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Background: The available literature on monsplasty remains sparse and most of the reports are limited to the description of one surgical technique, with limited to no post-operative data. This study aims to describe a reproducible monsplasty surgical technique and to analyze the post-operative functional and esthetic outcomes., Methods: Patients with at least grade 2 mons pubis ptosis were included in the study and observed for 3 months. Pre- versus post-operative analysis included body image, psychological function, sexual function, urinary function, hygiene maintenance of the pubic area, and post-operative complications. An additional retrospective analysis of a larger group of patients was also performed., Results: Between April 2021 and January 2022, a total of 25 patients were included in the prospective study. They reported a significant improvement in body image (p < 0.001), satisfaction with the abdomen (p < 0.001), and sexual functioning (p = 0.009). Functionally, improvements were recorded with regard to visualization of the genitalia (36%), hygiene maintenance of the pubic area (32%), sex life (48%), genital sensitivity (24%), and urinary continence (4%). Patient satisfaction was very high. There were no major complications. The retrospective study included 80 patients between 2010 and 2021, with a mean follow-up time of 18 months. No major complications were noted., Conclusion: Monsplasty is a simple and fast procedure that can truly bring an added value to the patient's satisfaction and functional outcomes. It can be incorporated in both esthetic and reconstructive abdominoplasties and should be a standard component of the procedure for cases with mons ptosis grade 2 or higher., Evidence Based Medicine Level: Level II., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflicts of interest to disclose., (Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: The medial gastrocnemius (GN) muscle flap is a historical reconstructive option in lower limb reconstruction. The flap is proximally based on the medial sural artery, and it is assumed not possible to harvest a distally based flap because of the absence of other minor pedicles. The aim of this study is to investigate the presence and the anatomy of a distal secondary pedicle given off by the posterior tibial artery (PTA)., Methods: A retrospective CTA study was performed of 120 limbs between April 2018 and June 2020. 3D reconstruction was performed to delineate the anatomy of the distal secondary pedicle, if present. The distance of the pedicle, if found, from the intermalleolar line to the patella was noted. The number of pedicles, if multiple, was documented, as well as branches to the soleus muscle and the skin., Results: A distal pedicle to the gastrocnemius muscle was found in 64% of limbs. The average location from the intermalleolar line is 168 mm. The branching pattern from the PTA showed an isolated vessel going to the distal medial gastrocnemius (32.8%), two branches to the medial gastrocnemius and skin (39.3%), two branches to the medial gastrocnemius and soleus (24.6%), and three branches to the medial gastrocnemius, soleus, and the skin (3.3%)., Conclusions: This study confirms the presence of the secondary axial distal pedicle of the GN muscle. Furthermore, this study confirms that there is a likely association between the distal medial gastrocnemius pedicle and the PTA skin perforators., (Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Introduction: Centrally located breast tumors represent a challenge for both oncological and reconstructive surgeons, mainly due to the necessity of nipple-areola complex (NAC) removal. We describe an original oncoplastic solution utilizing a displacement flap technique with immediate nipple reconstruction., Methods: Since 2008, we developed an oncoplastic technique using a septum-based island flap for the reconstruction of central breast defects, including the NAC. This technique is based on the Würinger's septum which is centered around the intercostal perforators. A retrospective study was performed collecting data on patient characteristics, oncological features, and outcomes. Patient satisfaction was reported using a Likert scale., Results: Reconstruction was successfully realized in 15 patients (14 immediate and one delayed post-lumpectomy correction). In immediate surgery, the excision margins were all free of tumor. Minor complications occurred in three patients; one small area of skin necrosis was managed by secondary intention, and two cases of partial nipple necrosis were treated by debridement under local anesthesia. Contralateral symmetrization surgery was performed on nine patients. Patient satisfaction scored high., Conclusion: In comparison with the previous oncoplastic techniques used for reconstructing central defects, the septum-based island flap has increased flexibility, provides better projection, and can be combined with immediate NAC reconstruction., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background and Aims: Familial hypercholesterolemia (FH) is a primary hyperlipemia. It is an autosomal dominant genetic disorder of lipoproteins metabolism mainly caused by mutations in the low density lipoprotein receptor gene (LDLR). We aimed to investigate the functional impact on the low density lipoprotein receptor (LDLR) activity of six uncharacterised variants located in the coding region of the LDLR gene, namely c.428G > T, c.640T > C, c.1708C > T, c.1736A > T, c.1981C > G and c.2114C > G (NM&#95;000527.4) and to attempt to define their clinical status., Methods: Functional studies were carried out using site-directed mutagenesis techniques and expression of LDLR protein in vitro. Results were correlated with clinical data and in silico analyses in order to assess the physiopathological role of these variants., Results: This work provides functional information about 6 uncharacterised mutations in LDLR., Conclusions: The six variants studied here appeared to affect the LDLR function in vitro to different degrees, ranging from receptors with normal to slightly reduced activity to receptors exhibiting less than 10% of the wild-type activity. According to these studies and The American College of Medical Genetics and Genomics (ACMG) Standards and Guidelines, two variants could be classified as "Likely Benign" (p.(Ala705Gly) and p.(Leu570Phe)), three variants as "Pathogenic" (p.(Asp579Val), p.(Cys143Phe) and p.(Trp214Arg)) and one variant as "Likely Pathogenic" (p.(Pro661Ala))., (Copyright © 2019 Elsevier B.V. All rights reserved.)

A 13-year-old girl came with the chief complaint of an unesthetic dental appearance. Her maxillary canines were bilaterally impacted. Treatment included extraction of the maxillary canines and the mandibular second premolars. The maxillary first premolars were substituted for the canines. After 26 months of active treatment, the patient had a Class I molar relationship and ideal overbite and overjet. Her profile was improved, lips were competent, and gingival levels were acceptable. Cephalometric evaluation showed acceptable maxillary and mandibular incisor inclinations. Intraoral pictures taken 3 years 7 months after the end of treatment demonstrated that the extraction of impacted canines and their substitution by first premolars can be a valid alternative to traditional orthodontic treatment when maxillary premolar extraction is a treatment option., (Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Surgical removal of mandibular deeply impacted third molars may be challenging and could be associated with several possible risks. Intra- or postoperative mandibular fracture during or after third molar extraction is a major though rare complication. Before starting the surgical removal of a mandibular deeply impacted third molar, various predisposing factors of mandibular fracture should be considered and kept in mind: adult age, male sex, deep inclusion, tooth ankylosis, and associated bony pathology. The aim of this article is to report and discuss the surgical management of a mandibular deeply impacted third molar associated with a follicular cyst., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background and Aims: Several studies have been carried out to characterize the different alterations associated with hypertriglyceridemia (HTG) and to identify this dyslipemia as an independent risk factor for cardiovascular disease (CVD). HTG is frequently, but not always, associated with insulin resistance (IR). The present study was aimed to evaluate if the alterations observed in biomarkers of CVD were similar in HTG states independently of IR., Methods: HTG was defined as triglycerides ≥1.69 mmol/l and IR as HOMA-IR ≥3.1. HTG-IR patients (n=15) were compared with HTG subjects without IR (WIR) (n=15) and with normotriglyceridemic (NTG)-WIR individuals (n=30)., Results: Both HTG groups shared the increment in VLDL-C and non-HDL-C, HDL enrichment in triglycerides and depletion in phospholipids, the decrease in adiponectin concentration, and the increase in CETP activity. HDL-C and VCAM-1 levels were altered only in HTG-IR patients in comparison with the other groups, while oxidized LDL was only higher in HTG-IR than the control group. Multiple regression analysis identified triglycerides as the independent predictor of HDL-C, CETP activity and oxidized LDL levels., Conclusion: The increase in triglycerides is the major determinant factor of the atherogenic modifications observed, while IR would be an amplifier factor., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: Inappropriate sinus tachycardia (IST) is characterized by an elevated heart rate (HR) at rest and an exaggerated HR response to physical activity or emotional stress. Beta-blockers and calcium channel blockers are the first-line therapy but sometimes are poorly tolerated due to side effects., Objective: The purpose of this study was to evaluate the efficacy and safety of ivabradine, a selective inhibitor of the I(f) current of the sinoatrial node, in patients affected by IST., Methods: Eighteen consecutive symptomatic patients (2 men and 16 women; mean age 45 +/- 15 years) affected by IST were enrolled in the study. Every patient underwent resting ECG, 24-hour Holter ECG, and exercise ECG at baseline and at 3-month and 6-month follow-up., Results: Sixteen patients (14 women; mean age 41 +/- 14 years) completed the study. Holter ECG assessment showed a significant reduction of medium HR (P <.001) and maximal HR (P <.001, basal vs 3-6 months; P = .02, 3 vs 6 months). Minimal HR slightly decreased at 3 months and then stabilized (P = .49, 3 vs 6 months) despite an increased drug dose. Stress test showed a significant decrease at rest (P <.001) and maximal HR (P <.05), suggesting an increased tolerance to physical stress, which was confirmed by a progressive increase of maximal load reached (>100 W) during stress test at 3 months (75%) and 6 months (85%). One patient was excluded because of phosphenes despite dose lowering, and another patient did not complete the protocol., Conclusion: Ivabradine could represent an effective and safe alternative to calcium channel blockers and beta-blockers for treatment of IST., (Copyright 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background and Aims: Adiponectin is an adipokine highly and specifically expressed by adipose cells with antiatherogenic and antiinflammatory activities. The aim of the present study was to evaluate plasma adiponectin concentration in patients with primary hypertriglyceridemia and its relationship with metabolic parameters., Methods and Results: Male patients with primary hypertriglyceridemia and without the metabolic syndrome (n=22) were compared with normotriglyceridemic individuals (n=25). Plasma adiponectin concentration was measured by standardised enzyme-linked immunosorbent assay. Body mass index, waist circumference, glucose, insulin and non-esterified fatty acid levels, lipoprotein profile, and CETP activity were evaluated. Adiponectin levels were significantly decreased in hypertriglyceridemic patients in comparison with normotriglyceridemic subjects (4292+/-1717 vs. 6939+/-3249 ng/ml, p<0.005, respectively). Adiponectin was negatively associated with glucose (r=-0.44, p<0.01), insulin (r=-0.37, p<0.01), HOMA (r=-0.40, p<0.01), triglycerides (r=-0.36, p<0.01), VLDL-C (r=-0.34, p<0.05), and CETP (r=-0.47, p<0.001). Positive and significant correlations were observed with QUICKI (r=0.49, p<0.001) and HDL-C (r=0.33, p<0.05). In the multiple linear regression analysis, considering waist circumference, QUICKI, Log-triglycerides, HDL-C, and CETP as independent variables, Log-adiponectin showed a positive correlation with QUICKI, with an r(2)=0.229 and p<0.001. Therefore, the independent variable QUICKI explained the 23% of the variance in Log-adiponectin concentration., Conclusions: We found low adiponectin levels in a population of primary hypertriglyceridemic men without the metabolic syndrome and an independent relationship between adiponectin concentration and insulin resistance. A reduction in insulin sensitivity and its impact on adiponectin concentration could be linked to high non-esterified fatty acid levels, increased triglyceride synthesis in the liver and impaired catabolism of triglyceride-rich lipoproteins.

In this work we apply a trajectory classification approach, aiming at identifying the role exerted by meteorology on air quality in the Naples urban area (Southern Italy). Towards that end, the HYSPLIT (HYbrid Single-Particle Lagrangian Integrated Trajectory) model was used; backward trajectories were calculated for the period 1995-2004 and classified, based on a combination of the k-means and PCA (Principal Component Analysis) approaches. The robustness of the classification was strengthened using an ensemble approach, based on back-trajectories calculated for different (in the horizontal and vertical directions) arrival points around Naples and different arrival time. Eight clusters were identified, and the effects on air quality were evaluated. We focused on ozone and PM10 concentration, and evaluated to what extent the prevailing meteorological conditions were associated with different levels and temporal profiles of these two pollutants. We found that ozone and PM10 profiles share some similarities since they both load high during anti-cyclonic, subsiding conditions, a common situation during the summer months. During these days stagnation and recirculation effects enhance the concentration of locally emitted air pollutant. We also found that ozone exhibits a marked seasonal cycle, whose maxima appears during the summer season, but the discrimination with respect to the area of origin indicated the presence of a second relative maxima, appearing early during the spring season. PM10 pollution levels often exceed the annual limit of 50 microg/m(3). The days associated with a significant exogenous contribution from the North African countries were identified.