Impact of COVID-19 on hand surgery in Italy: A comparison between the Northern and the Southern regions.

The aims of this study were to evaluate the impact of the COVID-19 pandemic on emergency and elective hand surgery in four Italian regions that had either a high (Lombardy and Piemonte) or a low (Sicilia and Puglia) COVID-19 case load to discuss problems and to elaborate strategies to improve treatment pathways. A panel of hand surgeons from these different regions compared and discussed data from the centers they work in. The COVID-19 pandemic had an enormous impact on both elective and emergency surgery in Italy, not only in highly affected regions but also - and paradoxically even at a higher extent - in regions with a low COVID-19 case load. A durable and flexible redesign of hand surgery activities should be promoted, while changing and hopefully increasing human resources and enhancing administrative support. Telematics must also be implemented, especially for delivering rehabilitation therapy.

AN OVERVIEW AND OUR APPROACH IN THE TREATMENT OF MALIGNANT CUTANEOUS TUMOURS OF THE HAND.

INTRODUCTION: Diagnosis of malignant cutaneous tumours of the hand is often difficult because of the different anatomic structures present in this region and yet clinicians must be able to distinguish typical benign entities from life-threatening or limb-threatening malignant diseases. Due to the hand's complex structures located in a small area, surgeons must evaluate constantly the balance of inadequate surgery against functional and cosmetic aspects. Thus, a multidisciplinary approach is recommended for a correct diagnosis and treatment design. MATERIALS AND METHODS: Between 2006 and 2017, 354 consecutive patients with basal and squamous cell carcinomas, and melanoma of the hand were retrospectively analysed at the Department of Plastic and Reconstructive Surgery at the University of Palermo, treatment was surgical for all of them; also radio- and chemotherapy were necessary based on the histological diagnosis. RESULTS: The most common tumour was basal cell carcinoma (BCCs), followed by squamous cell carcinoma (SCCs). Melanoma was the most frequent lesion diagnosed in the digits. Radical excision was the main treatment of choice. In 29 cases (11 with SCC, 18 with melanoma) axillary lymphadenectomy was performed, because of lymph nodes metastases. In the follow up, the spread of cancer to distant organs caused the death in three cases. Recurrence rate was higher in case of infiltrative SCCs and BCCs. CONCLUSIONS: The major references provide only limited information on malignant soft-tissue tumours of the hand. Our retrospective study aims to present the most commonly observed malignant soft-tissue tumours of the hand, analysing their causes, their objective and instrumental evaluation, and their treatments.

Optimising traceability in trade for live animals and animal products with digital technologies.

Sound animal traceability systems and supply chain management rely on data and information to respond to outcomes that will both protect animal and human health and facilitate trade. Digital technologies present opportunities and new methods for identifying and tracking animals, collecting more data, integrating communication flows, sharing data securely in supply chains, and analysing data to inform decisions and predict outcomes. Together, these technologies drive more efficient, productive and traceable supply chains, which can help to build more effective animal traceability systems. In addition, they can improve monitoring of, and response to, animal disease, food safety risks and food fraud risks; ensure compliance with animal health and food safety standards; simplify border procedures; facilitate trade with less friction; and raise consumer awareness. As the cost of these technologies decline and they become more accessible, the implementation of a digitally enabled animal traceability system will require an increase in supply chain capacity, improvements in digital infrastructure, and the development of a regulatory framework of standards and policies. Ensuring that these requirements are met will require strong commitment from governments, intergovernmental organisations and the wider animal health community.

Les systèmes fiables de traçabilité et de gestion des chaînes d'approvisionnement dépendent des données et de l'information pour élaborer des réponses permettant de protéger la santé publique et la santé animale tout en facilitant le commerce international. Les technologies numériques offrent de nouvelles perspectives et méthodologies pour identifier et tracer les animaux, collecter un plus grand volume de données, intégrer les flux de communication, partager les données de manière sécurisée tout au long des chaînes d'approvisionnement et analyser les données afin de prendre des décisions en connaissance de cause et d'anticiper leurs conséquences. Prises ensemble, ces technologies favorisent une meilleure efficience, productivité et traçabilité des chaînes d'approvisionnement, ce qui à son tour permet de concevoir des systèmes de traçabilité animale plus efficaces. En outre, elles renforcent les capacités de surveillance et de réponse en cas de maladies animales, de risques pour la sécurité sanitaire des aliments ou de fraude alimentaire ; leur utilisation contribue également à garantir la conformité aux normes de santé animale et de sécurité sanitaire des aliments, simplifie les procédures de contrôle aux frontières, facilite un commerce international moins conflictuel et participe à la sensibilisation des consommateurs. Ces technologies étant désormais moins onéreuses et plus faciles d'accès, les seules conditions pour mettre en oeuvre un système de traçabilité animale basé sur le numérique sont d'augmenter les capacités des chaînes d'approvisionnement, d'améliorer l'infrastructure numérique et de mettre en place un cadre réglementaire intégrant les normes et les politiques en la matière. Un engagement fort de la part des gouvernements, des organisations intergouvernementales et plus largement de la communauté de la santé animale sera nécessaire pour que ces conditions soient réunies.

La solidez de los sistemas de trazabilidad de animales y de gestión de las cadenas de suministro pasa por contar con datos e información cuya explotación dé lugar a una respuesta que a la vez proteja la salud animal y humana y facilite el comercio. Las tecnologías digitales abren posibilidades y traen consigo nuevos métodos para identificar y rastrear a los animales, obtener un mayor volumen de datos, integrar los circuitos de comunicación, compartir datos de forma segura en distintos eslabones de las cadenas de suministro y analizar estos datos para fundamentar decisiones y predecir los resultados. En conjunto, estas tecnologías dan lugar a cadenas de suministro más eficientes, productivas y fáciles de rastrear, lo que a su vez puede ayudar a instituir sistemas más eficaces de trazabilidad de animales. Además, pueden servir para: mejorar la vigilancia de las enfermedades animales y los riesgos de inocuidad de los alimentos y de fraude alimentario y la respuesta a tales enfermedades y riesgos; garantizar el cumplimiento de las normas de sanidad animal e inocuidad de los alimentos; simplificar los procedimientos aduaneros; facilitar un comercio más fluido; y sensibilizar a los consumidores. A medida que el costo de estas tecnologías vaya bajando y sea cada vez más fácil acceder a ellas, la implantación de un sistema digital de trazabilidad de animales exigirá una mayor capacidad de la cadena de suministro, una mejor infraestructura digital y la elaboración de un ordenamiento de normas y políticas que regule la cuestión. Para que todas estas condiciones se cumplan hará falta el firme empeño de gobiernos, organizaciones intergubernamentales y el conjunto de profesionales de la sanidad animal.

African swine fever: a global factor affecting agricultural markets over the medium term.

The African swine fever (ASF) outbreak in the People's Republic of China (China) is affecting regional and global meat and feed markets with potential impacts on vegetable oils, biofuels and even pharmaceuticals. Using the Aglink-Cosimo modelling system, the authors adopt three different scenarios to assess the impacts of ASF in China, South-East Asia and the world. The simulation results show a range of possible effects for agricultural commodity markets, notably a large initial protein gap that will be filled by higher production of both eggs and non-pork meats (poultry, beef and sheep/goat) in China and by pork imports from international markets. The results suggest a fast and near complete closure of the protein gap, reflecting China's low responsiveness of meat demand to prices. A sizeable share of the protein gap could remain unfilled if the necessary import infrastructure for meat, with gapless cold chains and efficient and comprehensive sanitary controls, is not set up as assumed in the scenarios. Not filling the protein gap would also leave domestic meat prices at permanently high levels, which could even translate into higher overall inflation rates. The simulations further suggest that an ASF pandemic would drive a lasting wedge between plant protein and animal protein prices, both locally and internationally. Oil meal prices will be particularly adversely affected, whereas pork and poultry will see a significant price rise. Countries that import the former and export the latter are likely to become the main beneficiaries of an ASF pandemic, benefiting from lower input prices and higher output prices for potentially large volumes of exports.

Le foyer de peste porcine africaine (PPA) survenu en République populaire de Chine (Chine) affecte les marchés régionaux et mondiaux de viande et d'aliments fourragers et a également un impact potentiel sur les huiles végétales, les bio-carburants voire les produits pharmaceutiques. En s'appuyant sur le système de modélisation Aglink-Cosimo, les auteurs ont élaboré trois scénarios différents pour évaluer les impacts de la PPA en Chine, en Asie du Sud-Est et dans le monde entier. Les résultats de la simulation font apparaître un large éventail d'effets sur les marchés de produits agricoles, en particulier un déficit protéique initial majeur qui sera compensé par une augmentation de la production d'oeufs et de viande issue d'autres animaux que le porc (volaille, boeuf, mouton et chèvre) en Chine, et par des importations de viande de porc à partir des marchés internationaux. Ces résultats semblent indiquer une élimination rapide et quasiment complète du déficit protéique, traduisant une faible réactivité aux prix de la demande chinoise en viande. Une part non négligeable du déficit protéique pourrait ne pas être comblée si les infrastructures nécessaires pour les importations de viande, avec des chaînes du froid ininterrompues et des inspections sanitaires complètes ne sont pas en place comme le prévoient les scénarios. Le maintien d'un déficit protéique aurait également pour effet de pousser les prix de la viande locale à des niveaux durablement élevés, ce qui pourrait se traduire par une hausse générale de l'inflation. Les simulations indiquent par ailleurs qu'une pandémie de PPA pourrait induire un écart de prix durable entre les protéines végétales et animales, aussi bien localement qu'au niveau international. Les prix des farines de tourteaux seraient particulièrement affectés tandis que les prix de la viande de porc et de volaille connaîtraient une hausse significative. Les pays importateurs de farines de tourteaux et exportateurs de viande de porc et de volaille seront probablement les principaux gagnants en cas de pandémie de PPA, bénéficiant de prix d'intrants bas et de prix d'extrants élevés sur des volumes potentiellement importants d'exportations.

El brote de peste porcina africana en la República Popular de China (China) está afectando a los mercados regionales y mundiales de carne y piensos y puede tener repercusión en los de aceites vegetales, biocombustibles e incluso productos farmacéuticos. Los autores aplican el sistema de modelización Aglink-Cosimo a tres hipótesis distintas para estudiar los efectos de la peste porcina africana a la escala de China, el Sudeste asiático y el mundo entero. Los resultados de la simulación revelan todo un conjunto de posibles efectos sobre los mercados de productos agrícolas, empezando por un gran déficit de proteínas que se cubrirá con una mayor producción tanto de huevos como de carnes no porcinas (avícola, vacuna y ovina/caprina) en China y con la importación de carne porcina a través de los mercados internacionales. Los resultados parecen indicar asimismo una rápida y cuasi completa corrección del déficit de proteínas, lo que pone de relieve que en China la demanda de carne es poco reactiva a los precios. Es posible que una parte considerable del déficit de proteínas quedara por cubrir en caso de que la infraestructura necesaria para las importaciones de carne, con cadenas de frío ininterrumpidas y controles sanitarios eficientes y exhaustivos, no correspondiera a los supuestos contemplados en las hipótesis. El hecho de no cubrir el déficit de proteínas también mantendría en niveles continuamente elevados los precios de la carne en el país, lo que podría incluso hacer subir las tasas de inflación generales. Las simulaciones llevan a pensar además que una pandemia de peste porcina africana induciría un desfase duradero entre los precios de las proteínas vegetales y los de las proteínas animales, tanto en el país como a nivel internacional. El precio de los piensos de aceite, en particular, se vería afectado negativamente, mientras que el de la carne porcina y la avícola sufrirían un sustancial aumento. Los países que importan los primeros y exportan las segundas serían presumiblemente los principales beneficiarios de una pandemia de peste porcina africana, pues saldrían ganando con el menor precio de los insumos y el mayor precio de los productos finales, que podrían exportar en grandes cantidades.

Giant condylomata (Buschke-Löwenstein tumours): our case load in surgical treatment and review of the current therapies.

BACKGROUND: Buschke-Löwenstein tumour (BLT) or giant condyloma is a verrucous infiltrating lesion, due to a sexually transmitted virus infection, human papilloma virus subtypes 6 and 11. Poor hygiene, promiscuity, chronic irritation and cellular immunocompromised states are often implicated in its genesis. Typical treatment of giant condyloma includes imiquimod cream, podophillin resin, cryotherapy, laser surgery, tangential shave excision with electrocautery. OBJECTIVE: The authors report their case load in the treatment of giant condyloma and the review of the modern therapies. METHODS AND MATERIALS: 27 consecutive patients (18 men, nine women) underwent surgery for giant condylomata of perianal region and externa genitalia at the Department of Plastic Surgery of the University of Palermo, from October 2006 to December 2009. All the patients had been treated before with conservative therapies without significant results. We performed the radical excision with split-thickness skin graft in all the patients. RESULTS: No significant complications have occurred in all the cases. The functional and aesthetic outcome were satisfying. No recurrence of disease were noticed in the follow-up. CONCLUSION: the radical excision with split-thickness skin graft appears to be a successful option of treatment for Buschke-Löwenstein tumours. Compared to other methods it does not necessitate several stages of treatment, moreover it has the advantage of a lower risk of recurrence, it allows a complete histologic examination, the healing process is rapid, the improvement of quality of patients's life is significant.

Dupuytren's contracture as result of prolonged administration of phenobarbital.

Dupuytren's disease is a fibroproliferative condition involving the superficial palmar fascia, leading to a progressive and irreversible flexion of the fingers. In literature, there are different opinions regarding the phenobarbital, a common antiepileptic drug, and its effective role in the genesis and development of Dupuytren's disease. In this retrospective investigation the association between phenobarbital and Dupuytren's contracture is discussed. Three patients in treatment with phenobarbital who had no others significant risk factors for Dupuytren's contracture were included in this study. The disease occurred after one to four years of drug therapy, at dosage of 100 mg/day. After surgery, Dupuytren's disease showed different evolutions in relation to dosage and type of antiepileptic drug used. Phenobarbital causes a dose and time-dipendent profibrotic effect. A clinical regression was observed when phenobarbital was substituted by carbamazepine, maintaining the same dosage (100 mg/day). This data confirms that not all the antiepileptic drugs are implicated in palmar fibrosis, and suggests that, according to the efficacy and adverse effects, the administration of benzodiazepine reduces the risk of Dupuytren's recurrence.

The "Jacobsen Flap" for the treatment of stages III-IV Dupuytren's disease: a review of 98 cases.

The treatment of severe Dupuytren's disease of the little finger is controversial: several techniques have been described with variable reported results and postoperative complications. This paper reviews 98 cases that underwent surgery between 2001 and 2006 using the Jacobsen flap procedure, a modification of the McCash technique. We found this technique relatively simple and it allowed significant correction of the contracture, with a low rate of complication. We believe this is an excellent alternative to dermofasciectomy or amputation.

Dupuytren's contracture: an update of biomolecular aspects and therapeutic perspectives.

The so-called fibrogenic cytokines, able to induce the growth of fibroblasts and their differentiation into myofibroblasts and to stimulate their production of extracellular matrix, are involved in the genesis of Dupuytren's contracture. Although many studies have been made of biomolecular aspects of palmar fibromatosis, practical applications from them are still far from imminent because of the real difficulty of blocking their action in vivo, even in a chronic, progressive lesion such as Dupuytren's disease. Consequently, surgical excision of the palmar fascia still remains the treatment of choice.

Associations between dogs that were serologically positive for Rickettsia conorii relative to the residences of two human cases of Mediterranean spotted fever in Piemonte (Italy).

A geographic information system and K-function analysis were used to evaluate the spatial association of canine serological results for Rickettsia conorii, the causative agent of Mediterranean spotted fever (MSF), and clinical cases of MSF in humans in Piemonte, northwest Italy. The residences of dog owners were clustered in two rural villages in the province of Cuneo, where two human cases of MSF occurred in 1997 and 1998. Eighteen out of 116 dogs examined were positive by indirect immunofluorescent assay (IFA+, titre > or =1:160) for MSF. K-functions were compared for IFA+ dogs and for all dogs sampled. Monte Carlo and bootstrap simulations demonstrated that clustering of IFA+ dogs was significantly greater than clustering of all dogs, at distances of less than 0.6 km from human cases of MSF. Logistic regression analysis indicated that the risk of being IFA+ was highest for dogs residing within the first quartile of distance (0.7 km) from human cases of the disease, and for dogs that were not confined. However, year and season of blood collection were not associated with IFA status. It was concluded that a relatively high dog population density along with a rural or semi-rural environment favours the occurrence of emergent foci of MSF in the province of Cuneo.

Sleep features in Tourette's syndrome, neuroacanthocytosis and Huntington's chorea.

Twenty-one patients affected by extrapyramidal disorders were polygraphically recorded during spontaneous nocturnal sleep for two consecutive nights to assess their sleep and movement patterns. The patients (pts) sample included: Gilles de La Tourette syndrome (TS, nine pts), neuroacanthocytosis (NA, six pts) and Hungtington's chorea (HC, six pts). Sleep recording included C3/A2, 01/A2, ROC/LOC, submental EMG, EKG, nasal airflow thoracoabdominal respirogram, bilateral anterior tibialis and other EMGs, in relation to the individual distribution of the abnormal movements. According to our observations, abnormal movements always decreased but never ceased completely during sleep. Sleep efficiency (SE) was nearly always poor with a high percentage of wakefulness after sleep onset (WASO) and increased number of arousals. REM sleep was often reduced and in some cases (3 TS pts) incompletely defined as far as its microstructural aspects. Slow wave sleep (SWS) was reduced in HC, normal in NA, and increased in all TS patients with the exception of the two adult subjects more severely affected, while the percentage of stage 2 was not affected. Spindling was increased in NA, HC and in the two most severely affected adult TS patients.

Atrophy of the soleus muscle in the albino rat induced by immobilization.

The morphological changes in the soleus muscle, immobilized by means of a plaster cast applied to the posterior limb of albino rats was studied. The animals were sacrificed 20 and 30 days after immobilization. The Authors agree with the hypothesis put forth by Lazarides regarding the cytoskeleton model of striated muscle fiber: morphological changes of the sarcomeres and myofilaments are brought on by translateral and longitudinal bridge damage.