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Summary:. Postoperative sensitivity of the nipple–areola complex (NAC) is an important concern for women after reduction mammoplasty. Previous studies have demonstrated that sensory branches of the fifth anterior intercostal nerve are important for innervating the NAC and that using an inferior pedicle technique is associated with improved sensory retention. The significance of this case report is that it demonstrates the importance of the fifth anterior intercostal sensory nerve branches using a prototype fluorescent imaging camera. The benefit of this device is that it can detect intraoperative auto-fluorescence of nerves and facilitate their identification and preservation, potentially facilitating the retention of sensation in the NAC and surrounding skin. The goals of this article are, therefore, to demonstrate the importance of this neurovascular pedicle when the inferior pedicle technique is used for breast reduction; and to provide demonstrative evidence of the nerve’s presence within the fifth anterior intercostal artery perforator pedicle. The case involved a woman with mammary hypertrophy who underwent bilateral reduction mammoplasty using the inferior pedicle technique. Full NAC sensation was demonstrated on postoperative day 3 with complete sensory recovery at 1- and 3-month follow-up confirmed. To our knowledge, this is the first reported instance of the fifth intercostal nerve being visualized during aesthetic breast surgery, demonstrating the importance of this neurovascular bundle for sensory preservation when an inferior pedicle reduction mammaplasty technique is used.

MYC is a pleiotropic transcription factor involved in multiple cellular processes. While its mechanism of action and targets are not completely elucidated, it has a fundamental role in cellular proliferation, differentiation, metabolism, ribogenesis, and bone and vascular development. Over 4 decades of research and some 10,000 publications linking it to tumorigenesis (by searching PubMed for “MYC oncogene”) have led to MYC becoming a most-wanted target for the treatment of cancer, where many of MYC’s physiological functions become co-opted for tumour initiation and maintenance. In this context, an abundance of reviews describes strategies for potentially targeting MYC in the oncology field. However, its multiple roles in different aspects of cellular biology suggest that it may also play a role in many additional diseases, and other publications are indeed linking MYC to pathologies beyond cancer. Here, we review these physiological functions and the current literature linking MYC to non-oncological diseases. The intense efforts towards developing MYC inhibitors as a cancer therapy will potentially have huge implications for the treatment of other diseases. In addition, with a complementary approach, we discuss some diseases and conditions where MYC appears to play a protective role and hence its increased expression or activation could be therapeutic.

Blunt breast trauma occurs in 2% of blunt chest injuries. This study aimed to evaluate the evidence on breast reconstruction after blunt trauma associated with the use of a seat belt. Also, we describe the first case of breast reconstruction using the Ribeiro technique. In November 2022, a systematic search of MEDLINE, EMBASE, and Google Scholar databases was conducted. The literature was screened independently by two reviewers, and the data was extracted. Our search terms included breast, mammoplasty, blunt injury, and seat belts. In addition, we present the case of a woman with a left breast deformity and her reconstruction using the inferior Ribeiro flap technique. Six articles were included. All included studies were published between 2010 and 2021. The studies recruited seven patients. According to the Teo and Song classification, seven class 2b cases were reported. In five cases a breast reduction was performed in the deformed breast with different types of pedicles (three superomedial flaps, one lower flap, one superior flap). Only one case presented complications. The case here presented was a type 2b breast deformity in which the lower Ribeiro pedicle was used successfully without complications during follow-up. Until now there has been no consensus on reconstructive treatment due to the rarity of this entity. However, we must consider surgical treatment individually for each patient. We believe that the Ribeiro technique is a feasible and safe alternative in the treatment of posttraumatic breast deformities, offering very good long-term results.

The huge cadre of genes regulated by Myc has obstructed the identification of critical effectors that are essential for Myc-driven tumorigenesis. Here, we describe how only the lack of the receptor Fzd9, previously identified as a Myc transcriptional target, impairs sustained tumor expansion and β-cell dedifferentiation in a mouse model of Myc-driven insulinoma, allows pancreatic islets to maintain their physiological structure and affects Myc-related global gene expression. Importantly, Wnt signaling inhibition in Fzd9-competent mice largely recapitulates the suppression of proliferation caused by Fzd9 deficiency upon Myc activation. Together, our results indicate that the Wnt signaling receptor Fzd9 is essential for Myc-induced tumorigenesis in pancreatic islets.

Introducción: La implementación de una tecnología enzimática capaz de operar a elevadas temperaturas con una termoestabilidad que permita la hidrólisis de soluciones concentradas de sacarosa, constituye una alternativa novedosa en el proceso de producción de glucosa. Objetivo: Realizar un análisis comparativo de los métodos de producción de glucosa por hidrólisis ácida y enzimática de la sacarosa, considerando la tecnología instalada en la UEB Derivados Chiquitico Fabregat y la concepción tecnológica para la operación que emplea el biocatalizador. Materiales y Métodos: Se desarrollaron los balances de masa y energía en la tecnología instalada que emplea la hidrólisis ácida de la sacarosa. Con los resultados experimentales reportados en la utilización de la enzima invertasa termoestable, se desarrolló el estudio cinético, la concepción tecnológica y la cuantificación de las corrientes que intervienen. Con estos resultados se realizó un análisis comparativo de los consumos anuales para la etapa de hidrólisis y los productos que se generan por ambos métodos. Resultados y Discusión: Se obtuvo un bajo rendimiento de glucosa ácida, mientras que la hidrólisis enzimática arrojó un incremento en la producción de 1,83 veces. El comportamiento cinético del biocatalizador se ajustó a una reacción de primer orden. La concepción tecnológica para el empleo de la hidrólisis enzimática incluyó tres biorreactores, un tanque disolutor y un intercambiador de calor, que garantizan un balance productivo anual favorable. Conclusiones: En condiciones de máximo aprovechamiento de la capacidad instalada, los elevados rendimientos de glucosa enzimática y la sustitución de sustancias agresivas, garantizan la factibilidad técnica, económica y ambiental del proceso.

Guglielmo Mantica,1 Francesco Chierigo,1,2 Farzana Cassim,3 Francesca Ambrosini,1,2 Stefano Tappero,1,2 Rafaela Malinaric,1,2 Stefano Parodi,1,2 Andrea Benelli,4 Federico Dotta,4 Marco Ennas,4 Martina Beverini,1,2 Chiara Vaccaro,5 Salvatore Smelzo,6 Giovanni Guano,1,2 Federico Mariano,1,2 Calogero Paola,1,2 Giorgia Granelli,1,2 Virginia Varca,5 Carlo Introini,4 Salvatore Dioguardi,7 Alchiede Simonato,7 Andrea Gregori,8 Franco Gaboardi,6 Carlo Terrone,1,2 André Van der Merwe3 1IRCCS Ospedale Policlinico San Martino, U.O. Urologia, Genova, Italy; 2Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy; 3Department of Urology, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa; 4Department of Urology, Galliera Hospital, Genoa, Italy; 5Department of Urology, ASST Rhodense, G. Salvini Hospital, Milan, Italy; 6Department of Urology, San Raffaele Turro Hospital, Milan, Italy; 7Department of Surgical, Oncological, and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy; 8Urology Unit, Ospedale Sacco, Milan, ItalyCorrespondence: Guglielmo Mantica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, 16132, Italy, Tel +390105552815, Email guglielmo.mantica@gmail.comPurpose: To evaluate the prostate cancer (PCa) detection rate in men with chronic use of Aspirin and to compare it with the detection rate of non-users.Patients and Methods: Prospectively maintained database regarding patients undergoing prostate biopsy over the last 10 years in five institutions. Patients were divided into two groups according to their exposure to Aspirin. We relied on multivariable linear and logistic regression models to test whether Aspirin administration was associated with lower PSA values at prostate biopsy, higher PCa diagnosis, and higher Gleason Grade Grouping (GGG) at biopsy.Results: Were identified 1059 patients, of whom 803 (76%) did not take Aspirin vs 256 (24%) were taking it. In multivariable log-linear regression analysis, Aspirin administration was associated with lower PSA levels (OR 0.83, 95% CI 0.71– 0.97, p = 0.01), after controlling for age, prostate volume, smoking history, associated inflammation at prostate biopsy, presence of PCa at biopsy, and GGG. In multivariable logistic regression analysis, Aspirin administration was not found to be a predictor of PCa at prostate biopsy (OR 1.40, 95% CI 0.82– 2.40, p = 0.21) after controlling for age, PSA, smoking history, prostate volume, findings at digital rectal examination and the number of biopsy cores. In patients with PCa at prostate biopsy (n = 516), Aspirin administration was found to predict higher GGG (OR 2.24, 95% CI 1.01– 4.87, p = 0.04).Conclusion: Aspirin administration was found to be a predictor of more aggressive GGG. These findings suggest that a lower PSA threshold should be considered in patients taking Aspirin, as, despite low PSA levels, they might harbour aggressive PCa.Keywords: prostate-specific antigen, aspirin, inflammation, prostate cancer, prostate biopsy

Filippo Mariano,1,2,&ast; Valeria Malvasio,3,4,&ast; Daniela Risso,3 Nadia Depetris,5 Anna Pensa,3,6 Giacomo Fucale,7 Fabrizio Gennari,4 Luigi Biancone,1,2 Maurizio Stella3 1Nephrology, Dialysis and Transplantation U, Department of General and Specialized Medicine, City of Science and Health, CTO Hospital, Torino, Italy; 2Department of Medical Sciences, University of Torino, Torino, Italy; 3Burn Center and Plastic Surgery, Department of General and Specialized Surgery, City of Science and Health, CTO Hospital, Torino, Italy; 4Department of Pediatric General Surgery, City of Science and Health, Regina Margherita Children’s Hospital, Torino, Italy; 5Anesthesia and Intensive Care 3, Department of Anesthesia and Intensive Care, City of Science and Health, CTO Hospital, Torino, Italy; 6Department of Surgical Sciences, University of Torino, Torino, Italy; 7Laboratory of Microbiology and Virology, City of Science and Health, Molinette Hospital, Torino, Italy&ast;These authors contributed equally to this workCorrespondence: Filippo Mariano, Nephrology, Dialysis and Transplantation U, AOU City of Science and Health, CTO Hospital, Via G. Zuretti 29, Torino, 10126, Italy, Tel +39-011-6933-674, Fax +39-011-6933-672, Email filippo.mariano@unito.itPurpose: Colistin is still a therapeutic cornerstone against multidrug-resistant gram-negative bacteria (MDRGN), mostly when other antibiotics do not gain adequate activity on these strains. In the present study, we evaluated in a cohort of burn patients the relationship between colistin therapy, survival and requirement of renal replacement therapy (CRRT).Patients and Methods: Retrospective study of 133 burn patients treated with iv colistimethate sodium (loading dose 9.0 × 106 IU, maintenance dose 4.5 × 106 IU BID) and 35 treated with other antibiotics for MDRGN infection including Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae between January 2008 and December 2017. Multivariate analysis with logistic regression was used to determine the effect of the predictors such as age, total body surface area (TBSA), third-degree burn areas, Revised Baux score, Charlson comorbidity score, length of stay, colistin dose and duration of treatment, mechanical ventilation, and need of CRRT on in-hospital mortality. To investigate the relationship between colistin and renal function, we focused on survivor patients as the completion of the therapeutic course of colistin represented the basic requirement to analyze its impact on the kidney.Results: Out of 133 colistin- and 35 other antibiotics-treated patients, 83 (62.4%) and 31 (88.6%) survived, and 53 (39.8%) and 3 (9.7%) required CRRT, respectively. The severity of burns, as well as CRRT requirement and mortality, was significantly higher in colistin-treated patients than in other antibiotics-treated patients. Age and TBSA% were the significant predictors of mortality. Out of 83 colistin-treated survivors, 19 (22.9%) required CRRT (9 before and 10 after the start of colistin), and 64 (77.1%) had a normal renal function. No difference about the colistin dose and baseline characteristics, but the revised Baux score was found between the 9 patients requiring CRRT before the colistin course and the 10 patients after. Similarly, among the 64 patients not undergoing CRRT, no difference was found between the patients treated with the cumulative dose of colistin < 99.0 × 106 IU (n = 33, median daily dose of 4.0 × 106 IU) and > 99.0 × 106 IU (n = 31, median daily dose of 9.0 × 106 IU) about the baseline characteristics and the daily median plasma creatinine over 24 days of therapy.Conclusion: Colistin therapy was associated with more severe burns, mortality, and CRRT requirement. A short course therapy, at appropriate cumulative dosage, can lead to clinical success without a significant association with severe renal impairment.Keywords: colistin, burns, acute kidney injury, MDRGN infection, CRRT, clinical outcome

Introducción: Dada la necesidad de explorar el mejor comportamiento operacional en procesos químicos y alimentarios, la presente investigación propone el uso de la Metodología de Superficie de Respuesta (MSR) como herramienta de optimización. Objetivo: Identificar el fundamento teórico, metodológico, potencialidades y resultados obtenidos en la aplicación de la Metodología de Superficie de Respuesta al desarrollo de procesos químicos y alimentarios. Materiales y Métodos: Se efectuó definición teórica y práctica del método, estableciendo las relaciones entre los factores de entrada para diferentes modelos en la fase de búsqueda y el ajuste de la superficie respuesta. Se seleccionaron los diseños experimentales y paquetes estadísticos más adecuados y se realizó la propuesta metodológica para la conducción de la optimización apoyada en el análisis de ejemplos prácticos de su aplicación. Resultados y Discusión: Se muestra el fundamento teórico de la MSR teniendo en cuenta su carácter secuencial, funciones de aproximación y diseños experimentales tanto para variables independientes como factores de mezcla. Además, se consideraron las técnicas de optimización según el modelo y su aplicación en investigaciones de la industria química y alimentaria. Los resultados alcanzados muestran las potencialidades del método en la búsqueda del óptimo operacional. Conclusiones: La MSR es una técnica sumamente versátil que permite la utilización de diferentes diseños experimentales y herramientas estadísticas para resolver problemas de optimización de procesos químicos y de la industria alimentaria.

Introdução: Apesar de avanços importantes nas políticas públicas de medicamentos no Brasil, a disponibilização de medicamentos de forma contínua e em quantidade adequada às necessidades da população ainda é um desafio, especialmente, para medicamentos de alto valor agregado. Há poucos estudos que avaliam o Componente Especializado da Assistência Farmacêutica (CEAF) na perspectiva dos profissionais envolvidos com sua gestão. Objetivo: Descrever os resultados de três oficinas sobre a gestão do CEAF. Métodos: Estudo descritivo, qualitativo com discussão em grupos envolvendo informantes chaves da gestão da Assistência Farmacêutica das Secretarias Estaduais de Saúde (SES’s). Resultados: Diversas barreiras para a melhor gestão do CEAF foram identificadas, incluindo questões relacionadas ao financiamento, recursos humanos, infraestrutura das unidades de saúde, gestão da logística de medicamentos e sistemas de informação para o gerenciamento das atividades. Conclusões: A implementação de novas diretrizes de financiamento da Assistência Farmacêutica, que garantam melhor equilíbrio financeiro entre os entes federados, e a melhor articulação entre o Ministério da Saúde e as SES’s foram apontados como alternativas para melhor da gestão da Assistência Farmacêutica.

Introducción: Es necesario estudiar los beneficios de extraer el jugo de los filtros de la producción de azúcar crudo en una industria azucarera. La misma es destinada a la producción de azúcar refino que se emplea como materia prima para la obtención de glucosa. Objetivo: Cuantificar el efecto que tiene la mejora de la calidad del azúcar crudo con la extracción del jugo de los filtros, analizando su efecto en la producción de azúcar crudo, azúcar refino y glucosa por vía enzimática, y en las inversiones necesarias. Materiales y Métodos: La investigación se realizó combinando experimentos a nivel de laboratorio, de control operacional y análisis de alternativas técnico económico, ajustándolos en un procedimiento de estrategia y análisis de procesos. Resultados y Discusión: Mientras que la inversión en la refinería de azúcar es rápidamente recuperable, no lo es en la de extracción del jugo de los filtros, si esta tiene solamente como destino la producción de etanol. Por lo que es recomendable aprovechar la capacidad extractiva en otras producciones de alto valor agregado. Conclusiones: El orden de ejecución de las inversiones debe realizarse con una proyección de futuro del desarrollo como biorrefinería.

Venous thromboembolism (VTE) is a serious but rare complication of aesthetic surgery, with an incidence of 0.017% for liposuction and 0.01%–0.02% for augmentation mammoplasty. Despite the low incidence and appropriate patient selection, we present two cases of VTE in low-risk patients without hypercoagulability undergoing aesthetic procedures. In the first case, a 45-year-old woman with a history of anemia developed bilateral pulmonary embolism after ultrasound-assisted liposuction. In the second case, a 33-year-old woman with a history of oral contraceptive use developed deep vein thrombosis in the right upper extremity after augmentation mammoplasty. The patients were treated early and fully recovered after 12 months. This report highlights the importance of early diagnosis and treatment of VTE in aesthetic surgery, even in low-risk patients. [ABSTRACT FROM AUTHOR]

Walnut (Juglans regia) and rice (Oryza sativa) are among the most important crops grown in the Sacramento Valley of California. Because rice herbicides are often applied by air, there are occasional allegations of rice herbicide drift onto walnut trees. This study was established to investigate bispyribac-sodium residues on walnut leaves after simulated drift treatments. The objectives were to determine whether bispyribac-sodium can generate visual symptoms on walnut trees without leaving detectable residues in leaf tissues and to evaluate the subsequent impacts on walnut yield. Two experiments were conducted in a 3-year-old walnut orchard. In the first experiment bispyribac-sodium was applied to walnut trees at 0.125%, 0.25%, 0.5%, and 1% of the normal use rate in rice (45 g·ha−1). In the second experiment, rates were 1%, 3%, 10%, and 100% of the normal use rate in rice. Bispyribac-sodium caused general leaf chlorosis and discrete yellow spotting on walnut leaves even at very low concentrations; symptoms were recorded on trees exposed to rates as low as 0.125% of the normal use rate in rice. However, based on high-performance liquid chromatography analysis, the lowest simulated drift treatment from which bispyribac-sodium could be detected 10 d after treatment was 1% of the rice use rate. In general, visual injury symptoms remained constant over time, or even worsened, whereas bispyribac-sodium residues decreased or became not detectable. There was no measurable impact on walnut yield from any of the simulated drift treatments in these experiments.

Si nuestra época es producto de la Ilustración en los terrenos del pensamento económico y político, tanto o más lo es, sin lugar a dudas, en el del pensamiento educativo. No en vano la mayoría de los principales pensadores del movimiento iluminista le concedieron un importante espacio en su obra. Locke nos legó los Thoughts on education, Helvetius su De l’Homme, Rousseau el Emilio, Condorcet el Rapport sur l’Instruction Publique, Kant la Pädagogik, y ello sin contar los escritos menores de Voltaire, La Chalotais, Mirabeau y otros o, entre nosotros, Quintana.

Filippo Mariano,1 Chiara Cogno,1 Fulvia Giaretta,2,3 Ilaria Deambrosis,2,3 Simona Pozza,4 Maurizio Berardino,5 Giuseppe Massazza,6 Luigi Biancone1,3 1Department of General and Specialist Medicine, Nephrology, Dialysis and Transplantation Unit, City of Health and Science, CTO Hospital, Turin, 2Department of General and Specialist Medicine, Laboratory of Nephrology and Immunopathology, City of Health and Science, Molinette Hospital, Turin, 3Department of Medical Sciences, University of Turin, Turin, 4Department of Radiology and Radiotherapy, CTO Radiology, City of Health and Science, CTO Hospital, Turin, 5Department of Anesthesiology and Intensive Care, Anesthesiology and Intensive Care 5, City of Health and Science, CTO Hospital, Turin, 6Department of Orthopedics and Traumatology, Week Hospital Unit, City of Health and Science, CTO Hospital, and University of Turin, Turin, Italy Background: Parenteral administration of ketorolac is very effective in controlling postoperative pain for orthopedic surgery. Ketorolac can induce clinically relevant renal alterations in elderly patients, whereas its short course is considered safe for young adults with normal preoperative renal function. In this study, of a cohort of young adults undergoing elective orthopedic day surgery, we sought cases complicated by readmission due to acute kidney injury (AKI).Patients and methods: Among 1397 young adults, aged 18–32 years who were admitted to undergo orthopedic day surgery from 2013 to 2015, four patients (0.29%, three males/one female) treated in postprocedure with ketorolac (from 60 to 90 mg/day for 1–2 days) were readmitted for suspected severe AKI. We evaluated functional outcome, urinary protein profiles and kidney biopsy (1 patient).Results: After day surgery discharge, they experienced gastrointestinal disturbances, flank pain and fever. Readmitted on post-surgery days 3–4, they presented with oliguric AKI (creatinine range 158.4–466.4 µmol/L) and frank proteinuria (albumin range 2.1–6.0 g/L). Urine protein profiles demonstrated a nonselective glomerular proteinuria, with a significant 9.4-fold increase in glomerular/tubular index on day 6. Kidney biopsy on day 19 showed normal glomeruli and minimal tubular alterations and negative immunofluorescence. All patients recovered their renal function, and after 20 days proteinuria disappeared.Conclusion: AKI can ensue even in young adults who have undergone a short course of ketorolac, when they suffered from relative dehydration, abdominal disturbances, flank pain and oliguria after discharge. Urine findings were characterized by a marked nonselective glomerular proteinuria disappearing in 2–3 weeks. Keywords: ketorolac, acute kidney injury, glomerular tubular index, orthopedic day surgery