[Impact of Facebook patient groups in the surgical decision making process: The example of Biocell® macro-textured implants recall]. / Impact des groupes de patientes Facebook dans le processus décisionnel chirurgical : l'exemple du rappel des implants macro-texturés Biocell®.

BACKGROUND: The use of social media, has been a major upheaval in our lifestyles in the last decade. At the forefront in the crisis of BIA-ALCL, as soon as February 2019, our university centre took steps to identify and contact all patients with macro-textured implants. The purpose of this recall was to educate patients and establish a monitoring system. The purpose of this work is to analyse the patients' decision-making process. METHODS: A retrospective study of patients, who requested and attended appointments with a surgeon, was made. The number of patients with clinical symptoms of BIA-ALCL, the number of patients who requested implant removal surgery, the histological diagnoses found after surgery were collected. We then calculated the proportion of Facebook group members among patients who required implant removal in the absence of a diagnosis or even warning signs. RESULTS: Seven hundred and seventy women requested an appointment with one of the surgeons in our department. Of all the women who requested consultation, 497 (64.55%) had symptoms. 199 patients were members or had attended one of the Facebook groups of patients. At the end of the consultation with their surgeon, almost 25% of patients made a decision to have the implant removed against medical advice. Among these patients, 67% were part of a group of patients on the Facebook network. To date, no patient has been diagnosed with BIA-ALCL. CONCLUSIONS: These results support the hypothesis that belonging to Facebook groups of patients becomes, for some, a key element in the decision-making process beyond expert opinion. In the future, preliminary work with patient groups on social networks should be done in order to obtain additional health efficiency.

Immediate breast reconstruction surgery with expander/direct implant and use of acellular dermal matrix: Does hormone therapy increases the risk of infection?

BACKGROUND: The use of hormone therapy (tamoxifen and aromatase inhibitors) has been shown to increase venous thromboembolism. However, while estrogens play a crucial role in wound healing, no study has assessed the impact of tamoxifen or aromatase inhibitors on other postoperative breast reconstruction complications, including infections, necrosis, capsular contracture and seroma. As breast cancer patients undergoing Implants-ADMs breast reconstruction are often receiving hormone therapy, it is unclear whether this increased infection risk is associated with increased infections cases. METHODS: A prospective study was performed on patients undergoing breast reconstruction at an academic institution from 2013 to 2016. Patients were divided by use of hormone therapy at the time of surgery. Complication rates, including infections, necrosis, seroma and hematomas, were compared and analyzed using univariate and logistic regression models. RESULTS: Among a total of 112 patients (183breasts), 58 patients (91 breasts) were receiving hormone therapy and 54 patients (92 breasts) were not. The hormone therapy group had a higher incidence of postoperative mastectomy skin infection (20.7% versus 7.4%; P=0.0447), we didn't find any significant differences in necrosis. CONCLUSIONS: Hormone therapy was associated with a higher incidence of Infections after breast reconstruction with ADMs and implants. The authors propose an individualized approach to the preoperative cessation of tamoxifen or aromatase inhibitors. Immediate breast reconstruction surgery with expander/direct implant and use of acellular dermal matrix: does hormone therapy increases the risk of infection?

Could predicting fatty acid profile by mid-infrared reflectance spectroscopy be used as a method to increase the value added by milk production chains?

The aims of this work were (1) to develop prediction equations from mid-infrared spectroscopy (MIRS) to establish a detailed fatty acid (FA) composition of milk; (2) to propose a milk FA index, utilizing MIRS-developed equations, in which the precision of the FA-prediction equations is taken into account to increase the value of milk; and (3) to show application examples. A total of 651 bulk cow milk samples were collected from 245 commercial farms in northwest Italy. The results of the 651 gas chromatography analyses were used to establish (421 samples) and to validate (230 samples) the outcomes of the FA composition prediction that had been obtained by MIRS. A class-based approach, in which the obtained MIRS equations were used, was proposed to define a milk classification. The method provides a numerical index [milk FA index (MFAI)] that allows a premium price to be quantified to increase the value of a favorable FA profile of milk. Ten FA were selected to calculate MFAI, according to their relevance for human health and potential cheese sensory properties, and animal welfare and environmental sustainability were also considered. These factors were selected as dimensions of MFAI. A statistical analysis and expert judgment aggregation were performed on the selected FA by weighting the FA and normalizing the dimensions to reduce redundancy. A class approach was applied, using the precision of the MIRS equations to establish the classes. The median FA concentration of the data set was set as a reference value of class 0. The width, number, and limits of classes above and below the median were calculated using the 95% confidence level of the standard error of prediction, corrected with the bias of each FA. A progressive number and a positive or negative sign were assigned to each FA class above or below the median according to their role in the above mentioned dimensions. The sum of the numbers of each class, associated with its sign for each FA, was used to generate MFAI. The MFAI was applied to dairy farms characterized by different feeding strategies, all of which deliver milk to a commercial dairy plant. The MFAI values ranged from 0.7 to 4.2, and large variations, which depended on the cows' diet and forage quality, were observed for each feeding system. The proposed method has been found to be flexible and adaptable to several contexts on both intensive and extensive dairy farms.

Effect of different feeding strategies in intensive dairy farming systems on milk fatty acid profiles, and implications on feeding costs in Italy.

The aim of this work was to characterize the fatty acid (FA) profile of milk from intensive dairy farming systems in the Po Plain (Italy) to estimate the costs of the adopted feeding strategies and to simulate the effect of supplementary premiums on the basis of milk FA composition on milk income. Twenty dairy farms with 5 different feeding strategies were studied: 3 corn silage-based systems in which cows were supplemented with a great proportion (CCH), a medium proportion (CCM), or without commercial concentrate mix (CC0), and 2 systems in which part of corn silage was replaced with grass or legume silage (HF) or with fresh herbage (G), cut and fed indoors. Bulk milk was sampled and lactating cow performance, feeding strategies and forage characteristics were recorded through a survey, 3 times during a year. The milk FA supplementary premium was calculated considering C18:3n-3 and saturated FA (SFA) concentrations, and ratio of total cis C18:1 isomers to C16:0. The CCH, CCM, and CC0 systems bought most of their dairy cow feeds off farm, which allowed them to increase milk production to 35,000 L/yr per hectare. Their low dry matter and crude protein self-sufficiency led to higher feeding costs per liter of milk (from €0.158 to €0.184), and highest income over feed cost was achieved only for milk yield performance greater than 10,000 kg/cow per year. The use of homegrown forages in HF and G increased dry matter and crude protein self-sufficiency and reduced the feeding costs per liter of milk from 9 to 22%, compared with the other studied systems, making HF and G feeding economically competitive, even for a lower milk yield per cow. The studied systems highlighted a remarkable variation in FA profiles. The concentrations of C16:0 and SFA were the highest in CCH (31.53 and 67.84 g/100g of FA) and G (31.23 and 68.45 g/100g of FA), because of the larger proportion of commercial concentrate mix in the cow diet. The concentrations of C16:0 and SFA were the lowest in CCM (27.86 and 63.10 g/100g of FA), because of low roughage-to-concentrate ratio in the cow diet, which is known to favor milk fat depression, affecting particularly these FA. The calculated supplementary premium was the highest in the CCM system, based on milk FA profiles from those herds. The HF diet was rich in forages and resulted in greater concentration of C18:3n-3 in milk (0.57 g/100g of FA) than the other systems and thus led to an increase in milk FA supplementary premium. Milk from G and HF milk had the lowest ratio of Σn-6:Σn-3 FA compared with milk from the systems based on higher corn silage proportion in the cow diet (3.71, and 3.25, respectively, vs. 4.58 to 4.78), with the lower ratios being closer to recommendation for human nutrition.

Comparison of hay and haylage from permanent Alpine meadows in winter dairy cow diets.

In an Alpine environment, diets based on local forage resources are needed to maintain the link with the territory and confer special characteristics to typical cheeses. Harvesting at a late stage of maturity, high mechanical losses, and frequent rainfall often make the hay that is harvested of a poor quality. The aim of this study was to evaluate the effects of 2 different conservation methods (late hay, LH, vs. early haylage, ES) of natural permanent meadows on milk production in dairy cows, on the chemical and microbiological characteristics of the milk, and on the quality of the cheese over the winter period. Haylage and hay were harvested from the same permanent meadow at the Vittorino Vezzani experimental farm in Sauze d'Oulx (45 degrees 02'N, 6 degrees 53'E, Italy). The ES forage was cut 4 wk earlier than traditional hay, wilted for 30 h, baled at a dry matter (DM) content of about 50%, wrapped with 6 layers of stretch film, and stored in a protected area. The LH forage was harvested later, when the weather conditions were favorable and, after a 3-d wilting, it was baled and stored indoors. After an 8-mo storage period, the ES had a greater crude protein concentration, organic matter digestibility, and net energy for lactation than LH and a lower neutral detergent fiber and acid detergent fiber. Forty multiparous lactating Aosta Red Pied cows were used in a 19-d period crossover design to assess the nutritional value of the stored forages. The diets included ES fed ad libitum and 3.5 kg of DM per cow of concentrate or LH fed ad libitum and 5.1 kg of DM per cow of concentrate. The dietary DM was 90.1% for the LH and 59.9% for the ES. The diets contained 12.6 and 13.0% crude protein and 48.6 and 48.0% neutral detergent fiber, for the LH and ES, respectively. The forage intake was greater in the ES treatment than in the LH treatment. The ES treatment produced more milk (1.7 kg/d) and more 3.5% fat-corrected milk (1.5 kg/d) than the cows on the LH treatment. The milk fat and protein concentrations were similar in both diets, resulting in a greater protein yield in the ES treatment. The lactose, pH, total bacterial count, and somatic cell count were not different for the treatments. The clostridial spores did not differ between the treatments from preharvest forage to cheese, and no differences were found in terms of cheese quality after maturation. Conserving forage as wrapped bale silage combined with an earlier harvesting date than traditional hay resulted in a suitable method to improve forage quality without increasing the risk of clostridial contamination in the milk and cheeses.