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For many years, it was clearly shown that surgical procedures might be associated with surgical site infection (SSI). Many scientific institutions prepared guidelines to use in surgery to reduce abuse and misuse of antibiotics. However, in the general guidelines for surgical antibiotic prophylaxis, plastic surgical procedures are not addressed or are only marginally discussed, and children were almost systematically excluded. The main aim of this Consensus document is to provide clinicians with recommendations on antimicrobial prophylaxis for pediatric patients undergoing plastic surgery. The following scenarios were considered: clean plastic surgery in elective procedures with an exclusive skin and subcutis involvement; clean-contaminated/contaminated plastic surgery in elective procedures with an exclusive skin and subcutis involvement; elective plastic surgery with use of local flaps; elective plastic surgery with the use of grafts; prolonged elective plastic surgery; acute burns; clean contused lacerated wounds without bone exposure; high-risk contused lacerated wounds or with bone exposure; contused lacerated wound involving the oral mucosa; plastic surgery following human bite; plastic surgery following animal bite; plastic surgery with tissue expander insertion. Our Consensus document shows that antimicrobial perioperative prophylaxis in pediatric patients undergoing plastic surgery is recommended in selected cases. While waiting the results of further pediatric studies, the application of uniform and shared protocols in these procedures will improve surgical practice, with a reduction in SSIs and consequent rationalization of resources and costs, as well as limiting the phenomenon of antimicrobial resistance.

This paper stems from long­lasting research dedicated to urban risk reduction through a planning approach. It focuses on public space, proposing an inversion of the usual perspective: instead of considering public spaces for risk mitigation and urban redevelopment, here the imperatives of environmental safety and urban resilience can be instrumental for exploring the meaning and role of the public space from a different, rather compelling point of view. One starting point is the concept of SUM, Strategic Urban Structure (or Framework), from the Italian “Struttura urbana minima”, which has been introduced in order to set out the contents of urban risk reduction in local administration agendas and particularly into ordinary planning processes. The SUM has been conceived both as an analytical and a normative/planning tool. Public spaces are the backbone of both urban structure and of the SUM. From their features, localization, distribution within thesettlement, and their systemic characters, largely depend the capacity of a town to positively react to a seismic event. Six case­studies of small and medium­size historic towns in the Umbria Region (one of the many Italian Regions with a high level of seismic risk), help to understand the complexities and problems related to seismic prevention within historical centres, and the conflicts between conservation of the heritage and the imperatives of environmental safety. In order to overcome possible criticalities identified in a SUM, it is necessary to provide alternatives to its functioning through redundant elements. The concept of redundancy, which is strictly related to that of uncertainty, is very interesting and promising in this field of research.

The Authors report an unusual case of appendiceal mucocele associated with a large bowel carcinoma occasionally observed in the course of examinations for the first pathology. Due to the rareness of the association of the two affections, the clinical problems and pathogenetic theories are reviewed, also analysing the histological differences of the various mucoceles which need a different surgical approach. They conclude stating that the preoperative diagnosis of appendiceal mucocele, is easier today than in the past, thanks to the routine use of ultrasonography and tomography through which it is possible to reveal concomitant pathologies often clinically silent.

The benign parietal lesions of the gallbladder are diseases that, as known, found their pathogenetic moment on hyperplasia of constituent tissues of the gallbladder wall and comprises the controversial chapter of "cholecystosis". The Authors, to contribute to their better clinical and pathogenetic staging, report their experience on 25 cases. They debate on the usefulness of ultrasonography, surely a diagnostic progress for these formations, which are small structures more or less echogenic and that they develop in the gallbladder; the echographic imaging, for its sharpening, has substituted the cholecystographic procedure. The aim of present study is to analyse the results obtained by using echography as diagnostic preoperative procedure of "cholecystosis". The ultrasonography supplies the surgeon an indication to prophylactic surgical treatment as single, effective procedure in preventing the gallbladder carcinoma.

Background: Enterai feeding for infants with birth weight1000 g (ELBWI) is still a controversial issue. The aim of the present survey was to ascertain the attitudes of Italian neonatal intensive care units (NICUs) regarding this point. Method: A questionnaire, with multiple choice answers, regarding the timing of enteral feeding, its progression, the different techniques utilised, the eventual use of fortifiers and the interrupting criteria, was mailed to 92 Italian NICUs. Results: 74 NICUs all over the country participated in the study.1153 ELBWI were hospitalised in 1996 in these Units. Enterai feeding for babies between 501 g and 750 g is started on the 1st day of life in 23.3% of the NICUs and for babies between 751 g and 1000 g in 36.5%. NICUs that start enteral feeding not later than the 3rd day of life are 75.3% and 86.5% respectively. The most frequent investigation prior to starting enterai feeding was the evaluation of gastric aspirate. Mechanical ventilation is considered a contraindication for starting enterai feeding only in 1/4 of NICUs. Enterai feeding is started most often with glucose water solution and raw human milk. The most frequent administration techniques are interminent oro- and nasogastric gavage. Pasteurization facilities are available in 31 % of NICUs, but are located mostly in the Centre and North of Italy. Conclusion: This survey shows that enterai feeding policy for ELBWI varies among different Italian NICUs. In Italy there is a common tendency to start feeding early, even in ventilated infants.

INTRODUCTION: Variation of respiratory care is described between centers around the world. The Italian Neonatal Network (INN), as a national group of the Vermont-Oxford Network (VON) allows to perform a wide analysis of respiratory care in very low birth weight infants. METHODS: We analyzed the dataset of infants enrolled in the INN in 2009 and 2010 and, for surfactant administration only, from 2006 to 2010 from 83 participating centers. All definitions are those of the (VON). A questionnaire analysis was also performed with a questionnaire on centers practices. RESULTS: We report data for 8297 infants. Data on ventilator practices and outcomes are outlined. Variation for both practices and outcome is found. Trend in surfactant administration is also analyzed. CONCLUSIONS. The great variation across hospitals in all the surveyed techniques points to the possibility of implementing potentially better practices with the aim of reducing unwanted variation. These data also show the power of large neonatal networks in identifying areas for potential improvement.

Homocysteine (Hcy) is a sulfur-containing amino acid generated during methionine metabolism, accumulation of which may be caused by genetic defects or the deficit of vitamin B12 and folate. A serum level greater than 15 micro-mols/L is defined as hyperhomocysteinemia (HHcy). Hcy has many roles, the most important being the active participation in the transmethylation reactions, fundamental for the brain. Many studies focused on the role of homocysteine accumulation in vascular or degenerative neurological diseases, but the results are still undefined. More is known in cardiovascular disease. HHcy is a determinant for the development and progression of inflammation, atherosclerotic plaque formation, endothelium, arteriolar damage, smooth muscle cell proliferation, and altered-oxidative stress response. Conversely, few studies focused on the relationship between HHcy and small vessel disease (SVD), despite the evidence that mice with HHcy showed a significant end-feet disruption of astrocytes with a diffuse SVD. A severe reduction of vascular aquaporin-4-water channels, lower levels of high-functioning potassium channels, and higher metalloproteinases are also observed. HHcy modulates the N-homocysteinylation process, promoting a pro-coagulative state and damage of the cellular protein integrity. This altered process could be directly involved in the altered endothelium activation, typical of SVD and protein quality, inhibiting the ubiquitin-proteasome system control. HHcy also promotes a constant enhancement of microglia activation, inducing the sustained pro-inflammatory status observed in SVD. This review article addresses the possible role of HHcy in small-vessel disease and understands its pathogenic impact.

End-stage liver diseases are one of the leading causes of death in the world. Often orthotopic liver transplantation represents the final therapeutic choice. The limits of this approach are the scarcity of donor livers available, and the many side effects related to the administration of immune suppressants to the patients. Cellular therapy for liver diseases is increasingly being viewed as a promising strategy to provide hepatocytes to replenish the parenchymal cells of the organ. This technique suffers of some important limitations, such as the difficulty in isolating sufficient cell numbers (e.g. when adult or foetal hepatocytes are used for transplantation), the limited viability of isolated hepatocytes and, when applicable, the limited differentiation of stem cells (when hepatocyte-like cells are derived from hepatic or extra-hepatic progenitor populations). In recent years, perinatal stem cells have been proposed as reliable cellular populations which may be successfully used to derive hepatocyte-like cells. These cells feature key advantages over other adult stem cells: may be easily sourced from the tissues of origin, can be expanded ex vivo to obtain high cell numbers, may be differentiated towards hepatocyte-like cells. In addition, these cells feature relevant immunomodulatory and anti-inflammatory activities, and their sourcing is not limited by ethical concerns In the present review we analyze the molecular basis of hepatocyte biology and development, and discuss the recent advances in deriving hapatocyte-like cells from perinatal stem cells. Very recent papers on mesenchymal stem cells derived from bone marrow and adipose tissues are also comparatively discussed as prototypes of the use of adult extrahepatic stem cells. In our opinion, perinatal stem cells do represent a promising tool for liver regenerative medicine, and recent research reports further strengthened this perception and fostered further efforts by multiple research groups worldwide.

Biografia sintetica dell'architetto G. Caronia e regesto delle opere d'architettura e dei piani urbanisici, progettate dagli anni della formazione al primo dopoguerra e documentate nei materiali delle collezioni scientifiche del Dipartimento di Architettura dell'Università di Palermo

Il testo, per il volumetto Archivi di Architetti Siciliani 1915-1945, tratteggia la figura professionale di Salvatore Benfratello, allievo prediletto di Ernesto Basile e docente di Architettura Tecnica presso le Università di Pisa e Palermo, il percorso progettuale e le principali opere progettate e realizzate. Il breve saggio descrive l'Archivio che la famiglia Benfratello ha donato all'Università e che è ospitato presso il Dipartimento di Architettura di Palermo, i disegni, i libri, i documenti che consentono di apprezzare di Salvatore Benfratello le capacità grafiche e progettuali.

Background: The use of the Bio-Enterics intra-gastric balloon (BIB) has been shown to be a safe and effective procedure for the temporary treatment of morbid obesity. We conducted a retrospective comparative analysis of the weight loss in patients that after BIB removal underwent bariatric surgery and those who did not wish surgery. Methods: From January 2000 to March 2004, 182 BIBs were positioned in 175 patients (104 F / 71 M; mean age 37.1 ±11.6 years, range 16-67; mean BMI 54.4 ± 8.1 kg/m 2 , range 39.8-79.5; mean %EW 160.8±32.9% range 89-264). Patients were excluded from this study who had emergency BIB removal for balloon rupture (n=2, 1.1%) and for psychological intolerance (n=7, 7.8%). All patients were scheduled for a bariatric operation, before BIB positioning. After BIB removal, a number of patients now declined surgery. Consequently, patients were allocated into 2 groups: Group A in whom BIB removal was followed by bariatric surgery (Lap-Band ® , laparoscopic gastric bypass, duodenal switch) (n=86); Group B patients who after BIB removal refused any surgical procedure (n=82). Both groups were followed for a minimum of 12 months. Results were reported as mean BMI and %EWL ± SD. Statistical analysis was done by Student t-test or Fisher’s exact test, with P

Background: Intrauterine growth restriction (IUGR) and small for gestational age (SGA) birth have been considered possible indicators of the presence of malformations. The aim of this study is to evaluate such relationships in a population of newborns, along with other epidemiological and auxological parameters, in particular the ponderal index (PI). Methods: We analyzed the birth data of 1093 infants, classified according to weight for gestational age as SGA, appropriate for gestational age (AGA) or large for gestational age (LGA). The prevalence of malformations was analyzed in relation to weight percentile at birth and SGA birth, maternal smoking, pregnancy diseases and PI. Results: Our analysis showed no significant relationship between the prevalence of malformations and SGA birth. Maternal smoking and pregnancy diseases were strongly related to SGA birth, but not to a higher prevalence of malformations. PI, however, had a significant relationship with a higher prevalence of malformations, if analyzed as either a continuous variable or a categorical variable (cutoff: < 2.4). Conclusions: The association between congenital malformations and birth weight for gestational age seems to be weak. As part of diagnostic screening for malformations in the neonatal period, PI could be considered a better predictor of risk than weight percentile.