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Development of a Murine Model for the Exploration of the Biological Effects of External Volume Expansion. Sviluppo di un modello murino per l'esplorazione degli effetti biologici dell'espansione volumetrica esterna
Full text linkBackground: External Volume Expansion (EVE) refers to a class of devices that non-invasively stretch and expand tissue compartments by external application of suction. EVE has been suggested to increase compartments volume and stimulate the formation of a more developed vascular network, leading to less stiff and better vascularized tissues. It is proposed to patients as a method to prepare recipient sites, in particular breasts, in view of a fat grafting procedure, basing on the theory that fat grafts will better survive and retain volume if the recipient site is more vascularized and provides less compression. However, the method requires high patient compliance and no experimental validation for it has been attempted.
Aims: basing on our group's previous experience in downsizing and testing in animal models clinical devices for wound healing, in particular in settings requiring the application of mechanical forces to soft tissues, we proposed to design an animal model for EVE in which to test the validity of the hypothesis of its being beneficial to fat grafting and explore its mechanisms and potentials.
Methods: we designed and built a miniaturized EVE device to be applied to the dorsum of mice. We then designed a series of stepwise incremental studies. We tested the capacity of EVE of inducing angiogenesis and cell proliferation with 28 days long continuous stimulation. We analyzed its effects on tissues in terms of mechanical stretch, hypoxia and ischemia, edema, inflammation, cell proliferation and angiogenesis after a single 2 hours stimulation. We produced a mathematical modeling for the effects of EVE on tissues in relation to fat grafting. We tested if EVE is beneficial to fat grafting and if beneficial effects are maintained also in the setting of chronic radiation damage. We tested if EVE can stimulate adipogenesis and what role inflammation can play in it.
Results: in our series of studies, we successfully designed a miniaturized animal model in which to test External Volume Expansion. We demonstrated that the hypotheses of stimulation of cell proliferation, angiogenesis, and expansion of tissue compartments on which it is proposed as a preparatory method to fat grafting is confirmed in experimental settings. We showed how mechanical stretch of tissues, hypoxia and ischemia, edema, and inflammation are all intervening factors that can contribute to these effects. Our results suggest that pre-stimulation with EVE is successful in achieving increased fat graft weight and volume retention, and that its beneficial effects are maintained also in the setting of recipient sites having sustained radiation injury. We also demonstrated that EVE has a potential for direct stimulation of adipogenesis, and gathered supportive results to a role for macrophages in this.
Discussion: our results validate the technique for its use in the preparatory phase to fat grafting, and can help moving towards making fat grafting a more effective and reliable procedure with improved outcomes for patients. We gathered evidence that help increasing our understanding of how EVE works and what it implies for tissues. This is the basis for optimizing the technique, make it safer, and increase patients' compliance. For example, stimulation patterns can be improved, duration of treatment can be reduced, and practices such as continuation of EVE after fat grafting should be abandoned as detrimental. Our unexpected observations on adipogenesis also open interesting opportunities, such as that of re-starting EVE after fat grafting when this is at the peak of its remodeling phase. And linking this effect with the understanding of the similarity to other conditions in which adipogenesis is seen and desired, such as tissue engineering, or pathological, such as lymphedema, can expand the potential of our animal model to alternative broader fields
"Synchronous" multifocal necrotizing fasciitis
No full textBackground: Necrotizing fasciitis (NF) is an infection of the soft tissue, and is fatal if not promptly and aggressively treated. Although it is rare, it is not exceptional; nevertheless, its presentation may be misleading and may delay the diagnosis. We highlight the possible synchronous development of NF in multiple noncontiguous areas. Case Report: A 44-year-old diabetic man with no history of trauma complained of nonspecific lower back pain, which he treated with analgesics and oral antibiotics. Erythema at the left arm appeared, and the general condition worsened. The patient was admitted to the Emergency Department, and NF was diagnosed at the right gluteus and left arm. Conclusion: "Synchronous" multifocality is not an expected presentation of NF, and it complicates the diagnosis and delays treatment, with a potentially negative impact on outcome. (C) 2013 Elsevier Inc
PSYCHIATRIC ASPECTS IN BURN PATIENTS
No full textAfter an epidemiological analysis of psychiatric disorders as a consequence of burns and also psychiatric aspects of burn victims before the accident, this paper discusses the correlation between psychiatric disorders and burns from the epidemiological, etiopathogenetic and clinical-therapeutic aspects.
Burn patients often suffer from psychiatric disorders and there is a clear connection between the extent and/or severity of injuries (TBSA) and mental illness, particularly anxiety, mood disorders, and post-traumatic stress disorder.
The occurrence of psychiatric disorders (mainly substance or alcohol abuse/dependence, suicidal behaviour, schizophrenia and personality disorders – antisocial or borderline) is a clear-cut risk factor for those with burn injuries.
The occurrence or onset of psychiatric illness during burn hospitalization or recovery is a negative factor for wellbeing and also for the quality of life in the medium-long term.
A burn injury is a traumatic experience for patients, not only as regards psychological aspects (no integration of the traumatic experience with self-perception of life) but also personal ones (knowledge of self-vulnerability, difficulty in accepting the new aspect of the body, with its possible deformation and scars) after trauma. All aspects which may refer to primordial and psychoanalytic fear of death must be taken into consideration. It is also necessary to consider the concepts of accident proneness and consequent pre-burn impulsivity, which may anticipate/represent a person's predisposition to a traumatic event.
All these concepts have clinical and therapeutic importance for multidisciplinary care.
This paper focuses on the relationship between burn injuries and psychiatric illness: post-traumatic stress disorder (acute and chronic), affective disorders, and personality traits. They must all be examined not only as regards their outcomes but also the patient's pre-trauma psychopathology and susceptibility. Also of importance is facing therapy for all these disorders and its correlation with burn care (in terms of length of hospital stay, quality of life, and functional and psychological results)
Studio pilota di valutazione psichiatrica in pazienti sovrappeso
No full textE’ noto dai dati di letteratura che vi è una stretta correlazione tra patologia psichiatrica ed obesità e problematiche connesse.
Tali correlazioni possono essere considerate sotto due punti di vista: come causa che ha condotto alla condizione organica di obesità (depressione maggiore, disturbi del comportamento alimentare, in particolare Binge Eating Disorder o Obesità psicogena, disturbi della personalità), ma anche come conseguenza per la gestione delle implicazioni dovute all’obesità stessa (disturbi dell’immagine corporea, agiti autolesionistici, disturbi affettivi, condotte parasuicidarie).
Il presente studio, nato dalla collaborazione tra la Clinica Psichiatrica e la Chirurgia Plastica dell’Università di Padova, vuole evidenziare la presenza/assenza e la natura della psicopatologia precedente o conseguente all’aumento di peso nei pazienti che si sono rivolti all’ambulatorio chirurgico dedicato ad interventi di riduzione della massa adiposa (liposuzione e addominoplastica). Inoltre si sono voluti caratterizzare i tratti temperamentali di questi pazienti per valutare se questi potessero in qualche modo correlarsi alla patologia obesità.
Un totale di 28 pazienti, reclutati da marzo 2008 fino a giugno 2011, sono stati confrontati con 25 controlli dalla popolazione generale confrontabile per caratteristiche anagrafiche e di peso. Hanno rifiutato la valutazione psichiatrica 30 pazienti. Sono stati inclusi i soggetti maschi e femmine di età compresa tra i 18 e i 60 anni con BMI non superiore a 34.9 ed esclusi soggetti con patologie organiche debilitanti o francamente causa del sovrappeso/obesità, con deficit cognitivi e/o sensoriali e con disturbi della sfera psicotica franca (schizofrenia, disturbi psicotici acuti o cronici e disturbo schizoaffttivo).
Tutti i soggetti sono stati intervistati da un medico psichiatra, che li ha sottoposti alle seguenti valutazioni testistiche: intervista anagrafica, anamnesi clinica e chirurgica, valutazione BMI di partenza (alla prima valutazione ambulatoriale), BMI alla valutazione attuale, Mini International Neuropsychiatric Interview (MINI), Paykel Interview (nei 6 mesi precedenti), Tridimensional Personality Questionaire (TPQ), Beck Depression Inventory (BDI), Body Shape Questionaire (BSQ), Five Factor Inventory (FFI), Yale Brown per i tratti ossessivo-compulsivi.
Dopo analisi statistica di confronto tra il gruppo dei casi e dei controlli, sono emerse differenze significative, in accordo con la letteratura, in merito alla maggiore presenza dei casi sui controlli di depressione maggiore in anamnesi e di depressione attuale; è emersa inoltre franca significatività per aspetti di tipo ossessivo-compulsivi sia alla MINI che alla YALE BROWN che alla FFI.
Per quanto riguarda i tratti temperamentali è emersa una maggiore tendenza dei casi alla dipendenza dalla ricompensa, e dei controlli rispetto ad aspetti legati alla curiosità e all’apertura verso l’esterno, facendo intravedere la possibilità che tratti ossessivi (maggiori nei casi) con aspetti di controllo siano un fattore importante (oltretutto strutturale) nella psicopatogenesi dell’obesità.
Tali dati sono stati analizzati anche in termini comparativi evidenziando che possono compartecipare sicuramente degli aspetti depressivi sulla genesi e sullo sviluppo della problematica dell’aumento di peso, ma che, quando si introduce l’aspetto ossessivo-compulsivo centrato sul corpo (Yale Brown), è questo a determinare il reale fattore di rischio come predisposizione psichica a sviluppare obesità (ad ogni aumento di 1 punteggio della Yale corrisponde un aumento del 37% di essere un soggetto “caso”). C’è inoltre una correlazione proporzionale tra l’aumento di peso e l’aumento del valore complessivo della scala Yale totale (oltre che relativa).
In conclusione, da questi dati, emerge una preponderanza degli aspetti ossessivi (e compulsivo/impulsivi) sugli aspetti di tipo depressivo nel determinare patologie legate al sovrappeso; ed inoltre tali aspetti sembrerebbero più di tipo temperamentale che di tipo assiale sintomatologico.
Per l’interesse suscitato da questi dati, abbiamo considerato questo studio solamente il punto di partenza per un progetto più ampio. E’ infatti già in atto un follow-up post-intervento allo scopo di individuare ulteriori fattori di vulnerabilità e/o di rischio che potrebbero rivelarsi utili nell’ evitare precoci ricadute post-intervento ed uno studio caso-controllo per valutare l’intervento sui fattori ossessivo-compulsivi vs placebo.
Sarebbe inoltre utile considerare la possibilità di un supporto psichiatrico-psicologico sia nella fase pre-intervento che post-intervento, sia nei pazienti che presentino queste caratteristiche temperamentali sia in quelli che presentino una franca turba psicopatologica (DOC, depressione maggiore)
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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