A Retrospective Comparative Analysis of Latissimus Dorsi (LD) Flap Versus Thoracodorsal Artery Perforator (TDAP) Flap in Total Breast Reconstruction with Implants: A Pilot Study

INTRODUCTION

 In breast surgery, an autologous flap combined with implant may reduce the risk or repair the soft-tissue defects in several cases. Traditionally, the preferred flap is the myocutaneous latissimus dorsi (LD) flap. In the perforator flap era, the evolution of LD flap is the thoracodorsal artery perforator (TDAP) flap. The aim of this study is the comparison between LD flap and TDAP flap with implants in terms of early complications and shoulder function.

METHODS

 We performed a retrospective cohort study in accordance with the STROBE guidelines. Between January 1 2015 and January 1 2020, 27 women underwent a unilateral total breast reconstruction with LD or TDAP flap combined with an implant at our institution. 15 women were operated with LD flap and 12 with TDAP flap. The most frequent indications for intervention were results of mastectomy and radiation-induced contracture. We evaluated several data in terms of clinical and demographical characteristics, operative and perioperative factors, and follow-up variables. We assessed shoulder function through the Disability of the Arm, Shoulder and Hand Questionnaire (DASH).

RESULTS

 The rate of complications was significantly lower in the TDAP group compared with the LD group (16.7% vs 60.0%, p = 0.047. Table 3). Although the small sample size limited further detailed statistical analyses, we particularly noticed no cases of donor site seroma in the TDAP group, as compared with four in the LD group. Patients in the TDAP group had an ∼11-point lower mean DASH score compared with the LD group (9.8 vs 20.5). This difference was statistically significant (p = 0.049).

CONCLUSIONS

 TDAP flap seems to be a reliable technique for soft-tissue coverage in total breast reconstruction with implants. In comparison with the traditional LD flap, it could be a more favorable option in terms of less complications and better quality of life.

Magnetic-field-induced spin excitations and renormalized spin gap of the underdoped La1.895Sr0.105CuO4 superconductor

High-resolution neutron inelastic scattering experiments in applied magnetic fields have been performed on La1.895Sr0.105CuO4 (LSCO). In zero field, the temperature dependence of the low-energy peak intensity at the incommensurate momentum transfer QIC=(0.5,0.5+/-delta,0),(0.5+/-delta,0.5,0) exhibits an anomaly at the superconducting Tc which broadens and shifts to lower temperature upon the application of a magnetic field along the c axis. A field-induced enhancement of the spectral weight is observed, but only at finite energy transfers and in an intermediate temperature range. These observations establish the opening of a strongly downward renormalized spin gap in the underdoped regime of LSCO. This behavior contrasts with the observed doping dependence of most electronic energy features.

Muons as local probes of three-body correlations in the mixed state of type-II superconductors

The vortex glass state formed by magnetic flux lines in a type-II superconductor is shown to possess nontrivial three-body correlations. While such correlations are usually difficult to measure in glassy systems, the magnetic fields associated with the flux vortices allow us to probe these via muon-spin rotation measurements of the local field distribution. We show via numerical simulations and analytic calculations that these observations provide detailed microscopic insight into the local order of the vortex glass and more generally validate a theoretical framework for correlations in glassy systems.

Square vortex lattice at anomalously low magnetic fields in electron-doped Nd1.85Ce0.15CuO4

We report here on the first direct observations of the vortex lattice in the bulk of electron-doped Nd1.85Ce0.15CuO4 single crystals. Using small-angle neutron scattering, we have observed a square vortex lattice with the nearest neighbors oriented at 45 degrees from the Cu-O bond direction, which is consistent with theories based on the d-wave superconducting gap. However, the square symmetry persists down to unusually low magnetic fields. Moreover, the diffracted intensity from the vortex lattice is found to decrease rapidly with increasing magnetic field.

Direct observation of the flux-line vortex glass phase in a type II superconductor

The order of the vortex state in La1.9Sr0.1CuO4 is probed using muon-spin rotation and small-angle neutron scattering. A transition from a Bragg glass to a vortex glass is observed, where the latter is composed of disordered vortex lines. In the vicinity of the transition the microscopic behavior reflects a delicate interplay of thermally induced and pinning-induced disorder.

Direct evidence for an intrinsic square vortex lattice in the overdoped high- T(c) superconductor La(1.83)Sr(0.17)CuO(4+delta)

We report here the first direct observations of a well ordered vortex lattice in the bulk of a La(2-x)Sr(x)CuO(4+delta) single crystal (slightly overdoped, x = 0.17). Our small angle neutron scattering investigation of the mixed phase reveals a crossover from triangular to square coordination with increasing magnetic field. The existence of an intrinsic square vortex lattice has never been observed in high-temperature superconductors and is indicative of the coupling of the vortex lattice to a source of anisotropy, such as those provided by a d-wave order parameter or the presence of stripes.

Copper(I)-catalyzed [2 + 2] photocycloadditions with tethered linkers: synthesis of syn-photodimers of dicyclopentadienes

Cu(I)-catalyzed intramolecular photocycloadditions of diesters made of endo-dicyclopentadiene derivatives linked by the ester bonds with tethers are highly regio- and stereoselective and complete within hours, and the tethers can be easily cleaved afterward upon reduction with LiAlH4-Irradiation of the diesters afforded a 1:1 mixture of the heretofore unknown exo-cis-exo dimer, originating from the (R,S/S,R) diastereomer of the diester and the exo-trans-exo, deriving from the (R,R/S,S) diastereomer. The intermolecular photodimerization yielded, instead, only exo-trans-exo isomers and side products after irradiation for several days. The role of the tether's length and structure on the course of the photocycloadditions was investigated, and it was observed that short tethers introduce considerable strain in the products' framework. Adamantyl-containing tethers provided the shortest reaction times and highest yields. X-ray diffraction analysis of an exo-cis-exo stereoisomer containing adamantane in the tether exhibited an unusually close approach between H atoms on the methylene bridges and a long C-C distance in the cyclobutane ring. A rearrangement induced by X-ray irradiation was observed in this molecule.

[Ultrasonographic study of urethral sphincter in vesico-sphincter dyssynergia]

The ultrasound study of bladder neck and urethral sphincter in men could be performed by means of transrectal ultrasound scan in longitudinal scanning or by probing the surface in transperineal scanning. The endocavitary ultrasound scan study gives the best indications in the evaluation of the bladder neck in men. The neuromuscular bladder dysfunctions' (neurologic bladder), which can be studied by ultrasound scan are dyssinergia, striped detrusor, detrusor-bladder-neck dyssinergia, detrusorial iper-reflexy bladder instability. In paraplegic subjects the exam should be performed in gynecological position or in side decubitus, and micturition is obtained by means of sovrapubic percussion and compression or with prevailing action of the abdominal press. The detrusor-striped dyssinergia is the dysfunction of the bladder where the ultrasound scan results are more meaningful and give the best elements. In these cases, already in basal conditions, could be present a bladder neck half-opened. During micturition there is an ample opening of the bladder neck and of the prostatic urethra, but scarce relaxation of the membranous urethra; sometimes a protrusion of the back lip of the bladder neck could be present too. In iper-reflexy (unstable bladders) and in detrusorial ipo-reflexy, ultrasound scans could result poorly specific and non-significative.

[Role of Doppler color ultrasonography in the diagnosis of renovascular abnormalities associated with stenosis of the pyeloureteral junction]

The obstruction of the pielo-ureteral junction, in most of the cases, recognizes an intrinsic etiopathogenesis, the presence of a segment ureteral aperistaltic and alteration of the ureteral musculature. The association of GPU stenosis and the presence of vascular anomalous shanks are frequent. The knowledge of this anatomical situation is important for choosing the therapeutic strategy and the surgical technique. The pre-operative diagnosis of the anomalous vase could condition the choice of the technique (endoscopic technique, laparoscopic), opting for open surgery to have a better control of the vascular shank. We have examined the use of the echo-color Doppler to diagnose the presence of anomalous vase. We have studied 13 patients (6 men and 7 women) between 18 and 62 years of age (average 35 years); the side interested by the obstruction was in 8 cases the right and in 5 cases the left. During surgery in 4 cases out of 13 examined anomalous vases were present. The pre-operative color Doppler found 3 anomalous shanks with a negative false, a positive false and 8 negative trues, showing a sensibility of 75%, a specificity of 88% with a global diagnostic ability of the 84%. We therefore believe that the echo-color Doppler is reliable enough in the pre-operative diagnosis of vascular anomalies associated to stenosis of the GPU and that could be used for pre-operative diagnosis of this urological affection.

Design and synthesis of AB(3)-type (A = 1,3,5-benzenetricarbonyl unit; B = Glu diOME or Glu(7) octa OMe) peptide dendrimers: crystal structure of the first generation

The first generation molecule of glutamic acid-based dendrons on a 1, 3,5-benzenetricarbonyl core leads to a cylindrical assembly as demonstrated by single crystal x-ray diffraction. The benzene pi-pi stack (A) is stabilized by vertical NH...O===C hydrogen bonding with each subunit participating in three intermolecular hydrogen bonds related by three-fold rotation symmetry.

Surgery-induced decline in circulating dendritic cells in operable cancer patients: a possible explanation of postoperative immunosuppression

BACKGROUND/AIMS

The recent advances in the immunobiology of tumor have demonstrated the essential role of dendritic cells in anticancer immunity. Dendritic cells activate anticancer immunity by secreting interleukin-12 and by activating T helper lymphocytes, with the following production of interleukin-2. Since surgery-induced immunosuppression has been proven to be associated with a decline in the blood levels of both interleukin-2 and interleukin-12, it could depend at least in part on a transient deficiency of dendritic cells system. Unfortunately, at present there are no data about changes in circulating dendritic cell number during the postoperative period. This preliminary study was performed to evaluate the influence of surgery on dendritic cell number in the peripheral blood.

METHODOLOGY

The study included 14 consecutive operable gastrointestinal tract cancer patients, who were evaluated before and at day 7 of the postoperative period. The control group consisted of 50 healthy subjects. Immature (CD 123+) and mature (CD 11+) dendritic cell subsets were measured by FACS and monoclonal antibodies.

RESULTS

Cancer patients showed a significantly lower mean number of immature dendritic cells with respect to that found in controls. The mean number of mature dendritic cells was also lower in patients than in controls, without, however, significant differences. Finally, surgery induced a statistically significant decline in the mean number of both immature and mature dendritic cells, and the decrease was particularly pronounced for immature dendritic cells.

CONCLUSIONS

In addition to the well-demonstrated surgery-induced lymphocytopenia, this preliminary study shows that the surgical treatment may determine a significant decrease in circulating immature and mature dendritic cells. Because of the fundamental role of dendritic cells in regulating the immune responses, surgery-induced decline in circulating dendritic cells number could play a role in determining the immunosuppressive status, which characterizes the postoperative period.

Abrogation of surgery-induced decline in circulating dendritic cells by subcutaneous preoperative administration of IL-2 in operable cancer patients

Surgery-induced immunosuppression is characterized by a decline in lymphocyte count, particularly T lymphocyte number. In addition, preliminary studies have shown that the postoperative period is also characterized by a decline in the number of circulating dendritic cells (DC), whose fundamental anticancer role has been recently demonstrated. Previous studies had already shown that the preoperative injection of IL-2 may completely abrogate surgery-induced lymphocytopenia, whereas its eventual influence on DC system during the perioperative period is still unknown. The present study was performed to evaluate the influence of IL-2 preoperative immunotherapy on the perioperative changes in circulating DC number in patients affected by colorectal cancer. The study included 14 consecutive patients, who were randomized to be treated with or without IL-2 presurgical immunotherapy (12 million IU/day for 3 days subcutaneously). Circulating immature and mature cells were evaluated before surgery and at days 3 and 7 of the postoperative period. The detection was made by FACS using monoclonal antibodies against CD123 and CD11c to recognize immature and mature DC, respectively. Surgery induced a significant decline in the mean number of both immature and mature DC. The pre-surgical administration of IL-2 completely abrogated surgery-induced decline in immature DC cell amount. Moreover, mature DC mean number was diminished only at day 3 of the postoperative period, since the value observed at day 7 was not significantly lower than that found before surgery. This preliminary study shows that surgery-induced immunosuppression is characterized also by a significant decline in the mean number of both immature and mature DC. Moreover, this study would suggest that the preoperative immunotherapy with IL-2 may counteract surgery-induced failure of DC system. Because of the fundamental antitumor role of DC, this evidence could have a prognostic impact on the clinical course of the neoplastic disease.

Pentafluorosulfanylnitramide salts

The synthesis and properties of a new class of inorganic salts, named pentafluorosulfanylnitramide salts (or pentafluorosulfanylnitraminic acid salts) [Z+SF5NNO2-], are described. A number of SF5-nitramide salts (Z+SF5NNO2-) were successfully prepared via nucleophilic displacements from carbamates and/or ion exchange techniques, but some salts [M(SF5NNO2)x; M = Li, Mg, Al] decomposed during isolation procedures and appear to be unstable in the solid state. Single-crystal X-ray diffraction was used to fully characterize the Z+SF5NNO2-, and their properties/structures are compared with those of the corresponding dinitramide salts (or dinitraminic acid salts), Z+N(NO2)2-. X-ray crystallography revealed major structural differences between N(NO2)2- and SF5N(NO2)- salts concerning the N-N distances and the angles subtended at the central nitrogen atom. In the N(NO2)2- salts, there are two nonequivalent N-N (average lengths 1.372(2) and 1.354(2) A) distances and an average N-N-N angle of 115.8(3) degrees (falls between sp3 and sp2 hybridization). In the SFsNNO2- salts, the average N-N distance is much shorter, 1.308(9) A, and the average N-N-S angle is 120.0(5) degrees (closely fits sp2 hybridization). The SF5NNO2- salts show a remarkable metrical similarity for the SF5 moiety in all structures, indicating a lack of sensitivity to its steric and electronic environment. This is in marked contrast to N(NO2)2-, where there is a wide variation in conformations adopted by these anions which can be related to their environment.

Hepta- and Octanitrocubanes

Four of the eight nitro groups of octanitrocubane 1 are introduced by functional group modification, three more by the astonishingly rapid, low-temperature N(2)O(4) nitration of sequentially formed polynitrocubyl anions, and the eighth and last by nitrosation of the heptanitrocubyl anion followed by ozonation.

Rigid phencyclidine analogues. Binding to the phencyclidine and sigma 1 receptors

Three phencyclidine (PCP) analogues possessing a highly rigid carbocyclic structure and an attached piperidine ring which is free to rotate were synthesized. Each analogue has a specific fixed orientation of the ammonium center of the piperidinium ring to the centrum of the phenyl ring. The binding affinities of the rigid analogues 1-piperidino-7,8-benzobicyclo[4.2.0]octene (14), 1-piperidinobenzobicyclo[2.2.1]heptene (16), and 1-piperidinobenzobicyclo[2.2.2]octene (13) for the PCP receptor ([3H]TCP) and th-receptor (NANM) were determined. The three analogues show low to no affinity for the PCP receptor but good affinity for the th-receptor and can be considered th-receptor selective ligands with PCP/th ratios of 13, 293, and 368, respectively. The binding affinities for the th-receptor are rationalized in terms of a model for the th-pharmacophore.

1 alpha,24(S)-dihydroxyvitamin D2: a biologically active product of 1 alpha-hydroxyvitamin D2 made in the human hepatoma, Hep3B

A major metabolite of the vitamin D analogue 1 alpha-hydroxyvitamin D2 in human liver cells in culture has been identified as 1 alpha,24(S)-dihydroxyvitamin D2 [1 alpha,24(S)-(OH)2D2]. 1 alpha-Hydroxyvitamin D3 incubated with the same cells gives rise to predominantly 25- and 27-hydroxylated products. Our identification of 1 alpha,24(S)-dihydroxyvitamin D2 is based on comparisons of the liver cell metabolite with chemically synthesized 1 alpha,24(S)-(OH)2D2 and 1 alpha,24(R)-(OH)2D2 by using HPLC, GC and GC-MS techniques. The stereochemical orientation of the 24-hydroxyl group was inferred after X-ray-crystallographic analysis of the 24(R)-OH epimer. 1 alpha,24(S)-Dihydroxyvitamin D2 binds strongly to the vitamin D receptor and is biologically active in growth hormone and chloramphenicol acetyltransferase reporter gene expression systems in vitro, but binds poorly to rat vitamin D-binding globulin, DBP. We suggest that this metabolite, 1 alpha,24(S)-(OH)2D2, possesses the spectrum of biological properties to be useful as a drug in the treatment of psoriasis, metabolic bone disease and cancer.