Surgical anatomy of the nail.

Knowledge of nail anatomy is a prerequisite for both diagnostic and therapeutic purposes. The nail apparatus is a highly specialized structure, but is in close relationship to the distal phalanx which supports it and to the pulp which carries the sensory receptors and is involved in pinching. It can be divided by the nail plate into the perionychium underneath, and the paronychium above. The perionychium includes, from proximal to distal: the nail matrix, the sole structure responsible for the growth of the nail plate; the nail bed, mostly responsible for adhesion of the plate; and the hyponychium, which is the most distal part, where the nail plate loses its adhesion. The paronychium comprises three nail folds, one proximal and two lateral, that embed the nail plate. The nail apparatus is richly vascularized, with three main sources, and richly innervated, which explains why trauma and surgery are so painful.

Lung ultrasound to evaluate aeration changes in response to recruitment maneuver and prone positioning in intubated patients with COVID-19 pneumonia: preliminary study.

BACKGROUND: This single-center preliminary prospective observational study used bedside ultrasound to assess the lung aeration modifications induced by recruitment maneuver and pronation in intubated patients with acute respiratory disease syndrome (ARDS) related to coronavirus 2019 disease (COVID-19). All adult intubated COVID-19 patients suitable for pronation were screened. After enrollment, patients underwent 1 h in a volume-controlled mode in supine position (baseline) followed by a 35-cmH2O-recruitment maneuver of 2 min (recruitment). Final step involved volume-controlled mode in prone position set as at baseline (pronation). At the end of the first two steps and 1 h after pronation, a lung ultrasound was performed, and global and regional lung ultrasound score (LUS) were analyzed. Data sets are presented as a median and 25th-75th percentile. RESULTS: From January to May 2022, 20 patients were included and analyzed. Global LUS reduced from 26.5 (23.5-30.0) at baseline to 21.5 (18.0-23.3) and 23.0 (21.0-26.3) at recruitment (p < 0.001) and pronation (p = 0.004). In the anterior lung regions, the regional LUS were 1.8 (1.1-2.0) following recruitment and 2.0 (1.6-2.2) in the supine (p = 0.008) and 2.0 (1.8-2.3) in prone position (p = 0.023). Regional LUS diminished from 2.3 (2.0-2.5) in supine to 2.0 (1.8-2.0) with recruitment in the lateral lung zones (p = 0.036). Finally, in the posterior lung units, regional LUS improved from 2.5 (2.3-2.8) in supine to 2.3 (1.8-2.5) through recruitment (p = 0.003) and 1.8 (1.3-2.2) with pronation (p < 0.0001). CONCLUSIONS: In our investigation, recruitment maneuver and prone positioning demonstrated an enhancement in lung aeration when compared to supine position, as assessed by bedside lung ultrasound. TRIAL REGISTRATION: www. CLINICALTRIALS: gov , Number NCT05209477, prospectively registered and released on 01/26/2022.

First record of Aedes japonicus in Liguria region, Northwest of Italy.

Aedes japonicus is an invasive Asian mosquito species, and to date it is widespread in many European countries. In Italy, it was first recorded in 2015 at the Austrian border and it then spread throughout the Northeast of the country. In 2019, it was also identified in Piedmont region, near the Swiss border. In the framework of the Italian program for prevention, surveillance, and response to Arboviruses, from June to November 2021, biweekly entomological surveillance was performed in the Liguria region (Northwest Italy). The collected mosquitoes were morphologically and genetically identified and molecularly analysed for the detection of West Nile and Usutu viruses. Six female mosquitoes, trapped on the 6th of July 2021 using a gravid trap in Albenga (Savona province), were morphologically identified as Ae. japonicus and the identification was genetically confirmed. The pool tested was negative for the presence of West Nile and Usutu viruses. The detection of Ae. japonicus was performed in a coastal area characterized by the presence of many floriculture activities. Considering the distance from the established Ae. japonicus mosquito populations in Italy and other European countries, this could represent an independent introduction in this country.

Hepatitis E Virus (HEV): Identification of Subtypes 3b and 3m in Wild Boar Population in Liguria Region, Italy.

The wild boar is an important natural reservoir for the zoonotic transmission of the hepatitis E virus (HEV) around the world. In particular, HEV genotypes 3 and 4 are an emerging problem in industrialized countries, as the number of wild boars has increased, and their territory is ever closer to farms and populated areas. This study describes the HEV prevalence and geographic circulation among wild boar populations in the Ligurian region (Italy) during the period 2019-2022. Liver samples from 849 wild boars were analyzed for HEV RNA using real-time RT-PCR; positive samples were then subjected to sequencing and phylogenetic analysis. Overall, 6.7% of the wild boars were positive for HEV RNA; however, in the last two years, the percentage of positive animals almost doubled. Phylogenetic analysis showed that wild boar HEV sequences belonged to genotype 3 and clustered within subtypes 3a and 3c, and, for the first time in Italy, subtypes 3b and 3m were identified. Interestingly, 13 sequences could not be assigned to a recognized subtype. Furthermore, the results showed different circulations of identified subtypes across the territory. These findings increase the knowledge of HEV-3 heterogeneity in Italy and describe the role of wild boars in maintaining an active viral circulation in the environment.

Potential SARS-CoV-2 Susceptibility of Cetaceans Stranded along the Italian Coastline.

Due to marine mammals' demonstrated susceptibility to SARS-CoV-2, based upon the homology level of their angiotensin-converting enzyme 2 (ACE2) viral receptor with the human one, alongside the global SARS-CoV-2 occurrence and fecal contamination of the river and marine ecosystems, SARS-CoV-2 infection may be plausibly expected to occur also in cetaceans, with special emphasis on inshore species like bottlenose dolphins (Tursiops truncatus). Moreover, based on immune and inflammatory responses to SARS-CoV-2 infection in humans, macrophages could also play an important role in antiviral defense mechanisms. In order to provide a more in-depth insight into SARS-CoV-2 susceptibility in marine mammals, we evaluated the presence of SARS-CoV-2 and the expression of ACE2 and the pan-macrophage marker CD68. Aliquots of tissue samples, belonging to cetaceans stranded along the Italian coastline during 2020-2021, were collected for SARS-CoV-2 analysis by real-time PCR (RT-PCRT) (N = 43) and Immunohistochemistry (IHC) (N = 59); thirty-two aliquots of pulmonary tissue sample (N = 17 Tursiops truncatus, N = 15 Stenella coeruleoalba) available at the Mediterranean Marine Mammal Tissue Bank (MMMTB) of the University of Padua (Legnaro, Padua, Italy) were analyzed to investigate ACE2 expression by IHC. In addition, ACE2 and CD68 were also investigated by Double-Labeling Immunofluorescence (IF) Confocal Laser Microscopy. No SARS-CoV-2 positivity was found in samples analyzed for the survey while ACE2 protein was detected in the lower respiratory tract albeit heterogeneously for age, gender/sex, and species, suggesting that ACE2 expression can vary between different lung regions and among individuals. Finally, double IF analysis showed elevated colocalization of ACE2 and CD68 in macrophages only when an evident inflammatory reaction was present, such as in human SARS-CoV-2 infection.

PINK1 Protects against Staurosporine-Induced Apoptosis by Interacting with Beclin1 and Impairing Its Pro-Apoptotic Cleavage.

PINK1 is a causative gene for Parkinson's disease and the corresponding protein has been identified as a master regulator of mitophagy-the autophagic degradation of damaged mitochondria. It interacts with Beclin1 to regulate autophagy and initiate autophagosome formation, even outside the context of mitophagy. Several other pro-survival functions of this protein have been described and indicate that it might play a role in other disorders, such as cancer and proliferative diseases. In this study, we investigated a novel anti-apoptotic function of PINK1. To do so, we used SH-SY5Y neuroblastoma cells, a neuronal model used in Parkinson's disease and cancer studies, to characterize the pro-survival functions of PINK1 in response to the apoptosis inducer staurosporine. In this setting, we found that staurosporine induces apoptosis but not mitophagy, and we demonstrated that PINK1 protects against staurosporine-induced apoptosis by impairing the pro-apoptotic cleavage of Beclin1. Our data also show that staurosporine-induced apoptosis is preceded by a phase of enhanced autophagy, and that PINK1 in this context regulates the switch from autophagy to apoptosis. PINK1 protein levels progressively decrease after treatment, inducing this switch. The PINK1-Beclin1 interaction is crucial in exerting this function, as mutants that are unable to interact do not show the anti-apoptotic effect. We characterized a new anti-apoptotic function of PINK1 that could provide options for treatment in proliferative or neurodegenerative diseases.

Parkinson's Disease Phenotypes in Patient Neuronal Cultures and Brain Organoids Improved by 2-Hydroxypropyl-ß-Cyclodextrin Treatment.

BACKGROUND: The etiology of Parkinson's disease (PD) is only partially understood despite the fact that environmental causes, risk factors, and specific gene mutations are contributors to the disease. Biallelic mutations in the phosphatase and tensin homolog (PTEN)-induced putative kinase 1 (PINK1) gene involved in mitochondrial homeostasis, vesicle trafficking, and autophagy are sufficient to cause PD. OBJECTIVES: We sought to evaluate the difference between controls' and PINK1 patients' derived neurons in their transition from neuroepithelial stem cells to neurons, allowing us to identify potential pathways to target with repurposed compounds. METHODS: Using two-dimensional and three-dimensional models of patients' derived neurons we recapitulated PD-related phenotypes. We introduced the usage of midbrain organoids for testing compounds. Using Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/CRISPR-associated protein 9 (Cas9), we corrected the point mutations of three patients' derived cells. We evaluated the effect of the selected compound in a mouse model. RESULTS: PD patient-derived cells presented differences in their energetic profile, imbalanced proliferation, apoptosis, mitophagy, and a reduced differentiation efficiency to tyrosine hydroxylase positive (TH+) neurons compared to controls' cells. Correction of a patient's point mutation ameliorated the metabolic properties and neuronal firing rates as well as reversing the differentiation phenotype, and reducing the increased astrocytic levels. Treatment with 2-hydroxypropyl-ß-cyclodextrin increased the autophagy and mitophagy capacity of neurons concomitant with an improved dopaminergic differentiation of patient-specific neurons in midbrain organoids and ameliorated neurotoxicity in a mouse model. CONCLUSION: We show that treatment with a repurposed compound is sufficient for restoring the impaired dopaminergic differentiation of PD patient-derived cells. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Mechanisms of neurodegeneration in Parkinson's disease: keep neurons in the PINK1.

Extensive studies on PINK1, whose mutations are a confirmed cause of Parkinson's disease (PD), have been conducted in animal models or immortalized cell lines. These include initial ground-breaking discoveries on mitophagy, which demonstrated that PINK1 recruits Parkin on depolarized mitochondria, initiating a signalling cascade eventually resulting in their autophagic degradation. Not all features of this complex molecular pathway have been reproduced in mammalian or human neurons, undermining the hypothesis proposing mitophagy as the most relevant biochemical link between PINK1 deficiency and PD pathogenesis. Experiments in murine primary neurons examined another possible neuroprotective function of PINK1, namely its involvement in mitochondrial motility along axons and dendrites. PINK1 interacts with Miro, a component of the motor/adaptor complex binding mitochondria to microtubules and allowing their movement to and from cellular processes. Distinct subcellular pools of PINK1, cytosolic and mitochondrial, appear to regulate anterograde and retrograde transport, respectively. Technological advancements today allow researchers to de-differentiate fibroblasts into induced pluripotent stem cells and re-differentiate them into dopaminergic neurons. Few studies based on this technique address possible neuroprotective effects of PINK1, including mitophagy and mitochondrial homeostasis, but underline the need for a broader characterization of its function in neurons.

Effects and Changes on Voice After Rhinoplasty: A Long-Term Report.

INTRODUCTION: Vocal changes after rhinoplasty have been poorly investigated, although this surgical procedure is nowadays one of the most requested. The production of voice largely depends on the anatomy and the size of the pyramid and the nasal cavity. The authors report 51 cases of both closed and open rhinoplasty and propose a 2-year report to analyze potential effective changes on voice. MATERIALS AND METHODS: Fifty-one patients were enrolled and evaluated from September of 2012 to January of 2018. All patients were studied before and 2 years after surgery. Vocal changes were assessed with an objective and a subjective evaluation. The first one allowed to perform the measurement of the intensity and frequency of vowel sound ("a") and nasal consonant sounds ("n" and "m"). For the subjective evaluation, our modified version of Voice Handicap Index Score allowed us to evaluate every single characteristic of the personal perception of voice. RESULTS: The objective evaluation showed an increased frequency of production of the consonant sounds in 62% of cases and an increased frequency of production of the vowel sound in 68% of cases. The subjective evaluation allowed us to notice significant changes after surgery (P = .044). No significant differences were noticed between closed and open approach. CONCLUSION: Reduction rhinoplasty technique proved to induce several alterations on vocal pattern. The surgeon should always inform patients about the potential effects on the voice, particularly when such changes may produce influences on the working life.

INTRODUCTION: Les changements vocaux après une rhinoplastie ont fait l'objet de peu d'études, même si cette intervention est actuellement l'une des plus demandées. La production de la voix dépend largement de l'anatomie et de la dimension de la pyramide et de la fosse nasales. Les auteurs rendent compte de 51 cas de rhinoplastie fermée et ouverte et présentent un rapport sur deux ans pour analyser les changements effectifs potentiels sur la voix. MATÉRIEL ET MÉTHODOLOGIE: Les chercheurs ont inscrit 51 patients qu'ils ont évalués entre septembre 2012 et janvier 2018. Ils ont étudié tous les sujets avant l'opération, puis deux ans après. Ils ont estimé les changements vocaux au moyen d'une évaluation objective et subjective. La première permet de mesurer l'intensité et la fréquence de la voyelle « a ¼ et des consonnes nasales « n ¼ et « m ¼. Dans le cadre de l'évaluation subjective, ils ont modifié la version du score de handicap vocal pour évaluer chaque caractéristique de la perception personnelle de la voix. RÉSULTATS: L'évaluation objective a révélé une plus grande fréquence lors de la production des consonnes dans 62 % des cas et lors de la production de la voyelle dans 68 % des cas. Grâce à l'évaluation subjective, les auteurs ont remarqué des changements importants après l'opération (P = .044). Ils n'ont remarqué aucune différence significative entre l'intervention fermée et ouverte. CONCLUSION: Il est démontré que la technique de rhinoplastie de réduction provoque plusieurs altérations du profil vocal. Le chirurgien devrait toujours informer les patients des effets potentiels de l'opération sur la voix, particulièrement lorsque ces effets peuvent avoir une incidence sur la vie professionnelle.

Oculonasal Synkinesis: Video Report and Surgical Solution of a Rare Phenomenon.

BACKGROUND: Synkinesis represents involuntary muscular movements that occur in association with voluntary contraction of other muscle groups. Oculonasal synkinesis is a rare phenomenon. OBJECTIVES: In a series of videos, the authors present clinical findings and surgical correction of oculonasal synkinesis. METHODS: Two women who underwent surgical procedures to correct oculonasal synkinesis were evaluated in a prospective study. One patient presented with bilateral synkinesis after 2 previous rhinoplasties. She underwent open rhinoplasty in our office. The other patient had unilateral synkinesis of the left side and received endonasal rhinoplasty. RESULTS: The patients' mean age was 27.5 years, and follow-up was conducted for 6 months. Both patients experienced complete, stable resolution of synkinesis after surgical correction. No complications were recorded. CONCLUSIONS: Patients with oculonasal synkinesis may not notice it preoperatively and may regard these muscle movements as an unfavorable result of rhinoplasty. Therefore, careful preoperative evaluation is crucial.

Merkel cell tumour of the finger.

Merkel cell carcinoma (MCC) is a rare primary neuroendocrine tumour. Biologically aggressive, it may be difficult to treat. We report a case of MCC on the dorsal base of the left second finger and we discuss its treatment and prognosis.

Anconeus muscle transposition for chronic lateral epicondylitis, recurrences, and complications.

The use of the anconeus muscle in the treatment of chronic lateral epicondylitis (CLE), recurrences, and infection is presented. In chronic lateral epicondylitis, a wide degenerative area of epicondyle tendon is not frequently found, but when it occurs, its treatment is quite difficult. Recurrences of CLE and superficial or articular infections of the radiohumeral joint after surgical treatment or cortisone infiltrations are 2 more major conditions in which the use of anconeus muscle transposition demonstrated to be a promising technique. The procedure is widely described based on personal experience of 13 cases, 8 of which were CLE (group 1), and 5 recurrences and infection (group 2). Rotation of this muscle close to the epicondyle makes it possible to cover the epicondyle bone and the exposed radiohumeral joint in all cases. Additional surgical time usually requires only an extra 15 minutes. At the mean follow-up of 74 and 55 months, all the patients of the first group were painless, and the patients of the second group showed a decrease in pain from 9 to 3. Patients of the 2 groups returned to their previous work with a complete recovery of elbow range of motion and grip strength.

Vascular dominance in the forearm.

The dominance of the radial or ulnar artery at the forearm level and their contributions to the circulation of the hand remain a matter of contention. Therefore, the authors proposed to investigate the predominance of one of these arteries first by anatomic studies on 40 fresh cadaver upper extremities, and then by dynamic studies. The dynamic studies included color Doppler sonography in 22 individuals (44 hands) and five-channel plethysmography in 40 individuals (40 right hands). It was found that the ulnar artery is dominant at the elbow, but after originating its collateral branches, the radial artery becomes the dominant artery in the distal forearm and, consequently, constitutes the major source of vascularization to the hand. The ulnar artery is rarely dominant at the forearm level and is physiologically less important. Therefore, there is no hemodynamic reason to prefer the radial artery to the ulnar artery for any invasive maneuvers.

Study of anatomical bases of a latero-dorsal flap of the forearm preserving the radial artery

The authors studied the dorso-lateral cutaneous branches of the radial artery in 26 forearms of fresh cadavers following injection of latex. Three toeight branches were identified, with frequent anastomoses. Extensive venous drainage was also observed. One to three cutaneous branches arose within a 3-cm region close to the radial styloid precess. This provides a basis for an island flap supplied by these branches and thus, it is possible to mantain the radial artery intact