The Alar Extension Graft Technique for the Treatment of External Nasal Valve Collapse: Preliminary Results of a Single-Centre Prospective Analysis.

BACKGROUND: The aim of this study is to describe the efficacy of the alar extension graft for the correction of external nasal valve collapse and to evaluate the functional and aesthetic results. METHODS: The study included 51 patients who underwent alar extension grafting for external nasal valve collapse. Pre- and post-operative rhinomanometry was performed before and after surgery. NOSE and SNOT 20 questionnaires were completed before and 9 months after surgery. Patients were also asked about their post-operative satisfaction. RESULTS: 90% of patients were subjectively satisfied with the post-operative improvement in nasal breathing. There was a significant improvement in the values of the pre- and post-operative NOSE and SNOT 20 questionnaire scores. Rhinomanometry showed increased nasal flow with a statistically significant difference between pre- and post-operative results. CONCLUSIONS: The alar extension graft has been proved to be effective and reliable in the surgical treatment of external nasal valve collapse, improving the patients' objective and subjective breathing with good functional and aesthetic results. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Hybrid primary puncture in stapler-assisted total laryngectomy.

In Video S1, a new surgical technique for hybrid primary tracheoesophageal (TE) puncture in stapler-assisted total laryngectomy is shown. The video describes the surgical steps of the procedure and illustrates some tips and tricks. The procedure incorporates an upper mini-pharyngotomy to enable retrograde placement of the voice prosthesis (VP), eliminating the need for rigid esophagoscopy. This has made it possible to exploit, without additional risks, the potential of the stapler combined with primary TE puncture and VP placement. In our experience, this hybrid procedure in stapler-assisted total laryngectomy is not related to adverse events such as pharyngocutaneous fistula (PCF), hypertonicity, and functional complications. Therefore, it can be considered a valid technique that allows for easy insertion of a primary voice prosthesis also in case of mechanical sutures.

Robotic Hysterectomy as a Step of Gender Affirmative Surgery in Female-to-Male Patients.

INTRODUCTION: To evaluate the feasibility and safety of robotic hysterectomy in the "transgender male/non-conforming" population and the short and long-term surgical outcomes of robotic surgery in these patients. MATERIALS AND METHODS: A retrospective analysis was carried out from February 2016 to January 2018. Twenty female transgender patients with a previous psychiatric diagnosis of gender dysphoria who did not present genital pathologies were included in the study. The robotic hysterectomies were performed from June 2016 to March 2018 using a Da Vinci Xi Robot (Intuitive Surgical, Sunnyvale, CA, USA). RESULTS: No intraoperative or postoperative complications were recorded. The median duration of the intervention was of 90 minutes, including docking which lasted 16 minutes, while the median stay in the operating room was of 140 minutes. The median time of duration of intervention was of 90 minutes. The median blood loss was about 90 ml with a percentage decrease in hemoglobin between pre- and post-operative of about 8%. Postoperative pain was assessed using the VAS scale in the immediate postoperative period, on the first and second day, resulting of 3 and 2, respectively. The pathological examination of surgical specimens confirmed the absence of malignancy. CONCLUSIONS: The robotic approach represents a feasible, safe, and effective surgical option for hysterectomy for "transgender male" affected by gender dysphoria.

The WNT receptor FZD7 is required for maintenance of the pluripotent state in human embryonic stem cells.

WNT signaling is involved in maintaining stem cells in an undifferentiated state; however, it is often unclear which WNTs and WNT receptors are mediating these activities. Here we examined the role of the WNT receptor FZD7 in maintaining human embryonic stem cells (hESCs) in an undifferentiated and pluripotent state. FZD7 expression is significantly elevated in undifferentiated cells relative to differentiated cell populations, and interfering with its expression or function, either by short hairpin RNA-mediated knockdown or with a fragment antigen binding (Fab) molecule directed against FZD7, disrupts the pluripotent state of hESCs. The FZD7-specific Fab blocks signaling by Wnt3a protein by down-regulating FZD7 protein levels, suggesting that FZD7 transduces Wnt signals to activate Wnt/ß-catenin signaling. These results demonstrate that FZD7 encodes a regulator of the pluripotent state and that hESCs require endogenous WNT/ß-catenin signaling through FZD7 to maintain an undifferentiated phenotype.

Enrichment from activated sludges of aerobic mixed cultures capable to degrade vinyl chloride (VC) as the sole carbon source.

Two microbial cultures able to degrade high concentrations of VC as the sole carbon source have been obtained by enrichment from activated sludge. The cultures began consuming VC (0.02 mmol l(-1)) only after a long initial acclimation period (1-2 months). After then the concentration of VC was gradually increased (from 0.02 to 0.8 mmol l(-1)) and the cultures were able to maintain VC degrading ability for long time (over 500 days). VC-degrading biomass in the two cultures was characterized by low specific maximum growth rates (0.19-0.21 d(-1)) compared to heterotrophic organisms typically present in activated sludge processes. Monod half-saturation constant was rather low (0.7-1.6 mg VC l(-1)) indicating that it is possible to effectively remove VC to low residual concentrations. The cultures were highly sensitive to even short periods of VC lack (with quick decrease of VC degradation rates) whereas they were not to sudden load increases (up to 3.4 mmol l(-1)). After being cultured with only ethene as the sole carbon and energy source, the cultures kept the ability of degrading VC. Possibility of maintaining the mixed cultures on non-toxic ethene, without loosing VC degradation ability, is very promising for bioaugmentation treatments.