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The COVID-19 pandemic has accelerated the use of mobile operator data to support public policy, although without a universal governance framework for its application. This article describes five principles to guide and assist statistical agencies, mobile network operators and intermediary service providers, who are actively working on projects using mobile operator data to support governments in monitoring the effectiveness of its COVID-19 related interventions. These are principles of necessity and proportionality, of professional independence, of privacy protection, of commitment to quality, and of international comparability. Compliance with each of these principles can help maintain public trust in the handling of these sensitive data and their results, and therefore keep citizen support for government policies. Three projects (in Estonia, Ghana, and the Gambia) were described and reviewed with respect to the compliance and applicability of the five principles. Most attention was placed on privacy protection, somewhat at the expense of the quality of the compiled indicators. The necessity and proportionality in the choice of mobile operator data can be very well justified given the need for timely, frequent and granular indicators. Explicitly addressing the five principles in the preparation of a project should give confidence to the statistical agency and its partners, that enough care has been exercised in the set up and implementation of the project, and should convey trust to public and government in the use mobile operator data for policy purposes.

Background: The thoracodorsal artery perforator (TAP) flap is a versatile tool that can be used to reconstruct the breast. The authors use preoperative perforator mapping using color Doppler ultrasonography and present a safe, efficient harvesting technique to demonstrate reliable use of the TAP flap in reconstructive surgery., Methods: A multicenter, retrospective review was performed on all patients undergoing TAP flap reconstruction from August 2011 to November 2014. Data were collected from patient records as well as outpatient interviews., Results: A total of 106 TAP flaps were performed in 97 patients. The flaps were raised with either 1 perforator (42/106), 2 perforators (55/106), or three perforators (9/106), and turned as a propeller in 99 of 106 (93%) flaps or buried as a turnover in 7 of 106 (7%) of flaps. The mean operative time was 200 minutes (range, 60-485). Major complications occurred in 10 of 106 (10%) cases and included hematoma (1/108), venous congestion (2/108), and partial flap necrosis (7/108). The reconstructive goal was achieved in 103 of 106 (97%) flaps., Conclusions: The TAP flap is a pedicled, fasciocutaneous flap that can be used for total breast reconstruction as well as breast conserving surgery. This large, multicenter series describes our techniques of preoperative perforator mapping and a fast, reliable harvest. Reconstructive goals are accomplished in the great majority of patients.

A 73-year-old woman was referred to the hospital due to a pigmented, asymptomatic nevus on her right arm that had changed in size and color. The histopathological examination showed a superficial spreading malignant melanoma, Clark level III, 2.26 mm in thickness. Two years later, the patient presented a 10 cm rapidly growing mass in her right axilla. The mass in the axilla measured 12.5΄9΄cm. It revealed a lymph node metastases with a tumor growth composed of two different contiguous morphological and immunohistochemical components, respectively, melanosomes and leiomyosarcoma. The combination of a melanocytic nevus with other tumor of epidermal or adnexal origin has been described before, but still the co-existence of two different neoplasms within a lesion is still uncommon. The most common combination is basal cell carcinoma and melanocytic nevus or one of them together with a seborrheic keratosis. There have also been occasional reports of rhabdomyosarcomatous differentiation. However, mesenchymal differentiation, and in this case leiomysarcoma, with formation of heterologous elements in melanocytic tumor is very rare. Another plausible explanation may be that malignant melanoma cells could have transdifferentiated into a leiomyosarcomatoid phenotype with resulting metastases of either type. Malignant melanomas have shown a wide variety of cytological changes and can mimic carcinomas, lymphomas, and sarcomas. Spindle cell melanomas commonly simulate spindle cell carcinomas. It has also been documented that desmoplastic melanomas can change into fibroblastic, Schwannian, and myofibroblastic differentiation.

Melanoma is generally accepted as being an antigenic tumor capable of eliciting T-cell responses that, however, in most cases are inadequate to control tumor growth. Tumor-infiltrating lymphocytes (TIL) in melanoma lesions comprise clonotypic T cells, indicating the in situ recognition of melanoma-associated peptide epitopes. Cultured TIL have been studied in order to unveil characteristics of TIL and the interactions of TIL and melanoma cells. Whether in vitro cultured TIL mirrors the in situ situation has, however, been questioned. In the present study we have taken advantage of T-cell receptor clonotype mapping methodology to conduct a full and detailed analysis of the T-cell clonotypes in melanoma lesions and in corresponding lines of TIL established in vitro. All melanoma lesions and the corresponding TIL cultures comprised high numbers of T-cell clonotypes, typically in the range of 40 to more than 60. The subsequent comparison of T-cell clonotypes present in the original lesions and in the corresponding T-cell lines established in vitro demonstrated that a very limited number of the T-cell clonotypes established in vitro are identical to the T-cell clonotypes expanded in situ. These results demonstrate that in situ T-cell clonotypes in melanoma are not readily expanded in vitro and that the majority of T-cell clonotypes present in cultured TIL are not present in situ., (Copyright 2000 Academic Press.)

Thirty-five women whose breast cancer had been treated by radiation and 111 in whom it had not underwent unilateral breast reconstruction with the tissue expansion technique after modified radical mastectomy. Their records were reviewed and in a questionnaire the patients reported their own opinion on the results. The two groups differed significantly, because those patients who had been irradiated had a more painful course of expansion and a less over-expansion. Their reconstructed breasts were harder, had more deformities, and they required significantly more capsulotomies. The irradiated group also reported less satisfaction with the cosmetic results and more unfulfilled expectations. Tissue expansion cannot therefore be recommended as a routine procedure for breast reconstruction in patients after irradiation. However, our results do not show whether other methods are better for these patients.

Twenty consecutive breast reconstructions were done by the expansion technique. Either textured or smooth expander prostheses were used followed by silicone implants. Histological samples were taken from the capsule when the expander was removed and the implant inserted. The results show no difference in capsular formation between the groups, although the microscopic evaluations from the group with textured prostheses showed considerable numbers of silicone droplets. The patients were generally pleased with the results even though some reconstructed breasts were slightly firm when evaluated postoperatively.

The T cell receptor (TCR) alpha beta variable (V) gene family usage of tumour-infiltrating lymphocytes (TIL) in four different primary human malignant melanomas and their corresponding metastatic lesions was characterized using a recently developed method based on the reverse-transcription-coupled polymerase chain reaction (RT-PCR). All patients were typed for HLA-A1 and -A2, either serologically or by a newly developed RT-PCR method. Two of these patients expressed HLA-A2, one the HLA-A1 haplotype and one further patient was heterozygous HLA-A1/-A2. The prognostic parameters for all four patients indicated that rapid progression of the disease was to be expected. However, only two of the patients showed rapid progression, while the remaining two patients are still alive after more than 3 years. In TIL in primary melanomas, a possible correlation was suggested between HLA-A2 and the preferential usage of the TCR V gene families V alpha 4, V alpha 5, V alpha 22 and V beta 8, whereas the V beta 3 gene family appeared to be expressed together with HLA-A1. Other highly expressed V gene families, apparently not restricted to either HLA-A1 or -A2, were V alpha 1 (expressed in three of four primary tumours) and V alpha 21 (expressed in two of four tumours). We found no evidence suggesting any correlations between the haplotypes HLA-A1 and -A2 and preferential V gene family expression in the metastatic lesions, and the only common feature was V alpha 8, which was found to be highly expressed in two out of three subcutaneous metastases. The V gene families, which were highly expressed in the primary tumour were generally not, or only very weakly, expressed in metastases and vice versa, possibly reflecting a change in the phenotype of the metastatic melanoma target cells. With regards to patient 0368, it was possible to obtain and study material from two subcutaneous metastases. The first metastasis was excised more than a year after the primary tumour, showing a completely different V region repertoire. The second metastasis was excised at surgery 2 years after primary surgery and likewise showed a dramatic shift in comparison to the first subcutaneous metastasis. Although the present study only included a small number of patients, it suggests that the estimation of V gene expression, if applied to a larger amount of patient material, might make it possible to substantiate further the suggested correlations between the T cell response against the tumour, HLA and antigen expression.(ABSTRACT TRUNCATED AT 400 WORDS)

In the surgery of burns a good healing of donor areas is essential. A controlled trial of 17 cases is presented. Mirror-image donor areas in the same patient were treated on one leg with a traditional dressing of paraffin gauze, Jelonet, on the other leg with Kaltostat, a calcium sodium alginate wound dressing. Healing time, haemostasis, ease and comfort with removal, dressings, infection and quality of the regenerated skin, were estimated. The Kaltostat dressing seemed to be superior due to the quality of the re-epithelialized donor site, the haemostatic quality and the ease and comfort with removal. There was a marginal profit in healing time.

Reconstructive surgery was performed in 18 knee arthroplasties because of wound-healing problems or skin necrosis. The procedure, after debridement, included myocutaneous, muscle flap, and split-skin grafts. Revision was necessary in 6 cases. After 1-17 years, 6 patients had died, 2 had had a low femur amputation, and 5 had had an arthrodesis. Five patients had retained the prosthesis, although 3 of them had considerable pain and poor mobility; only 2 patients were tolerably painfree and had acceptable mobility. Patients with an exposed knee endoprosthesis should be referred to centers with special competence in plastic reconstructive surgery.

Experimental skin flaps in rats were treated with an active/non-active Diapulse unit in a double-blind trial to clarify whether or not pulsed electromagnetic energy had any effect on the surviving length of flaps. The observed differences in surviving flap areas between the Diapulse treated group and the untreated group as compared to the predicted survival by fluoresceine and/or vital capillary television microscopy were not statistically significant (p less than 0.10) in a set up, that on a significance level of 5%, would have detected an enhancement of flap survival of greater than or equal to 10% in 98% of trials.

In a retrospective survey the efficacy of a prophylactic antacid regime with aluminiumhydroxyde/magnesiumcarbonate (LINK, A.L. pharma) was investigated in 157 patients with major burns. Only 14% developed any sign of upper gastrointestinal stress ulceration, and only 5% revealed clinically significant bleeding indicating blood transfusion. No case developed haemodynamic instability, nor need for acute surgery, and no one died from haemorrhage. We found the regime economically attractive, and with few and reversible side effects. We conclude that our prophylactic regime is highly effective.

Two patients are reported with repeated, nonhealing wounds due to auto-mutilation. The diagnostic and psychiatric problems involved are discussed.