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One key task in the early fight against the COVID-19 pandemic was to plan non-pharmaceutical interventions to reduce the spread of the infection while limiting the burden on the society and economy. With more data on the pandemic being generated, it became possible to model both the infection trends and intervention costs, transforming the creation of an intervention plan into a computational optimization problem. This paper proposes a framework developed to help policy-makers plan the best combination of non-pharmaceutical interventions and to change them over time. We developed a hybrid machine-learning epidemiological model to forecast the infection trends, aggregated the socio-economic costs from the literature and expert knowledge, and used a multi-objective optimization algorithm to find and evaluate various intervention plans. The framework is modular and easily adjustable to a real-world situation, it is trained and tested on data collected from almost all countries in the world, and its proposed intervention plans generally outperform those used in real life in terms of both the number of infections and intervention costs.

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OBJECTIVE: Anatomical abnormalities in the thoracic outlet syndrome are very frequent, but radiological images are not always reliable. Therefore, the different features and abilities of CT angiogram and brachial plexus MRI to detect anatomical abnormalities have been investigated. METHODS: All radiological and surgical records of patients operated for thoracic outlet syndrome between January 2011 and December 2018 were retrospectively analyzed. Considering the CT angiogram and/or brachial plexus MRI reports of the preoperative period, the performance of these investigations was evaluated by calculating the precision (P), sensitivity (Recall) and Hamming loss (L). RESULTS: From a total of 107 patients screened, 84 were eligible for study inclusion. Out of these, 46 had surgical abnormalities (group 1), while 38 did not (group 2). Among them, 30 patients have performed CT angiogram (subgroup A), 32 brachial plexus MRI (subgroup B) and 22 both (subgroup C). The best result is obtained when both diagnostic examinations are performed (subgroup C: P = 0.62; recall = 0.52; L = 0.038). CONCLUSIONS: Prescribing both investigations in selected patients increases the probability of finding anatomic anomalies and facilitates preoperative planning. However, as the radiological images are not completely exhaustive, the surgeon should always actively search and remove any potential source of compression on the nervous vascular bundle along the thoracic outlet.

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Prosthesis-based techniques are the predominant form of breast reconstruction worldwide. The most performed surgical technique involves the placement of the expander in a partial submuscular plane. The coverage of the implant remains a difficult management problem that can lead to complications and poor outcomes. The use of the serratus fascia flap may be the best choice to create a subpectoral pocket for the placement of a tissue expander, with excellent results in terms of morbidity and cost-effectiveness. A total of 20 breast reconstructions with the inferolateral coverage with the serratus fascia were performed. Patients demonstrated a low overall complication rate (9.5%), such as seroma and infection, with complete resolution during the follow-up and no major complications. The US examination of the soft tissues over the implant reported thickness measurements that demonstrated a good coverage over the inferolateral area. Our study shows that using the serratus fascia flap to create a pocket with the pectoralis major for the placement of the tissue expander is an effective technique during two-stage breast reconstruction. The resulting low rate of morbidity and the US findings collected reveal the safety of this procedure. Its success relies on appropriate patient selection and specific intraoperative technique principles.

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BACKGROUND: The number of patients undergoing mastectomy and immediate breast reconstruction with tissue expanders followed by post-mastectomy radiotherapy (PMRT) is exponentially increasing. To reduce the rate of complications, in 2011, the senior author of this manuscript described the use of protective lipofilling in patients undergoing unplanned PMRT to the expander with a specific protocol aiming to decrease the rate of complications. OBJECTIVES: A study was performed to evaluate the thickness of the breast irradiated tissue to create a standard pattern of "protective" lipofilling infiltration on limited key areas that could re-establish a thickness similar to non-radiotreated tissues. METHODS: We studied 15 patients who had modified radical mastectomy (MRM) with immediate breast reconstruction with tissue expanders and PMRT (Group 1) before expansion (Time1), before PMRT (Time2), after PMRT (Time3), 3 months after "protective" lipofilling (Time4), and 6 months after "protective" lipofilling (Time5). As a control group, we studied 15 patients who had MRM and immediate breast reconstruction with tissue expanders that would not undergo PMRT (Group 2) at the same time points of GROUP 1 (Time1,2,3). Tissue thickness was studied in specific areas using ultrasounds (US) and magnetic resonance imaging (MRI). RESULTS: US and MRI measurements obtained 6 weeks after PMRT and 3 months after lipofilling showed an initial decrease and then an average increase in tissue thickness reaching values even higher than the non-radiotreated control group. CONCLUSIONS: This preliminary report shows how a one-step "fat belt" surgical pattern of lipofilling delivered to central "selected" areas of the breast can achieve adequate tissue thickness in patients who underwent breast reconstruction with PMRT reaching a thickness similar (and in most cases higher) to non-radiotreated tissues. Further follow-up studies are needed to analyze long-term complications of tissue thinning such as ulceration and implant exposure, in comparison with the "fat capsule" pattern. LEVEL OF EVIDENCE IV: 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 .

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