Analytical characterization of products obtained from slow pyrolysis of Calophyllum inophyllum seed cake: study on performance and emission characteristics of direct injection diesel engine fuelled with bio-oil blends

Abstract

This paper aims to analyse the characteristics and properties of the fractions obtained from slow pyrolysis of non-edible seed cake of Calophyllum inophyllum (CI). The gas, bio-oil and biochar obtained from the pyrolysis carried out at 500 °C in a fixed bed batch type reactor at a heating rate of 30 °C/min were characterized by various analytical techniques. Owing to the high volatile content of CI biomass (72.61%), it was selected as the raw material in this present investigation. GC-MS and FT-IR analysis of bio-oil showed the presence of higher amount of oxygenated compounds, phenol derivatives, esters, acid and furans. The physicochemical properties of the bio-oil were tested as per ASTM norms which imply that bio-oil is a highly viscous liquid with lower heating value as compared to that of diesel fuel. The chemical composition of evolved gas was analysed by using GC testing which revealed the presence of combustible components. The FT-IR characterization of biochar showed the presence of aliphatic and aromatic hydrocarbons whereas the elevated amount of carbon in biochar indicates its potential to be used as solid fuel. The performance and emission characteristics of CI engine were assessed with different CI bio-oil blends and compared with baseline diesel fuel. The results showed that addition of bio-oil leads to decreased brake thermal efficiency and increased brake specific energy consumption. Meanwhile, increase in blend ratio reduces harmful pollutants such as oxides of nitrogen and smoke in the exhaust. From the engine testing, it is suggested to employ 20% of CI bio-oil blends in CI engine to obtain better operation.

Combined treatment of contaminated soil with a bacterial Stenotrophomonas strain DXZ9 and ryegrass ( Lolium perenne ) enhances DDT and DDE remediation

Abstract

Bioremediation of contaminated soils by a combinational approach using specific bacterial species together with ryegrass is a promising strategy, resulting in potentially highly efficient degradation of organic contaminants. The present study tested the combination of strain DXZ9 of Stenotrophomonas sp. with ryegrass to remove DDT and DDE contaminants from soil under natural conditions in a pot experiment. The strain DXZ9 was successfully colonized in the natural soil, resulting in removal rates of approximately 77% for DDT, 52% for DDE, and 65% for the two pollutants combined after 210 days. Treatment with ryegrass alone resulted in slightly lower removal rates (72 and 48%, respectively, 61% for both combined), while the combination of strain DXZ9 and ryegrass significantly (p < 0.05) improved the removal rates to 81% for DDT and 55% for DDE (69% for both). The half-life of the contaminants was significantly shorter in combined treatment with DXZ9 and ryegrass compared to the control. The remediation was mostly due to degradation of the contaminants, as the net uptake of DDT and DDE by the ryegrass accounted for less than 3% of the total amount in the soil. DDT is reductively dechlorinated to DDD and dehydrochlorinated to DDE in the soil; the metabolites of DDE and DDD were multiple undefined substances. The toxicity of the soil was significantly reduced as a result of the treatment. The present study demonstrates that the bioremediation of soil contaminated with DDT and DDE by means of specific bacteria combined with ryegrass is feasible.

Is trade openness good for environment in South Korea? The role of non-fossil electricity consumption

Abstract

The paper investigates the linkage of carbon dioxide (CO₂) emissions, per capita real output, share of non-fossil electricity consumption, and trade openness in South Korea from 1971 to 2013. The empirical results indicate that the environmental Kuznets curve (EKC) is supported by autoregressive distributed lag (ARDL) test. Both short- and long-run estimates indicate that increasing non-fossil electricity consumption can mitigate environmental degradation, and increasing trade aggravates carbon dioxide emissions. By Granger causality, long-run causalities are found in both equations of CO₂ emissions and trade openness, as well as exports and imports. In the short-run, evidence indicates feedback linkage between output and trade, unidirectional linkages from trade to emissions, from emissions to output, and from output to non-fossil electricity use. Therefore, South Korea should strengthen the sustainable economy, consume clean energy, and develop green trade.

Leukocyte adhesion deficiency-I: A comprehensive review of all published cases

Publication date: Available online 20 January 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Elena Almarza Novoa, Sanchali Kasbekar, Adrian J. Thrasher, Donald B. Kohn, Julian Sevilla, Tony Nguyen, Jonathan D. Schwartz, Juan A. Bueren

Retrospective Analysis of Physician-based Surveys Published in OPRS

Purpose: To review physician-based clinical surveys published in Ophthalmic Plastic and Reconstructive Surgery. Methods: Complementary Ovid and PubMed searches of Ophthalmic Plastic and Reconstructive Surgery journal content were performed for the term "survey." Results were narrowed to studies that specifically addressed physicians' clinical practices. This search resulted in 162 articles, and after dual-investigator independent screening, 13 surveys met inclusion criteria. Results: Of the 13 surveys published from 2007 to January 2017, 6 were published since 2015, showing an increased trend in survey-based publications. Topics included assessing practice patterns regarding eyelid disorders, thyroid eye disease, optic nerve sheath fenestration, anophthalmic socket, and diagnosing lacrimal disorders. Average response rate was 38.7% (range 17.5–60%), with 201 average number of replies (range 72–310). Nine out of 13 surveys included some form of statistical analysis with the remainder presenting data in percentages. Conclusions: There has been an increased rate of survey-type publications in Ophthalmic Plastic and Reconstructive Surgery over the past 10 years. The low response rate and frequent lack of statistical analysis raise concerns regarding the validity and usefulness of such studies. The authors believe that survey studies can be improved through better standardization and the use of author guidelines. They have made specific recommendations to improve the impact of survey papers in the future. Accepted for publication October 6, 2017. Presented at Spring ASOPRS meeting, June 2017 in Vancouver, Canada. Funded in part by Research to Prevent Blindness, New York, NY. The authors have no conflicts of interest to disclose. Correspondence address and reprint requests to H.B. Harold Lee, M.D., F.A.C.S., Oculofacial Plastic and Orbital Surgery, 201 Pennsylvania Parkway, Suite 225, Indianapolis, IN 46280. E-mail: huibae@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Chronic Hematic Cyst of the Right Maxillary Sinus and Orbit Presenting as Proptosis

A 28-year-old man presented to the emergency room complaining of right proptosis. He also manifested eye pain and facial fullness and redness in this side. Seven years ago, he had right hemifacial gunshot trauma treated with surgical reconstruction. The CT scan showed expansion of the right maxillary sinus due to a hypodense nonenhancing lesion extending to the nasal cavity, masticatory space, and extraconal space of the orbit. MRI was performed showing high signal intensity of the lesion on T2-weighted images indicating a cystic nature. T1-weighted images also demonstrated high signal intensity of the lesion suggesting hemorrhage. At endoscopic maxillary antrostomy, the diagnosis of a chronic hematic cyst was confirmed. Chronic hematic cysts of the orbit should be included in the differential diagnosis of proptosis, especially if there is clinical history of past trauma. Due to the fact that physical examination is nonspecific, radiologic evaluation is useful to confirm the diagnosis and for presurgical planning. Accepted for publication December 5, 2017. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Martin Ochoa-Escudero, M.D., Department of Radiology, Neuroradiology Section, Hospital Pablo Tobón Uribe, Medellín, Colombia. E-mail: martin127d@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Liming induces carbon dioxide (CO 2 ) emission in PSB inoculated alkaline soil supplemented with different phosphorus sources

Abstract

Agricultural land is a major sink of global organic carbon (C). Its suitable management is crucial for improving C sequestration and reducing soil CO₂ emission. Incubation experiments were performed to assess the impact of phosphate solubilizing bacterial (PSB) inoculation (inoculated and uninoculated) and soil calcification (4.78, 10, 15, and 20% crushed CaCO₃) with phosphorus (P) sources [single superphosphate (SSP), rock phosphate (RP), farm yard manure (FYM), and poultry manure (PM)] in experiment 1 and with various rates of PM (4, 8, and 12 kg ha⁻¹) in experiment 2 on cumulative soil respiration. These experiments were arranged in three factorial, complete randomize design (CRD) with three replications. Interactively, lime with P sources (at day 1 and 3) and lime with PSB (at day 1) significantly expedited soil respiration. Mainly, PSB inoculation, liming, PM fertilization, and its various rates significantly enhanced soil respiration with time over control/minimum in alkaline soil at all incubation periods. Higher CO₂ emission was detected in soil supplemented with organic P sources (PM and FYM) than mineral sources (SSP and RP). CO₂ emission was noted to increase with increasing PM content. Since liming intensified CO₂ discharge from soil, therefore addition of lime to an alkaline soil should be avoided; instead, integrated approaches must be adopted for P management in alkaline calcareous soils for climate-smart agriculture.

Deference and Uniqueness

Abstract

Deference principles are principles that describe when, and to what extent, it's rational to defer to others. Recently, some authors have used such principles to argue for Evidential Uniqueness, the claim that for every batch of evidence, there's a unique doxastic state that it's permissible for subjects with that total evidence to have. This paper has two aims. The first aim is to assess these deference-based arguments for Evidential Uniqueness. I'll show that these arguments only work given a particular kind of deference principle, and I'll argue that there are reasons to reject these kinds of principles. The second aim of this paper is to spell out what a plausible generalized deference principle looks like. I'll start by offering a principled rationale for taking deference to constrain rational belief. Then I'll flesh out the kind of deference principle suggested by this rationale. Finally, I'll show that this principle is both more plausible and more general than the principles used in the deference-based arguments for Evidential Uniqueness.

The effects of rainfall regimes and terracing on runoff and erosion in the Three Gorges area, China

Abstract

Changes in natural rainfall regimes have taken place and are expected to become more pronounced in future decades. These changes are also likely to be accompanied by changes in crop management practices. The main purpose of this study was to analyze runoff and soil loss in relation to rainfall regimes and terracing in the Three Gorges area, China. Based on 10 years of field observation and k-mean clusters, 101 rainfall events were grouped into three rainfall regimes. Rainfall regime I was the group of events with strong rainfall intensity, high frequency, and short duration. Rainfall regime III consisted of events with low intensity, long duration, and high rainfall amount. Rainfall regime II was the aggregation of events of high intensity and amount, and less frequent occurrence. The results showed that event runoff coefficients were not significantly different among rainfall regimes. However, the average soil erosion rates in rainfall regimes I and II were significantly higher than that in regime III. The average erosion rates under rainfall regimes I, II, and III were 21.6, 39.7, and 9.8 g m⁻², respectively. The effect of rainfall regime on soil erosion also was changed by terracing. On unterraced cropland, soil erosion rate in rainfall regime I is significantly higher than that in regime III. However, the situation did not exist in unterraced orchard. Terracing significantly reduced runoff and soil erosion, and compensated the effects of rainfall regime on soil erosion, which indicated that runoff and erosion in terraced system may be little influenced by climate change. Based on these results, it was suggested more attention should be paid to the timing of rainfall events in relation to crop development and the high erosion on unterraced citrus orchard to control soil erosion in this area.

In situ monitoring of the Sinos River, southern Brazil: water quality parameters, biomarkers, and metal bioaccumulation in fish

Abstract

The Sinos River is an important water supply in Southern Brazil and receives industrial, agricultural, and domestic effluents which may affect aquatic biota. Water physicochemical and microbiological analyses, biomarker responses (scaled mass index (SMI), gill histopathology, and micronucleus and nuclear abnormality (MN and NA) frequencies), and metal bioaccumulation in muscle were assessed in the fish species Bryconamericus iheringii (Characidae) captured at three sampling sites (S1, S2, and S3) in four sampling periods. The mean values of five parameters (total phosphorus, thermotolerant coliforms, aluminum, iron, and lead) exceeded the limits established by the Brazilian legislation at the three sampling sites. Although physicochemical analysis indicated higher impacts at S3, in some samples, significantly higher MN frequencies and bioaccumulation of manganese in fish muscle were observed at S1, whereas low SMI and higher concentrations of aluminum and zinc in fish muscle were found at S2. Histopathological alterations in gills were observed in fish collected at the three sampling sites; however, no spatial differences were observed, indicating similar environmental conditions with respect to this biomarker. Moreover, temporal variation of biomarker responses and metal bioaccumulation were found at all sampling sites. Furthermore, the consumption of fish from the Sinos River should be avoided given the concentrations of chromium (all samples), cadmium, and lead in fish muscle above the threshold for safe human consumption.

Heath risk among pesticide sellers in Bamenda (Cameroon) and peripheral areas

Abstract

In Bamenda and peripheral zones, studies have been focused on the effects of pesticides on farmers (pesticide users) while nothing has been done to assess the exposure of sellers to pesticides. This study aimed at evaluating the exposure of pesticide sellers in the same area. Thirty-two questionnaires were administered to 32 pesticide sellers systematically selected, and chi-square was used for statistical analysis. From each shop, a respondent was chosen among the workers according to its daily time spent in the workplace. The results showed that there is similarity between sellers in Bamenda and peripheral area; one active ingredient (metalaxyl) and one formulation (beauchamp) sold are not registered; throat irritation, headaches, fatigue, skin irritation, eye irritation, and difficulty in breathing with more cases of nose irritation were symptoms observed; pesticides are stored either in the shops or in warehouses; safety measures generally applied are sitting outside the shop, taking medicated charcoal and the use of protective clothing; 56% have less than 5 years experience. Permanent pesticide sellers are then exposed to chronic intoxication in Bamenda and neighboring zones. Employers should make use of protective clothing in their shops when manipulating pesticides in the application of safety measures.

Modeling the impact of transport energy consumption on CO 2 emission in Pakistan: Evidence from ARDL approach

Abstract

The objective of this research is to examine the relationship between transport energy consumption, economic growth, and carbon dioxide emission (CO₂) from transport sector incorporating foreign direct investment and urbanization. This study is carried out in Pakistan by applying autoregressive distributive lag (ARDL) and vector error correction model (VECM) over 1990–2015. The empirical results indicate a strong significant impact of transport energy consumption on CO₂ emissions from the transportation sector. Furthermore, foreign direct investment also contributes to CO₂ emission. Interestingly, the impact of economic growth and urbanization on transport CO₂ emission is statistically insignificant. Overall, transport energy consumption and foreign direct investment are not environmentally friendly. The new empirical evidence from this study provides a complete picture of the determinants of emissions from the transport sector and these novel findings not only help to advance the existing literature but also can be of special interest to the country's policymakers. So, we urge that government needs to focus on promoting the energy efficient means of transportation to improve environmental quality with less adverse influence on economic growth.

Helicobacter pylori LPS-induced gastric mucosal spleen tyrosine kinase (Syk) recruitment to TLR4 and activation occurs with the involvement of protein kinase Cδ

Abstract

Spleen tyrosine kinase (Syk) has emerged recently as a major effector of proinflammatory genes expression induced by LPS-elicited TLR4 activation, and manifested by the up-amplification in the production of inflammatory mediators, including PGE2 and NO. Here, we investigated the nature of factors involved in the recruitment and interaction of Syk with TLR4 in gastric mucosa in response to H. pylori LPS. We show that stimulation of gastric mucosal cells with the LPS leads to localization of Syk with the membrane-associated TLR4 complex and its activation through phosphorylation on Tyr. Furthermore, we reveal that the membrane translocation of Syk upon the LPS stimulation occurs with the involvement of protein kinase Cδ (PKCδ)-mediated phosphorylation of Syk on Ser. Thus, our findings demonstrate that H. pylori LPS-induced up-regulation in Syk activity proceeds through the stage of PKCδ-mediated Syk phosphorylation on Ser, required for its recruitment to the membrane-anchored TLR4, followed by the kinase activation through phosphorylation on Tyr. Hence, the phase of PKCδ-mediated Syk phosphorylation on Ser affects the extent of amplification in gastric mucosal inflammatory response to H. pylori.

A multi-centre, open, investigator initiated phase IV clinical trial to evaluate the efficacy and safety of ingenol mebutate gel, 0.015% on the face and scalp, and 0.05% on the trunk and extremities, in Korean patients with actinic keratosis (PERFECT)

Abstract

Background

Ingenol mebutate gel is a novel, field-directed topical treatment for actinic keratosis (AK). Most pivotal studies have targeted Western populations. No clinical study has been conducted to investigate its efficacy and safety in Asian populations.

Objectives

To evaluate the efficacy and safety of ingenol mebutate gel for treating AK of face/scalp and trunk/extremities in a large Asian (Korean) population.

Methods

In this multi-centre, open-label, interventional, parallel group, prospective phase 4 study (PERFECT, NCT02716714), the eligible subjects were allocated into either the face/scalp or the trunk/extremities group, according to their selected treatment area location. After application of ingenol mebutate gel, the subjects were followed-up for 6 months. The primary efficacy endpoint was complete clearance (CC) rate of AK lesions in the selected treatment area on Day 57. The quality of life was evaluated using Skindex-29. Safety endpoints included local skin responses, scar, pigmentation, pain, and adverse events.

Results

In total, 78.1% (95% CI: 66.86–86.92%) of subjects had CC on day 57, with 76.6% (95% CI: 64.31–86.25%) in face/scalp group and 88.9% (95% CI: 51.75–99.72%) in trunk/extremities group. Among them, the CC rate was sustained in 88.9% (48/54 subjects, 95% CI: 77.37–95.81%) on Month 6. The local skin responses significantly increased 1 day after the treatment compared to baseline, and decreased afterwards. Among the total subjects, 7.8% (6/77 subjects) had hyperpigmentation on the application area. Scars were not reported.

Conclusions

Ingenol mebutate is effective for the treatment of AK in Asians, with tolerable safety profiles.

This article is protected by copyright. All rights reserved.

Severe cutaneous adverse reactions due to inappropriate medication use

Summary

Backgroud

The proportion of severe cutaneous adverse reactions (SCARs) that could be avoided if medication use was consistent with good medical practice is unknown.

Objectives

To estimate the proportion of SCARs related to inappropriate medication use.

Methods

Retrospective study of all validated SCARs collected in a French registry between 2003 and 2016. For each case, all plausible drugs suspected to induce SCARs (i.e., not just the drug regarded as "the most probable") were considered regarding three causes of preventability: (1) prescription for an inappropriate indication, (2) unintentional rechallenge despite a previous allergy to the drug, or (3) self-medication with prescription medicines.

Results

602 cases were included in the analyses. Antibiotics, anticonvulsants and allopurinol were the drugs most frequently involved, accounting for more than 50% of all cases. All suspected medications were considered appropriately used for 417 of the 602 individuals included in the study population (69.3%, 95% CI [65.6-73.0]),and inappropriately used. for 144 individuals (23.9% [20.5-27.3]).. These inappropriate uses were mainly due to prescriptions for inappropriate indication (65.8% [58.4-73.2]) or unintentional rechallenge (20.9% [14.6-27.2]). Allopurinol and cotrimoxazole were the drugs most frequently involved in inappropriate indications (accounting for 51.9% [42.3-61.5] and 13.5% [6.9-20.1] of cases, respectively). Antibiotics were the largest group involved in unintentional rechallenge. Non-steroidal anti-inflammatory drugs available on prescription were most involved in inappropriate self-medication.

Conclusions

Our results underline the need for respecting the appropriate indication of drugs to reduce the incidence of SCARs. All efforts to reduce unintentional rechallenge also seem to be necessary preventive measures.

This article is protected by copyright. All rights reserved.

The effect of oral clindamycin and rifampicin combination therapy in patients with hidradenitis suppurativa in Singapore

Microcystic adnexal carcinoma with sebaceous differentiation: three cases

Abstract

Microcystic adnexal carcinoma (MAC) is a low-grade malignant tumor of the skin. Histologically, this tumor shows a biphasic pattern, with cords and nests of basaloid cells, as well as keratin horn cysts. This biphasic histological appearance has been interpreted by some authors as a sign of double eccrine and folliculosebaceous-apocrine differentiation, whereas some other authors defend an solely eccrine differentiation. In this context, sebaceous differentiation in MAC would support the first option. However, there are only three cases of MAC with sebaceous differentiation in the literature, and all of them are previous to adipophilin, which in the appropriate context (for example testing clear cells for sebaceous versus eccrine differentiation) is very useful. In the current paper, we present three cases of MAC with focal sebaceous differentiation confirmed by inmmunoexpression of adipophilin in the sebaceous foci.

Bronchiolitis obliterans syndrome is associated with increased p-glycoprotein expression and loss of glucocorticoid receptor from steroid resistant pro-inflammatory CD8+T cells

Summary

Immunosuppressive therapy fails to suppress the production of pro-inflammatory cytokines, particularly by CD8+T cells, in stable lung transplant recipients and those undergoing chronic rejection, suggesting that some patients may become relatively resistant to immunosuppressants such as glucocorticoids (GC). We have shown loss of GC receptor (GCR) from the CD8+ cells, and we hypothesized that the drug membrane efflux pump, p-glycoprotein-1 (Pgp), may also be involved in lymphocyte steroid resistance following lung transplant.

Pgp/GCR expression and IFNγ/TNFα pro-inflammatory cytokine production was measured in blood lymphocytes from 15 stable lung transplant patients, 10 patients with bronchiolitis obliterans syndrome (BOS) and 10 healthy aged-matched controls (± prednisolone ± Pgp inhibitor, cyclosporin A ± GCR activator, Compound A) using flow cytometry.

Both Pgp+ and Pgp- lymphocyte subsets from all subjects produced IFNγ/TNFα pro-inflammatory cytokines. Pgp expression was increased in CD8+Pgp+T cells and correlated with IFNγ/TNFα expression and BOS grade. Reduced GCR was observed in CD8+Pgp-T, NKT-like and NK cells from stable patients compared with controls, and further reduced in CD8+Pgp-T cells in BOS. Addition of 2.5ng/ml cyclosporine A and 1µM prednisolone significantly inhibit IFNγ/TNFα production by CD8+Pgp+ T cells from BOS patients. Addition of 10µM Compound A and 1µM prednisolone significantly inhibit IFNγ/TNFα production by CD8+Pgp- T cells from BOS patients.

BOS is associated with increased Pgp expression and loss of GCR from steroid resistant pro-inflammatory CD8+T cells. Treatments that inhibit Pgp and upregulate GCR in CD8+T cells may improve graft survival. This article is protected by copyright. All rights reserved.

Generation of shrimp waste-based dispersant for oil spill response

Abstract

In this study, shrimp waste was enzymatically hydrolyzed to generate a green dispersant and the product was tested for crude oil dispersion in seawater. The hydrolysis process was first optimized based on the dispersant effectiveness (DE) of the product. The functional properties of the product were identified including stability, critical micelle concentration, and emulsification activity. Water was confirmed as a good solvent for dispersant generation when compared with three chemical solvents. The effects of salinity, mixing energy, and temperature on the dispersion of the Alaska North Slope (ANS) crude oil were examined. Microtox acute toxicity test was also conducted to evaluate the toxicity of the produced dispersant. In addition, DE of the product on three different types of crude oil, including ANS crude oil, Prudhoe Bay crude oil (PBC), and Arabian Light crude oil (ALC) was compared with that of the Corexit 9500, respectively. The research output could lead to a promising green solution to the oil spill problem and might result in many other environmental applications.

Autologous Fat Transfer for Facial Rejuvenation: A Systematic Review on Technique, Efficacy, and Satisfaction

Background: Parallel to the steady decline in surgical aesthetic procedures to the face, dermal fillers seem to have gained a more prominent place in facial rejuvenation over the last couple of years. As a dermal, facial filler, autologous fat transfer (AFT) seems to have real potential because of the biocompatibility of adipose tissue besides being a procedure with few and primarily minor complications. This systematic review aims to evaluate the available evidence regarding the safety and effectiveness of AFT for facial rejuvenation. Method: A systematic review after the Preferred-Reporting-Items-for-Systematic-Reviews-and-Meta-Analysis (PRISMA) statement was conducted. MEDLINE, Embase, and Cochrane Library were searched up to December 2016, with no language restrictions imposed. Case series, cohort studies, and randomized controlled trials (RCTs) reporting on relevant outcomes were included. Results: Eighteen clinical articles were included, reporting on 3,073 patients in total over a mean follow-up period of 13.9 months. Meta-analysis showed an overall complication rate of 6% (95% CI 3.0–14.0), with hematoma/ecchymosis (5%), fat necrosis/oil cysts (2%), and irregular fat distribution and scars (both 2%) being among the most reported. No major complications were reported, and the overall patient satisfaction rate was 81%. Conclusion: Although the evidence in this systematic review is still limited and plagued by heterogeneity between studies, AFT seems to be a promising method in facial rejuvenation with fewer complications than other fillers and high patient satisfaction rates. Further large-cohort, preferably multicenter, RCTs should substantiate these results through quantifiable volumetric assessment tools and validated patient questionnaires, while adhering to predetermined nomenclature in terms of complications.

A Histological Comparison of Two Human Acellular Dermal Matrix Products in Prosthetic-Based Breast Reconstruction

Background: Acellular dermal matrices (ADMs) are an integral component of breast reconstruction. The ideal matrix would be relatively immuno-inert, allow rapid vascularization, and be affordable. The purpose of this study was to histologically compare 2 commonly used ADM products. Methods: This is a prospective histological study of 17 patients (20 breasts) following prosthetic-based breast reconstruction with ADM: Alloderm (LifeCell Corp, Branchburg, N.J.) or Cortiva (RTI Surgical, Alachua Fla.). Biopsies were taken from the dermal matrix and natural capsules surrounding the expander/implant during secondary surgery [Range, 72—694 days (mean, 217 days)]. Biopsy specimens were prepared via hematoxylin and eosin, Masson's trichrome, elastin, and transforming growth factor (TGF)-1 stains. Quantitative analysis of staining was performed with ImageJ software. The clinical outcome of each patient is analyzed in relation to capsule architecture and ADM performance. Results: There were 7 breasts in the Alloderm group and 13 in the Cortiva group. Both groups had similar demographic, aesthetic results, and complication profiles. The TGF-1 staining demonstrated significantly lower levels in the Cortiva capsules (P = 0.0139). The percentage of elastin and collagen are similar in the Cortiva, Alloderm, and natural peri-implant capsules. The native capsules show a significantly greater number of blood vessels when compared with Cortiva and Alloderm (P = 0.0371 and P = 0.0347, respectively); however, there is no difference in vascular pattern between the 2 dermal matrices. Discussion: Postoperatively, Cortiva demonstrates equal vascularity with less TGF-1 activation compared with Alloderm. The clinical success and complication profile were similar between the Alloderm and Cortiva patients.

A Giant Neurovascular Lower Limb Fillet Flap Can Simultaneously Cover Pelvic and Abdominal Defects

Summary: The first description of simultaneous pelvic and abdominal soft-tissue reconstruction with a giant lower limb fillet flap after hip exarticulation and open abdomen is presented. The unfortunate circumstances of a 67-year-old female patient are described leading to soft-tissue necrosis over a periprosthetic femur fracture and open abdomen after emergency implantation of an aortic bifemoral Y-prosthesis because of thrombotic obliteration of the aortic bifurcation. After removal of the hip prosthesis, the neurovascular pedicled myocutaneous fillet flap of the entire left leg was raised and folded proximally at the level of the exarticulated joint of the hip and set into the pelvic and abdominal defect. A giant pedicled neurovascular myocutaneous fillet flap raised over the entire lower extremity is a safe, effective, durable, and sensation-preserving treatment to reconstruct combined pelvic and abdominal soft-tissue defects.

Complete Lower Lip Reconstruction with a Large Lip Switch Flap and a Composite Modiolus Advancement Flap

Summary: Total loss of the lower lip is debilitating and poses a reconstructive challenge. Aiming to restore oral continence and function and also cosmetic appearance, a successful reconstruction has a huge impact on the quality of life for the individual patient. Early sources of local tissue rearrangement for lip reconstruction date back 3000 years, with earliest reports of lip switch procedures more than 2 centuries ago in Europe, when noma was still endemic in Europe, indicating that the anatomy was better understood by the barber surgeons of the past than we like to acknowledge. We are still faced with such challenging cases all over the world where resources are limited. Our current understanding of perforator anatomy and blood supply makes more frequent revisits to flaps of the past with modern advances. Innovative solutions are imperative for salvage, and old ideas tend to reappear when they prove to be useful. Herein, we describe in open access a new reconstructive method where we combined a large lip switch flap together with a composite advancement modiolus flap to reconstruct a whole lower lip and the donor defect of the upper lip all at once, a procedure that is simple to perform and works in settings where it is greatly needed.