Roberto Bracaglia

Up-regulation of pro-inflammatory genes as adaptation to hypoxia in MCF-7 cells and in human mammary invasive carcinoma microenvironment

The role of tumor cells in synthesizing pro‐inflammatory molecules is still controversial. Here we report that hypoxic treatment of the MCF‐7 human mammary adenocarcinoma cell line induced activation of hypoxia‐inducible factor 1α (HIF‐1α) and nuclear factor‐kappa B (NF‐κB). Importantly, hypoxia regulated expression of alarmin receptors such as the receptor for advanced glycation end products (RAGE) and the purinoreceptor (P2X7R), and up‐regulated inflammatory response (IR) genes such as the inducible enzymes nitric oxide synthase (NOS2), cycloxygenase (COX2), and the acute‐phase protein pentraxin‐3 (PTX3). Hypoxia also stimulated chemokine (C‐X‐C motif) receptor 4 (CXCR4) mRNA synthesis. In fact, the CXCR4 ligand stromal‐derived factor‐1α (SDF‐1α) increased invasion and migration of hypoxic MCF‐7 cells. Inhibition of HIF‐1α by chetomin and NF‐κB by parthenolide reduced mRNA and protein expression of the studied molecules and prevented invasion of hypoxic MCF‐7 cells. Moreover, solid invasive mammary tumor microenvironment was analyzed after laser‐capture microdissection (LCMD) comparing tumor versus host normal tissue. Nuclear translocation of HIF‐1α and NF‐κB and up‐regulation of IR, CXCR4, estrogen receptor α (ERα), and epithelial growth factor receptor (EGFR) was observed in tumor but not in host normal tissue in the absence of a local inflammatory leukocyte infiltrate. We conclude that under hypoxic conditions MCF‐7 cells acquire a pro‐inflammatory phenotype, and that solid human mammary carcinoma evidenced a similar activation of HIF‐1α, NF‐κB, and IR genes in malignant tumor cells as compared to the normal host tissues. We suggest a role for IR activation in the malignant progression of transformed cells.

Our experience with the so-called pull-through technique combined with liposuction for management of gynecomastia

Gynecomastia is a benign enlargement of male breast, common in adolescents and adults. To treat this deformity, we have been carrying out liposuction through small cutaneous incisions placed in the axilla and on the sternum. If necessary, we performed a surgical excision of glandular tissue through a periareolar incision. From 1995, we started to perform surgical excision of glandular tissue, if necessary, through the small incisions made for liposuction, thus avoiding the periareolar scars. We describe our experience with this technique, which we believe excellent for the correction of glandular and fatty glandular gynecomastia, obtaining excellent esthetic results and minimal local scarring.

Prolactin and insulin ultradian secretion and adipose tissue lipoprotein lipase expression in severely obese women after bariatric surgery.

Background: Hyperprolactinemia is associated with obesity. Furthermore, in human adipose tissue cultured in vitro, prolactin (PRL) inhibited lipoprotein lipase (LPL) activity via functional PRL receptors.

Sporadic distal myopathy

SummaryThe sporadic distal myopathies are uncommon primary muscle diseases, the pathogenesis of which is still unclear. The inclusion body myositides are inflammatory myopathies, the distal form of which presents some features resembling those of sporadic distal myopathy. A case is reported of a patient showing features of both the first and the second forms.

Morbidly obese patients undergoing bariatric and body contouring surgery: Psychological evaluation after treatments

our colleagues some practical tips that will optimise patient safety. Rhabdomyolysis e a syndrome caused by damage to skeletal muscle and the release of intracellular muscle enzymes into the circulation e has been previously described in patients undergoing bariatric surgery (incidence estimated at between 1.4% and 75%). It is believed to be due to the increased pressure from prolonged pressure due to excessive weight on skeletal muscle (e.g. gluteal muscles) whilst in an unchanging position during lengthy surgery. Its effects may range from asymptomatic to acute renal failure (as in the case presented here) to death. Our patient did report some pain in his left buttock and parasthesia in the lateral calf and foot on the second post-operative day and that this had been present since the time of surgery. Clinical examination showed full power in both legs and reduced sensation in the left lateral calf. There were no signs of cord compression or compartment syndrome. The neurologists noted his past medical history of sciatica and at the time attributed the symptoms and signs to sciatic nerve root compression. However, it is likely this buttock pain represented left gluteal muscle damage acquired peri-operatively which led to the release of muscle enzymes and subsequent biochemical picture. The operating surgeon should be aware of risk factors predictive for developing post-operative rhabdomyolysis. These have previously been described as:

Micro- and Macroscopic Structural Modification of Subcutaneous Adipose Tissue After Bariatric Surgery

We found the article by Levy et al. [1] entitled Macroscopic Anatomic Changes of Subcutaneous Fat Tissue in Massive-Weight Loss Patients, recently published in your online journal, very interesting. It is a relevant article from a scientific point of view and extremely useful in terms of surgical repeatability. As clearly mentioned in the article, obesity currently is a worldwide disease, with several physical and psychological consequences [2–4] affecting both developed and developing countries. Because of scarce compliance to physical exercise and diet prescriptions, obese, and particularly severely obese individuals, are unable to achieve a proper and durable weight loss. By contrast, bariatric surgery has shown long-term effectiveness in treating morbid obesity, allowing great and stable weight loss. However, one of its side effects is represented by hanging and redundant skin, which is responsible for functional and psychological disturbance for the patients. Such unaesthetic deformities are correctable only with plastic surgery in the form of reconstructive body contouring. Despite this, modifications in the tissue composition of surgical massive weight loss patients can be noticed. These patients typically experience a higher rate of surgical complications than the standard population, which can be partly explained by these alterations [5]. Based on the anatomic data from the study performed by Levy et al. [1], after gastric banding, a restrictive bariatric procedure, significant macroscopic alterations of the adipose tissue were found in all four areas they examined (epigastric, umbilical, hypogastric and lumbar regions). These alterations were loss of the superficial fascial system (with infiltration by white, atrophic, and hyperplastic adipose cells) and discontinuation of the areolar and lamellar layers. Our experience with body contouring for massive weight loss after bariatric surgery is linked primarily to biliopancreatic diversion, a mainly malabsorptive bariatric procedure. Nevertheless, our macroscopic observations are similar to those obtained by Levy et al. [1]: penetration of the superficial fascial system by white atrophic adipose cells combined with gelatinous consistency and absence of compactness of the subcutaneous tissue (Fig. 1). We underscore how the aforementioned anatomic changes, in our case, were associated with microscopic modifications, as shown in our previous study [5] evaluating the problematic wound-healing process in postbariatric patients. In fact, using evidence by Weigert–Van Gieson stain for elastic fibers and connectivum applied on the cutaneous and subcutaneous tissue taken from the horizontal scar during abdominoplasty, we documented anomalies of the dermal elastic (overgrowth, disarray, greater dimensions, serpiginous and polyfragmented aspect, occasional increment in number) and collagen (thickened, hyperosinophilic, and sclerodermoid) fibers. Moreover, we noted modifications involving the subcutaneous tissue: diffuse sclerosis, collapsed adipocytes, fibrous septum thickening, and pseudocysts. Finally, in the extracellular matrix, there was evidence of persistent inflammation (Fig. 2). M. D’Ettorre (&) R. Bracaglia D. Tambasco S. Gentileschi Department of Plastic and Reconstructive Surgery, Catholic University, Largo A. Gemelli, 8, 00168 Rome, RM, Italy e-mail: marco.dettorre@hotmail.it

Frontal exostose resection during an endoscopic subperiosteal lifting: case report

Abstract. Ever slowly, plastic surgery has adopted minimally invasive procedures in order to avoid extensive incisions, large scars, and to obtain better results. Endoscopy was introduced into cosmetic surgery of the face in 1992 and it is getting more and more widespread as are its indications, often replacing open surgical approach. Sometimes, a patient seeking a solution to the stigma attached to the aging face may present other problems that are surgically treatable. The authors describe a case of surgical endoscopic resection of a frontal osteoma during endoscopically assisted brow-lift rhytidoplasty.

“Kris Knife” Brachioplasty After Bariatric Surgery and Massive Weight Loss

Level of Evidence V This 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

A Simple Way to Choose the Right Implant Volume in Breast Augmentation

In planning a breast augmentation, the choice of an appropriate breast implant volume is sometimes a problem, particularly for unskilled surgeons. The authors have used a little trick to make the choice easier for both the surgeon and the patient.

Variation in acute phlogistic reactions in the skin of rabbit fetuses

There is little in the literature on cutaneous inflammatory reactions in mammal fetuses. The subject now has practical import since advances in medical science allow surgical intervention in premature infants. A study was performed on 45 rabbit fetuses. They were inoculated in the derma of the dorsum with 0.01 ml of a 1 % solution of carrageenan, a strong inflammatory drug. Treatment was performed on the nineteenth, twenty-third, and twenty-seventh days of pregnancy. Two rabbits were treated twenty-four hours after birth, and 6 adult rabbits were treated. Histological examination and a count of inflammatory cells were performed on each fetus. The results showed that, during fetal life, the cellular inflammatory reaction is low in the earliest stages but increases gradually during gestation. It is only after birth that there is a great increase, and even then the level remains lower than in adults.