[COVID-19 emergency management activities promoted by an university hospital in Northern Italy]. / Attività di prevenzione e protezione nell'ambito della gestione dell'emergenza COVID-19 promosse da un Ospedale Universitario nel Nord Italia.

SUMMARY: Background. In December 2019, a Coronavirus 2019 epidemic (COVID-19) was reported, caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which occurred in the city of Wuhan, Hubei province, China. Perceived risk of contracting diseases has led many Governments and Healthcare Organizations to implement a variety of control and protection measures for the population, in particular for health professionals who have made contact with positive Covid-19 patients. In this publication, we have carried out a review of the information available, in order to share the prevention and protection measures for health and safety at work, which a University Hospital of Pavia, in Northern Italy, has remodulated, according to the changed scenario in which professionals finds themselves carrying out their profession in the post lockdown, in account to the specificity of processes and methods of work organizing, which overall, they serve to characterize risks, in order to be able to prevent them in the best possible way for patients, visitors and healthcare professionals.

Randomized Double-Blind Controlled Study on the Safety and Efficacy of a Novel Injectable Cross-linked Hyaluronic Gel for the Correction of Moderate-to-Severe Nasolabial Wrinkles.

INTRODUCTION: The current study compares two hyaluronic acid fillers, Ial System Duo and Belotero Basic/Balance, for the treatment of wrinkles. MATERIALS AND METHODS: This is a single-center, double-blind randomized controlled study. Inclusion criteria consisted of subjects with bilateral nasolabial wrinkles. Each subject was treated with both products: One was applied on the right side and the other on the left side of the face. The quantity of product injected and any problems or local reactions (erythema, edema, pain or itching) were recorded and reassessed at 3 and 6 months and then monthly until complete absorption of the product. The Wrinkle Severity Rating Scale (WSRS) and the Global Aesthetic Improvement Scale (GAIS) were used for the assessment, as well as an ultrasound measurement of the skin thickness. RESULTS: Complete data were available for 59 subjects. At 3 and 6 months, both products showed improvement in the WSRS and GAIS score in the areas treated compared to pre-treatment assessments, although no significant differences were observed between them. No resulting significant differences were observed on skin thickness among the two products, which were completely reabsorbed in 285 ± 34 days (Ial System Duo) and 277 ± 34 days (Belotero Basic/Balance; Student's t test: p = 0.2181). No significant differences were observed with regard to the subject's satisfaction and adverse events. CONCLUSIONS: The Ial System Duo achieves long-term permanence (more than 9 months confirmed by ultrasound) in correction of moderate and severe wrinkles, similar to Belotero Basic/Balance. Both products showed a high safety profile and a high degree of subject and physician satisfaction. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Liposuction Aspirate Fluid Adipose-Derived Stem Cell Injection and Secondary Healing in Fingertip Injury: A Pilot Study.

BACKGROUND: Although fingertip injuries account for a high proportion of trauma patients, the correct surgical approach is still debated. The authors compared the traditional conservative approach and a new treatment based on the injection of liposuction aspirate fluid. METHODS: Forty consecutive patients with a fingertip injury were dichotomized into group A (control group; conservative approach) and group B (treatment group). Group B underwent liposuction, followed by filtration of the lipoaspirate in a closed device (MyStem EVO kit), allowing the nonenzymatic separation of liposuction aspirate fluid, which was then injected at the site of injury. Objective outcomes were time for healing, strength, mobility of joint, and touch and sensory function. Subjective outcomes were cold intolerance, pain, hand disability, and aesthetic result. An aliquot of liposuction aspirate fluid was sent to the laboratory for cellular isolation and analysis by flow cytometry and in vitro differentiation assays. RESULTS: The average healing time was 22.3 days in group B and 24.9 days in group A (p < 0.05). Eighty-five percent of group B patients and 67 percent of group A patients scored normal to diminished superficial sensibility (p < 0.05). Group A had higher pain and cold intolerance scores (p < 0.05). Group B scored greater aesthetic and disabilities outcome results (p < 0.05). The cell isolation yield was 8.3 × 10(5)/ml, with a percentage of viable cells of 74.3 percent. Flow cytometry identified a mesenchymal immunophenotype, and in vitro osteogenic and adipogenic induction confirmed the bilinear potential of the isolated cells. CONCLUSION: This clinical study demonstrates for the first time the regenerative potential of liposuction aspirate fluid adipose-derived stem cells in a clinical application. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Long-term Outcomes of a Modified Technique Using the Baerveldt Glaucoma Implant for the Treatment of Refractory Glaucoma.

PURPOSE OF THE STUDY: The purpose of the study was to evaluate the long-term effectiveness and safety profile of Baerveldt glaucoma implant (BGI) in patients with refractory glaucoma operated using a modified technique to avoid postoperative complications. PATIENTS AND METHODS: A total of 160 eyes from 147 glaucomatous patients were enrolled in a consecutive interventional noncomparative case series. All the patients were treated with a 350-mm BGI using a modified technique. Intraocular pressure (IOP), the number of medications, the complications, and the postoperative interventions were reported preoperatively and during the follow-up. Postoperative IOP and the rate of complications were the primary outcome measures. The complete and qualified surgical success was the second endpoint. RESULTS: BGI obtained a mean IOP reduction from 31.8±6.4 mm Hg (baseline) to 14.4±3.5 mm Hg after a mean follow-up period of 38.4±9.6 months. The mean number of medications reduced between preoperative (n=3.17±1.03) and postoperative period (n=0.58±0.83) (P<0.0001). Cumulative probability of maintaining an IOP between 5 and 21 mm Hg and/or a 25% or greater reduction in IOP was 78.7% at 1 year and 72.1% at 4 years, including 39 eyes (24.4%) in which postoperative interventions were required (qualified success). If we exclude those eyes from the analysis, the probability of complete success was 93.4% at 1 year and 91.4% at 4 years in 75.4% of the eyes. CONCLUSIONS: This modified technique achieved a high percentage of surgical success during the whole follow-up time and was effective in preventing the most serious immediate complications of nonvalved tube shunts.

Disfiguring facial hemangioma compromising labial functionality: a case report.

Hemangiomas are proliferative lesions characterized by increased endothelial cell turnover. Lip hemangiomas can distort lip anatomy and are at increased risk of ulceration and/or bleeding, which lead to impaired function and disfigurement. Surgery can provide active treatment but it can be problematic because vermilion tissue is unique and not found elsewhere on the body. Since there is no similar tissue that can easily be used for reconstructing missing vermilion, its preservation is essential for a satisfactory cosmetic result. We present the case of a 74 year old woman suffering from a large hemangioma of the mid-face and particulary with an angiomatous ulcerated lesion at the level of the lower lip. We describe clinical management and surgical treatment of this pathology.

Free-style perforator flaps in the reconstruction of the lower limb.

INTRODUCTION: The evolving concept of free-style flaps with one or more perforators able to lend support, has been shown to have noteworthy advantages in the context of reconstructive surgery, especially in relation to the distal portion of the lower limb. Among the advantages, an analogy of the covering tissues with pre-existing ones in the compromised area, reduced morbidity of the donor site, less time spent in theatre and a greater flexibility from the surgeons' point of view. MATERIAL AND METHODS: Between 2009 and 2012, 18 patients were treated with local free-style flaps for lesions involving the leg and the foot. The median age of the patients, (11 men and 7 women) was 63.2 years. Subsequently, the patients were followed up for 6 months-1 year. RESULTS: In the period following surgery all the free style flaps have survived completely; further surgery has not been warranted. Healing of the donor sites took place by primary intention in 17 cases; in one case, a V-Y advancement flap adapted as a cover for a loss of substance of the calcaneus, it occurred by secondary intention. DISCUSSION AND CONCLUSIONS: Lower limb reconstruction, in virtue of the fact that adjacent tissues for reconstruction are scarce and vascularization is an issue, has always constituted a problem which has not been easy to solve for the surgeon. The application of the free-style concept to loco-regional flaps has yielded satisfactory results in our experience, from both a functional as well as an aesthetic point of view.

A modified scalpel in hair restoration.

One limiting factor of hair transplantation is the amount of hair available in the patient donor scalp. Several techniques have been proposed as steel punches, multiblade knives, FUE (follicular unit extract) and single-strip harvesting. The authors introduce a modified surgical scalpel with a No. 10 blade to minimize side effects. This scalpel is folded at 120-degree angle and allows the incision to be parallel to the hair follicles and help the surgeon to avoid resection of the hair during dissection. The authors propose this modified scalpel as a new ideal instrument for removing the donor area in hair transplantation.

Assessment of a new hyaluronic acid filler. double-blind, randomized, comparative study between Puragen and Captique in the treatment of nasolabial folds.

Fillers represent a field of aesthetic medicine under remarkable expansion. Over the past few years, in the USA, there has been a huge increase in the use of fillers, especially for hyaluronic acid (400% in 2004). The causes of this increase have been the greater tolerability of this reabsorbable filler with respect to the others, and its prolonged efficacy in time due to chemical modifications of its molecular structure. In our study, we report the results of a double-blind comparative study between Puragen (latest-generation hyaluronic acid with double cross-linking) and Captique (second generation hyaluronic acid with single cross-linking), in the treatment of nasolabial folds. Each patient received Puragen in one nasolabial fold and Captique in the contralateral fold, at random. Clinical efficacy was assessed independently by the investigator and the patient 2, 4 and 6 months after baseline or when the optimal cosmetic result was obtained. The tolerability assessment was made by the patient (using a daily diary to record any adverse events) for 2 weeks after each treatment, and by the operator 2, 4, and 6 months after baseline. Sixty-eight patients completed follow up at 6 months. From the results obtained in this study, Puragen remained stably in the treated tissues even after 6 months while less satisfactory results were obtained with Captique.

Hair regeneration from transected follicles in duplicative surgery: rate of success and cell populations involved.

BACKGROUND: The use of bisected hair follicles in hair transplantation has been previously reported, but the capacity of each half to regenerate the entire hair has not been clarified. OBJECTIVE: To evaluate duplicative surgery rate of success and to analyze the cell populations involved in hair regeneration. METHODS: We screened 28 patients undergoing duplicative surgery. Approximately 100 hair follicles from each patient were horizontally bisected and implanted. Upper and lower portions were stained for the known epithelial stem cell markers CD200, p63, beta1-integrin, CD34, and K19. RESULTS: Similar percentages of hair regrowth after 12 months were observed when implanting the upper (72.7 +/- 0.4%) and lower (69.2 +/- 1.1%) portions. Expression of CD200, p63, and beta1-integrin was detected in both portions, whereas K19 and CD34 stained different cell populations in the upper and lower fragment, respectively. CONCLUSION: Duplicative surgery might represent a successful alternative for hair transplantation, because both portions are capable of regenerating a healthy hair. Moreover, our results suggest the possible presence of stem cells in both halves of the follicle.

Use of systemic cyclosporin A in a case of severe Toxocara uveitis.

The report describes the case of an adult patient presenting a severe, serologically proven, Toxocara endophthalmitis, unresponsive to the common surgical and medical approach (vitrectomy, anti-parasitic treatment followed by high-dose corticosteroids). The association of oral cyclosporin A to a lower dose of prednisone was successful in achieving a long-term control of the ocular inflammation without systemic side effects.

The neuromelanin of human substantia nigra: physiological and pathogenic aspects.

Neuromelanin (NM) accumulates as a function of age in normal human substantia nigra (SN) but is relatively depleted in the SN of patients with Parkinson disease (PD). Several studies have been performed to further our understanding of the role of NM in neuronal aging and neurodegenerative mechanisms of PD. To this purpose, NM from human SN was isolated and its structure and molecular interactions were investigated. Cysteinyl-dopamine was shown to be one precursor of NM synthesis. A striking affinity of NM for specific metals, lipids, drugs and pesticides was found in vitro, and in animal and human brain postmortem studies. Because of these affinities, NM seems to play a protective role in the human brain by blocking toxic molecules. On the other hand, experiments in cell culture indicate that NM can activate microglia, eliciting the release of cytotoxic factors that can induce neurodegeneration.

The role of iron and copper molecules in the neuronal vulnerability of locus coeruleus and substantia nigra during aging.

In this study, a comparative analysis of metal-related neuronal vulnerability was performed in two brainstem nuclei, the locus coeruleus (LC) and substantia nigra (SN), known targets of the etiological noxae in Parkinson's disease and related disorders. LC and SN pars compacta neurons both degenerate in Parkinson's disease and other Parkinsonisms; however, LC neurons are comparatively less affected and with a variable degree of involvement. In this study, iron, copper, and their major molecular forms like ferritins, ceruloplasmin, neuromelanin (NM), manganese-superoxide dismutase (SOD), and copper/zinc-SOD were measured in LC and SN of normal subjects at different ages. Iron content in LC was much lower than that in SN, and the ratio heavy-chain ferritin/iron in LC was higher than in the SN. The NM concentration was similar in LC and SN, but the iron content in NM of LC was much lower than SN. In both regions, heavy- and light-chain ferritins were present only in glia and were not detectable in neurons. These data suggest that in LC neurons, the iron mobilization and toxicity is lower than that in SN and is efficiently buffered by NM. The bigger damage occurring in SN could be related to the higher content of iron. Ferritins accomplish the same function of buffering iron in glial cells. Ceruloplasmin levels were similar in LC and SN, but copper was higher in LC. However, the copper content in NM of LC was higher than that of SN, indicating a higher copper mobilization in LC neurons. Manganese-SOD and copper/zinc-SOD had similar age trend in LC and SN. These results may explain at least one of the reasons underlying lower vulnerability of LC compared to SN in Parkinsonian syndromes.