Paolo Giovanni Morselli

Enhanced engraftment and repairing ability of human adipose-derived stem cells, conveyed by pharmacologically active microcarriers continuously releasing HGF and IGF-1, in healing myocardial infarction in rats.

One of the main cause of ineffective cell therapy in repairing the damaged heart is the poor yield of grafted cells. To overcome this drawback, rats with 4-week-old myocardial infarction (MI) were injected in the border zone with human adipose-derived stem cells (ADSCs) conveyed by poly(lactic-co-glycolic acid) microcarriers (PAMs) releasing hepatocyte growth factor (HGF) and insulin-like growth factor-1 (IGF-1) (GFsPAMs). According to treatments, animals were subdivided into different groups: MI_ADSC, MI_ADSC/PAM, MI_GFsPAM, MI_ADSC/GFsPAM, and untreated MI_V. Two weeks after injection, a 31% increase in ADSC engraftment was observed in MI_ADSC/PAM compared with MI_ADSC (pu2009<u20090.05). A further ADSC retention was obtained in MI_ADSC/GFsPAM with respect to MI_ADSC (106%, pu2009<u20090.05) and MI_ADSC/PAM (57%, pu2009<u20090.05). A 130% higher density of blood vessels of medium size was present in MI_ADSC/GFsPAM compared with MI_ADSC (pu2009<u20090.01). MI_ADSC/GFsPAM also improved, albeit slightly, left ventricular remodeling and hemodynamics with respect to the other groups. Notably, ADSCs and/or PAMs, with or without HGF/IGF-1, trended to induce arrhythmias in electrically driven, Langendorff-perfused, hearts of all groups. Thus, PAMs releasing HGF/IGF-1 markedly increase ADSC engraftment 2 weeks after injection and stimulate healing in chronically infarcted myocardium, but attention should be paid to potentially negative electrophysiological consequences.

Evidence of the involvement of the DHFR gene in nonsyndromic cleft lip with or without cleft palate.

Studies aimed at evidencing genetic causes for neural tube defect (NTD) occurrence have often provided the inspiration for orofacial cleft aetiology investigations. The correlation between the two congenital malformations is provided by the similar incidence timing and the involvement of structures localized in the midline of the embryo. This connection is corroborated by the existence of a number of genes involved in both malformations. In this article, we considered the dihydrofolate reductase (DHFR) gene, previously seen implicated in NTDs, as a candidate for cleft lip with or without cleft palate (CL/P) risk. Four SNPs mapping on the DHFR gene were genotyped for 400 Italian CL/P triads, using TaqMan(®) approach. The rs1677693 provided evidence of association, even if at borderline level (P value 0.049). In particular, the variant allele seems to have a protective effect ORxa0=xa00.80 (95% C.I. 0.64-0.99). Moreover, the combination of rs1677693(A)-rs1650723(G) alleles showed a significant association OR 0.64 (95% C.I. 0.47-0.86) (P valuexa0=xa00.006). This represents the first attempt to demonstrate a role for DHFR in CL/P aetiology, howbeit the study of such gene deserves a deepening.

Non-syndromic cleft lip with or without cleft palate in Asian populations: Association analysis on three gene polymorphisms of the folate pathway

OBJECTIVEnOrofacial clefts (OFCs) are one of the most common birth defects in humans. They are the subject of a number of investigations aimed at elucidating the bases of their complex mode of inheritance involving both genetic and environmental factors. Genes belonging to the folate pathway have been among the most studied. The aim of the investigation was to replicate previous studies reporting evidence of association between polymorphisms of folate related genes and the occurrence of non-syndromic cleft lip with or without cleft palate (NSCL/P), using three independent samples of different ancestry: from Tibet, Bangladesh and Iran, respectively.nnnDESIGNnSpecifically, the polymorphisms rs1801133 of MTHFR, rs1801198 of TCN2, and rs4920037 of CBS, were tested.nnnRESULTSnA decreased risk of NSCL/P was observed in patients presenting the C677T variant at MTHFR gene (relative risk for heterozygotes=0.53; 95% confidence interval [C.I.]=0.32-0.87). The investigated polymorphisms mapping at TCN2 and CBS genes did not provide any evidence of association.nnnCONCLUSIONnOverall, these results indicate that NSCL/P risk factors differ among populations and confirm the importance of testing putative susceptibility variants in different genetic backgrounds.

Eumorphic Plastic Surgery: Expectation Versus Satisfaction in Body Dysmorphic Disorder

BackgroundEumorphic Plastic Surgery aims at improving the severe psychosocial pain caused by a deformity. Dysmorphopathology is an increasingly relevant problem facing the plastic surgeon.ObjectiveThe aim of this study is to describe the perioperative questionnaires created by the senior author and to present a cohort of plastic surgery patients suffering from dysmorphopathies. These patients were prospectively followed and evaluated with the proposed questionnaires through their surgical pathway to explore the degree of satisfaction or disappointment compared to expectations.MethodsAll candidates for plastic surgery procedures between April 2011 and June 2013 were included in the study. Preoperatively, all patients completed the Patient Expectation Questionnaire (E-pgm). Twelvexa0months postoperatively, they completed the Patient Satisfaction Questionnaire (S-pgm). The E-pgm and S-pgm were compared to evaluate the consistency between the patient’s preoperative expectations and postoperative evaluations.ResultsA total of 158 patients were included in the study. Out of them, 79xa0% experienced an improvement or no variation between preoperative expectations and postoperative satisfaction. With regard to the motivation for undergoing surgery, 91xa0% showed that the surgical procedure met the motivation. An overall positive perioperative change in life was experienced by 93xa0% of patients.ConclusionsThe E-pgm questionnaire proved to be a valid and reliable tool for the selection of suitable candidates for surgery and for identification of dysmorphophobic patients. Enhancing the doctor–patient relationship and communication can reduce ambiguity and avoid troublesome misunderstandings, litigation and other legal implications.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Patient Satisfaction and Quality of Life in DIEAP Flap versus Implant Breast Reconstruction

The psychological impact of breast reconstruction has widely been described, and multiple studies show that reconstruction improves the well-being and quality of life of patients. In breast reconstruction, the goal is not only the morphological result, but mainly the patients perception of it. The objective of our study is to compare the physical and psychosocial well-being and satisfaction concerning the body image of patients who had reconstruction with breast implants to those of patients who had reconstruction with deep inferior epigastric artery perforator flaps. Our results demonstrated a similar quality of life between the two groups, but the satisfaction level was significantly higher in patients who had reconstruction with autologous tissue. Feedback from patients who have already received breast reconstruction may be useful in the decision-making process for future patients and plastic surgeons, enabling both to choose the reconstructive technique with the best long-term satisfaction.

Management of acid burns: Experience from Bangladesh

Acid burn injuries in Bangladesh primarily occur as a result of intentional attacks although there are incidences of accidental acid burns in industry, on the street, and at home. A total of 126 patients with acid burns, 95 from attacks and 31 from accidents, were studied from July 2004 to December 2012. A diagnosis of acid burn was made from history, physical examination and in some cases from chemical analysis of the patients clothing. Alkali burns were excluded from the study. In the burn unit of Dhaka Medical College Hospital, we applied a slightly different protocol for management of acid burns, beginning with plain water irrigation of the wound, which effectively reduced burn depth and the requirement of surgical treatment. Application of hydrocolloid dressing for 48-72 h helped with the assessment of depth and the course of treatment. Early excision and grafting gives good results but resultant acid trickling creates a marble cake-like appearance of the wound separated by the vital skin. Excision with a scalpel and direct stitching of the wounds are often a good option. Observation of patients on follow-up revealed that wounds showed a tendency for hypertrophy. Application of pressure garments and other scar treatments were given in all cases unless the burn was highly superficial.

Lull pgm System for Autologous Fat Grafting: A Simple Closed System with Minimal Equipment and No Extra Cost.

Summary: The “Lull pgm system” is a closed system for purifying harvested fat. It processes the collected tissue safely without any additional cost. The system was conceived by referring to the targets described in the literature with the aim of creating a simple system that guarantees a high standard of purification and requires minimal equipment that is available in every operating room. Cost must be always considered: even the most prosperous hospitals must keep within tight annual budgets. “Lull” can be used instead of expensive devices or disposable kits, without substantially increasing the operating time. The system has been used in clinical practice for many plastic reconstructive procedures and has obtained positive results and patient satisfaction, and no contraindications or disadvantages have been observed.

Perineal Flap Reconstruction after Oncologic Resection

METHODS Patients who underwent abdominoperineal resections for anorectal or vulvovaginal cancer were retrospectively analyzed. We include all the patients who could not be repaired by direct closure due to excessive skin tension. We assessed the different flaps used, the surgical complications rate, wound healing, or the progression to chronic wounds. RESULTS We identified 20 patients who underwent this procedure in the last 10 years. The flaps used were all fasciocutaneous, either in a random or perforator fashion. Our first choice for defects of the external vulvar region or the perineum area was lotus petal flap (Figs. 1, 2).3 Second, we used vertical deep inferior epigastric artery perforator flap if there was a large dead space to fulfill or a defect involving the vaginal wall.4 If the deep inferior epigastric artery perforator flap would be too thick or not available according to previous abdominal surgeries, we used the anterolateral thigh flap.5 In some other cases where the lotus petal flap was not available due to poor local conditions (radiotherapy damage) and the defect was small, we used local random fasciocutaneous flaps from the gluteal or the medial thigh region.6 We reported no major complications necessitating intervention, and there were no complete flap necrosis or reconstructive failures. All the cases of partial flap loss (approximately 20%) healed by second intention without important scarring retraction. We assessed no progression to chronic wounds. Perineal Flap Reconstruction after Oncologic Resection

Pressure Ulcers in Patients with Spinal Cord Injuries: Concordance Between Swab and Intraoperative Culture

1 BACKGROUND Infection of pressure ulcers constitutes the most frequent complication in spinal cord–injured patients; evidently, the surgical treatment of infected pressure ulcers is effective only when combined with a selected antibiotic therapy. However, the choice of the appropriate antibiotics is not simply due to the widespread variety of bacterial species involved in such infections. Only a few studies in the literature compare wound swabs with biopsies for the diagnosis of chronic infected wounds.1 Until now, the Levine technique has been considered as the most reliable and valid method. Still, the best sampling technique for taking a swab has not yet been identified and validated.2 The objective of our study is to assess the predictive value of ulcer swab specimen culture in identifying etiological agents of infection in patients with spinal cord injury (SCI) and pressure sores.

Management of the Exposed and/or Infected Breast Prosthesis: A Proposal for a Standardized Approach.

1 BACKGROUND Implant infection and exposure are the main complications related to breast reconstructive and aesthetic surgery.1,2 In the past, treatment was immediate device removal with implant repositioning no earlier than 6 months. Recently, numerous successful attempts of device salvage have been reported.3,4 There is still disagreement about the indications and the procedures.5 We propose the protocol adopted at Bellaria Hospital of Bologna for device salvage.