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Role of nutritional ketosis in the improvement of metabolic parameters following bariatric surgery

World Journal of Diabetes 2022年第1期13卷 54-64页

作者： Fioralba Pindozzi Carlo Socci massimiliano bissolati Monica Marchi Elisabetta Devecchi Alessandro Saibene Caterina Conte Unitàdi Chirurgia Generale Provinciale Ospedale del DeltaLagosanto(FE)44023Italy Transplant and Metabolic/Bariatric Surgery Unit IRCCS Ospedale San RaffaeleMilan 20132Italy Department of General Medicine Diabetes and EndocrinologyIRCCS Ospedale San RaffaeleMilan 20132Italy Department of Human Sciences and Promotion of the Quality of Life San Raffaele Open UniversityRome 00166Italy Department of Endocrinology Nutrition and Metabolic DiseasesIRCCS MultiMedicaMilan 20099Italy

BACKGROUND Ketone bodies(KB)might act as potential metabolic modulators besides serving as energy *** metabolic surgery(BMS)offers a unique opportunity to study nutritional ketosis,as acute postoperative caloric restriction leads to increased lipolysis and circulating free fatty *** To characterize the relationship between KB production,weight loss(WL)and metabolic changes following *** For this retrospective study we enrolled male and female subjects aged 18-65 years who underwent BMS at a single *** on demographics,anthropometrics,body composition,laboratory values and urinary KB were *** Thirty-nine patients had data available for analyses[74.4%women,mean age 46.5±9.0 years,median body mass index 41.0(38.5;45.4)kg/m^(2),fat mass 45.2%±6.2%,23.1%had diabetes,43.6%arterial hypertension and 74.4%liver steatosis].At 46.0±13.6 d post-surgery,subjects had lost 12.0%±3.6%of pre-operative ***-nine percent developed *** with nutritional ketosis were significantly younger[42.9(37.6;50.7)years vs 51.9(48.3;59.9)years,P=0.018],and had significantly lower fasting glucose[89.5(82.5;96.3)mg/dL vs 96.0(91.0;105.3)mg/dL,P=0.025]and triglyceride levels[108.0(84.5;152.5)mg/dL vs 152.0(124.0;186.0)mg/dL,P=0.045]vs those with *** 6 mo,percent WL was greater in those with postoperative ketosis(-27.5%±5.1%vs 23.8%±4.3%,P=0.035).Urinary KBs correlated with percent WL at 6 and 12 *** metabolic changes were *** Our data support the hypothesis that subjects with worse metabolic status have reduced ketogenic capacity and,thereby,exhibit a lower WL following BMS.

关键词： Obesity Ketone bodies Bariatric surgery Weight loss Glucose metabolism Lipid metabolism

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Antifouling Properties of Electrospun Polymeric Coatings Induced by Controlled Surface Morphology

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Energy & Environmental Materials 2024年第6期7卷 409-419页

作者： Fabio L.Favrin Lorenzo Zavagna Matteo Sestini Semih Esin Bahareh Azimi massimiliano Labardi Mario Milazzo Giuseppe Gallone Giovanna Batoni Serena Danti Department of Civil and Industrial Engineering University of PisaLargo Lucio Lazzarino 256122PisaItaly Department of Translational Research and New Technologies in Medicine and Surgery University of Pisavia San Zeno 35-3956123PisaItaly Institute for Chemical and Physical Processes(IPCF) National Research Council(CNR)Pisa Research AreaVia Moruzzi 156124PisaItaly Department of Civil and Environmental Engineering Massachusetts Institute of Technology(MIT)Massachusetts Ave.77CambridgeMassachusetts 02139USA

Nosocomial infections affect implanted medical devices and greatly challenge their functional outcomes,becoming sometimes life threatening for the ***,aggressive antibiotic therapies are administered,which often require the use of last-resort drugs,if the infection is caused by multi-drug-resistant *** the risk of bacterial contamination of medical devices in the hospitals has thus become an emerging *** routes to control these infections are based on materials provided with intrinsic bactericidal properties(i.e.,chemical action)and on the design of surface coatings able to limit bacteria adhesion and fouling phenomena(i.e.,physical action),thus preventing bacterial biofilm ***,we report the development and validation of coatings made of layer-by-layer deposition of electrospun poly(vinylidene fluoride-co-trifluoro ethylene)P(VDF-TrFE)fibers with controlled orientations,which ultimately gave rise to antifouling *** obtained 10-layer surface morphology with 90°orientation fibers was able to efficiently prevent the adhesion of bacteria,by establishing a superhydrophobic-like behavior compatible with the Cassie-Baxter ***,the results highlighted that surface wettability and bacteria adhesion could be controlled using fibers with diameter comparable to bacteria size(i.e.,achievable via electrospinning process),by tuning the intra-fiber spacing,with relevant implications in the future design of biomedical surface coatings.

关键词： additive manufacturing Escherichia coli fibers Poly(vinylidene fluoride-cotrifluoro ethylene)P(VDF-TrFE) Pseudomonas aeruginosa superhydrophobic

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Intraplaque injections of hyaluronic acid for the treatment of stable-phase Peyronie’s disease:a retrospective single-center experience

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Asian Journal of Andrology 2024年第3期26卷 268-271页

作者： Simone Cilio Roberto La Rocca Giuseppe Celentano Claudio Marino massimiliano Creta Gianluigi Califano Celeste Manfredi Giorgio Ivan Russo Afonso Morgado Marco Falcone Marco Capece YAU Working Group Sexual and Reproductive Health Department of Neurosciences Reproductive Sciences and OdontostomatologyUrology UnitUniversity of Naples“Federico II”Naples 80131Italy Urology Unit Department of WomenChild and General and Specialized Surgery“Luigi Vanvitelli”UniversityNaples 80131Italy Urology Section Department of SurgeryUniversityof CataniaCatania 95131Italy Department of Urology Centro Hospitalar Universitário São JoãoPorto 4200-319Portugal Urology Clinic-A.O.U.“Cittàdella Salute edella Scienza”-Molinette Hospital University of TurinTurin 10100Italy 不详

Peyronie’s disease(PD)is a condition of penile connective tissue affecting up to 10%of men *** the complexity ofits management,nonsurgical treatments,such as intraplaque injections,are gaining *** current literature shows dataon the efficacy of intraplaque injections of hyaluronic acid(HA)mainly in acute-phase ***,data on injections of HA instable-phase PD are *** for this retrospective study were derived from a prospectively maintained database of privatepatients presenting at a private medical practice affiliated to the University of Naples“Federico II”(Naples,Italy)with stable-phasePD between January 2020 and March *** underwent a standard protocol of three injections,each administered at atwo-week *** the intervals,patients performed vacuum device therapy,penile stretching,and modeling *** compiled the Peyronie’s Disease Questionnaire(PDQ)and Global Assessment of Peyronie’s Disease(GAPD)at baselineand 2 weeks after the third injection.A penile Doppler ultrasound was performed 2 weeks after the last injection to record thefinal ***,we recruited 62 patients with stable-phase PD and a mean(±standard deviation[s.d.])curvature of52.7°(±9.7°).After 6 weeks,eight(12.9%)patients did not experience any curvature *** remaining 54 patientshad a final mean(±s.d.)curvature of 40.3°(±9.1°)with P<0.001,compared to that before *** found improvement inall PDQ domains(all P≤0.01),and 50(80.6%)patients reported subjective improvement of the penile curvature according to *** conclusion,we demonstrated that after three injections of HA administered according to the adopted protocol,patientswith stable-phase PD could experience significant improvements in penile curvature,and physical and psychological consequencesof the disease without significantly relevant side effects.

关键词： hyaluronic acid intraplaque injection Peyronie’s disease stable-phase therapy

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Two-step exhumation of Caucasian intraplate rifts:A proxy of sequential plate-margin collisional orogenies

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Geoscience Frontiers 2024年第2期15卷 68-84页

作者： William Cavazza Thomas Gusmeo massimiliano Zattin Victor Alania Onise Enukidze Sveva Corrado Andrea Schito Department of Biological Geologicaland Environmental SciencesUniv.of BolognaItaly Department of Geosciences Univ.of PaduaItaly Institute of Geophysics I.Javakhishvili State UniversityTbilisiGeorgia Department of Sciences Roma Tre UniversityRomeItaly Department of Geology and Geophysics Univ.of AberdeenUnited Kingdom

Intraplate structural deformation is diagnostic of tectonic stress regime changes linked to plate interactions and can result from superposed tectonic events whose single contributions are hardly *** this paper,we present a set of integrated thermochronologic inverse models along a 140 km-long transect across the central Greater Caucasus and the adjacent Adjara-Trialeti fold-and-thrust belt of Georgia,two intraplate orogens produced by structural inversion of parallel continental rift zones located on the Eurasian *** dataset allows to distinguish discrete and superposed deformation episodes and quantify their respective contributions to orogenic *** integration of(U-Th)/He analysis on apatite and zircon,fission-track analysis on apatite,and peak-temperature determinations(clay mineralogy,organic matter petrography,Raman spectroscopy)shows that structural inversion was punctuated by two incremental steps starting respectively in the latest Cretaceous and the *** Cretaceous partial inversion of the Greater Caucasus is documented here for the first time and placed in a geographically wider context of coeval *** two episodes of intraplate structural inversion,exhumation,and sediment generation are chronologically and physically correlated with docking of(i)the Anatolide-Tauride-Armenian terrane(Late Cretaceous-Paleocene)and(ii)Arabia(Miocene hard collision)against the southern Eurasian plate *** deformation in the Caucasian domain was triggered by far-field propagation of plate-margin collisional stress which focused preferentially along rheologically weak rift zones.

关键词： Intraplate deformation Far-field tectonics Greater Caucasus Structural reactivation Terrane accretion

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Distinct molecular targets of ProEGCG from EGCG and superior inhibition of angiogenesis signaling pathways for treatment of endometriosis

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Journal of Pharmaceutical Analysis 2024年第1期14卷 100-114页

作者： Sze Wan Hung massimiliano Gaetani Yiran Li Zhouyurong Tan Xu Zheng Ruizhe Zhang Yang Ding Gene Chi Wai Man Tao Zhang Yi Song Yao Wang Jacqueline Pui Wah Chung Tak Hang Chan Roman A.Zubarev Chi Chiu Wang Department of Obstetrics&Gynaecology The Chinese University of Hong KongHong KongChina Division of Physiological Chemistry I Department of Medical Biochemistry and BiophysicsKarolinska InstitutetStockholmSE 17177Sweden Chemical Proteomics Core Facility Department of Medical Biochemistry and BiophysicsKarolinska InstitutetStockholmSE 17177Sweden Unit of Chemical Proteomics Science for Life Laboratory(SciLifeLab)StockholmSE 17177Sweden Center for Reproductive Medicine Henan Key Laboratory of Reproduction and GeneticsThe First Affiliated Hospital of Zhengzhou UniversityZhengzhou450003China Department of Chemistry McGill UniversityMontrealH3A2K6Canada Department of Pharmacological&Technological Chemistry I.M.Sechenov First Moscow State Medical UniversityMoscow119146Russia Reproduction and Development Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong KongChina School of Biomedical Sciences The Chinese University of Hong KongHong KongChina Chinese University of Hong Kong-Sichuan University Joint Laboratory in Reproductive Medicine The Chinese University of Hong KongHong KongChina

Endometriosis is a common chronic gynecological disease with endometrial cell implantation outside the *** is a major pathophysiology in *** previous studies have demonstrated that the prodrug of epigallocatechin gallate(ProEGCG)exhibits superior anti-endometriotic and anti-angiogenic effects compared to epigallocatechin gallate(EGCG).However,their direct binding targets and underlying mechanisms for the differential effects remain *** this study,we demonstrated that oral ProEGCG can be effective in preventing and treating ***,1D and 2D Proteome Integral Solubility Alteration assay-based chemical proteomics identified metadherin(MTDH)and PX domain containing serine/threonine kinase-like(PXK)as novel binding targets of EGCG and ProEGCG,*** simulation and BioLayer interferometry were used to confirm their binding *** results showed that MTDH-EGCG inhibited protein kinase B(Akt)-mediated angiogenesis,while PXK-ProEGCG inhibited epidermal growth factor(EGF)-mediated angiogenesis via the EGF/hypoxia-inducible factor(HIF-1a)/vascular endothelial growth factor(VEGF)*** vitro and in vivo knockdown assays and microvascular network imaging further confirmed the involvement of these signaling ***,our study demonstrated that ProEGCG has superior therapeutic effects than EGCG by targeting distinct signal transduction pathways and may act as a novel antiangiogenic therapy for endometriosis.

关键词： Molecular targets ProEGCG EGCG Angiogenesis Treatment Endometriosis

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Case study of seismic performance assessment of irregular RC buildings: hospital structure of Avezzano(L'Aquila, Italy)

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Earthquake Engineering and Engineering Vibration 2015年第1期14卷 141-156页

作者： massimiliano Ferraioli Department of Civil Engineering Design Building and Environment

Most published studies on inelastic earthquake response of non-symmetric buildings are based on simplified inelastic, highly idealized models, while general conclusions regarding the inelastic torsional response of multistory building are still lacking. This paper aims to provide a useful contribution in the study of the torsional response of real irregular buildings. To this aim, the manuscript reports the comprehensive study on the seismic vulnerability of an irregular RC building： the hospital building ofAvezzano （L＇Aquila Italy）. For this multi-story building, which is irregular in both plan and elevation, the application of nonlinear static evaluation procedures is by no means straightforward. The study proposes a nonlinear static procedure based on pushover analysis under the multimodal distribution of lateral loads and a capacity spectrum method. This pushover procedure accounts for mass distribution, higher modes contribution and mode-shapes correlation. Furthermore, due to its non-iterative feature, it avoids problems of non-convergence and multiple solutions of the conventional capacity spectrum method. Applied to a real case study, the procedure is used to investigate, in a 3D plan irregular building, the sensitivity of torsional inelastic response to lateral force distribution, higher modes contribution, accidental eccentricity and controlled point for monitoring the target displacement.

关键词： irregular buildings torsion pushover analysis seismic performance assessment

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Petrological geodynamics of mantle melting Ⅲ.AlphaMELTS+multiphase flow:The effect of water

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Geoscience Frontiers 2020年第4期11卷 1381-1402页

作者： massimiliano Tirone 161 Ninos Heroes Sur JocotepecJalisco 45800Mexico

The influence of water is evaluated in this last contribution of a series aiming to study the petrological and dynamic evolution of mantle *** is considered to be either a chemical component in the melt or solid assemblage but it can also be present as a pure water phase in a oversaturated environment.A three-phase-flow model was developed for this *** a limited set of conditions has been applied to the 1-D upwelling mantle column.A range of fixed temperatures(1150-1450℃) and water contents in the solid mantle(0,0.02 wt.%,0.2 wt.%) have been imposed at the entry point(120 km deep) for the two melting models introduced in the previous installments,dynamic equilibrium melting(DEM) and dynamic fractional melting(DFM) *** expected,for a given temperature at the base of the mantle column,the depth of the first melt formation increases with higher water content in the *** the first melt is created,very negligible amount of melt is formed over a certain depth interval which approximately ends at the depth where the first melting of the dry mantle would take *** melt is present as a dynamic phase thorough the entire region regardless whether the DEM or DFM model has been *** a quasi-steady state regime,the melt and residual mantle compositions vary significantly over depth,depending on the conditions imposed to the model(DEM,DFM,bottom temperature and water content).Several distinctions can be made at the extraction point(top of the mantle column=15 km deep).For DEM and DFM models at this lowest depth,the most influential factor affecting the melt composition after the quasi-steady state condition has been reached is the temperature at the base of the *** general,for a high temperature model,the input water in the mantle does not seem to play a significant role on the bulk composition of the melt(except for the water content in melt).But at low temperature water does have some noticeable influence on the variation o

关键词： Petrology Mantle melting Geodynamics Thermodynamics AlphaMELTS Numerical modeling

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Addition of Thermoplastic Starch(TPS)to Binary Blends of Poly(lactic acid)(PLA)with Poly(butylene adipate-co-terephthalate)(PBAT):Extrusion Compounding,Cast Extrusion and Thermoforming of Home Compostable Materials

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Chinese Journal of Polymer Science 2022年第10期40卷 1269-1286,I0011页

作者： Clizia Aversa massimiliano Barletta Università degli Studi Roma Tre Dipartimento di Ingegneria Industriale Elettronica e MeccanicaVia della Vasca Navale 7900146 RomaItaly

Development of home compostable materials based on bioavailable polymers is of high strategic interest as they ensure a significant reduction of the environmental footprint in many production *** this work,the addition of thermoplastic starch to binary PLA/PBAT blends was *** compounds were obtained by a reactive extrusion process by means of a co-rotating twin screw ***,physical and chemical characterization tests were carried out to highlight the effectiveness of the material design *** compounds were subsequently reprocessed by cast extrusion and thermoforming in order to obtain products suitable for the storage of hot *** extruded films and the thermoformed containers were further characterized to highlight their thermo-mechanical,physical and chemical ***-rheological,mechanical and physical properties of the material and of the cast film were analyzed thoroughly using combined technique as capillary rheometer,MFI,DSC,VICAT/HDT,XRD,FTIR,UV-Vis,SEM,permeability and,lastly,running preliminary chemical inertness and biodegradation *** attention was also devoted to the evaluation of the thermo-mechanical resistance of the thermoformed containers,where the PLA/PBAT/TPS blends proved to be very effective,also presenting a high disintegration rate in ambient conditions.

关键词： Thermoplastic starch(TPS) Poly(lactic acid)(PLA) Poly(butylene adipate-co-terephthalate)(PBAT) Extrusion Thermoforming Compostability

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围术期神经肌肉阻滞的管理:欧洲麻醉和重症监护学会临床指南

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中华麻醉学杂志 2024年第6期44卷 641-656页

作者： Thomas Fuchs-Buder Carolina S.Romero Heidrun Lewald Massimo Lamperti Arash Afshari Ana-Marjia Hristovska Denis Schmartz Jochen Hinkelbein Dan Longrois Maria Popp Hans Dde Boer massimiliano Sorbello Radmilo Jankovic Peter Kranke 法国南锡大学医学院附属医院麻醉学、重症监护与围术期医学科法国南锡54000 巴伦西亚大学综合医院麻醉与重症监护科西班牙巴伦西亚46014 慕尼黑工业大学麻醉学与重症监护科德国慕尼黑80333 克利夫兰阿布扎比诊所麻醉学研究所阿联酋阿布扎比31250 哥本哈根大学医院小儿和产科麻醉科丹麦哥本哈根2100 哥本哈根大学医院麻醉学与重症监护科丹麦赫维德2650 布鲁塞尔自由大学Erasme医院麻醉科比利时布鲁塞尔1070 科隆大学医院麻醉学与重症监护科德国科隆50937 巴黎大学附属比查特克劳德伯纳德医院麻醉学与重症监护医学科法国巴黎75018 维尔茨堡大学医院麻醉学、危重病医学、急诊医学和疼痛医学科德国维尔茨堡97080 格罗宁根大学医院麻醉学、疼痛医学与程序性镇静与镇痛科荷兰格罗宁根9713 GZ 卡坦尼亚大学医院麻醉与重症监护科意大利卡坦尼亚95123 尼什大学医学院尼什临床中心麻醉学与重症治疗科塞尔维亚尼什18000

近来的研究表明,由于围术期神经肌肉阻滞管理不当,肌肉松弛药(肌松药)残留阻滞及其术后并发症的发生率居高不下。需要重视神经肌肉功能监测仪、肌松药及其拮抗剂的合理应用,以利于改善神经肌肉阻滞管理。欧洲麻醉和重症监护学会(Europea... 详细信息

近来的研究表明,由于围术期神经肌肉阻滞管理不当,肌肉松弛药(肌松药)残留阻滞及其术后并发症的发生率居高不下。需要重视神经肌肉功能监测仪、肌松药及其拮抗剂的合理应用,以利于改善神经肌肉阻滞管理。欧洲麻醉和重症监护学会(European Society of Anaesthesiology and Intensive Care,ESAIC)首次发布围术期神经肌肉阻滞管理临床指南,旨在为临床医生提供最佳医疗管理的循证建议,以提高围术期患者安全。本指南主要聚焦在3个临床问题:肌松药是否有助于成人气管插管?神经肌肉阻滞深度是否影响腹部手术患者的预后?肌松药残留阻滞的诊断和治疗策略有哪些?根据PICO原则(患者、干预、对照、结局;patient,intervention,comparator,outcome;PICO)构建临床问题并进行文献检索。初始纳入的临床研究为24 000篇,采用逐步筛选策略,最终临床研究88篇纳入指南分析。应用GRADE方法学(Grading of Recommendations,Assessment,Development and Evaluation,GRADE)对结局指标证据、质量等级进行评价。运用两轮德尔菲法收集专家组建议并形成统一推荐:R1推荐应用肌松药辅助气管插管(1A)。R2推荐应用肌松药以减少气管插管导致的咽部和(或)喉部损伤(1C)。R3推荐在快速顺序诱导插管(rapid sequence induction intubation,RSII)时使用短效肌松药,例如琥珀胆碱1 mg/kg或罗库溴铵0.9~1.2 mg/kg(1B)。R4推荐在需要改善外科手术条件时,加深神经肌肉阻滞深度(1B)。R5尚无足够的证据推荐深度神经肌肉阻滞可减轻术后疼痛或降低围术期并发症的发生率(2C)。R6推荐在拇内收肌处刺激尺神经,定量监测神经肌肉阻滞深度以排除肌松药残留阻滞(1B)。R7推荐应用舒更葡糖钠逆转甾体类肌松药(罗库溴铵、维库溴铵)诱导的深、中及浅度神经肌肉阻滞(1A)。R8推荐在使用新斯的明前,TOFr自行恢复至>0.2,并继续定量监测神经肌肉功能,直至TOFr超过0.9(1C)。

关键词：神经肌肉阻滞神经肌肉功能肌松药临床指南罗库溴铵琥珀胆碱外科手术定量监测

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C1C2 Wiring and Posttraumatic Atlantoaxial Dislocation: An Effective and Cheap Surgical Procedure in a Developing Country

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Surgical Science 2024年第5期15卷 357-370页

作者： Ibrahim Dao massimiliano Visocchi Salah Sow John Jabang Ousmane Ouattara Astride Somda Abdoulaye Sanou Elie Dibloni Nassoum Arsène Tossou Narcisse Ouedraogo Frédéric Bako Massadiami Soulama Malick Diallo Patrick Wendpouiré Hamed Dakouré Department of Neurosurgery University Hospital Souro Sanou Nazi Boni University Bobo Dioulasso Burkina Faso High Institute of Health Sciences Nazi Boni University Bobo Dioulasso Burkina Faso Military Hospital Colonel Major Tanguet Ouattara Bobo Dioulasso Burkina Faso Institute of Neurosurgery Craniovertebral Junction Surgery Unit School of Medicine Catholic University Rome Italy Department of Radiology and Medical Imaging University Hospital Yalgado Ouedraogo Joseph Ki-Zerbo University Ouagadougou Burkina Faso Department of Neurosurgery (Unit) Edward Francis Small Teaching Hospital Banjul Gambia Department of Neurosurgery University Hospital Yalgado Ouedraogo Joseph Ki-Zerbo University Ouagadougou Burkina Faso Department of Neurosurgery Military Hospital Capitaine Halassane Coulibaly Ouagadougou Burkina Faso Department of Orthopedic Surgery University Hospital Souro Sanou Nazi Boni University Bobo Dioulasso Burkina Faso

Objectives: Atlantoaxial dislocation remains a rare and serious condition with a high preoperative and postoperative morbidity and mortality. Its successful surgical management is still challenging and gratifying for neurosurgeons. Several technics have been described such as wiring, trans articular screwing, C1C2 screwing with plate and screw introduced by Goel et al., and modified by insertion of polyaxially screw and rod many years later by Harms. Unavailability and expensiveness of upper cervical spine instrumentation device led us to C1C2 Wiring resulting in a good outcome. Finally, a quadriplegic patient with a more comfortable financial condition had ordered devices from abroad and benefit for Goel and Harms screwing technique and improved dramatically from ASIA A to ASIA E. Material and methods: This is a retrospective study of patients managed in our department by a same neurosurgeon from January 2019 to April 2024. Results: We defined 6 men and 1 woman with an average age of 33 years. Unrestrained driver in a rollover motor vehicle accident was most common. Only one patient was neurologically intact on admission. Neurovegetative disorders were noticed in one patient. Dislocation was associated to a fracture of the dens in two patients. Three patients have been successfully operated with remarkable outcome, mostly from ASIA A to E. Conclusion: C1C2 dislocation is a serious condition and C1C2 Wiring represents an effective and cheaper technic. Therefore, this technic should deserve consideration above all in low incomes countries when screwing devices are not available. Seatbelt should be demanded for motor vehicle drivers and passengers.

关键词： Superior Cervical Spine Dislocation Fracture Wiring Screwing Neurovegetative Disorders

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