Omics sciences and precision medicine in sarcoma.

Background: Sarcomas are a relatively rare but diverse group of cancers that typically develop in the mesenchymal cells of bones and soft tissues. Occurring in more than 70 subtypes, sarcomas have broad histological presentations, posing significant challenges of prognosis and treatment. Modern multi-omics studies, which include genomics, proteomics, metabolomics, and micro-biomics, are vital to understand the underlying mechanisms of sarcoma development and progression, identify molecular biomarkers for early detection, develop personalized treatment plans, and discover drug resistance mechanisms in sarcomas to upsurge the survival rate. Aim: This study aims to highlight the genetic risk factors responsible for sarcoma-genesis, and to present a comprehensive review of multi-omics studies about sarcoma. Methods: Extensive literature research was undertaken using reliable and authentic medical journals, e-books, and online cancer research databases. Mendelian inheritance in man database (OMIM) was explored to study particular genes and their loci that are responsible to cause various sarcomas. Result: This in-depth research led to the finding out that omics studies provide a more comprehensive understanding of underlying molecular mechanisms of sarcomas. Through genomics, we can reveal genetic alterations that predispose to sarcoma, like mutation in TP53, NF1, and so on. Pharmacogenomics enable us to find molecular targets for specific drugs. Whereas, proteomic and metabolomic studies provide insights into the biological pathways involved in sarcoma development and progression. Conclusion: Future advancements in omics sciences for sarcoma are on the cutting-edge of defining precision treatment plans and improved resilience of sarcoma patients.

Skin expansion in head and neck reconstructive surgery.

We used a tissue-expansion technique to achieve soft-tissue reconstruction in congenital and acquired defects of head and neck. One hundred and fifty-five head and neck reconstructions have been performed, with a 6 percent rate of major complications. We present our planning and surgical approach for single areas. From a technical point of view, the only major difference from the rest of literature is the approach to the problem of periprosthetic capsule. In fact, we believe that complete removal of the capsule, which can be achieved without vascular risk thanks to a special technique, is necessary to obtain the best results.

Long-term histopathologic evaluation of human expanded skin.

Forty-two patients operated on by skin expansion have been contacted after a mean time of 25 months from the last surgery. Two biopsies have been taken from the expanded area of each patient. In 12 patients it has been possible to obtain a similar sampling from the opposite, nonexpanded area of the body. The samples underwent optic microscopy and cell kinetic and DNA content investigations. The epidermal structure of the followed-up skin, compared with the skin of the opposite side of the body, looks normal. The mitotic activity of the epidermal cells has returned to the values of preexpanded skin. The dermis shows a low degree of elastosis and zonal fragmentation of elastic fibers. The hypodermis, where the expander capsule was removed during the last surgery, does not show an accentuated fibrosis.

Cell kinetics and DNA content (ploidy) of human skin under expansion.

One question which still remains unanswered concerning expansion of human skin is whether expansion simply stretches the skin or whether it induces a real neo-production of epithelium. To evaluate the proliferative activity of the human skin before and after expansion, we performed an autoradiographic study and a densitometric analysis on sections of skin biopsy from 11 patients. The results of the cellular kinetic study showed that expansion induces an increase in the epidermal proliferative activity. On the contrary, the densitometric analysis did not show a parallel increase of the proliferating cells after expansion. This discrepancy is discussed in terms of the modified morphology of the tissue. The proliferative activity of skin in the back region increases more than in that of the neck. Preliminary results have shown that the proliferative activity increases with time of expansion in days. The presence of a low percentage of cells with altered DNA content indicates, at least over the short term, the absence of dysplastic processes in expanded skins.

[Experimental factors influencing the growth of the jaws]. / Etudes expérimentales des facteurs influençant la croissance des maxillaires.

An experimental study evaluated the effect of various surgical procedures on maxillary growth. Raising and excision of palatine muco-periosteum did not modify facial or palatine growth. Resection of the bony palate showed the non-essential nature of the medial palaxine suture during normal growth, even in the transverse direction. Coagulation of the two posterior palaxine arteries disturbed palaxine growth, but ligature of the external carotid artery failed to alter facial growth. Several tests were carried out to determine the importance of functional matrices: excision of facial nerve trunk did not affect bone growth, destruction of the trigeminal provoked obvious disturbance of craniofacial growth while obturation of a nasal fossa produced no observable anomaly. Enucleation demonstrated the need for an intact globe for normal orbital growth, and resection of the mandibular condyle showed the primordial role of cartilaginous centers in mandibular growth.

[Current therapeutic trends in the oto-mandibular syndrome]. / Attuali orientamenti terapeutici nella sindrome oto-mandibolare.

The authors describe the characteristics of oto-mandibular syndrome (hemifacial microsomia), underlining that the knowledge of the craniofacial growth and the analysis of the deformities are necessary for a correct surgical approach. The skeletal abnormalities, and in particular the mandibular deformity, are the first step of treatment, which is begun more and more often before the age of six to minimize the skeletal distortion and to decrease the psychological problems of the child. Nevertheless, several surgical procedures are generally required up to the age of 12-16 to obtain a good symmetry. The reconstruction of the ear is deferred, whenever possible, until the mandibular and zygomatic osseous framework have been established to avoid a location in an unfavorable site. The earliest age of repair is six years. Early correction of macrostomia is needed in order to obtain a functioning and symmetric oral sphincter. The possible deficiency of soft tissues does not always require surgery and is the last step of treatment of hemifacial microsomia.