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Introduction: Pyoderma gangrenosum is arare cause of skin necrosis after surgery. It often appears with extensive ulcerations and scaring with significant aesthetic aftermaths. The pathogenesis is poorly understood but often associated with inflammatory diseases, however post-surgical idiopathic pyoderma gangrenosum can occur. Case Report: We report a case of pyoderma gangrenosum following a bilateral breast reconstruction in a 33-year-old woman, successfully treated with steroids. A week after the surgery wounds started to break down and extensive necrotic ulceration appeared quickly covering both breasts. After dermatopathology evaluation she received antibiotics and prednisone and three months later wounds were completely healed and surgery was not necessary.

La reconstrucción mamaria con colgajo libre abdominal se ha convertido en la opción terapéutica de elección en nuestro centro hospitalario cuando se necesita abundante cantidad de tejido. La culminación de este tipo de reconstrucción requiere un número variable de procedimientos auxiliares de retoque. Revisamos las historias de las pacientes sometidas en nuestro centro a reconstrucción mamaria con colgajo libre abdominal entre enero de 2010 y diciembre de 2013. El criterio de inclusión fue la reconstrucción del pezón como última cirugía. Las pacientes fueron estratificadas atendiendo a factores relacionados con la reconstrucción microquirúrgica y la existencia de radioterapia adyuvante. Analizamos el número y tipo de procedimientos y cirugías de retoque, así como el tiempo transcurrido hasta completar el proceso de reconstrucción. En total, recogimos 68 pacientes reconstruidas con colgajo libre abdominal. De ellas, 31 (45,6%) completaron la reconstrucción mamaria. La media de procedimientos fue de 3,2 por paciente, con una media de 2,4 tiempos quirúrgicos y un tiempo medio de 15,5 meses hasta la reconstrucción del pezón. El momento de la reconstrucción, la bilateralidad, el tratamiento con radioterapia y la presencia de complicaciones tempranas del colgajo no se relacionaron con diferencias estadísticamente significativas en la tasa de cirugía secundaria. Los colgajos libres abdominales necesitan frecuentemente cirugías secundarias para mejorar el resultado y terminar la reconstrucción. Remarcamos la necesidad de planificar la reconstrucción desde el primer tiempo quirúrgico para disminuir la necesidad de cirugías de retoque y el tiempo hasta completar la reconstrucción mamaria.

Background: Artificial intelligence (AI) is rapidly fuelling a fundamental transformation in the practice of pathology. However, clinical integration remains challenging, with no AI algorithms to date in routine adoption within typical anatomic pathology (AP) laboratories. This survey gathered current expert perspectives and expectations regarding the role of AI in AP from those with first-hand computational pathology and AI experience., Methods: Perspectives were solicited using the Delphi method from 24 subject matter experts between December 2020 and February 2021 regarding the anticipated role of AI in pathology by the year 2030. The study consisted of three consecutive rounds: 1) an open-ended, free response questionnaire generating a list of survey items; 2) a Likert-scale survey scored by experts and analysed for consensus; and 3) a repeat survey of items not reaching consensus to obtain further expert consensus., Findings: Consensus opinions were reached on 141 of 180 survey items (78.3%). Experts agreed that AI would be routinely and impactfully used within AP laboratory and pathologist clinical workflows by 2030. High consensus was reached on 100 items across nine categories encompassing the impact of AI on (1) pathology key performance indicators (KPIs) and (2) the pathology workforce and specific tasks performed by (3) pathologists and (4) AP lab technicians, as well as (5) specific AI applications and their likelihood of routine use by 2030, (6) AI's role in integrated diagnostics, (7) pathology tasks likely to be fully automated using AI, and (8) regulatory/legal and (9) ethical aspects of AI integration in pathology., Interpretation: This systematic consensus study details the expected short-to-mid-term impact of AI on pathology practice. These findings provide timely and relevant information regarding future care delivery in pathology and raise key practical, ethical, and legal challenges that must be addressed prior to AI's successful clinical implementation., Funding: No specific funding was provided for this study., Competing Interests: Declaration of interests M.A.B. is a board member of Cells IA Technologies; D.S.M. received consulting fees from, and is a scientific advisory board member of, Epredia and Roche, received honoraria for a sponsored presentation from Roche, and holds a leadership or fiduciary role in the Digital Pathology Association (DPA); J.V.L. received research funding from ContextVision, Sectra, and Philips, consulting fees from, and is a scientific advisory board member of, ContextVision and Philips, is a member of the Board of Directors of the DPA, Chair of the AI Taskforce of the European Society of Pathology, and is Chief Scientific Officer of, and holds stocks or stock options from, Aiosyn B.V.; L.P. received consulting fees from Hamamatsu and Ibex, has patents planned, issued or pending (LeanAP Innovators), holds an unpaid leadership or fiduciary role in other board, society, committee or advocacy group (DPA and ASC), and is a shareholder of Ibex; C.E. received consulting fees from Mindpeak, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Leica and 3DHISTECH, and payment for expert testimony from MSD; D.J.H received royalties from Up-To-Date/LWW for the creation of educational content, consulting fees from IQVIA/Genae and VitaDx, and is a board member and shareholder of Techcyte Inc.; M.D.H received research funding from the National Cancer Institute (NCI), National Institutes of Health (NIH), and support for attending meetings and/or travel from the College of American Pathologists (CAP), DPA, and European Society for Digital and Integrative Pathology, and holds an unpaid leadership or fiduciary role in the DPA; M.E.S. and is a board member and shareholder of Techcyte Inc.; B.W. received honoraria for presentations from Leica Biosystems and is a scientific advisory board member of Paige AI; A.L. received honoraria from General Electric for lectures, and is a board member of Siemens Healthineers and Cells IA Technologies; J.A.F. is a shareholder of Cells IA Technologies; J.S. received institutional research funding from Google/Alphabet Inc. and Lunit Inc., consulting fees from KCK MedTech, and is an advisory board member of Crosscope, Inc. The remaining authors declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Human-adipose-derived mesenchymal stem cells (hADMSCs) are multipotent stem cells which have become of great interest in stem-cell therapy due to their less invasive isolation. However, they have limited migration and short lifespans. Therefore, understanding the mechanisms by which these cells could migrate is of critical importance for regenerative medicine. Methods: Looking for novel alternatives, herein, hADMSCs were isolated from adipose tissue and co-cultured with human monocytes ex vivo. Results: A new fused hybrid entity, a foam hybrid cell (FHC), which was CD90 + CD14 + , resulted from this co-culture and was observed to have enhanced motility, proliferation, immunomodulation properties, and maintained stemness features. Conclusions: Our study demonstrates the generation of a new hybrid cellular population that could provide migration advantages to MSCs, while at the same time maintaining stemness properties.

Background:  Ischemia-reperfusion (I/R) injury is a serious condition that can affect the success rate of microsurgical reconstructions of ischemic amputated limbs and complex tissue defects requiring free tissue transfers. The purpose of this study was to evaluate the effects of ischemic preconditioning (IPC) and C1 esterase inhibitor (C1-Inh) intravenous administration following I/R injury in a rat skin flap model., Methods:  Superficial caudal epigastric skin flaps (3 cm × 7 cm) were performed on 50 Wistar rats that were randomly divided into five groups. Ischemia was not induced in the control group. All other flaps underwent 8 hours of ischemia prior to revascularization: I/R control group (8-hour ischemia), IPC group (preconditioning protocol + 8-hour ischemia), C1-Inh group (8-hour ischemia + C1-Inh), and IPC + C1-Inh group (preconditioning protocol + 8-hour ischemia + C1-Inh). Survival areas were macroscopically assessed after 1 week of surgery, and histopathological and biochemical evaluations were also measured., Results:  There were no significant differences in flap survival between the treatment groups that were suffering 8 hours of ischemia and the control group. A significant increase in neovascularization and lower edema formation were observed in the IPC group compared with that in the I/R group. Biochemical parameters did not show any significant differences., Conclusion:  Intravenous administration of C1-Inh did not significantly modulate I/R-related damage in this experimental model, but further research is needed. On the other hand, IPC reduces tissue damage and improves neovascularization, confirming its potential protective effects in skin flaps following I/R injury., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Previous studies on solid organ transplantation have shown that cold ischemia contributes to the development of chronic allograft vasculopathy. The authors evaluated the effect of cold ischemia on the development of chronic rejection in vascularized composite allotransplantation., Methods: Thirty rat hindlimbs were transplanted and divided into two experimental groups: immediate transplantation and transplantation after 7 hours of cold ischemia. The animals received daily low-dose immunosuppression with cyclosporine A for 2 months. Intimal proliferation, arterial permeability rate, leukocyte infiltration, and tissue fibrosis were assessed. The CD3, CD4, CD8, CD20, and CD68 cells per microscopic field (200×) were counted, and C4d deposition was investigated. Cytokine RNA analysis was performed to measure tumor necrosis factor-α, interleukin-6, and interleukin-10 levels., Results: Significant differences were found in the intimal proliferation and arterial permeability rate between the two groups (p = 0.004). The arterial permeability rate worsened in the most distal and small vessels (p = 0.047). The numbers of CD3, CD8, CD20, and CD68 were also statistically higher in the cold ischemia group (p < 0.05, all levels). A trend toward significance was observed with C4d deposition (p = 0.059). No differences were found in the RNA of cytokines., Conclusions: An association between cold ischemia and chronic rejection was observed in experimental vascularized composite allotransplantation. Chronic rejection intensity and distal progression were significantly related with cold ischemia. The leukocyte infiltrates in vascularized composite allotransplantation components were a rejection marker; however, their exact implication in monitoring and their relation with cold ischemia are yet to be clarified.