The authors describe the most critical aspects of transplantation of the hand. Three successful cases are presented from the Italian Hand Transplantation National Program. The key issues of this new type of surgical reconstruction for major amputations are selection criteria of suitable candidates, technical aspects of surgery, postoperative regime and functional rehabilitation. Other important aspects are staff requisites and organisation of the clinical trial, ethical and legal implications, dealing with the media. The authors comment on the fact that we might be ready to accept that almost anything could come from a cadaver, even if it is not a life-saving organ, to reconstruct missing parts and restore anatomical integrity and, especially, function.

There is evidence that diet and nutrition are modifiable risk factors for several cancers. In recent years, attention paid to micronutrients in gynecology has increased, especially regarding Human papillomavirus (HPV) infection. We performed a review of the literature up until December 2022, aiming to clarify the effects of micronutrients, minerals, and vitamins on the history of HPV infection and the development of cervical cancer. We included studies having as their primary objective the evaluation of dietary supplements, in particular calcium; zinc; iron; selenium; carotenoids; and vitamins A, B12, C, D, E, and K. Different oligo-elements and micronutrients demonstrated a potential protective role against cervical cancer by intervening in different stages of the natural history of HPV infection, development of cervical dysplasia, and invasive disease. Healthcare providers should be aware of and incorporate the literature evidence in counseling, although the low quality of evidence provided by available studies recommends further well-designed investigations to give clear indications for clinical practice.

Background: The arterial switch operation (ASO) for transposition of the great arteries has excellent survival, but a substantial number of patients suffer from a reduced exercise capacity. The goal of this study was to identify imaging parameters associated with a reduced exercise capacity in patients after ASO. Methods: A retrospective analysis was performed of ASO patients who underwent cardiopulmonary exercise testing (CPET) between 2007 and 2017. Reduced exercise performance was defined as a reduced workload peak (W peak ) with Z-score <À2 or a peak oxygen uptake indexed for weight (VO 2peak /kg) with Z-score <À2. Data on echocardiography and cardiac magnetic resonance performed within 1 year of the CPET were collected for comparison. Results: A total of 81 ASO patients (age 17 AE 7 years) were included. Reduced exercise performance was found in 22 patients (27%) as expressed by either a reduced W peak and/or a reduced VO 2peak /kg. Main pulmonary artery gradient and tricuspid regurgitation gradient by echocardiography were found to be associated with reduced W peak (p = 0.031; p = 0.020, respectively). The main pulmonary artery gradient and tricuspid regurgitation gradient by echocardiography were found to be associated with reduced VO 2peak /kg (p = 0.009; p = 0.019, respectively). No left ventricular parameters were found to be associated with abnormal exercise performance. Conclusion: This study demonstrates that ASO patients frequently experience reduced exercise capacity. Echocardiographic evidence of main pulmonary artery stenosis and increased right ventricular pressure were associated with reduced exercise capacity, and are therefore key to monitor during serial follow-up of ASO patients.

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