hubo un\nincremento significativo para la fosfatemia (p 0.03) y el producto Ca x Pi (p 0.02) en el GC\nrespecto al resto.\nDe la eliminación de ambos minerales en orina, evaluada mediante la excreción fraccional (DIP\ny DICa) y por la relación Calcio o fósforo/creatinina, se observó una tendencia, no significativa,\na una menor eliminación de fósforo, según los valores de DIP en el grupo C (p 0.055). Los\nvalores de DIP y DICa se correlacionaron con los de Fósforo o Calcio/Creatinina (r 0.9, p < 0.0001),\nhaciendo que dichas relaciones pueden ser utilizadas para evaluar la excreción urinaria.\nEl rango etario debe tenerse en cuenta para interpretar resultados del fósforo en sangre y orina,\ndado que los valores de cortes mínimos y máximos son más elevados en los mayores de 10 años

Is fluorescein-guided technique able to help in resection of high-grade gliomas?

OBJECT: Fluorescein, a dye that is widely used as a fluorescent tracer, accumulates in cerebral areas where the blood-brain barrier is damaged. This quality makes it an ideal dye for the intraoperative visualization of high-grade gliomas (HGGs). The authors report their experience with a new fluorescein-guided technique for the resection of HGGs using a dedicated filter on the surgical microscope. METHODS: The authors initiated a prospective Phase II trial (FLUOGLIO) in September 2011 with the objective of evaluating the safety of fluorescein-guided surgery for HGGs and obtaining preliminary evidence regarding its efficacy for this purpose. To be eligible for participation in the study, a patient had to have suspected HGG amenable to complete resection of the contrast-enhancing area. The present report is based on the analysis of the short- and long-term results in 20 consecutive patients with HGGs (age range 45-74 years), enrolled in the study since September 2011. In all cases fluorescein (5-10 mg/kg) was injected intravenously after intubation. Tumor resection was performed with microsurgical technique and fluorescence visualization by means of BLUE 400 or YELLOW 560 filters on a Pentero microscope. RESULTS: The median preoperative tumor volume was 30.3 cm(3) (range 2.4-87.8 cm(3)). There were no adverse reactions related to fluorescein administration. Complete removal of contrast-enhanced tumor was achieved in 80% of the patients. The median duration of follow-up was 10 months. The 6-months progression-free survival rate was 71.4% and the median survival was 11 months. CONCLUSIONS: Analysis of these 20 cases suggested that fluorescein-guided technique with a dedicated filter on the surgical microscope is safe and allows a high rate of complete resection of contrast-enhanced tumor as determined on early postoperative MRI. Clinical trial registration no.: 2011-002527-18 (EudraCT)

Timing of Symptoms of Early-Onset Sepsis after Intrapartum Antibiotic Prophylaxis: Can It Inform the Neonatal Management?

The effectiveness of “inadequate” intrapartum antibiotic prophylaxis (IAP administered &lt; 4 h prior to delivery) in preventing early-onset sepsis (EOS) is debated. Italian prospective surveillance cohort data (2003–2022) were used to study the type and duration of IAP according to the timing of symptoms onset of group B streptococcus (GBS) and E. coli culture-confirmed EOS cases. IAP was defined “active” when the pathogen yielded in cultures was susceptible. We identified 263 EOS cases (GBS = 191; E. coli = 72). Among GBS EOS, 25% had received IAP (always active when beta-lactams were administered). Most IAP-exposed neonates with GBS were symptomatic at birth (67%) or remained asymptomatic (25%), regardless of IAP duration. Among E. coli EOS, 60% were IAP-exposed. However, IAP was active in only 8% of cases, and these newborns remained asymptomatic or presented with symptoms prior to 6 h of life. In contrast, most newborns exposed to an “inactive” IAP (52%) developed symptoms from 1 to &gt;48 h of life. The key element to define IAP “adequate” seems the pathogen’s antimicrobial susceptibility rather than its duration. Newborns exposed to an active antimicrobial (as frequently occurs with GBS infections), who remain asymptomatic in the first 6 h of life, are likely uninfected. Because E. coli isolates are often unsusceptible to beta-lactam antibiotics, IAP-exposed neonates frequently develop symptoms of EOS after birth, up to 48 h of life and beyond

Therapeutic immunization with HIV-1 Tat reduces immune activation and loss of regulatory T-cells and improves immune function in subjects on HAART.

Although HAART suppresses HIV replication, it is often unable to restore immune homeostasis. Consequently, non-AIDS-defining diseases are increasingly seen in treated individuals. This is attributed to persistent virus expression in reservoirs and to cell activation. Of note, in CD4(+) T cells and monocyte-macrophages of virologically-suppressed individuals, there is continued expression of multi-spliced transcripts encoding HIV regulatory proteins. Among them, Tat is essential for virus gene expression and replication, either in primary infection or for virus reactivation during HAART, when Tat is expressed, released extracellularly and exerts, on both the virus and the immune system, effects that contribute to disease maintenance. Here we report results of an ad hoc exploratory interim analysis (up to 48 weeks) on 87 virologically-suppressed HAART-treated individuals enrolled in a phase II randomized open-label multicentric clinical trial of therapeutic immunization with Tat (ISS T-002). Eighty-eight virologically-suppressed HAART-treated individuals, enrolled in a parallel prospective observational study at the same sites (ISS OBS T-002), served for intergroup comparison. Immunization with Tat was safe, induced durable immune responses, and modified the pattern of CD4(+) and CD8(+) cellular activation (CD38 and HLA-DR) together with reduction of biochemical activation markers and persistent increases of regulatory T cells. This was accompanied by a progressive increment of CD4(+) T cells and B cells with reduction of CD8(+) T cells and NK cells, which were independent from the type of antiretroviral regimen. Increase in central and effector memory and reduction in terminally-differentiated effector memory CD4(+) and CD8(+) T cells were accompanied by increases of CD4(+) and CD8(+) T cell responses against Env and recall antigens. Of note, more immune-compromised individuals experienced greater therapeutic effects. In contrast, these changes were opposite, absent or partial in the OBS population. These findings support the use of Tat immunization to intensify HAART efficacy and to restore immune homeostasis. TRIAL REGISTRATION: ClinicalTrials.gov NCT00751595

The Italian arm of the PREPARE study: an international project to evaluate and license a maternal vaccine against group B streptococcus.

BACKGROUND: Group B streptococcus (GBS) is a leading cause of sepsis, pneumonia and meningitis in infants, with long term neurodevelopmental sequelae. GBS may be associated with poor pregnancy outcomes, including spontaneous abortion, stillbirth and preterm birth. Intrapartum antibiotic prophylaxis (IAP) is currently the only way to prevent early-onset disease (presenting at 0 to 6 days of life), although it has no impact on the disease presenting over 6 days of life and its implementation is challenging in resource poor countries. A maternal vaccine against GBS could reduce all GBS manifestations as well as improve pregnancy outcomes, even in low-income countries. MAIN BODY: The term "PREPARE" designates an international project aimed at developing a maternal vaccination platform to test vaccines against neonatal GBS infections by maternal immunization. It is a non-profit, multi-center, interventional and experimental study (promoted by the St George University of London. [UK]) with the aim of developing a maternal vaccination platform, determining pregnancy outcomes, and defining the extent of GBS infections in children and mothers in Africa. PREPARE also aims to estimate the protective serocorrelates against the main GBS serotypes that cause diseases in Europe and Africa and to conduct two trials on candidate GBS vaccines. PREPARE consists of 6 work packages. In four European countries (Italy, UK, Netherlands, France) the recruitment of cases and controls will start in 2020 and will end in 2022. The Italian PREPARE network includes 41 centers. The Italian network aims to collect: GBS isolates from infants with invasive disease, maternal and neonatal sera (cases); cord sera and GBS strains from colonized mothers whose infants do not develop GBS infection (controls). SHORT CONCLUSION: PREPARE will contribute information on protective serocorrelates against the main GBS serotypes that cause diseases in Europe and Africa. The vaccine that will be tested by the PREPARE study could be an effective strategy to prevent GBS disease

Neurovascular coupling methods in healthy individuals using transcranial doppler ultrasonography: A systematic review and consensus agreement

This is the final version. Available from SAGE Publications via the DOI in this recordData availability. This was a systematic review of existing research studies and no primary research was conducted.Neurovascular coupling (NVC) is the perturbation of cerebral blood flow (CBF) to meet varying metabolic demands induced by various levels of neural activity. NVC may be assessed by Transcranial Doppler ultrasonography (TCD), using task activation protocols, but with significant methodological heterogeneity between studies, hindering cross-study comparisons. Therefore, this review aimed to summarise and compare available methods for TCD-based healthy NVC assessments. Medline (Ovid), Scopus, Web of Science, EMBASE (Ovid) and CINAHL were searched using a predefined search strategy (PROSPERO: CRD42019153228), generating 6006 articles. Included studies contained TCD-based assessments of NVC in healthy adults. Study quality was assessed using a checklist, and findings were synthesised narratively. 76 studies (2697 participants) met the review criteria. There was significant heterogeneity in the participant position used (e.g., seated vs supine), in TCD equipment, and vessel insonated (e.g. middle, posterior, and anterior cerebral arteries). Larger, more significant, TCD-based NVC responses typically included a seated position, baseline durations >one-minute, extraneous light control, and implementation of previously validated protocols. In addition, complementary, combined position, vessel insonated and stimulation type protocols were associated with more significant NVC results. Recommendations are detailed here, but further investigation is required in patient populations, for further optimisation of TCD-based NVC assessments.National Institute for Health and Care Research (NIHR)Stroke AssociationLeicester Biomedical Research Centr