Publications by authors named "Valerio Cervelli"

139 Publications

Neoadjuvant Treatment as a Risk Factor for Variation of Upper Limb Lymph Node Drainage During Axillary Reverse Mapping in Breast Cancer: A Prospective Observational Study.

Anticancer Res 2022 Aug;42(8):3879-3888

Breast Unit, Department of Surgical Science, PTV Policlinico "Tor Vergata" University, Rome, Italy.

Background/aim: The Axillary Reverse Mapping technique in breast cancer, was adopted in order to minimize the risk of upper limb lymphedema. Currently, there is only limited evidence available regarding its oncological safety. The aim of this study was to evaluate the presence of upper limb nodes in surgical specimens following axillary lymphadenectomy, and its relative predictive relevance.

Patients And Methods: All patients undergoing axillary lymphadenectomy were enrolled in the current prospective observational study. Indocyanine green was injected into the ipsilateral arm, followed by the standard axillary surgical procedure. Subsequently, the surgical specimens were examined in order to identify any resected upper limb nodes.

Results: Out of 22 patients, 5 (22.7%) exhibited fluorescent nodes in the surgical specimen. At univariate analysis, these patients presented statistically significant differences in terms of neoadjuvant treatment, estrogen receptor (ER), progesterone receptor (PR), Ki67 index and position of fluorescent lymph nodes (p=0.021, p=0.033, p=0.002, p=0.049 and p=0.001, respectively). At multivariate analysis, neoadjuvant chemotherapy and Ki67 index were associated with the risk of resecting fluorescent nodes during a standard lymphadenectomy (p=0.005 and p=0.018, respectively).

Conclusion: Axillary Reverse Mapping should be individually tailored for patients with advanced axillary breast cancer and those undergoing neoadjuvant treatment. Suspected metastases or upper limb nodes identified in unusual positions must always be resected.
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http://dx.doi.org/10.21873/anticanres.15881DOI Listing
August 2022

Adipose-Derived Stem/Stromal Cells in Kidney Transplantation: Status Quo and Future Perspectives.

Int J Mol Sci 2021 Oct 17;22(20). Epub 2021 Oct 17.

Plastic and Reconstructive Surgery, Department of Surgical Sciences, Tor Vergata University, 00133 Rome, Italy.

Kidney transplantation (KT) is the gold standard treatment of end-stage renal disease. Despite progressive advances in organ preservation, surgical technique, intensive care, and immunosuppression, long-term allograft survival has not significantly improved. Among the many peri-operative complications that can jeopardize transplant outcomes, ischemia-reperfusion injury (IRI) deserves special consideration as it is associated with delayed graft function, acute rejection, and premature transplant loss. Over the years, several strategies have been proposed to mitigate the impact of IRI and favor tolerance, with rather disappointing results. There is mounting evidence that adipose stem/stromal cells (ASCs) possess specific characteristics that could help prevent, reduce, or reverse IRI. Immunomodulating and tolerogenic properties have also been suggested, thus leading to the development of ASC-based prophylactic and therapeutic strategies in pre-clinical and clinical models of renal IRI and allograft rejection. ASCs are copious, easy to harvest, and readily expandable in culture. Furthermore, ASCs can secrete extracellular vesicles (EV) which may act as powerful mediators of tissue repair and tolerance. In the present review, we discuss the current knowledge on the mechanisms of action and therapeutic opportunities offered by ASCs and ASC-derived EVs in the KT setting. Most relevant pre-clinical and clinical studies as well as actual limitations and future perspective are highlighted.
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http://dx.doi.org/10.3390/ijms222011188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8538841PMC
October 2021

Extracellular Vesicles and Cancer Stem Cells in Tumor Progression: New Therapeutic Perspectives.

Int J Mol Sci 2021 Sep 29;22(19). Epub 2021 Sep 29.

Department of Biomedicine and Prevention, Anatomic Pathology Institute, University of Rome Tor Vergata, 00133 Roma, Italy.

Tumor burden is a complex microenvironment where different cell populations coexist and have intense cross-talk. Among them, a heterogeneous population of tumor cells with staminal features are grouped under the definition of cancer stem cells (CSCs). CSCs are also considered responsible for tumor progression, drug resistance, and disease relapse. Furthermore, CSCs secrete a wide variety of extracellular vesicles (EVs) with different cargos, including proteins, lipids, ssDNA, dsDNA, mRNA, siRNA, or miRNA. EVs are internalized by other cells, orienting the microenvironment toward a protumorigenic and prometastatic one. Given their importance in tumor growth and metastasis, EVs could be exploited as a new therapeutic target. The inhibition of biogenesis, release, or uptake of EVs could represent an efficacious strategy to impair the cross-talk between CSCs and other cells present in the tumor microenvironment. Moreover, natural or synthetic EVs could represent suitable carriers for drugs or bioactive molecules to target specific cell populations, including CSCs. This review will discuss the role of CSCs and EVs in tumor growth, progression, and metastasis and how they affect drug resistance and disease relapse. Furthermore, we will analyze the potential role of EVs as a target or vehicle of new therapies.
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http://dx.doi.org/10.3390/ijms221910572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8508599PMC
September 2021

Cartilage Remodeling in Nasal Tip Rhinoplasty Using "Lateral Crural Steal" and "Tongue in Groove" Strategies: A Randomized Controlled Trial.

J Craniofac Surg 2021 Sep 14. Epub 2021 Sep 14.

Plastic and Reconstructive Surgery at Department of Surgical Science, University "Tor Vergata", Rome, Italy.

Background: The authors present their experience using "Lateral Crural Steal" (LCS) and "Tongue in Groove" (TING) techniques in nasal tip remodeling.

Objectives: The paper aimed to evaluate the efficacy and safety of the use of LCS and TING in nasal tip remodeling for aesthetic improvement.

Methods: A randomized controlled trial was conducted. Thirty-five patients affected by low and boxy nasal tips were treated with LCS and TINGs (study group [SG]), comparing results with the control group (CG) (n = 30) treated with cartilage grafts. The preoperative analysis has been performed with an accurate clinical evaluation, a photographic assessment, and a computed tomography scan. Postoperative follow-up took place at 1, 2, and 4 weeks, 3, 6, and 12 months, and then annually.

Results: A total of 82.9% (n = 29) of SG patients showed excellent cosmetic and functional results after 1 year compared with the CG patients, who showed the same results in only 40% (n = 12) of cases. The tip projection maintenance and contour restoring in the SG were higher than that in the CG (P < 0.0001 versus CG).

Conclusions: The use of LCS and TING was safe and effective in this series of cases performed.
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http://dx.doi.org/10.1097/SCS.0000000000008083DOI Listing
September 2021

Mesenchymal Stem Cells in Adipose Tissue and Extracellular Vesicles in Ovarian Cancer Patients: A Bridge toward Metastatic Diffusion or a New Therapeutic Opportunity?

Cells 2021 08 18;10(8). Epub 2021 Aug 18.

Plastic and Reconstructive Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, 00133 Rome, Italy.

Ovarian cancer is one of the deadliest malignancies among women. Approximately 75% of the patients with ovarian cancer are diagnosed with advanced disease that already has metastasis, particularly to the omentum. The omentum constitutes the ideal soil for ovarian cancer metastasis due to a complex intraperitoneal milieu that favors and supports the whole metastatic process. Adipose-derived stem/stromal cells (ADSCs) are part of this microenvironment and foster tumor progression via sustained paracrine secretion, including extracellular vesicles (EVs). Nonetheless, the preferential relationship between ADSCs, ADSC-derived EVs, and ovarian cancer cells could be exploited to use ADSCs and EVs as a vehicle for anti-cancer therapies. This review will analyze the strict relations between tumor progression, metastatic disease, and adipose tissue with its staminal components. In addition, we will describe the crosstalk and biologic relationship between ADSCs and tumor cells, the role of EVs in intercellular communication, the establishment of drug resistance, metastatic capacity, and ovarian cancer progression. We will analyze the new therapeutic opportunities in treating ovarian cancer offered by ADSCs and EVs as a vehicle for therapeutic molecules to target precisely tumor cells and limit the systemic adverse effects. Finally, we will discuss the limitations of these therapeutic approaches.
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http://dx.doi.org/10.3390/cells10082117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8392703PMC
August 2021

PEEK Implants: An Innovative Solution for Facial Aesthetic Surgery.

Case Rep Surg 2021 5;2021:5518433. Epub 2021 Aug 5.

Department of Surgical Sciences, University "Tor Vergata", Rome, Italy.

The authors present a case report showing their experience with the use of PolyEtherEtherKetone (PEEK) implants as an innovative solution for the skeleton and soft tissues' reshaping in facial aesthetic plastic surgery. This technique offers the surgeon a reliable and effective way to answer patients' request of increasing volume and reshaping the malar area. A fifty-year-old patient complaining about hypoplasia of the malar area, after undergoing three operations of silicon implants' placement and replacement, was still unsatisfied about the symmetry and feeling through the skin of the lower lid, the rim of the prostheses. The authors suggested the use of bone-anchored PEEK implants, to increase the volume and reshape the malar area by a skeleton and soft tissue camouflage. The treatment was planned and previewed on the preop 3-dimensional CT scans for the customization of the implants. Although no cases are reported in international literature on the use of this material in facial aesthetic surgery, this technique seems to offer a safe and effective solution for the treatment of patients asking to increase and modify the shape of their malar area. Custom made PEEK implants are already used in craniofacial reconstructive bony surgery with good results, and 3D CT scan planning is widely used in these cases. No complications were reported in the case reported and the outcomes seem to the authors and to the patient being, finally, satisfactory.
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http://dx.doi.org/10.1155/2021/5518433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8363444PMC
August 2021

CD146 expression regulates osteochondrogenic differentiation of human adipose-derived stem cells.

J Cell Physiol 2022 01 20;237(1):589-602. Epub 2021 Jul 20.

Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.

Tissue engineering aims to develop innovative approaches to repair tissue defects. The use of adipose-derived stem cells (ASCs) in tissue regeneration was extensively investigated for osteochondrogenesis. Among the ASC population, ASCs expressing the CD146 were demonstrated to be multipotent and considered as perivascular stem cells, although the functional role of CD146 expression in these cells remains unclear. Herein, we investigated the influence of CD146 expression on osteochondrogenic differentiation of ASCs. Our results showed that, in two-dimensional culture systems, sorted CD146 ASCs proliferated less and displayed higher adipogenic and chondrogenic potential than CD146 ASCs. The latter demonstrated a higher osteogenic capacity. Besides this, CD146 ASCs in three-dimensional Matrigel/endothelial growth medium (EGM) cultures showed the highest angiogenic capability. When cultured in three-dimensional collagen scaffolds, CD146 ASCs showed a spontaneous chondrogenic differentiation, further enhanced by the EGM medium's addition. Finally, CD146 ASCs seeded on hexafluoroisopropanol silk scaffolds displayed a greater spontaneous osteogenetic capacity. Altogether, these findings demonstrated a functional and relevant influence of CD146 expression in ASC properties and osteochondrogenic commitment. Exploiting the combination of specific differentiation properties of ASC subpopulations and appropriate culture systems could represent a promising strategy to improve the efficacy of new regenerative therapies.
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http://dx.doi.org/10.1002/jcp.30506DOI Listing
January 2022

Endothelial Progenitor Cell-Derived Extracellular Vesicles: Potential Therapeutic Application in Tissue Repair and Regeneration.

Int J Mol Sci 2021 Jun 15;22(12). Epub 2021 Jun 15.

Department of Biomedicine and Prevention, Anatomic Pathology Institute, University of Rome Tor Vergata, 00133 Rome, Italy.

Recently, many studies investigated the role of a specific type of stem cell named the endothelial progenitor cell (EPC) in tissue regeneration and repair. EPCs represent a heterogeneous population of mononuclear cells resident in the adult bone marrow. EPCs can migrate and differentiate in injured sites or act in a paracrine way. Among the EPCs' secretome, extracellular vesicles (EVs) gained relevance due to their possible use for cell-free biological therapy. They are more biocompatible, less immunogenic, and present a lower oncological risk compared to cell-based options. EVs can efficiently pass the pulmonary filter and deliver to target tissues different molecules, such as micro-RNA, growth factors, cytokines, chemokines, and non-coding RNAs. Their effects are often analogous to their cellular counterparts, and EPC-derived EVs have been tested in vitro and on animal models to treat several medical conditions, including ischemic stroke, myocardial infarction, diabetes, and acute kidney injury. EPC-derived EVs have also been studied for bone, brain, and lung regeneration and as carriers for drug delivery. This review will discuss the pre-clinical evidence regarding EPC-derived EVs in the different disease models and regenerative settings. Moreover, we will discuss the translation of their use into clinical practice and the possible limitations of this process.
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http://dx.doi.org/10.3390/ijms22126375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232313PMC
June 2021

Malignant Skin Cancer Excision in Combined Therapy with Electro-Chemotherapy and Dermal Substitute.

Curr Oncol 2021 05 5;28(3):1718-1727. Epub 2021 May 5.

Surgical Science Department, Medical School, University "Tor Vergata", 00133 Rome, Italy.

Squamous cell carcinoma (SCC) is the second most common malignancy skin cancer. It is characterized by abnormal, accelerated growth of squamous cells (SCs). SCC occurs when DNA damage from exposure to ultraviolet radiation or other damaging agents trigger abnormal changes in the SCs, presenting as painless lesions on areas of high sun exposure, such as the dorsum of the hand and upper extremity. For most skin SCC, the surgical excision alone is standard practice. However, recent efforts in new treatment strategies have involved around adjuvant or concomitant electrochemotherapy (ECT). ECT is a non-thermal tumor ablation modality, safe and effective on any type of solid tumor. An 87-year-old patient affected by hand SCC with invasion of deep structures including tendons was treated with neoadjuvant intra-tumoral ECT sessions followed by a selective surgical removal and reconstruction of the substance loss with collagen dermal template (CDT). Two neoadjuvant intra-tumoral ECT procedures, at distance of 3 months, with the aim to reduce the tumor size before a selective surgery, were performed. This study shows that combined surgical selective excision with ECT and CDT is a valid technique for the extended-deep dorsal hand tumor lesions reconstruction.
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http://dx.doi.org/10.3390/curroncol28030160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161833PMC
May 2021

Medial Thigh Contouring After Massive Weight Loss: The Liposuction-Assisted Medial Thigh Lift (LAMeT).

J Cutan Aesthet Surg 2020 Oct-Dec;13(4):305-313

Department of Plastic and Reconstructive Surgery at the University of Rome "Tor Vergata".

Introduction: Following massive weight loss (MWL), medial contouring of the thigh is frequently requested to improve the appearance and function. Thigh lifting can be associated with significant complications if the medial thigh excess is removed en bloc. In this article, we describe the Liposuction-Assisted Medial Thigh Lift (LAMeT) and evaluate the outcomes and complications in a retrospective cohort study.

Materials And Methods: A total of 54 females aged between 25 and 61 years with Grade 2 or 3 of thigh deformity on Pittsburgh Rating Scale (PRS) underwent medial thigh reduction. Vertical thigh lift with fascia suspension was performed in 25 patients with third degree of ptosis on PRS, horizontal thigh lift with fascia suspension was performed in 3 patients with second degree on PRS, LAMeT was performed in 26 patients with second and third degree on PRS.

Results: Complications were observed in 35.7% of the patients that underwent the standard technique and in 3.8% patients that underwent the LAMeT. The most frequent complication was seroma. Hospital stay was significantly lower in the LAMeT group.

Conclusions: Medial thigh lift is a safe and satisfying procedure because it provides aesthetic improvement in massive weight loss patients. The complication rate is higher when skin excess and laxity are removed en bloc because the resection of the excess tissue is poorly selective. The LAMeT preserves lymphatic and blood vessels and allows a more anatomical resection of the excess skin. Thus, the incidence of postoperative complications is lower and the patients heal faster.
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http://dx.doi.org/10.4103/JCAS.JCAS_130_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061643PMC
April 2021

Silver Sulfadiazine Eradicates Antibiotic-Tolerant and Biofilms in Patients with Infected Diabetic Foot Ulcers.

J Clin Med 2020 Nov 25;9(12). Epub 2020 Nov 25.

Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy.

Infections are among the most frequent and challenging events in diabetic foot ulcers (DFUs). Pathogenic bacteria growing in biofilms within host tissue are highly tolerant to environmental and chemical agents, including antibiotics. The present study was aimed at assessing the use of silver sulfadiazine (SSD) for wound healing and infection control in 16 patients with DFUs harboring biofilm-growing and . All patients received a treatment based on a dressing protocol including disinfection, cleansing, application of SSD, and application of nonadherent gauze, followed by sterile gauze and tibio-breech bandage, in preparation for toilet surgery after 30 days of treatment. Clinical parameters were analyzed by the T.I.M.E. classification system. In addition, the activity of SSD against biofilm-growing and isolates was assessed in vitro. A total of 16 patients with and infected DFUs were included in the study. Clinical data showed a statistically significant ( < 0.002) improvement of patients' DFUs after 30 days of treatment with SSD with significant amelioration of all the parameters analyzed. Notably, after 30 days of treatment, resolution of infection was observed in all DFUs. In vitro analysis showed that both and isolates developed complex and highly structured biofilms. Antibiotic susceptibility profiles indicated that biofilm cultures were significantly ( ≤ 0.002) more tolerant to all tested antimicrobials than their planktonic counterparts. However, SSD was found to be effective against fully developed biofilms of both and at concentrations below those normally used in clinical preparations (10 mg/mL). These results strongly suggest that the topical administration of SSD may represent an effective alternative to conventional antibiotics for the successful treatment of DFUs infected by biofilm-growing and .
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http://dx.doi.org/10.3390/jcm9123807DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7760944PMC
November 2020

Autologous Micrografts from Scalp Tissue: Trichoscopic and Long-Term Clinical Evaluation in Male and Female Androgenetic Alopecia.

Biomed Res Int 2020 27;2020:7397162. Epub 2020 Jan 27.

Institute of Dermatology, F. Policlinico Gemelli IRCSS, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy.

Tissue engineering in hair regrowth aims to develop innovative and not-invasive procedures to advance the hair regrowth. A placebo-controlled, randomized, evaluator-blinded, half-head group study to compare hair regrowth with micrografts containing human hair follicle mesenchymal stem cells (HF-MSCs) vs. placebo was reported. After 58 weeks, 27 patients displayed in the targeted area an increase of hair count and hair density, respectively, of 18.0 hairs per 0.65 cm and 23.3 hairs per cm compared with baseline, while the control area displayed a mean decrease of 1.1 hairs per 0.65 cm and 0.7 hairs per cm (control vs. treatment: < 0.0001). After 26 months, 6 patients revealed dynamic hair loss and were retreated. More broad controlled examinations are required. HF-MSCs contained in micrografts may represent a safe and viable treatment alternative against hair loss.
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http://dx.doi.org/10.1155/2020/7397162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007958PMC
November 2020

Use of the Keystone Perforator Island Flap in the treatment of chronic lower extremity wounds complicated by osteomyelitis.

Injury 2020 Mar 10;51(3):744-749. Epub 2019 Dec 10.

Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Italy; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Department of Plastic and Reconstructive Surgery, Northumbria Healthcare NHS Foundation Trust, Northumberland, United Kingdom. Electronic address:

Introduction: Reconstruction of chronic lower extremity wounds can be especially challenging when these wounds are complicated by osteomyelitis. They require the joint expertise of plastic and orthopaedic surgeons.

Methods: We report our experience using the Keystone Perforator Island Flap following wound and bone debridement as a valuable surgical tool for coverage of complex wounds with bone infection.

Results: Twelve patients underwent similar procedures with overall good outcomes, although two patients experienced a complication, specifically partial flap necrosis and wound dehiscence subsequent to recurrent osteomyelitis. We also reviewed the underlying physiological mechanisms of employing the Keystone flap in order to demonstrate its advantages and efficacy.

Conclusion: Our results confirm that the Keystone flap can be a safe, reliable and effective method for coverage of soft tissue defects and the preservation of bone integrity in the management of patients with chronic osteomyelitis.
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http://dx.doi.org/10.1016/j.injury.2019.12.010DOI Listing
March 2020

Adipose-Derived Stem Cells in Bone Tissue Engineering: Useful Tools with New Applications.

Stem Cells Int 2019 6;2019:3673857. Epub 2019 Nov 6.

Plastic and Reconstructive Surgery, Department of Surgical Sciences, University of Rome - "Tor Vergata", Italy.

Adipose stem cells (ASCs) are a crucial element in bone tissue engineering (BTE). They are easy to harvest and isolate, and they are available in significative quantities, thus offering a feasible and valid alternative to other sources of mesenchymal stem cells (MSCs), like bone marrow. Together with an advantageous proliferative and differentiative profile, they also offer a high paracrine activity through the secretion of several bioactive molecules (such as growth factors and miRNAs) via a sustained exosomal release which can exert efficient conditioning on the surrounding microenvironment. BTE relies on three key elements: (1) scaffold, (2) osteoprogenitor cells, and (3) bioactive factors. These elements have been thoroughly investigated over the years. The use of ASCs has offered significative new advancements in the efficacy of each of these elements. Notably, the phenotypic study of ASCs allowed discovering cell subpopulations, which have enhanced osteogenic and vasculogenic capacity. ASCs favored a better vascularization and integration of the scaffolds, while improvements in scaffolds' materials and design tried to exploit the osteogenic features of ASCs, thus reducing the need for external bioactive factors. At the same time, ASCs proved to be an incredible source of bioactive, proosteogenic factors that are released through their abundant exosome secretion. ASC exosomes can exert significant paracrine effects in the surroundings, even in the absence of the primary cells. These paracrine signals recruit progenitor cells from the host tissues and enhance regeneration. In this review, we will focus on the recent discoveries which have involved the use of ASCs in BTE. In particular, we are going to analyze the different ASCs' subpopulations, the interaction between ASCs and scaffolds, and the bioactive factors which are secreted by ASCs or can induce their osteogenic commitment. All these advancements are ultimately intended for a faster translational and clinical application of BTE.
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http://dx.doi.org/10.1155/2019/3673857DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875209PMC
November 2019

Mastoplasty after Massive Weight Loss: Redefinition and Stabilization of the Breast Mound with Submuscular Autoprosthesis.

J Cutan Aesthet Surg 2019 Jul-Sep;12(3):164-173

Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata," Rome, Italy.

Context: After massive weight loss, breast changes dramatically becoming ptotic, flat in the upper pole, with significant skin excess. After mastoplasty, often ptosis can recur and the upper pole can lose its fullness again. The technique described in this study treats breast deformities ensuring stable results and avoiding ptosis recurrence.

Aim: To analyze a new modality of breast reshaping after massive weight loss, evaluating outcomes and complications as well as patient satisfaction.

Settings And Design: This was a case series.

Materials And Methods: Fifteen patients (all women, average age, 43.1 years) with bilateral breast ptosis after massive weight loss underwent mastoplasty: the technique included the creation of an inferior pedicle flap that was placed as a prosthesis under the pectoralis muscle and a superomedial pedicle flap containing the nipple-areola complex (NAC). Patients were followed up for at least 6 months, reporting any complications, and measuring the jugulum-NAC distance. Patients' satisfaction was also reported.

Statistical Analysis Used: Nil.

Results: All patients were extremely satisfied with the breast volume, shape, symmetry, and ptosis correction. The new mammary contour and the distance between the jugular fossa and the nipple were stable during the follow-up and the upper pole maintained its fullness. No major complications were reported.

Conclusion: Mastoplasty with submuscular autoprosthesis proved to be a safe and effective technique to treat breast deformities after massive weight loss because removed redundant tissue repositioned the NAC and filled the upper pole with stable results over time. A similar technique has not been described yet.
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http://dx.doi.org/10.4103/JCAS.JCAS_48_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785963PMC
October 2019

Wound Healing: In Vitro and In Vivo Evaluation of a Bio-Functionalized Scaffold Based on Hyaluronic Acid and Platelet-Rich Plasma in Chronic Ulcers.

J Clin Med 2019 Sep 18;8(9). Epub 2019 Sep 18.

Department of Surgical Science, University of Rome Tor Vergata, Rome 00133, Italy.

Chronic ulcers are characterized by loss of substance without a normal tendency towards spontaneous healing. The Wound Bed Preparation Guideline advises that after diagnosis, the expert should correct the biological state of the ulcer micro-environment based on TIME principles (Tissue, Infection, Moisture balance, Epidermal). There are many ways to treat such ulcers, for example through use of advanced dressings, negative pressure, surgical toilets, dermal substitutes, autologous skin grafting, and free or local flaps. In vitro and in vivo pre-clinical models hold widely acknowledged potential yet complex limitations. Tissue bioengineering could be an ideal approach to foster innovative strategies in wound healing. Our observational study reports on an in vitro and in vivo evaluation of a bio-functionalized scaffold composed of platelet-rich plasma (PRP) and hyaluronic acid (HA) used in 182 patients affected by chronic ulcers (diabetic and vascular), comparing the results with a control group of 182 patients treated with traditional dressings (HA alone). After 30 days the patients who had undergone the combined treatment (PRP + HA), showed 96.8% ± 1.5% re-epithelialization, as compared to 78.4% ± 4.4% in the control group (HA only). Within 80 days, they had 98.4% ± 1.3% re-epithelialization as compared to 87.8% ± 4.1% in the control group (HA only; < 0.05). No local recurrence was observed during the follow-up period. PRP + HA treatment showed stronger regenerative potential in terms of epidermal proliferation and dermal renewal compared with HA alone.
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http://dx.doi.org/10.3390/jcm8091486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780765PMC
September 2019

Incidence and Prevention of Cicatricial Scleral Show in the Subciliary Access in Patients With Orbital Fractures.

J Craniofac Surg 2019 Sep;30(6):1782-1786

Professor and Chief at Plastic and Reconstructive Surgery Department, University of Rome "Tor Vergata.

: Orbital fractures can involve floor, lateral and medial wall. Surgical access depends on fracture's severity, ocular trauma and patient's age. Subciliary, subtarsal, infraorbital or transconjunctival approaches are the main access to the orbit. Surgical interventions in the eyelid may induce scar tissue formation and, consequently, the cicatricial scleral show. The authors present a study with the aim to evaluate the incidence of cicatricial scleral show in patients treated for orbital fractures with or without simultaneous Tarsal Sling Canthopexy in our Plastic Surgery Department.

Methods: The authors evaluated 50 patients divided in 2 groups: Group 1, subciliary approach and reconstruction of orbital floor without simultaneous Canthopexy Tarsal Sling; Group 2: reconstruction of orbital floor through subciliary approach with simultaneous Canthopexy Tarsal Sling.

Results: Patients, who underwent Canthopexy Tarsal Sling, did not have any scleral show. Instead patients, who did not undergo this prevention technique, had scleral show even if a minor entity.

Discussion: Although there was no muscle or skin removed, in our procedure, but only cutaneous incision, scleral show can appear as a complication. Canthal ligament and tarsus' elasticity influence the incidence of post-surgical scleral show, which is more frequent in elderly patients. Therefore, the authors suggest to prevent it routinely with Tarsal Sling Canthopexy.

Conclusion: Canthopexy Tarsal Sling is procedure that stretch tarsal structure and it may help to prevent scleral show.
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http://dx.doi.org/10.1097/SCS.0000000000005461DOI Listing
September 2019

The Role of Breast Cancer Stem Cells as a Prognostic Marker and a Target to Improve the Efficacy of Breast Cancer Therapy.

Cancers (Basel) 2019 Jul 20;11(7). Epub 2019 Jul 20.

Anatomic Pathology Institute, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Roma, Italy.

Breast cancer is the most common form of tumor in women and the leading cause of cancer-related mortality. Even though the major cellular burden in breast cancer is constituted by the so-called bulk tumor cells, another cell subpopulation named cancer stem cells (CSCs) has been identified. The latter have stem features, a self-renewal capacity, and the ability to regenerate the bulk tumor cells. CSCs have been described in several cancer types but breast cancer stem cells (BCSCs) were among the first to be identified and characterized. Therefore, many efforts have been put into the phenotypic characterization of BCSCs and the study of their potential as prognostic indicators and therapeutic targets. Many dysregulated pathways in BCSCs are involved in the epithelial-mesenchymal transition (EMT) and are found up-regulated in circulating tumor cells (CTCs), another important cancer cell subpopulation, that shed into the vasculature and disseminate along the body to give metastases. Conventional therapies fail at eliminating BCSCs because of their quiescent state that gives them therapy resistance. Based on this evidence, preclinical studies and clinical trials have tried to establish novel therapeutic regimens aiming to eradicate BCSCs. Markers useful for BCSC identification could also be possible therapeutic methods against BCSCs. New approaches in drug delivery combined with gene targeting, immunomodulatory, and cell-based therapies could be promising tools for developing effective CSC-targeted drugs against breast cancer.
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http://dx.doi.org/10.3390/cancers11071021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678191PMC
July 2019

Medial Thigh Contouring in Massive Weight Loss: A Liposuction-Assisted Medial Thigh Lift.

World J Plast Surg 2019 May;8(2):171-180

Department of Plastic, Reconstructive and Regenerative Surgery, University of Rome "Tor Vergata", Italy.

Background: Thigh's lifting can be associated with significant complications, if the medial thigh excess is removed en bloc. In this study, the liposuction-assisted medial thigh's lift (LAMeT) procedure, outcomes and complications were assessed.

Methods: Twenty four females between 25 and 61 years with grade 2 or 3 on Pittsburgh Rating Scale (PRS) treated with medial thigh's reduction were enrolled. Medial thigh's reduction was performed in three different procedures of vertical, horizontal and LAMeT. Vertical thigh's lift with fascia suspension was conducted in 13 patients with grade 3 of ptosis on PRS; horizontal thigh's lift with fascia suspension was undertaken in 3 patients with grade 2 on PRS; vertical and horizontal thigh's lift considered as control group was described as excision-only group; and LAMeT was performed in 8 patients with grade 2 and 3 on PRS.

Results: Complications were observed in 62.5% of patients who underwent vertical or horizontal thigh's lift with fascia suspension and in 16.7% who experienced the LAMeT without fascia suspension. The most frequent complication was seroma. Hospital stay was significantly lower in the LAMeT.

Conclusion: Medial thigh's lift is a safe and satisfying procedure because it provides aesthetic improvement in massive weight loss patients. The complication rate is higher when skin excess and laxity are removed en bloc, as the resection of excess tissue is poorly selective. The LAMeT preserves lymphatic and blood vessels and allows a more anatomical resection of the excess skin. Thus postoperative complications incidence is lower and the patient heals faster.
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http://dx.doi.org/10.29252/wjps.8.2.171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6620815PMC
May 2019

Adipose-Derived Stem Cells in Cancer Progression: New Perspectives and Opportunities.

Int J Mol Sci 2019 Jul 4;20(13). Epub 2019 Jul 4.

Anatomic Pathology Institute, Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy.

Growing importance has been attributed to interactions between tumors, the stromal microenvironment and adult mesenchymal stem cells. Adipose-derived stem cells (ASCs) are routinely employed in regenerative medicine and in autologous fat transfer procedures. To date, clinical trials have failed to demonstrate the potential pro-oncogenic role of ASC enrichment. Nevertheless, some pre-clinical studies from in vitro and in vivo models have suggested that ASCs act as a potential tumor promoter for different cancer cell types, and support tumor progression and invasiveness through the activation of several intracellular signals. Interaction with the tumor microenvironment and extracellular matrix remodeling, the exosomal release of pro-oncogenic factors as well as the induction of epithelial-mesenchymal transitions are the most investigated mechanisms. Moreover, ASCs have also demonstrated an elective tumor homing capacity and this tumor-targeting capacity makes them a suitable carrier for anti-cancer drug delivery. New genetic and applied nanotechnologies may help to design promising anti-cancer cell-based approaches through the release of loaded intracellular nanoparticles. These new anti-cancer therapies can more effectively target tumor cells, reaching higher local concentrations even in pharmacological sanctuaries, and thus minimizing systemic adverse drug effects. The potential interplay between ASCs and tumors and potential ASCs-based therapeutic approaches are discussed.
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http://dx.doi.org/10.3390/ijms20133296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6651808PMC
July 2019

Vasculogenic Chronic Ulcer: Tissue Regeneration with an Innovative Dermal Substitute.

J Clin Med 2019 Apr 17;8(4). Epub 2019 Apr 17.

Department of Surgical Science, Plastic and Reconstructive Surgery Unit, University of Rome Tor Vergata, 00133 Rome, Italy.

The healing of venous and arterial ulcers is slow, and in some cases, they may not heal at all. This study aims to demonstrate the clinical advantage of Nevelia, an innovative collagen dermal template substitute (DS) in venous and arterial chronic ulcers treatment. 35 patients affected by chronic vascular ulcers with a mean area of 35.1 ± 31.8 cm were treated with DS followed by autologous dermal epidermal graft (DEG). Follow-up was performed at 7-14-21 and 28 days after DS implant and 7-14-21 and 28 days after DEG. At 28 days after DEG, the mean values of Manchester Scar Scale was of 1.8 ± 0.7 for skin color, 1.6 ± 0.7 for skin contour, 1.7 ± 0.7 for distortion, and 1.7 ± 0.7 for skin texture, whereas skin was matte in 27 patients (77%) and shiny in the remaining eight cases (23%). Histological findings correlate with the clinical result showing a regenerated skin with reactive epidermal hyperplasia and dermal granulation tissue after two weeks (T1), and after three weeks (T2) a re-epithelialization and a formed new tissue architecture analogue to normal skin physiology. These data suggest that Nevelia could be useful to treat chronic venous and arterial ulcers.
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http://dx.doi.org/10.3390/jcm8040525DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518262PMC
April 2019

Platelet-Rich Plasma and Micrografts Enriched with Autologous Human Follicle Mesenchymal Stem Cells Improve Hair Re-Growth in Androgenetic Alopecia. Biomolecular Pathway Analysis and Clinical Evaluation.

Biomedicines 2019 Apr 8;7(2). Epub 2019 Apr 8.

Institute of Dermatology, F. Policlinico Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.

Platelet rich plasma (PRP) and Micrografts containing human follicle mesenchymal stem cells (HF-MSCs) were tried as a potential treatment for androgenetic alopecia (AGA). However, little to no work has yet to be seen wherein the bio-molecular pathway of HF-MSCs or PRP treatments were analyzed. The aims of this work are to report the clinical effectiveness of HF-MSCs and platelet-rich plasma evaluating and reviewing the most updated information related to the bio-molecular pathway. Twenty-one patients were treated with HF-MSCs injections and 57 patients were treated with A-PRP. The Wnt pathway and Platelet derived-growth factors effects were analyzed. 23 weeks after the last treatment with mean hair thickness increments (29 ± 5.0%) over baseline values for the targeted area. 12 weeks after the last injection with A-PRP mean hair count and hair density (31 ± 2%) increases significantly over baseline values. The increment of Wnt signaling in Dermal Papilla Cells evidently is one of the principal factors that enhances hair growth. Signaling from mesenchymal stem cells and platelet derived growth factors positively influences hair growth through cellular proliferation to prolong the anagen phase (FGF-7), inducing cell growth (ERK activation), stimulating hair follicle development (β-catenin), and suppressing apoptotic cues (Bcl-2 release and Akt activation).
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http://dx.doi.org/10.3390/biomedicines7020027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631937PMC
April 2019

Fluid Cartilage as New Autologous Biomaterial in the Treatment of Minor Nose Defects: Clinical and Microscopic Difference Amongst Diced, Crushed, and Fluid Cartilage.

Materials (Basel) 2019 Mar 31;12(7). Epub 2019 Mar 31.

Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Rome 00133, Italy.

Developing cartilage constructs with injectability, appropriate matrix composition, and persistent cartilaginous phenotype remains an enduring challenge in cartilage repair. Fourteen patients with minor contour deformity were treated with fluid cartilage filler gently injected as autologous fluid graft in deep planes of defect of the nose that were close to the bone or the cartilage. A computerized tomographic scan control was performed after 12 months. Pearson's Chi-square test was used to investigate differences in cartilage density between native and newly formed cartilages. The endpoints were the possibility of using fluid cartilage as filler with aesthetic and functional improvement and versatility. Patients were followed up for two years. The constructs of fluid cartilage graft that were injected in the deep plane resulted in a persistent cartilage tissue with appropriate morphology, adequate central nutritional perfusion without central necrosis or ossification, and further augmented nasal dorsum without obvious contraction and deformation. This report demonstrated that fluid cartilage grafts are useful for cartilage regeneration in patients with outcomes of rhinoplasty, internal nasal valve collapse, and minor congenital nose aesthetics deformity.
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http://dx.doi.org/10.3390/ma12071062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6479609PMC
March 2019

Gentle Is Better: The Original "Gentle Technique" for Fat Placement in Breast Lipofilling.

J Cutan Aesthet Surg 2018 Jul-Sep;11(3):120-126

Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata," Rome, Italy.

Context: Breast lipofilling usually involves three different stages (harvesting, processing, and placement), and in each of these phases, adipocyte cells can be damaged. Our technique of fat placement is quite different from the others as we focus our attention on the last stage of fat graft procedure, which could explain the better results in graft survival.

Aims: Our method is focused on eliminating any unnecessary manipulation of the graft so as to optimize graft retention and clinical outcomes: Controlled movement and slow rate of fat injection are the cornerstone of our technique and guarantee a nontraumatic fat transfer and a greater survival rate of adipocytes.

Settings And Design: This was a retrospective cohort study.

Materials And Methods: Of 120 patients (average age 41,5 years) affected by breast soft tissue defects, 60 were managed with the lipofilling procedure using fat graft injected by "Gentle technique." To establish the effects of the injection's procedure, we compared the results obtained in fat graft maintenance with a control group made up of 60 patients, treated with fat graft injection according to Coleman procedure.

Statistical Analysis Used: Values are expressed as mean plus standard error and analyzed using Student's test.

Results: In patients treated with Gentle technique, we observed a 60.5% + 12.5% maintenance of contour restoring and three-dimensional volume after 1 year ( < 0.0001 vs. control group); we compared the results obtained with only 39% + 4.4% of the control group treated with fat graft injected according to Coleman.

Conclusions: Controlled 26 movement and slow rate of fat injection are the cornerstone of our technique and guarantee a nontraumatic fat transfer and a greater 27 survival rate of adipocytes.
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http://dx.doi.org/10.4103/JCAS.JCAS_24_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6243823PMC
December 2018

Hump-like giant desmoid tumor of the chest: a postresectional reconstruction challenge.

AME Case Rep 2017 17;1. Epub 2017 Nov 17.

Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.

Desmoid tumors (DT) are rare neoplasms with unknown etiology arising from musculoaponeurotic structures. Chest wall localization is uncommon and has been associated with high recurrence rate unless radical resection with negative margins is carried out. Postresectional reconstruction can be challenging in presence of giant lesions and might require adoption of complex reconstruction methods including use of well vascularized muscle flaps. We present a case of giant hump-like recurrent chest wall DT, which was radically resected following placement of multiple subcutaneous silicon tissue expanders, to gain redundant skin, which eventually allowed in conjunction with two transposition, cutaneous-adipose flaps, harvested from the upper gluteal region, an optimal reconstruction of the large postresectional defect.
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http://dx.doi.org/10.21037/acr.2017.11.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6155693PMC
November 2017

Arm Contouring After Massive Weight Loss: Liposuction-Assisted Brachioplasty Versus Standard Technique.

J Cutan Aesthet Surg 2018 Apr-Jun;11(2):73-78

Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Rome, Italy.

Massive weight loss (MWL) brachioplasty is frequently requested for the improvement of the appearance and function of arms. Despite its diffusion, this procedure can be associated with significant complications. Liposuction-assisted brachioplasty (LAB) preserves the vascular, nervous, and lymphatic network and reduces the incidence of postoperative complications. This retrospective cohort study is aimed at analyzing two different modalities of arm contouring after MWL by evaluating the outcomes and complications. Of 31 patients (all females, average age 43.5 years), 20 were managed with standard brachioplasty represented by a swallowtail scar and monobloc resection and 11 with brachioplasty combined with aggressive liposuction. Evaluated parameters included age, body mass index, method of weight loss, and complications rate. No statistical analysis was used. Major postoperative complications (reoperation, bleeding, or thromboembolism) were not reported in both groups. The incidence of minor complications (wound separation, wound infection, and seroma) was globally 42%; the incidence of complications was significantly lower in the LAB group (9% vs. 60%). The incidence of hypertrophic scarring or keloid was higher in the control group (55% vs. 18%). Most patients were satisfied after surgery: in the LAB group, 81.8% of the patients expressed a high degree of satisfaction and 18.2% a good degree of satisfaction after 4 months of follow-up. In our experience, the LAB should be preferred in MWL patients because it has a lower rate of complications and a faster recovery than the standard technique. Proper execution requires considerable technical skill and experience.
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http://dx.doi.org/10.4103/JCAS.JCAS_102_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128150PMC
September 2018

Adipose-derived stem cell-mediated paclitaxel delivery inhibits breast cancer growth.

PLoS One 2018 7;13(9):e0203426. Epub 2018 Sep 7.

Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.

Breast cancer represents the main malignancy in women and autologous fat grafting is a diffuse procedure in the management of post-surgical breast defects causing patients' psychosocial problems, with high costs for the public health. Recently, beneficial effects of fat grafting during post-surgical breast reconstruction have been amplified from the enrichment with human adipose-derived stem cells (ASCs) present in the stromal vascular fraction (SVF) of adult adipose tissue isolated during intraoperatory procedures. The major concern about the ASC enrichment during post-surgery breast reconstruction depends on their potential ability to release growth factors and hormones that can promote proliferation of residual or quiescent cancer cells, with the risk of de novo cancer development or recurrence. The recent description that adult stem cells primed in vitro may be vehicle for anti-cancer drug delivery offers a new vision concerning the role of ASCs in breast reconstruction after cancer surgery. Paclitaxel (PTX) is a chemotherapeutic agent acting as a microtubule-stabilizing drug inhibiting cancer cell mitotic activity. We optimized PTX loading and release in cultured ASCs and then analyzed the effects of PTX-loaded ASCs and their conditioned medium on CG5 breast cancer survival, proliferation and apoptosis in vitro, and inCG5 xenograft in vivo. We documented that ASCs can uptake and release PTX in vitro, with slight cytotoxic effects. Interestingly, PTX-loaded ASCs in co-culture, as well as conditioned medium alone, inhibited CG5 cell proliferation and survival in vitro and xenograft tumor growth in vivo. The antitumor effect of PTX-loaded ASCs may offer a new perspective concerning the use of ASCs during breast reconstruction becoming an additional local preventive chemotherapeutic agent against tumor recurrence. However, further experiments in vitro and in vivo are needed to collect more evidence confirming the efficacy and safety in cancer patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203426PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128546PMC
February 2019

Correction of cicatricial ectropion using non-ablative fractional laser resurfacing.

Lasers Med Sci 2019 Feb 28;34(1):79-84. Epub 2018 Jul 28.

Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Tor Vergata, Rome, Italy.

Lower eyelid malposition is the most frequent and severe complication after blepharoplasty and ectropion is observed in 1% of patients after surgery. This article describes a non-surgical method to treat lower eyelid cicatricial ectropion using a non-ablative laser as an alternative to surgery. Twelve patients with unilateral or bilateral lower lid cicatricial ectropion, following surgery or trauma, underwent laser therapy from 2012 to 2016. Laser therapy was performed with a fractional non-ablative laser emitting at a wavelength of 1540 nm. Ten patients had a full correction of their ectropion and two patients had a partial recovery after laser therapy at 6-month follow-up visit. No serious adverse events were reported. Non-ablative fractional laser resurfacing can successfully treat cicatricial ectropion by remodeling the periocular scar tissue and improving the scar texture, and as such may be considered as a valuable alternative to surgery in selected patients.
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http://dx.doi.org/10.1007/s10103-018-2601-yDOI Listing
February 2019

Recurrence of Critical Limb Ischemia After Endovascular Intervention in Patients with Diabetic Foot Ulcers.

Adv Wound Care (New Rochelle) 2018 Jun;7(6):171-176

Department of Systems Medicine, University of Tor Vergata, Rome, Italy.

To establish the rate of clinical recurrence of critical limb ischemia (CLI) in diabetic patients with ischemic foot ulcers (DFUs) treated by percutaneous transluminal angioplasty (PTA). The study group was composed of 304 patients with ischemic DFUs treated by PTA. We evaluated the rate of clinical recurrence of CLI requiring a second PTA (repeated PTA [rePTA]), the factors related to CLI relapse, and the outcomes of rePTA patients. The follow-up was 12.5 ± 6.6 months. Seventy-four of 304 patients (24.3%) needed rePTA. The mean time to rePTA was 3.5 ± 0.64 months. rePTA group in comparison with no rePTA group had lower rate of healing (28.5% vs. 71.9%  = 0.0001), higher rate of ulcer recurrence (20% vs. 10.3%  = 0.03), major amputation (24.3% vs. 4.3%  = 0.0005), and death (33.3% vs. 7.9%  = 0.002). Glycated hemoglobin, type A1C (HbA1c; 2.2 [1.9-2.7]  = 0.02) and dialysis (1.5 [1.4-3.6]  = 0.006) were independently associated to clinical recurrence of CLI after PTA. To identify the outcomes of patients with clinical recurrence of CLI and the clinical factors involved to reduce the rate of restenosis after endovascular treatment and improve the rate of limb salvage. Clinical recurrence of CLI is associated with a high rate of nonhealing ulcer recurrence, major amputation, and death. Dialysis and impaired glycemic control were independent predictors of CLI relapse after endovascular treatment.
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http://dx.doi.org/10.1089/wound.2017.0778DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994148PMC
June 2018

Adipose-Derived Stromal Vascular Fraction Cells and Platelet-Rich Plasma: Basic and Clinical Implications for Tissue Engineering Therapies in Regenerative Surgery.

Methods Mol Biol 2018 ;1773:107-122

Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Rome, Italy.

Cell-based therapy and regenerative medicine offer a paradigm shift in regard to various diseases causing loss of substance or volume and tissue or organ damage. Recently, many authors have focused their attention on mesenchymal stem cells for their capacity to differentiate into many cell lineages. The most widely studied types are bone marrow mesenchymal stem cells and adipose derived stem cells (ADSCs), which display similar results. Based on the literature, we believe that the ADSCs offer advantages because of lower morbidity during the harvesting procedure. Additionally, platelet-rich plasma can be used in this field for its ability to stimulate tissue regeneration. The aim of this chapter is to describe ADSC preparation and isolation procedures, preparation of platelet-rich plasma, and the application of ADSCs in regenerative plastic surgery. We also discuss the mechanisms and future role of ADSCs in cell-based therapy and tissue engineering.
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http://dx.doi.org/10.1007/978-1-4939-7799-4_9DOI Listing
June 2019
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