The unresolved case of sacral chordoma: from misdiagnosis to challenging surgery and medical therapy resistance.

PURPOSE: A sacral chordoma is a rare, slow-growing, primary bone tumor, arising from embryonic notochordal remnants. Radical surgery is the only hope for cure. The aim of our present study is to analyse our experience with the challenging treatment of this rare tumor, to review current treatment modalities and to assess the outcome based on R status. METHODS: Eight patients were treated in our institution between 2001 and 2011. All patients were discussed by a multidisciplinary tumor board, and an en bloc surgical resection by posterior perineal access only or by combined anterior/posterior accesses was planned based on tumor extension. RESULTS: Seven patients underwent radical surgery, and one was treated by using local cryotherapy alone due to low performance status. Three misdiagnosed patients had primary surgery at another hospital with R1 margins. Reresection margins in our institution were R1 in two and R0 in one, and all three recurred. Four patients were primarily operated on at our institution and had en bloc surgery with R0 resection margins. One had local recurrence after 18 months. The overall morbidity rate was 86% (6/7 patients) and was mostly related to the perineal wound. Overall, 3 out of 7 resected patients were disease-free at a median follow-up of 2.9 years (range, 1.6-8.0 years). CONCLUSION: Our experience confirms the importance of early correct diagnosis and of an R0 resection for a sacral chordoma invading pelvic structures. It is a rare disease that requires a challenging multidisciplinary treatment, which should ideally be performed in a tertiary referral center

Spectrally resolved observations of atmospheric emitted radiance in the H2O rotation band

This paper presents the project Earth Cooling by Water Vapor Radiation, an observational programme, which aims at developing a database of spectrally resolved far infrared observations, in atmospheric dry conditions, in order to validate radiative transfer models and test the quality of water vapor continuum and line parameters. The project provides the very first set of far-infrared spectral downwelling radiance measurements, in dry atmospheric conditions, which are complemented with Raman Lidar-derived temperature and water vapor profiles

The role of rationality in integer-programming relaxations

For a finite set X⊂ Zd that can be represented as X= Q∩ Zd for some polyhedron Q, we call Q a relaxation of X and define the relaxation complexity rc (X) of X as the least number of facets among all possible relaxations Q of X. The rational relaxation complexity rc Q(X) restricts the definition of rc (X) to rational polyhedra Q. In this article, we focus on X= Δ d , the vertex set of the standard simplex, which consists of the null vector and the standard unit vectors in Rd . We show that rc (Δ d) ≤ d for every d≥ 5 . That is, since rc Q(Δ d) = d+ 1 , irrationality can reduce the minimal size of relaxations. This answers an open question posed by Kaibel and Weltge (Math Program 154(1):407–425, 2015). Moreover, we prove the asymptotic statement rc(Δd)∈O(dlog(d)) , which shows that the ratio rc(Δd)rcQ(Δd) goes to 0, as d→ ∞

The proximal ulnar perforator flap (PUPF) for hand digital reconstruction: an anatomical study

Degloving injuries of the fingers represent a reconstructive challenge. Even if poorly described in literature, the proximal ulnar perforator flap (PUPF), based on perforator of the anterior ulnar recurrent artery or directly on a perforator branch of the ulnar artery, meets the requested criteria for the ideal coverage. We performed a cadaveric study in order to clarify the anatomical basis and vascularization of the PUPF flap. Eight injected upper limb specimens were dissected for this study: perforators were followed down to their origin and classified in terms of number, length, diameters and distances between their emergence and specific pre-determined landmarks as the medial humeral epicondyle. At least one ulnar perforator in the proximal third of the forearm was identified in all the specimens. In 50% of the upper limbs, the perforator branch came directly from the ulnar artery, while in the 87.5% a perforator branch came from the anterior recurrent ulnar artery; in 3 out of 8 cases both perforator branches were described. Mean lengths of the perforator branch were 57.9 mm and 44.3 mm, respectively and the mean diameters measured at their origin were 0.99 mm and 1.17 mm respectively. Our data illustrate the consistency of at least one perforator branch from the proximal third of the ulnar artery, most commonly coming from the anterior recurrent ulnar artery. Considering our results, the PUPF could be a good alternative to the classical free flaps for the resurfacing of the finger defects

Atmospheric Thermodynamic Profiling through the Use of a Micro-Pulse Raman Lidar System: Introducing the Compact Raman Lidar MARCO

It was for a long time believed that lidar systems based on the use of high-repetition micro-pulse lasers could be effectively used to only stimulate atmospheric elastic backscatter echoes, and thus were only exploited in elastic backscatter lidar systems. Their application to stimulate rotational and roto-vibrational Raman echoes, and consequently, their exploitation in atmospheric thermodynamic profiling, was considered not feasible based on the technical specifications possessed by these laser sources until a few years ago. However, recent technological advances in the design and development of micro-pulse lasers, presently achieving high UV average powers (1–5 W) and small divergences (0.3–0.5 mrad), in combination with the use of large aperture telescopes (0.3–0.4 m diameter primary mirrors), allow one to presently develop micro-pulse laser-based Raman lidars capable of measuring the vertical profiles of atmospheric thermodynamic parameters, namely water vapor and temperature, both in the daytime and night-time. This paper is aimed at demonstrating the feasibility of these measurements and at illustrating and discussing the high achievable performance level, with a specific focus on water vapor profile measurements. The technical solutions identified in the design of the lidar system and their technological implementation within the experimental setup of the lidar prototype are also carefully illustrated and discussed

Brain morphology and immunohistochemical localization of the gonadotropin-releasing hormone in the bluefin tuna, <i>Thunnus thynnus</i>

The present study was focused on the morphology of the diencephalic nuclei (likely involved in reproductive functions) as well as on the distribution of GnRH (gonadotropin-releasing hormone) in the rhinencephalon, telencephalon and the diencephalon of the brain of bluefin tuna (Thunnus thynnus) by means of immunohistochemistry. Bluefin tuna has an encephalization quotient (QE) similar to that of other large pelagic fish. Its brain exhibits well-developed optic tecta and corpus cerebelli. The diencephalic neuron cell bodies involved in reproductive functions are grouped in two main nuclei: the nucleus preopticus-periventricularis and the nucleus lateralis tuberis. The nucleus preopticus-periventricularis consists of the nucleus periventricularis and the nucleus preopticus consisting of a few sparse multipolar neurons in the rostral part and numerous cells closely packed and arranged in several layers in its aboral part. The nucleus lateralis tuberis is located in the ventral-lateral area of the diencephalon and is made up of a number of large multipolar neurones. Four different polyclonal primary antibodies against salmon (s)GnRH, chicken (c)GnRH-II (cGnRH-II 675, cGnRH-II 6) and sea bream (sb)GnRH were employed in the immunohistochemical experiments. No immunoreactive structures were found with anti sbGnRH serum. sGnRH and cGnRH-II antisera revealed immunoreactivity in the perikarya of the olfactory bulbs, preopticus-periventricular nucleus, oculomotor nucleus and midbrain tegmentum. The nucleus lateralis tuberis showed immunostaining only with anti-sGnRH serum. Nerve fibres immunoreactive to cGnRH and sGnRH sera were found in the olfactory bulbs, olfactory nerve and neurohypophysis. The significance of the distribution of the GnRHimmunoreactive neuronal structures is discussed

Characterization of the planetary boundary layer height and structure by Raman lidar: comparison of different approaches

Abstract. The planetary boundary layer (PBL) includes the portion of the atmosphere which is directly influenced by the presence of the earth's surface. Aerosol particles trapped within the PBL can be used as tracers to study the boundary-layer vertical structure and time variability. As a result of this, elastic backscatter signals collected by lidar systems can be used to determine the height and the internal structure of the PBL. The present analysis considers three different methods to estimate the PBL height. The first method is based on the determination of the first-order derivative of the logarithm of the range-corrected elastic lidar signals. Estimates of the PBL height for specific case studies obtained through this approach are compared with simultaneous estimates from the potential temperature profiles measured by radiosondes launched simultaneously to lidar operation. Additional estimates of the boundary layer height are based on the determination of the first-order derivative of the range-corrected rotational Raman lidar signals. This latter approach results to be successfully applicable also in the afternoon–evening decaying phase of the PBL, when the effectiveness of the approach based on the elastic lidar signals may be compromised or altered by the presence of the residual layer. Results from these different approaches are compared and discussed in the paper, with a specific focus on selected case studies collected by the University of Basilicata Raman lidar system BASIL during the Convective and Orographically-induced Precipitation Study (COPS)

Biodegradative mechanism of the brown rot basidiomycete Gloeophyllum trabeum: evidence for an extracellular hydroquinone-driven fenton reaction

AbstractWe have identified key components of the extracellular oxidative system that the brown rot fungus Gloeophyllum trabeum uses to degrade a recalcitrant polymer, polyethylene glycol, via hydrogen abstraction reactions. G. trabeum produced an extracellular metabolite, 2,5-dimethoxy-1,4-benzoquinone, and reduced it to 2,5-dimethoxyhydroquinone. In the presence of 2,5-dimethoxy-1,4-benzoquinone, the fungus also reduced extracellular Fe3+ to Fe2+ and produced extracellular H2O2. Fe3+ reduction and H2O2 formation both resulted from a direct, non-enzymatic reaction between 2,5-dimethoxyhydroquinone and Fe3+. polyethylene glycol depolymerization by G. trabeum required both 2,5-dimethoxy-1,4-benzoquinone and Fe3+ and was completely inhibited by catalase. These results provide evidence that G. trabeum uses a hydroquinone-driven Fenton reaction to cleave polyethylene glycol. We propose that similar reactions account for the ability of G. trabeum to attack lignocellulose

The “Sombrero-Shape” Super-Thin Pedicled ALT Flap for Complete Scrotal Reconstruction Following Fournier’s Gangrene

When the scrotal sac is entirely debrided following a Fournier gangrene, testes exposure poses unique challenges for the reconstructive surgeon. Despite the anterolateral thigh (ALT) flap is considered a workhorse in such context, aesthetic results are often suboptimal because of the lack of natural ptosis and patchwork appearance. We describe the use of a super-thin pedicled ALT flap for total scrotal reconstruction, modified according to a peculiar flap design and inset technique. A 42-year-old man was referred to our department for delayed total scrotal reconstruction 8 months after a Fournier gangrene extensive debridement. A super-thin pedicled ALT flap from the right thigh was designed: in the central portion of the ALT, a lateral skin paddle extension was marked to guarantee adequate posterior anchorage during insetting and ptosis of the scrotal sac. This particular flap arrangement has inspired the name “sombrero” as the shape is akin to the famous hat. No secondary refinements were needed, and the patient showed satisfying aesthetic and functional results at 12 months’ follow-up. The ALT flap design “sombrero” modification proposed in this article can improve scrotum cosmesis and patient satisfaction in a single-stage single-flap procedure

Full labia minora reconstruction with labia sharing flap: a case report.

Full labia minora reconstruction can be necessary due to congenital malformation or genetic syndromes, but more often is required following oncologic excisions, or debridements after vulvar or perineal infections. It is important to note that full labia reconstruction can be needed after genital mutilation, or iatrogenic deformity after previous labia reduction procedure. A 37-year-old female patient, with vulvar necrotizing fasciitis after a marsupialization of the right Bartholin's gland, was referred to the Gynecology and Obstetrics unit. Three surgical debridements were performed, associated with prolonged antibiotic therapy, leading to a total loss of the right labia minora and the clitoris glans, in addition to minimal loss of labia majora. With a two-stage approach on the labia minora, the first procedure allowed to pull the left labia minora as a labia sharing flap, in order to join the remnant scar tissue on the right side, respecting the anterior and posterior leaflets. The second part was performed five weeks later, after autonomization of the new labia minora flap. Once the flap was divided, a perfectly vascularized right neo-labia minora was obtained. The flap healed uneventfully. The patient was asked to complete a questionnaire at six months, which confirmed an excellent aesthetic result with a like with like reconstruction. Eight months later, a final correction was performed to enhance the definitive aesthetic aspect with lipofilling of the right labia majora. Two techniques have been previously published with a two-stage cross-labial transposition flap, one using a top cut leading to a bottom pedicle and another using a bottom cut with an upper pedicle. We proceeded with a one-time edge resection, respecting the full vascular pedicle and transposed the full height of the labia minora. This technique revealed to be extremely effective, guaranteeing a reliable vascularization and decreasing the risk of tearing on the pedicle