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Over the last decade, microsurgical soft-tissue transfer became the gold standard for various reconstructions throughout the body. Continuous improvement of instruments and surgical techniques, such as intraoperative indocyanine green angiography (ICG-A), allowed for a very high success rate. This study aimed to assess and validate the role of a standard intraoperative ICG-A in free and pedicled flap surgery to improve overall outcomes. From April 2018 to April 2023, 400 consecutive patients who underwent reconstruction using free and pedicled flaps were enrolled. ICG-A was always performed in a free flap after flap elevation, after microsurgical anastomosis, immediately after the flap inset, and after wound closure. In the pedicled flap, the sequential procedure was performed after flap elevation, flap inset, and wound closure. All 400 patients who underwent flap reconstruction using intraoperative ICG-A had an extremely low incidence of necrosis (0.75% partial necrosis among free and pedicled flaps) and reoperation for perfusion-related complications (0.75% due to acute ischemia and 0.50% due to flap congestion). Minor complications, such as hematoma, seroma, wound dehiscence, and wound infections, were managed with a second operation. No flaps were lost, and all patients were successfully treated. This study showed how systematic multistep ICG-A for intraoperative assessment of free and pedicled flap perfusion can significantly reduce the complication rate, including flap loss and re-exploration surgeries, in a time- and cost-effective manner. [ABSTRACT FROM AUTHOR]

Soft tissue defects involving the axilla and the upper back region are often complex to treat. The complexity of these defects may be extremely different, ranging from superficial skin damage to large loss of substance with lymphatic drainage impairment. The pedicled circumflex scapular artery (pCSA) perforator flap represents a valid procedure in this setting. It can be tailored according to the patient's needs, and its intraseptal pedicle allows a quick dissection with a wide range of motion. Twenty-four consecutive patients treated by means of pCSA perforator flap were included. All the flaps were pedicled and were used for locoregional reconstructions. The etiology of the defects was an oncologic resection in 15 cases, acne/hidradenitis suppurativa resection in 6 cases, lymphatic complication in 2 cases, and burn in 1 case. Patients' mean age was 61 years old; seventeen were males and seven were females. All the patients were successfully treated with good aesthetic and functional results. One patient presented with a wound dehiscence, which required secondary surgical treatment. No partial or complete flap losses were encountered. Primary closure of the donor site was achieved in all cases. The mean follow-up period was 10.5 months (range 6–12). This case series shows the reliability and versatility of the pCSA perforator flap for locoregional reconstructions. Because of its rich vascularisation, extensive or unconventionally-shaped flaps are possible. Moreover, its lymphatic rich tissues make it suitable for the treatment of complications related to axillary lymphadenectomy. [ABSTRACT FROM AUTHOR]

Martin and his colleagues in 1989 described for the first time a fasciocutaneous flap based on a posterior branch of the anterior interosseous artery (AIA). Despite its promising characteristics, this flap never achieved popularity and the literature about it is limited. The aim of the present study is to share our experience with the AIA flap both as a local and free flap in reconstructing defects of various body regions. A retrospective review of 26 consecutive patients operated between January2001 and August 2020 was conducted. Seventeen male and nine female patients, mean age 52 years, underwent reconstruction of local and distant soft tissue defects using the AIA flap. Fourteen flaps were raised as free flap and 12 as local flaps for a total of 26 flaps. The locations of the defects included the face, the lower limb, the hand dorsum, and fingers. Twenty-four out of 26 flaps survived completely, and two pedicled flaps presented partial necrosis, with one requiring a new free flap procedure. One free anterior interosseous flap required revision of the venous anastomosis. Two donor site dehiscence were observed, and they both healed by secondary intention healing. Follow-ups were conducted for a mean of 18 months. All patients showed good contour restoration of the affected body part. The AIA flap, either free or pedicled, represents a reliable tool to perform "like-with-like" reconstructions of hand defects. In some occasions, it is well suited for shallow defects in other body parts. [ABSTRACT FROM AUTHOR]

We consider an elliptic partial differential equation with a random diffusion parameter discretized by a stochastic collocation method in the parameter domain and a finite element method in the spatial domain. We prove for the first time convergence of a stochastic collocation algorithm which adaptively enriches the parameter space as well as refines the finite element meshes. [ABSTRACT FROM AUTHOR]

Resorting to perforators as recipient vessels is a valid alternative that might offer a series of advantages in many situations. They allow the use of a shorter pedicle, reduce the time of dissection, and are a good solution when deep vessels are difficult to reach. The aim of this study is to investigate the efficacy of P-to-P tissue transfer for reconstructing defects in different areas of the body. Between April 2018 and February 2020, 40 patients presenting soft tissue defects were reconstructed by using P-to-P-anastomosed free flap transfer. The cause of the defect was trauma in 16 cases and surgically excised tumor in 24. Five defects were located in the upper extremities, 1 in the neck, 1 in the thorax, and 21 in the lower limb, and 13 cases were breast reconstructions, 2 of which bilateral (43 total flaps). Of all 43 flaps, 22 were abdominal flaps, 17 flaps were harvested from the upper thigh, and 4 were harvested from the lower leg. At the 9 month follow-up, 42 flaps were successfully healed, 36 without complications, 3 after wound dehiscence, and 3 after wound infection, and only 1 flap was lost requiring further surgery. Flap failure rate was 2.3%. Free flaps anastomosed in perforator-to-perforator fashion can be safely used in different settings throughout the body. Even if they are technically more demanding, they may allow a quicker operation time and lower morbidity. With the developments in microsurgical instruments, we believe that this technique may become the gold standard for tissue-defect reconstruction. [ABSTRACT FROM AUTHOR]

Perianal and genital defects occur because of a vast etiology making the reconstruction of function and esthetics remain challenging. Depending on the extent of the defect, different techniques have been employed for coverage including skin grafts, local skin flaps, musculocutaneous flaps, and pedicled perforator flaps. The pedicled vertical posteromedial thigh (vPMT) flap is a new perforator flap that has rarely been employed for this kind of reconstruction. The purpose of this article is to focus on the vPMT perforator flap, which is mainly used as a propeller flap, for reconstructing the perianal and genital region as a feasible option in this area. From July 2013 to December 2018, we treated twelve patients with extensive perianal and/or genital defects with 21 pedicled vPMT flaps. Three patients needed unilateral reconstruction, while 9 patients bilateral needed bilateral reconstruction. The location of the defects included the scrotal region (3 cases), the perianal region (8 cases), and the vulvar region (5 cases), whereby some cases had combined defects. The flap sizes varied from 5-9 cm in width to 18-35 cm in length and all flaps were harvested as perforator-based island flaps. The flap movements used for defect coverage included V-Y advancement in three cases and rotation in propeller fashion in eighteen cases. All flaps survived without any major complications and all donor sites were closed primarily. Our case series showed an exemplary model for the coverage of the perianal and genital region by using the pedicle vPMT flap and the achievement of a sustainable treatment with a minor morbidity of the donor site. We believe that the vPMT flap could be an alternative option for the reconstruction of the perianal and genital region and could be inserted in the armamentarium of the reconstructive microsurgeon. [ABSTRACT FROM AUTHOR]

A mouse model of lung cancer is used to show that Pml inactivation leads to increased tumorigenesis in addition to the casein kinase 2 (CK2) pharmocological inhibition enhancing the PML tumor-suppressive property in vivo. Therapy with specific CK2 inhibitors or proteasome inhibitors like bortezomib, used in the treatment of several human cancers, may be effective in tumors that display aberrant CK2 activity and loss of PML protein.

There is evidence that microalgae phenolic compounds can inhibit the growth of toxigenic fungi. This study aimed to evaluate the ability of microalgae phenolic extracts to inhibit trichothecene production by Fusarium genus and thereby identify parameters that can promote a new technology to avoid contamination of crops by mycotoxins. The microalgae phenolic acids (Spirulina sp. and Nannochloropsis sp.) were extracted with methanol, clarified and resuspended in water. The in vitro experiment involved adding the phenolic extract from each microalga (40 μg/mL) to Petri dishes containing culture medium and previously sterilized wheat grains, with subsequent inoculation of an isolate belonging to the F. graminearum species complex. The control was cultured with sterile water. Treatment with the fungicide tebuconazole (0.6 mg/mL) was also performed. Petri dishes were incubated at 25 °C, with a light/dark photoperiod of 12–12 h. After 168 h, the samples were extracted by the adapted QuEChERS method; the trichothecenes (nivalenol, deoxynivalenol and acetylates) were identified and quantified by high-performance liquid chromatography. When the phenolic extracts from microalgae were applied, the characteristic peak of nivalenol was not detected, suggesting total inhibition, whereas, the nivalenol content increased (15%) in the presence of tebuconazole. Both microalgae phenolic extracts also had a promising effect on the inhibition of deoxynivalenol, with no detection (Nannochloropsis sp. extract) and 62% reduction (Spirulina sp. extract). The application of the fungicide tebuconazole increased the deoxynivalenol concentration. Both microalgae phenolic extracts and tebuconazole decreased the detection of acetylates. Thus, phenolic extracts from microalgae were more efficient than tebuconazole as antifungal and antimycotoxigenic agents in cultures in vitro. Unlabelled Image • Microalgae phenolic extracts showed antimycotoxigenic effect in cultures in vitro. • Microalgae phenolic extracts act mainly against nivalenol production. • Nannochloropsis sp. phenolic extract inhibited deoxynivalenol production completely. • Spirulina sp. phenolic extract inhibited 62% of deoxynivalenol production. • Fungicide tebuconazole resulted in an increase in deoxynivalenol concentration. [ABSTRACT FROM AUTHOR]

Summary Introduction The posteromedial thigh (PMT) perforator flap is a valuable reconstructive option. In its pedicled form, the experience is currently limited to a few case reports. The purpose of this article is to describe various clinical applications of the pedicled posteromedial thigh (pPMT) flap for reconstruction of loco-regional soft tissue defects. Patients and Methods From 2014 to 2016, 15 patients underwent reconstruction with 15 pPMT flaps. The locations of the defects included the inguinal region (4 cases), the perineal and genital region (3 cases), the proximal and distal medial thigh (3 and 2 cases, respectively), and the popliteal fossa (3 cases). The perforator selected was a branch of the profunda femoris artery (PFA) in 12 cases and the medial circumflex fermoral artery (MCFA) in 3 cases. In all cases, the flap was harvested as a perforator-based island flap, while the mechanism of flap transfer varied between V-Y advancement, interpolation, or different degrees of axial pivoting around the skeletonized perforator (propeller flap design). Results The flap sizes varied from 5 × 4 cm 2 to 29 × 8 cm 2 , and the pedicle could be skeletonized for up to 13 cm. All the flaps survived after surgery without complication. The donor sites were all primarily closed with minimal morbidity. Follow-up observations were conducted for 6 to 14 months, and all patients had good functional recovery. Conclusion The pPMT perforator flap is a reconstructive option that can be considered when dealing with soft tissue defects located in body regions ranging from the groin down to the popliteal fossa. It avoids the need for a microsurgical transfer and easily fulfills the dictum of replacing “like tissue with like tissue.” [ABSTRACT FROM AUTHOR]

Resumo A Sociedade Brasileira de Anestesiologia, pelo Núcleo Vida de Ecocardiografia Transesofágica Intraoperatória (ETTI/SBA) juntamente com o Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), fez uma força‐tarefa para normatizar a feitura da ecocardiografia transesofágica intraoperatória para os anestesiologistas e ecocardiografistas brasileiros com base nas evidências científicas da Sociedade dos Anestesiologistas Cardiovasculares/Sociedade Americana de Ecocardiografia (SCA/ASE) e da Sociedade Brasileira de Cardiologia. Through the Life Cycle of Intraoperative Transesophageal Echocardiography (ETTI/SBA) the Brazilian Society of Anesthesiology, together with the Department of Cardiovascular Image of the Brazilian Society of Cardiology (DIC/SBC), createded a task force to standardize the use of intraoperative transesophageal echocardiography by Brazilian anesthesiologists and echocardiographers based on scientific evidence from the Society of Cardiovascular Anesthesiologists/American Society of Echocardiography (SCA/ASE) and the Brazilian Society of Cardiology. [ABSTRACT FROM AUTHOR]

This paper first presents a highly flexible 3D manipulator with links of arbitrary shape, then develops a closed-form dynamic model that best describes it. The model is based on a Newton–Euler formulation and the substructuring method is used to account for large deformations. The formulation of the motion equations starts from a data set which can be either analytically or numerically computed by finite elements(FE) codes. Simulation has been used to validate the model and compare the results with those of two different multibody software and one experimental, which was obtained from the Multi-Elastic-Link Robot Identification Dataset (MERIt), developed by the TU Dortmund. Then, thanks to the approach here adopted, an integral manifold model is derived, suitable for advanced control system design. [ABSTRACT FROM AUTHOR]

Summary KRAS is one of the most commonly mutated oncogenes in human cancer. Mutant KRAS aberrantly regulates metabolic networks. However, the contribution of cellular metabolism to mutant KRAS tumorigenesis is not completely understood. We report that mutant KRAS regulates intracellular fatty acid metabolism through Acyl-coenzyme A ( CoA ) synthetase long-chain family member 3 ( ACSL3 ), which converts fatty acids into fatty Acyl-CoA esters, the substrates for lipid synthesis and β - oxidation. ACSL3 suppression is associated with depletion of cellular ATP and causes the death of lung cancer cells. Furthermore, mutant KRAS promotes the cellular uptake, retention, accumulation, and β-oxidation of fatty acids in lung cancer cells in an ACSL3 -dependent manner. Finally, ACSL3 is essential for mutant KRAS lung cancer tumorigenesis in vivo and is highly expressed in human lung cancer. Our data demonstrate that mutant KRAS reprograms lipid homeostasis, establishing a metabolic requirement that could be exploited for therapeutic gain. [ABSTRACT FROM AUTHOR]

Summary The MYC proto-oncogene is a transcription factor implicated in a broad range of cancers. MYC is regulated by several post-translational modifications including SUMOylation, but the functional impact of this post-translational modification is still unclear. Here, we report that the SUMO E3 ligase PIAS1 SUMOylates MYC. We demonstrate that PIAS1 promotes, in a SUMOylation-dependent manner, MYC phosphorylation at serine 62 and dephosphorylation at threonine 58. These events reduce the MYC turnover, leading to increased transcriptional activity. Furthermore, we find that MYC is SUMOylated in primary B cell lymphomas and that PIAS1 is required for the viability of MYC-dependent B cell lymphoma cells as well as several cancer cell lines of epithelial origin. Finally, Pias1 -null mice display endothelial defects reminiscent of Myc -null mice. Taken together, these results indicate that PIAS1 is a positive regulator of MYC. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine whether the mechanical contribution of ankle muscles in the upright stance differed among young adults (YA) (n = 10, age: ~ 24.3), elderly non-fallers (ENF) (n = 12, age: ~ 77.3) and elderly fallers (EF) (n = 20, age: ~ 80.7). Torque and electromyographic (EMG) activity were recorded on the triceps surae and tibialis anterior during maximum and submaximum contractions in the seated position. EMG activity was also recorded in subjects standing still. Plantar flexor (PF) and dorsal flexor (DF) torques generated in the upright posture were estimated from the torque–EMG relationship obtained during submaximum contractions in the seated position. Center of pressure (CoP) displacement was measured to quantify postural stability. Results showed that, in upright standing, EF generated greater ankle muscle relative torque (i.e. PF + DF torque in the upright stance/PF + DF during maximum isometric torque) than non-fallers (i.e. ENF, YA). The greater involvement of ankle muscles in EF was associated with higher CoP displacement. PF + DF torque in the upright stance was no different among the groups, but PF + DF torque during maximum effort was impaired in older groups compared with YA and was lower in EF than ENF. These results suggest that the postural stability impairment observed with aging is highly related to ankle muscle weakness. [ABSTRACT FROM AUTHOR]

Background Epicardial adipose tissue (EAT) and coronary artery calcium (CAC) have been associated with incident coronary artery disease (CAD) and all-cause mortality in the general population. Their prognostic impact in HIV is unknown. Methods Observational study of 843 consecutive HIV-infected patients receiving antiretroviral therapy for at least 6 months. Risk stratification was performed with coronary artery calcium (CAC) scoring and EAT screening. Patients were followed for CAD and all-cause mortality for a median of 2.8 years accounting for a total of 2572 patient-year follow-up. Results Mean patient age was 50 ± 8 years and 69% were men. At baseline EAT was associated with male gender, age, waist circumference, visceral adipose tissue, and lipodystrophy, while CAC score ≥100 was associated with male gender, age and total cholesterol. During follow-up 33 patients suffered an event (15 incident myocardial infarctions and 18 deaths); the EAT volume was larger and the CAC score was higher in patients with events (p = 0.038 and p = 0.001 respectively). Multivariable regression analyses demonstrated that the upper tertile of EAT (≥93 cc; OR 2.15, 95% CI 1.06 – 4.39, p = 0.034), and CAC score ≥100 (OR 3.37, 95% CI 1.49 – 7.60, p = 0.003) were independent predictors of events after adjusting for age and sex. Conclusions In this observational cohort of HIV patients, EAT and CAC were independent predictors of hard outcomes after a median follow-up of approximately 3 years. [ABSTRACT FROM AUTHOR]

Despite the general perception that women and men walk differently, little is known about the reasons for these differences, especially in older adults. Previous work on gender differences in older adults has focused on spatiotemporal parameters. This study aims to assess gender-related differences in gait spatiotemporal and quality parameters when walking on a flat walkway at two different self-selected speeds: comfortable and fast. Sensorimotor abilities (Strength, agility, standing balance, reaction time) were also compared by gender, and gender-specific associations between spatiotemporal and sensorimotor parameters and gait quality were studied. Two tri-axial accelerometers were used at head and pelvis levels to investigate spatiotemporal parameters (step length, velocity and cadence), and gait quality (harmonic ratios (HR) and attenuation of accelerations between body levels) in 122 older adults (90 women, 69.7 ± 5.1 y.o. and 32 men, 71.6 ± 6.4 y.o.). Both men and women walked with similar speed; however women presented faster cadence and shorter steps than men at both walking speeds. Women also walked with greater vertical HR (head and pelvis), mediolateral pelvis HR, and attenuation (mediolateral and anteroposterior) than men. Women had better control of standing balance on foam (eyes open and closed) and tandem test. Moreover, balance on foam, tandem test, step length and cadence were associated to gender-specific gait quality parameters. The aging process seems to be affecting men and women differently, thus, gender differences should be considered when preparing intervention programs to improve balance and gait in older populations or when establishing normative data for balance and gait in older adults. [ABSTRACT FROM AUTHOR]

Summary Background Vascularized lymph node transfer (VLNT) has shown promise as a treatment for breast cancer–related lymphedema, a common and debilitating condition among breast cancer survivors. In VLNT, the most popular lymph node flap donor site is the inguinal region; however, concerns about the possibility of iatrogenic lymphedema hamper the widespread adoption of VLNT. A better understanding of the anatomy of the lymphatic system in the inguinal region is essential to preserving lymph drainage in the leg and avoiding iatrogenic lymphedema. Methods Five human cadaver hind-quarter specimens were used for this study. First, the specimens were scanned with indocyanine green fluorescence lymphography to map the lymphatic vessels. A dual injection technique using different radiocontrast media was then applied to delineate arteries and lymphatic vessels on radiographs. Finally, radiological analysis and meticulous dissection were used to investigate relationships between the arteries and lymphatic vessels. Results By chasing the lymphatic vessels retrogradely from their corresponding lymph nodes, we were able to divide the superficial inguinal lymph nodes into three subgroups: the abdominal, medial thigh, and lateral thigh nodes. We found no connections between the superficial and deep lymphatic system in the inguinal region. The dominant lymph nodes draining the leg were in the lower part of the inguinal triangle, and their efferent lymphatic vessels ran medial to the common femoral artery. Conclusions Preserving the sentinel nodes of the lower leg in the medial thigh and their efferent lymphatic vessels is crucial to avoid iatrogenic lymphedema in limbs with donor sites for VLNT. [ABSTRACT FROM AUTHOR]