Migrants from Low-Income Countries have Higher Heat-Health Risk Profiles Compared to Native Workers in Agriculture.

The present observational study was conducted to uncover potential differences in the risk of experiencing high occupational heat strain during agriculture work between migrants and their native coworkers, as well as to elucidate the factors that may contribute to such differences. The study took place over the period from 2016 through 2019 and involved monitoring 124 experienced and acclimatized individuals from high-income (HICs), upper-middle-income (UMICs), as well as lower-middle- and low-income (LMICs) countries. Baseline self-reported data for age, body stature, and body mass were collected at the start of the study. Second-by-second video recordings throughout the work shifts were captured using a video camera and were used to estimate workers' clothing insulation, covered body surface area, and body posture, as well as to calculate their walking speed, the amount of time they spent on different activities (and their intensity) and unplanned breaks throughout their work shifts. All information derived from the video data was used to calculate the physiological heat strain experienced by the workers. The core temperature of migrant workers from LMICs (37.81 ± 0.38 °C) and UMICs (37.71 ± 0.35 °C) was estimated to be significantly higher compared to the core temperature of native workers from HICs (37.60 ± 0.29 °C) (p < 0.001). Moreover, migrant workers from LMICs faced a 52% and 80% higher risk for experiencing core body temperature above the safety threshold of 38 °C compared to migrant workers from UMICs and native workers from HICs, respectively. Our findings show that migrant workers originating from LMICs experience higher levels of occupational heat strain, as compared to migrant workers from UMICs and native workers from HICs, because they take fewer unplanned breaks during work, they work at a higher intensity, they wear more clothing, and they have a smaller body size.

Occupational Heat Stress: Multi-Country Observations and Interventions.

BACKGROUND: Occupational heat exposure can provoke health problems that increase the risk of certain diseases and affect workers' ability to maintain healthy and productive lives. This study investigates the effects of occupational heat stress on workers' physiological strain and labor productivity, as well as examining multiple interventions to mitigate the problem. METHODS: We monitored 518 full work-shifts obtained from 238 experienced and acclimatized individuals who work in key industrial sectors located in Cyprus, Greece, Qatar, and Spain. Continuous core body temperature, mean skin temperature, heart rate, and labor productivity were collected from the beginning to the end of all work-shifts. RESULTS: In workplaces where self-pacing is not feasible or very limited, we found that occupational heat stress is associated with the heat strain experienced by workers. Strategies focusing on hydration, work-rest cycles, and ventilated clothing were able to mitigate the physiological heat strain experienced by workers. Increasing mechanization enhanced labor productivity without increasing workers' physiological strain. CONCLUSIONS: Empowering laborers to self-pace is the basis of heat mitigation, while tailored strategies focusing on hydration, work-rest cycles, ventilated garments, and mechanization can further reduce the physiological heat strain experienced by workers under certain conditions.

One-Stage Reconstruction of Scalp after Full-Thickness Oncologic Defects Using a Dermal Regeneration Template (Integra).

The use of Dermal Regeneration Template (DRT) can be a valid alternative for scalp reconstruction, especially in elderly patients where a rapid procedure with an acceptable aesthetic and reliable functional outcome is required. We reviewed the surgical outcome of 20 patients, 14 (70%) males and 6 (30%) females, who underwent application of DRT for scalp reconstruction for small defects (group A: mean defect size of 12.51 cm(2)) and for large defects (group B: mean defect size of 28.7 cm(2)) after wide excision of scalp neoplasm (basal cell carcinoma and squamous cell carcinoma). In group A, the excisions were performed to the galeal layer avoiding pericranium, and in group B the excisions were performed including pericranium layer with subsequent coverage of the exposed bone with local pericranial flap. In both the groups (A and B) after the excision of the tumor, the wound bed was covered with Dermal Regeneration Template. In 3 weeks we observed the complete healing of the wound bed by secondary intention with acceptable cosmetic results and stable scars. Scalp reconstruction using a DRT is a valid coverage technique for minor and major scalp defects and it can be conducted with good results in elderly patients with multiple comorbidities.

Adipose-derived stromal vascular fraction cells and platelet-rich plasma: basic and clinical evaluation for cell-based therapies in patients with scars on the face.

BACKGROUND: Actually, autologous fat grafts have many clinical applications in breast surgery, facial rejuvenation, buttock augmentation, and Romberg syndrome as well as a treatment of liposuction sequelae. OBJECTIVE: The aim of this article was to describe the preparation and isolation procedures for stromal vascular fraction (SVF), the preparation of platelet-rich plasma (PRP), and the clinical application in the treatment of the scar on the face. METHODS: Ten patients with burns sequelae (n = 6) and post-traumatic scars (n = 4) were treated with SVF-enhanced autologous fat grafts obtained by the Celution System. Another 10 patients with burns sequelae (n = 5) and post-traumatic scars (n = 5) were treated with fat grafting based on the Coleman technique mixed with 0.5 mL of PRP.To assess the effects of their treatment, the authors compared their results with those of a control group consisting of 10 patients treated with centrifuged fat. RESULTS: In the patients treated with SVF-enhanced autologous fat grafts, we observed a 63% maintenance of contour restoring after 1 year compared with only 39% of the control group (n = 10) treated with centrifuged fat graft (P < 0.0001). In the patients treated with fat grafting and PRP, we observed a 69% maintenance of contour restoring after 1 year compared with that of the control group (n = 10). CONCLUSIONS: Autologous fat grafting is a good method for the correction of scars on the face instead of the traditional scar surgical excision.

Changes in nasal profile following maxillomandibular osteotomy for prognathism.

AIM: This article is based on a pre- and postoperative retrospective analysis of a sample of patients affected by progenic syndrome who underwent maxillary bone repositioning by maxillomandibular osteotomies. Pre- and postoperative clinical, photographic, and cephalometric analysis are carried out to assess modifications of the nasal shape due to maxillary osteotomies. METHODS: The sample group studied was made up of 25 patients (13 women, 12 men) who underwent orthodontic-surgical treatment for correction of maxillomandibular deformities. The sample group was divided into two groups: the first (group A) was made up of patients who underwent maxillomandibular repositioning with advancement and lowering of the maxilla, and the second (group B) comprised patients who, as a consequence of surgical repositioning, had a maxilla that was advanced and raised. Surgical treatment was based on Le Fort I and quadrangular Le Fort osteotomies. CONCLUSION: Evaluation of angular and linear measurements, derived from both photographic and cephalometric material, allowed the authors to compare the two groups of patients and the modifications of the nasal region. These results are then compared with those available from current scientific literature so as to define the predictability of nasal shape modification. In conclusion, it is inadvisable to perform rhinoplasty at the time of orthognathic surgery to correct pre-existing defects, such as a dorsal hump, a nasal base that is too wide or too narrow, a nasal pyramid deviation, or other esthetic defects resulting from orthognathic surgery.

Cardiovascular risk factors and events in pancreas-kidney transplants.

Cardiovascular and cerebrovascular disease (CCVD) are major causes of morbidity and mortality among patients with diabetes. Strict control of treatable risk factors that contribute to atherosclerosis is important to reduce the risk of stroke, myocardial infarction, and peripheral arterial disease. Simultaneous pancreas-kidney transplantation (SPKT) may significantly improve these risk factors in patients with type 1 diabetes. We studied 103 SPKT from our center with both organs functioning for metabolic and hypertensive control; body mass index (BMI); immunosuppression; and CCVD events. The 53 females/50 males showed a mean age of 35 ± 6 years, diabetes for 24 ± 6 years, and on dialysis for 31 ± 23 months. The follow-up ranged from 6-142 months. Mean value of last creatinine clearance was 76 ± 24 mL/min, all 103 SPKT were insulin-independent with mean glycemia = 81 ± 10 mg/dL and hemoglobin A1c (HbA1c) = 5.3% ± 0.4%. All of them were under tacrolimus treatment; 9.7% also with sirolimus but 67% steroid-free. According to the National Cholesterol Education Program Adult Treatment Panel 3 criteria, 4 patients showed a fasting glucose > 100 mg/dL; only one, HbA1c > 5.6%. Hypertension was recorded in 38.5%; low high-density lipoprotein cholesterol in 19.4%; hypertriglyceridemia in 7.8%; BMI > 30% in only 2 patients; 21.4% were prescribed statins. We registered cardiovascular events in 7 patients (6.8%). Patients with steroid treatment showed higher triglycerides (122 ± 53 vs 90 ± 36 mg/dL; P = .001) and more often tended to be hypertensive (41.2% vs 37.7%, P = .073) compared with those free of these drugs. Hypertension was associated with an higher BMI (24.1 ± 2.8 vs 22.3 ± 2.9 kg/m(2), P = .002). BMI > 25% was associated with higher total cholesterol (195 ± 47 vs 169 ± 28 mg/dL, P = .015) and low-density lipoprotein cholesterol (116 ± 40 vs 96 ± 27 mg/dL, P = .003). Among our SPKT the prevalences of CCVD and metabolic syndrome were low. Hypertension was the most frequent single factor. Obesity was rare. In patients on steroids, hypertriglyceridemia was more prevalent and hypertension tended to be more frequent. Hypertensive patients showed a higher BMI, which correlated with a worse lipid profile. Steroid withdrawal, whenever possible, may be important to achieve metabolic goals and minimize cardiovascular risk.

Epithelioid hemangioendothelioma of the facial bone.

The epithelioid hemangioendothelioma is an uncommon vascular neoplasm. Numerous sites of involvement are possible, but these tumors most commonly arise in the soft tissues, liver, and lung. We report a case of epithelioid hemangioendothelioma presenting as a single lesion on the nasal portion of the maxilla. Histologically, the tumor within bone and skin exhibited cords and nests of plump, epithelioid-appearing cells exhibiting rudimentary vascular differentiation within a myxohyaline stroma. Immunohistochemical reactivities for factor VIII-related antigen, CD31, CD34, and vimentin were demonstrated. Wide local excision with close clinical follow-up seems to be the treatment of choice for these tumors.

Application of platelet-rich plasma in maxillofacial surgery: clinical evaluation.

The authors report their experience on 15 cases, including reconstructive surgery of the jaws, postextraction alveolar bone regeneration, and oral implantology. The aim of the study was to evaluate the different effects on jaws' bone regeneration with or without the use of local application of platelet-rich plasma (PRP). The results we report showed the efficacy of the PRP treatment: postoperative patients' satisfaction and low-morbidity course confirmed the quality of the results. The article will help the reader to (1) understand the PRP preparation, (2) find local applications in oral and maxillofacial surgery, and (3) evaluate the general effect of PRP.

An original application of the Endotine Ribbon device for brow lift.

BACKGROUND: Correction of brow ptosis and lateral temporal laxity is one of the goals of surgical rejuvenation of the aging face. The Endotine Forehead (Coapt Systems, Inc., Palo Alto, Calif.) device is an effective bioabsorbable fixation tool for forehead and brow-lift procedures. However, the Endotine Forehead device alone is not able to correct lateral brow ptosis and temporal laxity. In this article, the authors propose an innovative use of another special device, the Endotine Ribbon (Coapt Systems), to provide long-lasting results in lateral brow-lift surgery and temporal lateral laxity correction. METHODS: Between February of 2006 and April of 2007, a total of 30 patients, aged between 38 and 70 years (average, 50 years), underwent brow-lift surgery. With this technique, the Endotine Ribbon is cut in halves and each portion of it is anchored to the deep temporal fascia with sutures, and its multiple tines facing outward grasp the superficial temporal fascia. The amount of brow elevation produced was assessed by comparison of the preoperative and postoperative vertical distances between the superior eyebrow hairline and the midpupil and lateral and medial canthal angle. The average follow-up period was 18 months. RESULTS: Using this technique, perfectly symmetric lateral eyebrows and temporal laxity correction were obtained in all patients. A lasting result was observed, and no significant adverse events were encountered. CONCLUSIONS: The application of the Endotine Ribbon for brow-lift procedures provides significant and reproducible lateral brow elevation and temporal laxity correction. This fixation method is effective, safe, and easy to use, and leads to high patient satisfaction.

Rhinoplasty procedures: state of art in plastic surgery.

We have retrospectively assessed the charts of 166 patients who underwent rhinoplasties from March of 2005 to July of 2007, in the Plastic Surgery Department of the University of Torvergata Rome, Italy. From the operation chart of each patient, we filled out a form with the following details: access incisions to the nasal bone cartilage skeleton, maneuvers performed on the inferior lateral and superior cartilages, implants and/or grafts used, procedures made to the nasal base, types of osteotomies, and number of concomitant septoplasties. All the patients were operated under total anesthesia. The results were plotted on tables and graphs. In percentages, each surgical maneuver was separately analyzed, the need for grafts or incision in relation to the total number of patients operated, thus allowing for a numerical analysis of the approaches carried out in rhinoplasty procedures performed in our department.

Open-tip approach: evolutions in rhinoplasty.

Modifications and innovations in open-structure rhinoplasty that have occurred as this technique has evolved are discussed. In addition, the philosophy and fundamentals of open-tip approach in rhinoplasty are reexamined. A retrospective review of representative patients in a hospital practice setting was performed. All surgical procedures were conducted in a department of plastic surgery of the University of Rome Tor Vergata. The preoperative and long-term results of each patient are compared to demonstrate the effectiveness of the described techniques. The fundamental philosophy of open-tip rhinoplasty is the maintenance of the integrity and strength of the nasal skeleton. Modifications of tip grafting techniques, along with additional domal grafting techniques, and a stronger focus on domal suturing techniques result in a softer contour and lack of tip tensions while maintaining structural support.

The use of bone-anchored implants for absent ear.

The sample of patients analyzed has been selected from 66 cases treated for extraoral bone-anchored implantology at the Plastic and Reconstructive Surgery Department of the "Tor Vergata" University of Rome. Optimal results can be obtained in the ear district because of the low surgical risks and few postsurgical complications. Advantages offered by extraoral bone integrated implants are obvious when compared with more traditional techniques: it is possible to obtain a better cosmetic result only from 2 surgical sessions; and adhesive prosthesis may be better placed without the usual local irritation, achieving a correct positioning. The authors present their experiences in using extraoral implants for the reconstruction of the ear area malformation.

Burns: bone-anchored, extra-oral implantology.

Extra-oral implants represent a valid alternative technique in aesthetic reconstruction of the craniofacial district in oncology surgery. Two female patients were selected; they were treated from December 2001 to June 2007 by implanting auricular epithesis. The age range was 27 years. They shared the same diagnosis: burns of the auricle-temporal region. The deformity in the auricle region and the complete absence of the pinna convinced the authors to choose this reconstructive method. Most patients showed a good stability of fixtures, epithesis and perimplants soft tissue, in some cases there has been a delay in the time to healing soft tissue perimplant and only one patient has removed the plant after 5 years cancer recurrence. No complications were observed, including bleeding and infections, in the postsurgery period. No report was made in any case of lesion of the facial nerve having the fixtures being positioned in the back and above the point of emergency.

Reconstruction of the nasal alar.

The authors of this study describe a case of nasal alar deformity with a congenital deficiency of cartilage treated with a rotation flap. To choose the reconstruction technique, reference parameters such as the age of the patient, the presence of preexisting scars, and the size of the defect are assessed by focusing on the tissue structure and on the major aesthetic demands of the younger patients. Good aesthetic results, with an acceptable cicatricial outcome and an excellent morphofunctional reconstruction of the ala, were achieved in the treated subject. The postoperative course was also good with no complications.

Reconstruction of the nasal valve.

The authors present their experience with reconstructive nasal valve surgery, evaluating the effects related to the use of a composite graft, which is a graft made of skin and cartilage, or mucosa and cartilage, and to the transposition of mucocartilaginous flaps. A sample of 15 patients (12 women and three men) selected among 452 cases treated with functional and aesthetic rhinoplasty at the Department of Plastic and Reconstructive Surgery of the "Tor Vergata" University of Rome was analyzed. Patients were between 25 and 50 years of age, with a mean age of 40 years, and were treated with secondary rhinoplasty for valvular stenosis. Of these patients, 12 had functional problems of the internal and external nasal valve, and three had internal valve stenosis. In our sample of 15 patients, respiratory symptoms improved at short- and long-term follow up. In all cases, a good aesthetic result was obtained. The patients were not satisfied with the aesthetic result in only three cases as a result of enlargement or asymmetry of the external valvular area. In 11 cases, an "open tip" rhinoplasty was performed with a retroauricular skin-cartilage composite graft to correct internal-external valvular stenosis. In all the cases of internal valvular stenosis (three patients) and in one case of internal-external valvular stenosis, a transposition of mucocartilaginous flaps with a section of the mucosa of the upper lateral cartilage was performed.

Primary tuberculosis of submandibular gland.

Salivary gland tuberculosis is a rare pathology and does not always have the diagnostic guidelines led by previous tubercular localizations. Tubercular bacillus can reach the salivary gland in different ways, but the condition that most frequently causes a tubercular infection is the decay of the human organism defensive capacity toward the germ.A 15-year-old Romanian boy presented with a swelling in the left submandibular region. Normal extraoral, intraoral examination, and routine diagnostic examinations were performed. In order to make a final diagnosis, we performed a surgical left submandibular gland sialo-adenectomy operation to enable a histologic examination of the withdrawn tissue. Microscopic examination of the gland and lymph nodes showed a chronic necrotizing phlogosis of tubercular type. Previous routine examinations have been important only after final diagnosis to confirm that the submandibular tubercular localization was a primary infection. Diagnosis of this kind of disease is extremely difficult and is made with certainty only with the histologic examination, as happened in our case.

Evaluation of farnesyl:protein transferase and geranylgeranyl:protein transferase inhibitor combinations in preclinical models.

Farnesyl:protein transferase (FPTase) inhibitors (FTIs) were originally developed as potential anticancer agents targeting the ras oncogene and are currently in clinical trials. Whereas FTIs inhibit the farnesylation of Ha-Ras, they do not completely inhibit the prenylation of Ki-Ras, the allele most frequently mutated in human cancers. Whereas farnesylation of Ki-Ras is blocked by FTIs, Ki-Ras remains prenylated in FTI-treated cells because of its modification by the related prenyltransferase, geranylgeranyl:protein transferase type I (GGPTase-I). Hence, cells transformed with Ki-ras tend to be more resistant to FTIs than Ha-ras-transformed cells. To determine whether Ki-ras-transformed cells can be targeted by combining an FTI with a GGPTase-I inhibitor (GGTI), we evaluated potent, selective FTIs, GGTIs, and dual prenylation inhibitors (DPIs) that have both FTI and GGTI activity. We find that in human PSN-1 pancreatic tumor cells, which harbor oncogenic Ki-ras, and in other tumor lines having either wild-type or oncogenic Ki-ras, treatment with an FTI/GGTI combination or with a DPI blocks Ki-Ras prenylation and induces markedly higher levels of apoptosis relative to FTI or GGTI alone. We demonstrate that these compounds can inhibit their enzyme targets in mice by monitoring pancreatic and tumor tissues from treated animals for inhibition of prenylation of Ki-Ras, HDJ2, a substrate specific for FPTase, and Rap1A, a substrate specific for GGPTase-I. Continuous infusion (72 h) of varying doses of GGTI in conjunction with a high, fixed dose of FTI causes a dose-dependent inhibition of Ki-Ras prenylation. However, a 72-h infusion of a GGTI, at a dose sufficient to inhibit Ki-Ras prenylation in the presence of an FTI, causes death within 2 weeks of the infusion when administered either as monotherapy or in combination with an FTI. DPIs are also lethal after a 72-h infusion at doses that inhibit Ki-Ras prenylation. Because 24 h infusion of a high dose of DPI is tolerated and inhibits Ki-Ras prenylation, we compared the antitumor efficacy from a 24-h FTI infusion to that of a DPI in a nude mouse/PSN-1 tumor cell xenograft model and in Ki-ras transgenic mice with mammary tumors. The FTI and DPI were dosed at a level that provided comparable inhibition of FPTase. The FTI and the DPI displayed comparable efficacy, causing a decrease in growth rate of the PSN-1 xenograft tumors and tumor regression in the transgenic model, but neither treatment regimen induced a statistically significant increase in tumor cell apoptosis. Although FTI/GGTI combinations elicit a greater apoptotic response than either agent alone in vitro, the toxicity associated with GGTI treatment in vivo limits the duration of treatment and, thus, may limit the therapeutic benefit that might be gained by inhibiting oncogenic Ki-Ras through dual prenyltransferase inhibitor therapy.