A combined proteomics and bioinformatics analysis of ZNHIT1-interacting proteins reveals a significant enrichment in proteins associated with mitochondrial function

Adenosine 5'-triphosphate (ATP) is the principal source of cellular energy, which is essential for neuronal health and maintenance. Parkinson's disease (PD) and other neurodegenerative disorders are characterised by impairments in mitochondrial function and reductions in cellular ATP levels. Thus there is a need to better understand the biology of intracellular regulators of ATP production, in order to inform the development of new neuroprotective therapies for diseases such as PD. One such regulator is Zinc finger HIT-domain containing protein 1 (ZNHIT1). ZNHIT1 is an evolutionarily-conserved component of a chromatin-remodelling complex, which has been recently shown to increase cellular ATP production in SH-SY5Y cells and to protect against impairments in mitochondrial function caused by alpha-synuclein, a protein which is integral to PD pathophysiology. This effect of ZNHIT1 on cellular ATP production is thought to be due to increased expression of genes associated with mitochondrial function, but it is also possible that ZNHIT1 regulates mitochondrial function by binding to mitochondrial proteins. To examine this question, we performed a combined proteomics and bioinformatics analysis to identify ZNHIT1-interacting proteins in SH-SY5Y cells. We report that ZNHIT1-interacting proteins are significantly enriched in multiple functional categories, including mitochondrial transport, ATP synthesis and ATP-dependent activity. Furthermore we also report that the correlation between ZNHIT1 and dopaminergic markers is reduced in the PD brain. These data suggest that the reported beneficial effects of ZNHIT1 on ATP production may be mediated, at least in part, by its direct interaction with mitochondrial proteins and suggest that potential alterations in ZNHIT1 in PD may contribute to the known impairments in ATP generation in midbrain dopaminergic neurons in PD.

The role of component separation in the treatment of severe diastasis recti abdominis: a new indication for a known technique

OBJECTIVE

Diastasis of the rectus abdominis muscle (DRAM) is a widening of linea alba, it also could be accompanied by abdominal bulging. DRAM is often a cause of quality-of-life impairment, especially when it is of large dimensions. Repair with direct rectus plication is the most common treatment for Diastasis Recti Abdominis (DRA), but it can result in high recurrence rates. The authors aimed to show their results in applying the component separation technique in wide DRA cases.

PATIENTS AND METHODS

From January 2015 to July 2018, 43 patients with DRA ≥ 10 cm at 3 cm over the umbilicus have been treated with component separation technique associated to panniculectomy. A biologic mesh was positioned onlay in cases of weakness along the semilunaris lines.

RESULTS

DRA repair was achieved in all cases. All patients completed the 1-year follow-up and no recurrence nor major complication were registered. Minor complications were observed in 12 (27.9%) cases.

CONCLUSIONS

This is the first study describing the component separation technique use in cases of DRA without hernia, associated to abdominoplasty surgery. Preliminary results were encouraging, but larger series are required.

Regulator of G-Protein Signalling 4 (RGS4) negatively modulates nociceptin/orphanin FQ opioid receptor signalling: Implication for l-Dopa-induced dyskinesia

BACKGROUND AND PURPOSE

Regulator of G-protein signalling 4 (RGS4) is a signal transduction protein that accelerates intrinsic GTPase activity of Gαi/o and Gαq subunits, suppressing GPCR signalling. Here, we investigate whether RGS4 modulates nociceptin/orphanin FQ (N/OFQ) opioid (NOP) receptor signalling and if this modulation has relevance for l-Dopa-induced dyskinesia.

EXPERIMENTAL APPROACH

HEK293T cells transfected with NOP, NOP/RGS4 or NOP/RGS19 were challenged with N/OFQ and the small-molecule NOP agonist AT-403, using D1-stimulated cAMP levels as a readout. Primary rat striatal neurons and adult mouse striatal slices were challenged with either N/OFQ or AT-403 in the presence of the experimental RGS4 chemical probe, CCG-203920, and D1-stimulated cAMP or phosphorylated extracellular signal regulated kinase 1/2 (pERK) responses were monitored. In vivo, CCG-203920 was co-administered with AT-403 and l-Dopa to 6-hydroxydopamine hemilesioned rats, and dyskinetic movements, striatal biochemical correlates of dyskinesia (pERK and pGluR1 levels) and striatal RGS4 levels were measured.

KEY RESULTS

RGS4 expression reduced NOFQ and AT-403 potency and efficacy in HEK293T cells. CCG-203920 increased N/OFQ potency in primary rat striatal neurons and potentiated AT-403 response in mouse striatal slices. CCG-203920 enhanced AT-403-mediated inhibition of dyskinesia and its biochemical correlates, without compromising its motor-improving effects. Unilateral dopamine depletion caused bilateral reduction of RGS4 levels, which was reversed by l-Dopa. l-Dopa acutely up-regulated RGS4 in the lesioned striatum.

CONCLUSIONS AND IMPLICATIONS

RGS4 physiologically inhibits NOP receptor signalling. CCG-203920 enhanced NOP responses and improved the antidyskinetic potential of NOP receptor agonists, mitigating the effects of striatal RGS4 up-regulation occurring during dyskinesia expression.

LINKED ARTICLES

This article is part of a themed issue on Advances in Opioid Pharmacology at the Time of the Opioid Epidemic. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v180.7/issuetoc.

A comparison of machine learning approaches for the quantification of microglial cells in the brain of mice, rats and non-human primates

Microglial cells are brain-specific macrophages that swiftly react to disruptive events in the brain. Microglial activation leads to specific modifications, including proliferation, morphological changes, migration to the site of insult, and changes in gene expression profiles. A change in inflammatory status has been linked to many neurodegenerative diseases such as Parkinson's disease and Alzheimer's disease. For this reason, the investigation and quantification of microglial cells is essential for better understanding their role in disease progression as well as for evaluating the cytocompatibility of novel therapeutic approaches for such conditions. In the following study we implemented a machine learning-based approach for the fast and automatized quantification of microglial cells; this tool was compared with manual quantification (ground truth), and with alternative free-ware such as the threshold-based ImageJ and the machine learning-based Ilastik. We first trained the algorithms on brain tissue obtained from rats and non-human primate immunohistochemically labelled for microglia. Subsequently we validated the accuracy of the trained algorithms in a preclinical rodent model of Parkinson's disease and demonstrated the robustness of the algorithms on tissue obtained from mice, as well as from images provided by three collaborating laboratories. Our results indicate that machine learning algorithms can detect and quantify microglial cells in all the three mammalian species in a precise manner, equipotent to the one observed following manual counting. Using this tool, we were able to detect and quantify small changes between the hemispheres, suggesting the power and reliability of the algorithm. Such a tool will be very useful for investigation of microglial response in disease development, as well as in the investigation of compatible novel therapeutics targeting the brain. As all network weights and labelled training data are made available, together with our step-by-step user guide, we anticipate that many laboratories will implement machine learning-based quantification of microglial cells in their research.

Peripheral administration of the Class-IIa HDAC inhibitor MC1568 partially protects against nigrostriatal neurodegeneration in the striatal 6-OHDA rat model of Parkinson's disease

Parkinson's disease (PD) is a neurodegenerative disorder characterised by nigrostriatal dopaminergic (DA) neurodegeneration. There is a critical need for neuroprotective therapies, particularly those that do not require direct intracranial administration. Small molecule inhibitors of histone deacetylases (HDIs) are neuroprotective in in vitro and in vivo models of PD, however it is unknown whether Class IIa-specific HDIs are neuroprotective when administered peripherally. Here we show that 6-hydroxydopamine (6-OHDA) treatment induces protein kinase C (PKC)-dependent nuclear accumulation of the Class IIa histone deacetylase (HDAC)5 in SH-SY5Y cells and cultured DA neurons in vitro. Treatment of these cultures with the Class IIa-specific HDI, MC1568, partially protected against 6-OHDA-induced cell death. In the intrastriatal 6-OHDA lesion in vivo rat model of PD, MC1568 treatment (0.5 mg/kg i.p.) for 7 days reduced forelimb akinesia and partially protected DA neurons in the substantia nigra and their striatal terminals from 6-OHDA-induced neurodegeneration. MC1568 treatment prevented 6-OHDA-induced increases in microglial activation in the striatum and substantia nigra. Furthermore, MC1568 treatment decreased 6-OHDA-induced increases in nuclear HDAC5 in nigral DA neurons. These data suggest that peripheral administration of Class IIa-specific HDIs may be a potential therapy for neuroprotective in PD.

LMK235, a small molecule inhibitor of HDAC4/5, protects dopaminergic neurons against neurotoxin- and α-synuclein-induced degeneration in cellular models of Parkinson's disease

Epigenetic modifications in neurodegenerative disease are under investigation for their roles in disease progression. Alterations in acetylation rates of certain Parkinson's disease (PD)-linked genes have been associated with the pathological progression of this disorder. In light of this, and given the lack of disease-modifying therapies for PD, HDAC inhibitors (HDIs) are under consideration as potential pharmacological agents. The neuroprotective effects of pan-HDACs and some class-specific inhibitors have been tested in in vivo and in vitro models of PD, with varying outcomes. Here we used gene co-expression analysis to identify HDACs that are associated with human dopaminergic (DA) neuron development. We identified HDAC3, HDAC5, HDAC6 and HDAC9 as being highly correlated with the DA markers, SLC6A3 and NR4A2. RT-qPCR revealed that mRNA expression of these HDACs exhibited similar temporal profiles during embryonic mouse midbrain DA (mDA) neuron development. We tested the neuroprotective potential of a number of class-specific small molecule HDIs on human SH-SY5Y cells, using neurite growth as a phenotypic readout of neurotrophic action. Neither the class I-specific HDIs, RGFP109 and RGFP966, nor the HDAC6 inhibitor ACY1215, had significant effects on neurite outgrowth. However, the class IIa HDI, LMK235 (a HDAC4/5 inhibitor), significantly increased histone acetylation and neurite outgrowth. We found that LMK235 increased BMP-Smad-dependent transcription in SH-SY5Y cells and that this was required for its neurite growth-promoting effects on SH-SY5Y cells and on DA neurons in primary cultures of embryonic day (E) 14 rat ventral mesencephalon (VM). These effects were also seen in SH-SY5Y cells transfected with HDAC5 siRNA. Furthermore, LMK235 treatment exerted neuroprotective effects against degeneration induced by the DA neurotoxin 1-methyl-4-phenylpyridinium (MPP⁺), in both SH-SY5Y cells and cultured DA neurons. Treatment with LMK235 was also neuroprotective against axonal degeneration induced by overexpression of wild-type (WT) or A53T mutant α-synuclein in both SH-SY5Y cells and primary cultures of DA neurons. In summary, these data show the neuroprotective potential of the class IIa HDI, LMK235, in cell models of relevance to PD.

Breast surgeons updating on the thresholds of COVID-19 era: results of a multicenter collaborative study evaluating the role of online videos and multimedia sources on breast surgeons education and training

OBJECTIVE

Current trends show a rise of attention given to breast cancer patients' quality of life and the surgical reconstructive result. Along with this trend, surgical training quality and efficacy are gaining importance and innovative training methods such as online videos shared on social media portals, are becoming main updating tools. In hazardous times like COVID-19 pandemic nowadays, online communication becomes of vital importance and adaptation and innovation are fundamental to keep research and education alive. The authors aimed to investigate the role of video and multimedia sources on the daily activity and surgical training of a representative group of surgeons specifically dedicated to oncologic, oncoplastic and reconstructive breast surgeries.

MATERIALS AND METHODS

A survey was produced and administered to 20 major Italian Breast Centers. Collected data were analyzed with Fisher's Exact Test.

RESULTS

From October 2019 to March 2020, a total of 320 surveys were collected. Among the responders, there were 188 trainees (intern medical doctors and residents) and 110 faculty, 72% of them belonged to a plastic surgery environment, while 28% to general surgery environment. Almost all respondents have ever watched videos concerning breast surgery.

CONCLUSIONS

The results of the study show how breast surgeons rely on videos and web platforms, mostly YouTube, when searching for training info about surgical procedures. Social media offer great opportunities for sharing knowledge and diffusion of new ideas but greater attention to their reliability is mandatory.

Operational functionalities of air-quality WSn metal-oxide sensors correlating semiconductor defect levels and surface potential barriers

The comprehension of atmospheric pollution levels worldwide is a crucial issue for assessing the health consequences from human exposure to polluted air, and for identifying emission reductions that will be effective for minimizing the potential risks. Advanced interconnected sensors are required that could monitor on real-time toxic gaseous concentration. The success of these instruments depends on the reliability of these devices to quantify and disseminate the pollution levels to nearby citizens. Metal-oxide semiconductors are widely used as functional materials for gas sensing because of their chemo-resistive effect when interacting with gases. Mixed oxides are usually considered for the superior performances shown with respect to the single oxides. In this work, tungsten-tin mixed oxides with different Sn molar fraction (0.0018, 0.12, 0.33 and 0.89 named WS-1, WS-2, WS-3 and WS-4) were synthesized by sol-gel co-precipitation. The powders were characterized by ICP-OES analysis, specific surface area measurements, electron microscopy, X-ray diffraction, UV-Vis-NIR and FT-IR spectroscopies. The powders were also deposited through screen-printing technology, obtaining thick film gas sensors, on which measurements of conductance as a function of temperature, surface potential barrier and dynamical responses in the presence of oxidizing or reducing gases were carried out. Based on the studied properties, the mixed oxides can be divided into two groups: the WO₃-like samples (WS-1, WS-2, WS-3) and the SnO₂-like sample (WS-4). All samples present pure crystalline structures: this is a new result for the WO₃-like samples. There is no literature data reporting about the introduction of so high Sn content in a WO₃ structure. The combination of spectroscopic and electrical characterizations allowed the definition of an interpretative model that correlates the deepness of defect levels in the band gap of these materials to the values of the surface potential barrier in air and, as a consequence, to the electrical responses to oxidizing and reducing gases.

Gene Co-expression Analysis Identifies Histone Deacetylase 5 and 9 Expression in Midbrain Dopamine Neurons and as Regulators of Neurite Growth via Bone Morphogenetic Protein Signaling

Parkinson's disease is characterized by the intracellular accumulation of α-synuclein which has been linked to early dopaminergic axonal degeneration. Identifying druggable targets that can promote axonal growth in cells overexpressing α-synuclein is important in order to develop strategies for early intervention. Class-IIa histone deacetylases (HDACs) have previously emerged as druggable targets, however, it is not known which specific class-IIa HDACs should be targeted to promote neurite growth in dopaminergic neurons. To provide insight into this, we used gene co-expression analysis to identify which, if any, of the class-IIa HDACs had a positive correlation with markers of dopaminergic neurons in the human substantia nigra. This revealed that two histone deacetylases, HDAC5 and HDAC9, are co-expressed with TH, GIRK2 and ALDH1A1 in the human SN. We further found that HDAC5 and HDAC9 are expressed in dopaminergic neurons in the adult mouse substantia nigra. We show that siRNAs targeting HDAC5 or HDAC9 can promote neurite growth in SH-SY5Y cells, and that their pharmacological inhibition, using the drug MC1568, promoted neurite growth in cultured rat dopaminergic neurons. Moreover, MC1568 treatment upregulated the expression of the neurotrophic factor, BMP2, and its downstream transcription factor, SMAD1. In addition, MC1568 or siRNAs targeting HDAC5 or HDAC9 led to an increase in Smad-dependent GFP expression in a reporter assay. Furthermore, MC1568 treatment of cultured rat dopaminergic neurons increased cellular levels of phosphorylated Smad1, which was prevented by the BMP receptor inhibitor, dorsomorphin. Dorsomorphin treatment prevented the neurite growth-promoting effects of siRNAs targeting HDAC5, as did overexpression of dominant-negative Smad4 or of the inhibitory Smad7, demonstrating a functional link to BMP signaling. Supplementation with BMP2 prevented the neurite growth-inhibitory effects of nuclear-restricted HDAC5. Finally, we report that siRNAs targeting HDAC5 or HDAC9 promoted neurite growth in cells overexpressing wild-type or A53T-α-synuclein and that MC1568 protected cultured rat dopaminergic neurons against the neurotoxin, MPP+. These findings establish HDAC5 and HDAC9 as novel regulators of BMP-Smad signaling, that additionally may be therapeutic targets worthy of further exploration in iPSC-derived human DA neurons and in vivo models of Parkinson's disease.

One-stage breast reconstruction techniques in elderly patients to preserve quality of life

OBJECTIVE

The aim of this study was to review one-stage breast reconstruction techniques performed in elderly patients at our institution to identify the criteria of selection of each in terms of outcomes and quality of life.

PATIENTS AND METHODS

Patients older than 65 years who underwent one-stage breast reconstruction between January 2004 and July 2014 at our hospital were included. Patients and procedure-related data were collected from the medical records. In particular, patient's age, comorbidities and related ASA physical status, type of one-stage breast reconstruction technique, and criteria of selection were analyzed. Outcomes and results were also evaluated in terms of quality of life using the EORTC QLQ-C30 and -BR23 questionnaires 1 year after surgery.

RESULTS

A total of 840 women underwent breast reconstruction, of whom 138 elderly women received one-stage breast reconstruction. There were 118 cases (85.5%) of monolateral reconstructions and 20 cases (14.5%) of bilateral reconstructions, resulting in 138 breast reconstructions. These were performed with permanent inflatable expanders in the sub-muscular position (Group A, n= 50), with acellular dermal matrix and partial sub-muscular anatomic implant (Group B, n= 50), and with Braxon® acellular dermal matrix and anatomic implant with muscle-sparing technique (Group C, n= 38). The EORTC questionnaires showed the best results in Group C regarding the quality of life.

CONCLUSIONS

The elderly population is rapidly increasing, and 50% of all breast cancers occur in women older than 65 years; among them, only 2% undergo breast reconstruction. A major aspect of breast cancer treatment and subsequent quality of life is the opportunity for a post-mastectomy reconstructive surgery. As survival rates are improving, a larger proportion of patients live with the long-term consequences of their treatment, and breast reconstruction ensures a better quality of life. To increase the reconstruction rates, surgery should be one-stage, less invasive as possible, allowing rapid recovery, especially in elderly women, in whom comorbidities are often present with a higher anaesthetic risk. Our study highlighted that non-skin sparing mastectomy (SSM) and delayed reconstructions should be addressed with Becker implants; immediate reconstructions after SSM should be followed by acellular dermal matrix (ADM)-assisted implant reconstruction, preferring the wrap technique offers a better quality of life in elderly patients.

Effects of Zafirlukast on Capsular Contracture: Controlled Study Measuring the Mammary Compliance

Capsular contracture is a highly distressing, difficult complication after breast augmentation for both the patient and the surgeon. Although capsular contracture is a multifactorial process, one common denominator in the successful treatment of this complication is believed to be the abatement of inflammation. Leukotriene antagonists have recently emerged as effective prophylactic agents in reactive airway diseases. Anecdotal reports have indicated that zafirlukast (Accolate, AstraZeneca) effectively reverses capsular contracture. A prospective study of capsular contracture in 120 female patients in whom a total of 216 prostheses were implanted was performed. The hardness of capsular contracture was assessed by means of the mammary compliance method (Anton Paar Mammacompliance system). The patients were divided into two groups: patients in group A received zafirlukast for a 6-month period, while those in group B received vitamin E. The results show a significant decrease of the values of breast compliance after 6 months in group A but not in group B and that the variation in compliance after 6 months in group A compared to group B is statistically significant. In zafirlukast-treated patients, we observed a reduction in mammary compliance of 7.69% after 1 month, 16.78% after 3 months and 24.01% after 6 months. The present study suggests that zafirlukast may be effective in reducing pain and breast capsule distortion in patients with longstanding contracture who are either not surgical candidates or who do not wish to undergo surgery.

Effects of zafirlukast on capsular contracture: long-term results

Capsular contracture is a distressing complication after breast augmentation for both the patient and surgeon. Although capsular contracture is a multifactorial process, one common denominator in the successful treatment of this complication is believed to be the abatement of inflammation. Leukotriene antagonists have recently emerged as effective prophylactic agents in reactive airway diseases. A prospective study was carried out on 60 female patients (120 prostheses implanted) with mild/severe capsular contracture in at least one breast. The hardness of capsular contracture was assessed by means of the mammary compliance method. Patients received zafirlukast (Accolate®) for a 6-month period. Mammary compliance was assessed at the start of the study and thereafter monthly, during drug intake and for one year after drug withdrawal. The results show a significant decrease in breast compliance values in the first 6 months, followed by a significant increase one year after the end of drug intake. Indeed, zafirlukast-treated patients displayed a 6.93 percent reduction in mammary compliance after 1 month, 14.42 percent after 3 months, 22.05 percent after 6 months and 22.52 percent after 7 months (1 month after the withdrawal of the drug). Thereafter, mammary compliance values gradually increased. A 5.47 percent reduction in mammary compliance was observed 1 year after drug withdrawal. The present study suggests that zafirlukast may be effective in reducing breast capsule distortion in patients with long-standing contracture, though reduced capsular contracture values are strictly related to the duration of drug intake.

Correction of tuberous breast with small volume asymmetry by using a new adjustable implant

BACKGROUND

The tuberous breast syndrome is a rare anomaly of breast shape, which can be associated to volume breast asymmetry. We report our caseload in the correction of tuberous breasts with small volume asymmetry by using the Muti's technique associated to the implantation of a new adjustable implant.

AIM

Purpose of the study is to evaluate the efficacy of treating tuberous breast deformity with two different types of implants (a textured round high profile cohesive I implant in the larger breast and a Spectra™ implant in the smaller breast).

PATIENTS AND METHODS

Since May 2008, patients affected by tuberous breast combined to small breast volume asymmetry were enrolled in a prospective study. After gland deformity correction, the adjustable implant was positioned in the smaller breast. A textured round implant was positioned in the contralateral breast. Standard pictures were taken before surgery and during follow-up visits over one year. A visual analogue scale (VAS) scale was used to evaluate patients' and external physicians' judgment. Standardized objective measurements of breast and chest were also taken. Statistical significance of any value variation was assessed with the Wilconxon's rank sum test.

RESULTS

Eleven patients were treated with the proposed surgical approach. VAS scores from patients and external physicians were high. Deformity correction was obtained in all patients as evidenced by the significant modifications of objective measurements. No major late complications occurred.

CONCLUSIONS

The new adjustable implant provides a reliable corrective option for hypoplastic tuberous breasts with small volume asymmetry. This device allows intra-operative modification of implant volume according to breast volume discrepancy. Although our findings are satisfying, a longer follow-up is required to evaluate long term results.

A study of postural changes after abdominal rectus plication abdominoplasty

PURPOSE

Factors such as body masses and humour are known to influence human posture. Abdominoplasty, which causes a sudden change in body masses, significantly improves body image and self-esteem. The aim of this study was to assess postural changes after abdominoplasty by studding the position and orientation through space of the body and the centre of pressure.

METHODS

Patients affected by excess abdominal skin and/or significant abdominal muscular anterior wall laxity due to undergo an abdominoplasty were enrolled. Posture was evaluated both before and for 1 year after surgery by quantifying the centres of mass, using the Fastrak™ system, and the centre of pressure, using stabilometry. The Wilcoxon signed-rank sum test was used to compare changes.

RESULTS

Forty-six patients were enrolled. A retro-positioning of the pelvis with a compensatory advancement of the head and shoulders, confirmed by the baropodometric analysis, was evident in the early post-operative period. The biomechanical system subsequently stabilized, achieving a state of equilibrium 1 year after surgery.

CONCLUSIONS

We believe that the change in posture following abdominoplasty is a consequence of both surgery (changes in body masses) and psychological factors that influence posture. Indeed, redundant abdominal skin and abdominal muscular anterior wall weakness are often associated with kyphosis since patients try to hide what they consider to be a source of embarrassment. The discovery of a new body image eliminates dissatisfaction, reduces anxiety and increases self-esteem, which provide psychological and physical benefits that improve the quality of life.

Doped calcium-aluminium-phosphate cements for biomedical applications

Calcium-aluminium-phosphate cements (CAPCs) for biomedical applications, mainly intended for applications in the dental field as non-resorbable fillers, were obtained by reacting Ca-aluminates compounds, i.e. CaO·Al(2)O(3) (CA) and CaO·2 Al(2)O(3) (CA(2)), with Al(H(2)PO(4))(3) aqueous solution. Hydroxyapatite was also introduced as a bioactive dispersed phase. Suitable elements like Sr and La were used to increase the radiopacity of the set yielded pastes towards X-ray wavelength used in clinical diagnostic radiographic equipments. La and Sr doped Ca-aluminates powders have been synthesized by solid state reaction at 1,400°C from a mixture of CaCO(3), Al(2)O(3), La(2)O(3) and SrCO(3). The characteristics of the obtained powders were analyzed and related to the starting compositions and synthesis procedures. The microstructure, setting time, radiopacity and compressive strength of the CAPCs have been investigated and discussed.

[Infiltrating ductal breast carcinoma after radiotherapy and chemotherapy for non-Hodgkin's lymphoma in a young woman. Case report]

Lymphoma was one of the first cancers curable by radiotherapy and/or chemotherapy. However the increased risk of second malignancies in lymphoma survivors appeared to be the price of success of modern treatment modalities. In particular, breast cancer has been a major concern among women irradiated for lymphoma at a young age. There are several reports of breast cancer after Hodgkin's lymphoma, but few after non-Hodgkin's lymphoma. Owing to the particularity of this condition and the difficulties in its diagnosis and treatment, we wish to report the case of ductal infiltrant carcinoma of the breast in a young woman survived to a non-Hodgkin's lymphoma. Women who are survivors of pediatric lymphoma have a significantly increased risk of subsequent breast cancer compared with the general population and are at a high risk of developing bilateral disease within a short interval. Several studies have shown that the relative risk for secondary breast cancer becomes significantly increased between 5 and 9 years and rises dramatically between 15 and 19 years after lymphoma treatment. Screening programs to detect breast cancer should be initiated early after Hodgkin's and non-Hodgkin's lymphomas. Screening have to include breast self examinations every month, clinical breast examinations every 6 months, and mammography every 2-3 years. The patients should start breast self-examination at puberty. In these high-risk patients, "aggressive" biopsy is appropriate for suspicious lesions.

Interventions to promote healthy eating habits: evaluation and recommendations

Although in several EU Member States many public interventions have been running for the prevention and/or management of obesity and other nutrition-related health conditions, few have yet been formally evaluated. The multidisciplinary team of the EATWELL project will gather benchmark data on healthy eating interventions in EU Member States and review existing information on the effectiveness of interventions using a three-stage procedure (i) Assessment of the intervention's impact on consumer attitudes, consumer behaviour and diets; (ii) The impact of the change in diets on obesity and health and (iii) The value attached by society to these changes, measured in life years gained, cost savings and quality-adjusted life years. Where evaluations have been inadequate, EATWELL will gather secondary data and analyse them with a multidisciplinary approach incorporating models from the psychology and economics disciplines. Particular attention will be paid to lessons that can be learned from private sector that are transferable to the healthy eating campaigns in the public sector. Through consumer surveys and workshops with other stakeholders, EATWELL will assess the acceptability of the range of potential interventions. Armed with scientific quantitative evaluations of policy interventions and their acceptability to stakeholders, EATWELL expects to recommend more appropriate interventions for Member States and the EU, providing a one-stop guide to methods and measures in interventions evaluation, and outline data collection priorities for the future.

[Surgical approach and indications in aesthetic treatment of body dysmorphic disorder]

INTRODUCTION

patients with body dysmorphic disorder often go to the plastic surgeon to correct what they consider a physical deformity or defect, although their appearance falls within normal aesthetic standards. The aim of our study was to evaluate the real need for aesthetic treatments in such patients.

PATIENTS AND METHODS

we included patients who practised an intense sport activity and believed they had body deformities ascribable to their sport activity. We evaluated whether the deformities described by the patients were real or exaggerated. The patients who did have a deformity underwent surgery to correct it; their level of satisfaction was evaluated at a 6-month follow-up examination. The patients with subjective deformities underwent a psychiatric examination.

RESULTS

we enrolled 51 patients who practised an intense sport activity and reported body deformities. Forty-one of these patients were found to have a body deformity upon examination and underwent surgery. Surgery was considered to be unnecessary in the remaining 10 patients. Thirty-two of the 41 patients who did undergo were highly satisfied with the outcome.

DISCUSSION

the plastic surgeon often sees patients with minor body deformities that do not require treatment but are a major cause of psychological disorders. A thorough psychiatric examination is necessary in such patients to rule out psychiatric diseases. The plastic surgeon should make every effort to identify patients with subjective body dysmorphic disorder to avoid the negative consequences due to the patient's insatisfaction for the outcome of surgery.

Breast desmoid tumor after augmentation mammoplasty: two case reports

Desmoid tumor of the breast is a rare fibroblastic disease, a slow-growing and histologically benign lesion that accounts for 0.2% of all breast tumors. It can arise either primarily from the breast parenchyma or, by secondary invasion, from the muscolo-aponeurotic layer of the pectoral muscles. These tumors do not metastatize, have no capsule but do have the propensity to aggressively invade local tissues and organs. It has been suggested that these tumours are associated with surgical and non-surgical tissue trauma, certain hormones and genetic susceptibility. We describe two cases of breast desmoid tumor after breast augmentation. A 52-year-old caucasian woman and 38-year-old caucasian woman presented for a breast implant change. During surgery an inelastic, soft, capsulated mass, arising from the periprosthetic capsula in the area of pectoralis major muscle was found. The mass was removed en bloc together with a portion of the periprosthetic capsula, the resection including a portion of the pectoralis major muscle fascia in both cases. The results of this histological examination suggested an extra-abdominal desmoid tumor. To date both the local and the general conditions of the two patients are good, with no signs of recurrence of the lesion.

[Treatment of the capsular contracture around mammary implants: our experience]

The most common complication in patients who underwent mammary implant surgery is capsular contracture. Actually, there is no standard effective treatment for this complication. The aim of this article is to show our experience about LTRAs (leukotriene receptor antagonists) for the treatment of the capsular contracture. The findings indicate that these drugs may reduce pain and breast capsule distortion for patients with long-standing contracture.

Innervated island pedicled anterolateral thigh flap for neo-phallic reconstruction in female-to-male transsexuals

Many techniques have been described to create an aesthetic and functional neo-phallus after penile amputation or in female-to-male transsexuals. Microsurgical free-flap phalloplasty seems to be the preferred method of penile reconstruction. For many years the radial forearm free flap has been considered the best procedure, but other flaps have been attempted to minimize donor site morbidity and optimize outcome. Pedicled flaps are considered to be reliable and to decrease the risk of total failure. Recently, a one-stage non-microsurgical technique was described for phallic reconstruction in a young male patient. We report successful total phallic reconstruction in a female-to-male transsexual patient using an island pedicled anterolateral thigh (ALT) flap. Urethral reconstruction was left as a possible further procedure due to patient's preference. A malleable soft silicone penile prosthesis was inserted within the flap and the lateral cutaneous femoral nerve stump was sutured to the dorsal clitoris branch from the pudendal nerve for flap sensation. After 6 months, the patient demonstrated successful aesthetic and functional reconstruction referring to satisfactory sexual activity. To our knowledge, this is the first report of an innervated island pedicled ALT flap used for female-to-male penile reconstruction in a transsexual patient. The pedicled ALT flap may be a reliable option to avoid visible scarring at the donor site on exposed parts of the body, and reduce the risk of total flap failure from microsurgical procedures for reconstruction of a neo-phallus in this increasing population of patients.

Combined transdermal scopolamine and botulinum toxin A to treat a parotid fistula after a face-lift in a patient with siliconomas

A parotid fistula is a rare, extremely unpleasant disease. Patients with chronic pathologies of the facial soft tissues have a high complication rate after aggressive treatments. Alternative conservative treatments have recently been reported for this condition. The case is described of a parotid fistula following a face-lift in a patient affected by facial siliconomas. A 41-year-old Caucasian who had undergone repeated facial silicone injections developed a diffuse granulomatous reaction accompanied by facial disfigurement. Thirteen surgical operations were performed to remove the siliconomas and correct the deformities, the last of which was a face-lift. After this procedure, the patient developed a parotid fistula. Conservative treatment, consisting of a combination of transdermal scopolamine and botulinum toxin A injections, was adopted. These antisialogogues gradually reduced saliva secretion, thereby preparing the wound bed for a skin graft and eventual healing. The choice of conservative therapy, as opposed to a surgical approach, was made to avoid further risks in what was already a highly complicated condition. The use of this conservative approach is recommended to treat complicated cases of parotid fistula.

Utilization of intense pulsed light in the treatment of face and neck erythrosis

Erythrosis is a clinical manifestation characterized by parossistic vasodilatations followed by fixed superficial venular dilatations localized at the face, neck, décolleté and pinnas. To date, a variety of lasers have been used for treating vascular skin lesions. This study will describe the response on these vascular lesions using the intense pulsed light (IPL) source. Twenty-two female patients and twelve men, aged between 19 and 65, had a phototype ranging from 2 to 4 on the Fitzpatrick scale. The technique is based on a pulsed light of high intensity obtained with a vascular filter of 560 nm. They underwent five treatments of twenty minutes each, at intervals of twenty-one days, with a variable fluency between 9-12 J/cm2 and impulse time of 10-20 ms. The sheaf used is a rectangular spot of 2 cm x 5 cm. In twenty-four patients we obtained a total regression of the cutaneous manifestation after 5 applications, whilst another two patients showed only an attenuation of the erythema. In five cases with erythrosis the erythema persisted after the end of the treatment, although the patients were satisfied with the evident benefits. In two patients affected by Civatte's poikiloderma of the neck we obtained differing results: In the first case an evident positive response of the clinical picture was perceived after only two application of the IPL; in the second case, the benefits were evident after 3-4 applications of IPL at a higher fluency of up to 14 J/ cm2. One patient in treatment with oral antibiotics showed good results from the first application with regression of the erythema up to its disappearance. Collateral effects are not reported, although there was a long-standing (more than 48 hours) post-treatment erythema in only one case. The IPL system, with its broad range of technical variables, is an effective tool in achieving meaningful and lasting clearance of erythrosis.

Composites between hydroxyapatite and poly(epsilon-caprolactone) synthesized in open system at room temperature

The hydroxyls present on the surface of hydroxyapatite (HA) granules, annealed at 700 composite function, 900 composite function and 1,100 composite function C, are able to initiate the polymerization of epsilon-caprolactone (CL), not only at 185 composite function C under vacuum, but also at room temperature in open system. A polymer layer ionically linked to the substrate is formed on HA surface, enhancing the compatibility between the organic phase and the inorganic one in composite biomaterials. We studied the characteristics of the polymer, produced by the reaction carried out at room temperature in open system, as well as the percentages of the poly(epsilon-caprolactone) (PCL) ionically bonded to the HA structure and of the "free" one. Both percentages appear very dependent on the annealing temperature; in particular, HA annealed for 1 h at 1,100 composite function C is the most efficient initiator of the reaction leading to ionically bonded PCL. The percentages of "free" polymer are much higher than at 185 composite function C under vacuum. Its formation is attributed to the role of water in opening the CL rings, and to the presence of CO(3) (2-) and HPO(4) (2-) ions in the HA annealed at lower temperatures. The presence of water appears to be the limiting factor for the production of PCL not bonded to the HA structure.

Use of the reverse flow island sural flap in the replacement of tissue loss involving the distal third of the leg, ankle and heel

The events leading to a tissue loss in the lower limbs are varied. The aetiology can be traumatic, infective, neoplastic, iatrogenic, vascular or systemic. Five patients with lesions involving the distal third of the lower limb, the ankle and the heel, traumatic in origin, presented at our service within the Faculty of Plastic and Reconstructive Surgery, University Hospital "La Sapienza" in Rome. In such patients, the surgical approach involved the repair of tissue loss through the use of the neurocutaneous distally based sural artery flap. The use of the reverse flow island sural flap, compared to other therapeutic options, is advantageous from varying points of view: ease in taking the sample, limited morbidity of the donator site, less time required for the surgical procedure. Regarding the flap, safety and simplicity of execution were implemented in accordance with our experience, dissecting a wide adipo-fascial peduncle. Post-operative precautions were implemented in order to avoid compression of the transposed flap and of the peduncle. The healing in these patients was satisfactory.

Ear reconstruction after cancer excision

Cancers which involve the external ear are difficult to eradicate and recur and develop metastases more often than tumours in other areas of the skin. The anatomy of the external ear presents a difficult reconstructive challenge so that various surgical techniques have been described for its reconstruction, but many of these are complex procedures and are inappropriate in the older population suffering from skin tumours. We carried out a retrospective study of the patient who underwent ear reconstruction after cancer excision analyzing the data concerning the type of cancer, the surgical procedures and the follow up. We conclude that all major defects involving one-quarter or more of the auricle can be repaired with a combination of skin flaps and a chondrocutaneous flap from the affected auricle. Sentinel node biopsy may be a useful tool in diagnosing early lymphatic spread.

Johnson's baby oil, a new type of filler ?

Discovered in 1830, paraffin oil, a purified hydrocarbon from petroleum, has been used in the past as an augmentation material in various parts of the human body, for restoration body defects or aesthetic body contouring. We illustrated the case of an 18-year-old guy who self-injected some paraffin oil (Baby Johnson's Oil) in his lips, cheek and chin, with aesthetical purpose. We showed the classical course and proper management of paraffinoma's lesions. The need for complete excision of all involved tissue to treat the condition successfully is illustrated, and a clinical, pathological and histological discussion is presented. To our knowledge paraffinoma of the face caused by a self-injection of mineral oil has been never reported in literature.

Comparison between the in vitro surface transformations of AP40 and RKKP bioactive glasses

Two bioactive silica-phosphate glasses, AP40 and RKKP, were compared in their behaviour in simulated biological environment. Their chemical composition is practically identical, except that RKKP contains small amounts of amphoteric network-former oxides Ta2O5 and La2O3 (composition in wt% for AP40: beta-Ca3(PO4)2 24.50, SiO2 44.30, CaO 18.60, Na2O 4.60, K2O 0.19, MgO 2.82, CaF2 4.99; RKKP: beta-Ca3(PO4)2 24.23, SiO2 43.82, CaO 18.40, Na2O 4.55, K2O 0.19, MgO 2.79, CaF2 4.94, Ta2O5 0.99, La2O3 0.09). Previous investigations showed a better performance in osteopenic bone for RKKP. To gain more insight into these differences in biological behaviour, the in vitro bioactivity of the glasses was studied by treatment with a continuously replenished Hanks' Balanced Salt Solution (HBSS). The glasses were examined before and after HBSS treatment for 20 and 40 days by X-ray Diffraction (XRD), Scanning Electron Microscopy (SEM), X-ray Energy Dispersion (EDX), Raman and IR vibrational spectroscopies. Some slight but notable differences between the two glasses were observed after HBSS treatment. IR and EDX analyses showed that deposits formed on both glasses were composed of a calcium deficient carbonate-apatite; however, the layer formed on RKKP glass was found to be slightly more calcium deficient and thinner. EDX analysis evidenced the presence of a small percentage of F- ions only in the layers formed on the RKKP samples. The differences disclosed, although slight, can contribute to the understanding of the different biological behaviour previously observed.

T-cell lymphoma presenting as a rapidly enlarging tumor on the lower eyelid

Lymphoma or leukemia skin lesions as a secondary site of disease are quite common; however, to discover a cutaneous Hodgkin or non-Hodgkin lymphoma is very unusual. To find a cutaneous T-cell lymphoma on the skin of the face is a rarity. Because the condition is so rare and difficult to diagnose and treat, we report the case of a young man with a T-cell lymphoma with atypical and anaplastic cells on the lower eyelid. The patient was treated with 4 cycles of chemotherapy, and radiotherapy, and the tumor was resolved after 6 weeks. Our case was clinically suggestive of a rapidly enlarging malignant lymphoma on the eyelid. If the lymphomas are detected at an early stage the prognosis for survival is favorable. A few forms of treatment are possible, either surgical treatment, or radiotherapy and chemotherapy, where response to the treatment is better.

Different types of embolization before surgical excision of haemangiomas of the face

The management of hemangiomas of the face depends on several clinical factors. Many treatments have been recommended for the management of patients with hemangiomas. However, most of them have not shown good results in terms of post-treatment morphology and function of the organs. Surgery of these benign lesions can at times be disfiguring, especially when the lips, muscles, or the maxilla are involved. In addition, by the very nature of these lesions, surgical treatment may be associated with excessive intra and perioperative blood loss. As an alternative to surgical excision, different types of embolization treatments have been developed for all types of hemangiomas. In many instances the procedure was performed preoperatively or intraoperatively. The various therapeutic embolizations, if performed correctly, lead to a significant reduction in the blood flow within the angiomatous mass. Different types of embolization of the lesions and subsequent surgical extirpation can be considered the method of choice in the treatment of voluminous hemangiomas of the face.

Protein adsorption onto two bioactive glass-ceramics

Recent research suggests that the biocompatibility of an implant is to a large extent determined by selective adsorption of proteins from surrounding body fluids. Protein adsorption from human plasma onto two bioactive glass-ceramics (RKKP and AP40) which differ in La and Ta content, was studied by means of chromatography and two-dimensional polyacrylamide gel electrophoresis (2D-PAGE). The quantitative analysis showed that the glass-ceramics have good protein binding capacities indicating multilayer formation. A correlation between chemical composition and the amount of adsorbed proteins was observed. The presence of La and Ta decreased the protein adsorption, so AP40 bound significantly more protein per surface unit then did RKKP. Preferential adsorption of apolipoprotein J, fibrinogen and fibronectin was observed.

Osteointegration of bioactive glass-coated and uncoated zirconia in osteopenic bone: Anin vivo experimental study

In elderly and osteoporotic patients an age-related loss of osteoinductivity could be the biological cause of implant failure regardless of the high quality of the implanted device. yttria stabilized tetragonal zirconia (YSTZ), either coated with the bioactive glass named RKKP bioglaze (RKKP) or uncoated, was implanted in the distal femurs of sham-operated and ovariectomized female rats. Animals were sacrificed at 30 and 60 days. Histomorphometry and microhardness tests were performed to assess osteointegration rate as well as bone quality around the implants. Significant decreases (p < 0.0005) in trabecular bone volume, BV/TV (41%), trabecular bone surface BS/TV (33%), trabecular thickness Tb.Th (20%), and trabecular number Tb.N (32%), together with a significant increase in trabecular separation Tb.Sp (184%), were found for the osteopenic rats compared with the sham-operated rats. At both experimental times the RKKP coating ensured a better osteointegration rate with higher AI values than the uncoated YSTZ, even when osteopenic rats were used (48% at 30 days and 12% at 60 days). No differences were observed at the bone-biomaterial interfaces for either material when comparing sham-operated with osteopenic rats. The present results demonstrate that the RKKP bioactive glass used as a coating ensures a high osteointegration rate even in osteoporotic bone, which is already visible from postoperative day 30 and is still apparent on day 60.

Osteointegration of bioactive glass-coated zirconia in healthy bone: an in vivo evaluation

Osteointegration of yttria stabilised tetragonal zirconia (YSTZ), either coated with bioactive glass named RKKP bioglaze (RKKP) or uncoated, was evaluated in an animal model. RKKP-coated and uncoated (controls) YSTZ cylinders were implanted in the distal femoral epiphyses of 14 Sprague Dawley rats under general anaesthesia. At the experimental times of 30 and 60 days after sacrifice, histomorphometry and SEM microanalysis were performed on methylmethacrylate-embedded undecalcified sections to determine the osteointegration rate. At 30 days, a significantly higher affinity index was demonstrated in vivo by histomorphometric evaluation in RKKP-coated versus uncoated YSTZ implants p < 0.05); at 60 days, the coated implants behaved better than controls (affinity index of + 32%), but the difference observed lay within the statistical uncertainty. SEM analysis demonstrated better bone adhesion to the material in RKKP-coated YSTZ at both 30 and 60 days. These findings suggest that YSTZ coated with the bioactive glass named RKKP enhances osteointegration of ceramics.

Improvement in zirconia osseointegration by means of a biological glass coating: An in vitro and in vivo investigation

The biocompatibility and osseointegration of zirconia (ZrO(2)), either coated with RKKP bioglazeor uncoated, were evaluated in vitro and in vivo. The in vitro test was performed in human osteoblasts, whereas maximal sensitization was performed in 23 Dunkin Hurtley guinea pigs. RKKP bioglaze-coated and uncoated (controls) ZrO(2) cylinders were implanted in the distal femoral epiphyses of 14 Sprague-Dawley rats under general anesthesia, and animals were sacrificed at 30 and 60 days. Lactate dehydrogenase, alkaline phosphatase, and Thiazolyl Blue (MTT) were tested in vitro. A graded score was used for evaluating the results of the sensitization test. Histomorphometry and microhardness testing were performed to quantify the osseointegration rate, as well as bone quality around the implants. Neither in vitro cytotoxicity nor sensitization were observed. Histomorphometry demonstrated that at 30 days, the affinity index was significantly higher in coated implants than in uncoated ones (p < 0.05); at 60 days, the behavior of coated implants was better than that of uncoated ones, but differences were not significant. Significant increases in bone microhardness were found at 1000 microm from the interface area for both uncoated (p < 0.0005) and RKKP bioglaze-coated (p < 0.0005) ZrO(2), and also within 200 microm from the interface (p = 0.014) but only for coated ZrO(2.) These results suggest that RKKP bioglaze-coated ZrO(2) permits biocompatible devices with improved osseointegration properties to be manufactured.

Effects of traditional and ultrasonic liposuction on adipose tissue: a biochemical approach

Little is known about the interaction of ultrasonic liposculpture with fat tissue. The surgical technique is well established and its clinical effects are satisfactory. However, the in vivo effects on adipose tissue remain to be determined. Previous studies have shown that ultrasound waves break fat cells. The purpose of this study was to ascertain whether ultrasound waves can cause the release of fatty acids from the molecular structure of triglycerides. A double-blind study was designed with samples obtained from traditional and ultrasonic liposuction of an equivalent area in the same patient. Samples were checked for triglycerides and for free fatty acids. Triglyceride values were always higher in the sample that had undergone ultrasonic procedure. No significant differences were observed between the free fatty acid chromatograms of the two kinds of samples analyzed. Data showed that no changes occurred in the triglyceride molecule when using ultrasound waves in the experimental conditions.

[Nurse-patient relations at hospitals in the Anzio and Nettuno communities in Italy]

Social surveys have been carrying out since 1983, in Sociology Course at the Nursing School in Nettuno, Rome. The principle aim is the professional and the social enrichment of the students, as well as the importance of working in group. These research works, passing from nursing education to a post basic nursing degree, belong, by now, to the nursing training. The work presented concerns patient-nurse relationship at the Anzio and Nettuno hospitals. The survey gave patients the opportunity to have a special frame where it is easier to be in good terms with the nurses, especially with the students, who understood the usefulness of the work. By this experience students realized the importance to be understanding person in the nursing profession.