Oral bisphosphonate use and lung cancer incidence among postmenopausal women

Abstract

Background

Bisphosphonates are common medications for the treatment of osteoporosis in older populations. Several studies, including the Women's Health Initiative (WHI), have found inverse associations of bisphosphonate use with risk of breast and endometrial cancer, but little is known about its association with other common malignancies. The objective of this study was to evaluate the association of bisphosphonate use on the incidence of lung cancer in the WHI.

Patients and methods

The association between oral bisphosphonate use and lung cancer risk was examined in 151,432 postmenopausal women enrolled into the WHI in 1993-1998. At baseline and during follow-up, participants completed an inventory of regularly used medications including bisphosphonates.

Results

After a mean follow-up of 13.3 years, 2,511 women were diagnosed with incident lung cancer. There was no evidence of a difference in lung cancer incidence between oral bisphosphonate users and never users (adjusted hazard ratio (HR), 0.91; 95% confidence intervals (CI), 0.80-1.04; P = 0.16). However, an inverse association was observed among those who were never smokers (HR = 0.57, 95% CI, 0.39-0.84; P < 0.01).

Conclusion

In this large prospective cohort of postmenopausal women, oral bisphosphonate use was associated with significantly lower lung cancer risk among never smokers, suggesting bisphosphonates may have a protective effect against lung cancer. Additional studies are needed to confirm our findings.

Particulate matter on two Prunus spp. decreases survival and performance of the folivorous beetle Gonioctena quinquepunctata

Abstract

Woody plants growing along streets and construction sites play an important role in removing harmful particulate matter (PM). Researchers rarely consider the impact of different types and size fractions of PM deposited on the leaves on insect folivores. We determined differences in the accumulation of cement and roadside PM on the leaves of two Prunus species (P. padus and P. serotina) with different leaf surface structures. We also determined the effect of PM on the beetle Gonioctena quinquepunctata, the main pest of these plants. Saplings were artificially dusted in greenhouses and leaves were utilised for larval and adult insect stages feeding in laboratory conditions. Road PM accumulated in greater amounts than did cement PM, regardless of plant species. For both PM sources, P. padus accumulated twofold more than did P. serotina. Insect survival was negatively affected by PM pollution; however, neither Prunus species nor PM source variant significantly affected masses of larvae and pupae, duration of larval and pupal development or relative growth rates. The experiment showed strong negative influences of PM were noted only for adult insects, due to the grazing period being longer than that in larvae. The mass of adult insects and the efficiency of conversion of ingested food (ECI) were lower for insects exposed to PM than those for control insects. Insects compensated for lower ECI by eating a greater total amount of food (TFE). Adult insects gained significantly higher mass when fed with P. serotina than with P. padus. The effect of PM on analysed plant metabolites was insignificant. Only Prunus sp. and date of collection affected the level of condensed tannins and total phenols. Our results indicate that, when investigating the effect of the host plant on folivore performance, the accumulation of PM, as well as its type and quantity, should be taken into account.

Huang, Chun-chieh 黃俊傑, ed. East Asian Studies of the Analects: Volume on China 東亞論語學: 中國篇

Submandibular Gland Transfer: A Potential Imaging Pitfall [HEAD & NECK]

BACKGROUND AND PURPOSE:

The Seikaly and Jha submandibular gland transfer surgery is performed to facilitate gland shielding during radiation therapy for head and neck tumors to circumvent radiation-induced xerostomia. It results in an asymmetric postsurgical appearance of the submandibular and submental spaces. Our purpose was to characterize the morphologic and enhancement characteristics of the transferred submandibular gland and identify potential pitfalls in postoperative radiologic interpretation.

MATERIALS AND METHODS:

This retrospective study identified patients with head and neck cancer who had undergone the submandibular gland transfer procedure at our institution. Chart reviews were performed to identify relevant oncologic histories and therapies. CT and MR neck imaging was reviewed to characterize morphologic and enhancement characteristics of the pre- and postoperative submandibular glands, as well as interpretive accuracy.

RESULTS:

Eleven patients with oropharyngeal and nasopharyngeal squamous cell carcinomas who underwent submandibular gland transfer were identified. The transferred glands were significantly lengthened in the anteroposterior dimension compared with contralateral glands (P < .001) and displaced anteriorly and inferiorly within the submandibular and submental spaces. Enhancement patterns of the transferred submandibular glands varied, depending on the time of imaging relative to the operation and radiation therapy. Submandibular gland transfer was acknowledged in the postoperative report in 7/11 cases. Errors in interpretation were present in 2/11 reports.

CONCLUSIONS:

After the submandibular gland transfer procedure, the submandibular and submental spaces lose their symmetric appearances as the transferred submandibular glands become lengthened and located more anteriorly and inferiorly, with variable enhancement characteristics. Familiarity with the postsurgical appearance of the transferred submandibular glands is key to accurate imaging interpretation.

Aneurysmal Parent Artery-Specific Inflow Conditions for Complete and Incomplete Circle of Willis Configurations [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Hemodynamics are thought to play a role in intracranial aneurysm growth and rupture. Computational fluid dynamics is frequently performed to assess intra-aneurysmal hemodynamics, using generalized flow waveforms of healthy volunteers as inflow boundary conditions. The purpose of this study was to assess differences in inflow conditions for different aneurysmal parent artery locations and variations of circle of Willis configurations.

MATERIALS AND METHODS:

In a series of 96 patients with 103 aneurysms, velocity measurements were acquired using 2D phase-contrast MR imaging perpendicular to the aneurysmal parent arteries in the circle of Willis. Circle of Willis configurations were inspected for variations using multiple overlapping thin-slab-acquisition MRAs. Flow rates, velocity magnitudes, and pulsatility indices were calculated for each parent artery location in subgroups of complete and incomplete circle of Willis configurations.

RESULTS:

Flow rates, velocity magnitudes, and pulsatility indices were significantly different among aneurysmal parent arteries. Incomplete circle of Willis configurations were observed in 24% of the cases. Significantly lower basilar artery flow rates were observed in configurations with hypoplastic P1 segments. Significantly higher A1 flow rates were observed in configurations with a hypoplastic contralateral A1 segment.

CONCLUSIONS:

Inflow conditions vary substantially between aneurysmal parent arteries and circle of Willis configurations. We have created a collection of parent artery–specific inflow conditions tailored to the patient-specific circle of Willis configuration that can be used in future computational fluid dynamics studies analyzing intra-aneurysmal hemodynamics.

Blood Flow Mimicking Aneurysmal Wall Enhancement: A Diagnostic Pitfall of Vessel Wall MRI Using the Postcontrast 3D Turbo Spin-Echo MR Imaging Sequence [ADULT BRAIN]

SUMMARY:

Our aim was to compare the detectability of aneurysmal wall enhancement in unruptured intracranial aneurysms between conventional and motion-sensitized driven equilibrium–prepared postcontrast 3D T1-weighted TSE sequences (sampling perfection with applicationoptimized contrasts by using different flip angle evolution, SPACE). Twenty-two patients with 30 unruptured intracranial aneurysms were scanned at 3T. Aneurysmal wall enhancement was more significantly detected using conventional compared with motion-sensitized driven equilibrium–prepared SPACE sequences (10/30 versus 2/30, P < .0001). Contrast-to-noise ratio measurements did not differ between conventional and motion-sensitized driven equilibrium–prepared sequences (P = .51). Flowing blood can mimic aneurysmal wall enhancement using conventional SPACE sequences with potential implications for patient care.

Signal Change of Acute Cortical and Juxtacortical Microinfarction on Follow-Up MRI [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Although the clinical importance of cortical microinfarcts has become well-recognized recently, the evolution of cortical microinfarcts on MR imaging is not fully understood. The aim of this study was to examine the temporal changes in acute cortical microinfarcts using susceptibility-weighted imaging and conventional MR imaging.

MATERIALS AND METHODS:

Patients with acute infarcts located in the cortical and/or juxtacortical region measuring ≤10 mm in axial diameter based on diffusion-weighted imaging who had a follow-up 3T MR imaging were retrospectively included in the study. All lesions did not show hypointensity on initial T2*WI. For cortical and/or juxtacortical microinfarcts detected on initial DWI, 2 neuroradiologists evaluated the follow-up MR imaging (T2WI, FLAIR, T2*WI, and SWI) and assessed lesion signal intensities and locations (cortical microinfarcts or microinfarcts with juxtacortical white matter involvement).

RESULTS:

On initial DWI, 2 radiologists observed 180 cortical and/or juxtacortical microinfarcts in 35 MR imaging examinations in 25 patients; on follow-up, the neuroradiologists identified 29 cortical microinfarcts (16%) on T2WI, 9 (5%) on FLAIR, 4 (2%) on T2*, and 97 (54%) on SWI. All cortical microinfarcts detected with any follow-up MR imaging showed hyperintensity on T2WI/FLAIR and/or hypointensity on T2*WI and SWI.

CONCLUSIONS:

SWI revealed conversion (paramagnetic susceptibility changes) of acute cortical microinfarcts, suggesting that a substantial number of cortical microinfarcts may contain hemorrhagic components.

An Update on the Adjunctive Neurovascular Support of Wide-Neck Aneurysm Embolization and Reconstruction Trial: 1-Year Safety and Angiographic Results [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

The safety and efficacy of the PulseRider for the treatment of wide-neck, bifurcation aneurysms at the basilar and carotid terminus locations were studied in a prospective trial, the Adjunctive Neurovascular Support of Wide-Neck Aneurysm Embolization and Reconstruction (ANSWER) trial, reporting on initial 6-month angiographic and clinical results. This report provides insight into the longer term durability and safety with 12-month data.

MATERIALS AND METHODS:

Aneurysms treated with the PulseRider among enrolled sites were prospectively studied. Updated 12-month data on clinical and imaging end points are included.

RESULTS:

Thirty-four patients were enrolled (29 women, 5 men) with a mean age of 60.9 years. The mean aneurysm height ranged from 2.4 to 15.9 mm with a mean neck size of 5.2 mm (range, 2.3–11.6 mm). At 1 year, there were no device migrations or symptomatic in-stent stenoses. Raymond-Roy I occlusion was achieved in 53% of cases at the time of treatment and progressed to 61% and 67% at 6 and 12 months, respectively. Adequate occlusion (Raymond-Roy I/II) progressed from 88% at 6 months to 90% at 12 months. No recanalizations were observed. There was 1 delayed ischemic event. Good outcome (mRS 0–2) was achieved in 90% of patients.

CONCLUSIONS:

The updated 1-year results from the ANSWER trial demonstrate aneurysm stability and an acceptable safety profile for aneurysms treated at the basilar apex and carotid terminus. Prospective data from a larger set of aneurysms treated at other locations are required to assess how treatment with PulseRider compares with alternatives for treating wide-neck bifurcation aneurysms.

Parent Artery Reconstruction for Large or Giant Cerebral Aneurysms Using the Tubridge Flow Diverter: A Multicenter, Randomized, Controlled Clinical Trial (PARAT) [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Although flow diverters have been reported with favorable clinical and angiographic outcomes in various literatures, randomized trials determining their true effectiveness and safety are still in lack. The Parent Artery Reconstruction for Large or Giant Cerebral Aneurysms Using the Tubridge Flow Diverter (PARAT) trial was designed to evaluate the safety and efficacy of the Tubridge flow diverter in the treatment of large or giant aneurysms in comparison with Enterprise stent-assisted coiling.

MATERIALS AND METHODS:

This prospective, multicenter, randomized trial was conducted at 12 hospitals throughout China. Enrolled adults with unruptured large/giant intracranial aneurysms were randomly assigned (1:1) to receive either Enterprise stent-assisted coiling or Tubridge flow diverter implantation. The primary end point was complete occlusion at 6-month follow-up, while secondary end points included technical success, mortality, target vessel–related stroke, aneurysm bleeding, in-stent stenosis, parent artery occlusion, and the frequency of all adverse events.

RESULTS:

Among 185 enrolled subjects, 41 withdrew before procedure initiation. Overall, 82 subjects underwent Tubridge implantation, and 62 subjects were primarily treated with stent-assisted coiling. The results of 6-month follow-up imaging included complete occlusion rates of 75.34% versus 24.53% for the Tubridge and stent-assisted coiling groups, respectively, with a calculated common odds ratio of 9.4 (95% confidence interval, 4.14–21.38; P < .001). There was a higher, nonsignificant frequency of complications for Tubridge subjects. Multivariate analysis showed a decreased stroke rate at the primary investigational site, with a marginal P value (P = .051).

CONCLUSIONS:

This trial showed an obviously higher rate of large and giant aneurysm obliteration with the Tubridge FD over Enterprise stent-assisted coiling. However, this higher obliteration rate came at the cost of a nonsignificantly higher rate of complications. Investigational site comparisons suggested that a learning curve for flow-diverter implantation should be recognized and factored into trial designs.

Optimization of photo-Fenton process for the treatment of prednisolone

Abstract

Prednisolone is a widely prescribed synthetic glucocorticoid and stated to be toxic to a number of non-target aquatic organisms. Its extensive consumption generates environmental concern due to its detection in wastewater samples at concentrations ranged from ng/L to μg/L that requests the application of suitable degradation processes. Regarding the actual treatment options, advanced oxidation processes (AOPs) are presented as a viable alternative. In this work, the comparison in terms of pollutant removal and energetic efficiencies, between different AOPs such as Fenton (F), photo-Fenton (UV/F), photolysis (UV), and hydrogen peroxide/photolysis (UV/H₂O₂), was carried out. Light diode emission (LED) was the selected source to provide the UV radiation. The UV/F process revealed the best performance, reaching high levels of both degradation and mineralization with low energy consumption. Its optimization was conducted and the operational parameters were iron and H₂O₂ concentrations and the working volume. Using the response surface methodology with the Box-Behnken design, the effect of independent variables and their interactions on the process response were effectively evaluated. Different responses were analyzed taking into account the prednisolone removal (TOC and drug abatements) and the energy consumptions associated. The obtained model showed an improvement of the UV/F process when treating smaller volumes and when adding high concentrations of H₂O₂ and Fe²⁺. The validation of this model was successfully carried out, having only 5% of discrepancy between the model and the experimental results. Finally, the performance of the process when having a real wastewater matrix was also tested, achieving complete mineralization and detoxification after 8 h. In addition, prednisolone degradation products were identified. Finally, the obtained low energy permitted to confirm the viability of the process.

Spectral fitting approach for the determination of enrichment and contamination factors in mining sediments using laser-induced breakdown spectroscopy

Abstract

Monitoring of pollution index values in sediments is crucial in assessing the environmental impacts of toxic metals in a given location. These indices are typically acquired using elaborate and tedious calibration curve-dependent techniques such as (inductively coupled plasma – optical emission spectroscopy) ICP-OES and (atomic absorption spectroscopy) AAS. In this study, laser-induced breakdown spectroscopy (LIBS) was used as a simple and fast alternative method for estimating enrichment factor (EF) and contamination factor (CF) of the sediment samples obtained from selected mining sites. Quantitative analyses of three metal targets (Cd, Pb, and Zn) were done using a calibration-free LIBS method based on the Boltzmann population distribution. Both the EF and CF values calculated from classical ICP-OES method provided significantly high correspondence with the respective EF (R² = 0.8862–0.9770, p < 0.01–0.05) and CF (R² = 0.9454–0.9714, p < 0.01) obtained from the developed LIBS method. The intensity-based LIBS approach identified samples AC2 and CCC as the ones with the highest and lowest pollution index values, respectively. The same observation was seen using the concentration-based ICP-OES technique which showed good correlation between the two methods. The correlation results showed the potential of the curve-fitting LIBS analysis in evaluating the level of metal contamination in an area without the preparation of matrix-matched calibration curves.

A comparative evaluation of spectrophotometric intracutaneous analysis and laser doppler imaging in the assessment of adult and paediatric burn injuries

Clinical assessment of mid dermal burns can be challenging. Currently, Laser Doppler Imaging is the gold standard adjunct in the assessment of burn injuries. Whilst Laser Doppler Imaging has demonstrated reliable accuracy, it poses various limitations in everyday use including cost and ease of use. In comparison, Spectrophotometric Intracutaneous Analysis is a relatively cheaper technique which can be carried out using a modified digital camera which enables easy image acquisition. We aim to compare the accuracy of the two modalities in the assessment of mid-dermal burn injuries.

Tissue expansion in cranioplasty - a collaborative approach for all involved for improved outcomes?

The use of tissue expanders is well established in plastic surgery. However, there are currently no clear indications for tissue expansion as an adjunct to cranioplasty. We present a series of nine patients who underwent tissue expansion prior to cranioplasty after removal of an infected bone flap and/or radiotherapy. Family members of 8 patients were taught how to undertake expansion at home. Two patients experienced exposure and infection of the expander. Post-operatively two patients developed an infection of their cranioplasty implant which was removed.

The Burden of Rhinitis and the Impact of Medication Management within the Community Pharmacy Setting

Publication date: Available online 29 March 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Rachel Tan, Biljana Cvetkovski, Vicky Kritikos, David Price, Kwok Yan, Peter Smith, Sinthia Bosnic-Anticevich
BackgroundThe burden of rhinitis is high. It is unknown to what extent this burden is related to inappropriate medication use.ObjectiveThis study aimed to identify the way in which people with rhinitis medicate their condition and to evaluate the appropriateness of this medication management.MethodsPharmacy customers who visited Sydney metropolitan community pharmacies and purchased medication for nasal symptoms were the sampling frame for this study. To determine the condition for which the participants were seeking medication and the appropriateness of their medication selection, the following data were collected with a researcher-administered questionnaire: participant's demographics, symptoms, medication selected. An expert panel of clinical researcher pharmacists and specialist respiratory physician evaluated the appropriateness of medication selection based on the Allergic Rhinitis and its Impact on Asthma international guidelines.ResultsTwo hundred and ninety-six participants were recruited from 8 pharmacies; 63.2% had a doctor's diagnosis for the symptoms for which they were selecting treatment. Seventy percent of participants self-selected their medications. Seventy-one percent of the participants were identified as having rhinitis. Overall, 16.5% of participants who had rhinitis selected optimal medications. Sixteen percent of participants with allergic rhinitis reported wheezing (6.3% selected optimal medications).ConclusionsThe majority of the participants with rhinitis selected suboptimal medications from community pharmacy highlighting the significant burden of rhinitis in community pharmacy and the contribution of medication management. Pharmacists need to take a proactive and evidence-based role in the management of rhinitis supported by clinical pathways when need to be articulated and promoted in all rhinitis guidelines.

Differential diagnoses of diaper dermatitis

Pediatric Dermatology, Volume 35, Issue S1, Page s10-s18, March/April 2018.

Introduction: Hot topics in neonatal skin care from the 13th World Congress of Pediatric Dermatology (Chicago, IL – July 6‐9, 2017)

Pediatric Dermatology, Volume 35, Issue S1, Page s3-s4, March/April 2018.

Issue Information ‐ Table of Contents

Pediatric Dermatology, Volume 35, Issue S1, Page s2-s2, March/April 2018.

Prevention and treatment of diaper dermatitis

Pediatric Dermatology, Volume 35, Issue S1, Page s19-s23, March/April 2018.

Issue Information ‐ Editorial Board

Pediatric Dermatology, Volume 35, Issue S1, Page s1-s1, March/April 2018.

Skin barrier in the neonate

Pediatric Dermatology, Volume 35, Issue S1, Page s5-s9, March/April 2018.

Radiation exposure for intraoperative 3D scans in a hybrid operating room: how to reduce radiation exposure for the surgical team

Abstract

Background

Hybrid operating rooms are used in different fields of surgery. In orthopedic surgery, the possibility of a 3D scan of difficult anatomical regions (spine, pelvis) showed promising results not only in navigated screw placement. The associated exposure to radiation raises questions regarding potential risks for the operating room personal and the patient. The present study focuses on scatter radiation during 3D scans in a hybrid operating room, the adjacent rooms, and methods to reduce radiation exposure.

Material and Methods

\(\hbox {RaySafe}^{\mathrm{TM}}\) i2 dosimeters were used to measure scatter radiation during 3D scans of different anatomical regions in different distances and heights in a hybrid operating room. The 3D scans were performed with a floor-based flat-panel robotic C-arm with 3D scan capability (Artis Zeego, Siemens; Germany). The 3D scans were performed using a human cadaver. The 3D scans were performed using a standard and a dose reduction protocol (DRP).

Results

The highest scatter radiation was measured during 3D scans of the pelvis on the side of the surgical assistant (39.5 Sv in height of 1 m) compared to the side of the main surgeon (23 Sv in height of 1 m). Scatter radiation was less on the position of the scrub nurse (6.8 Sv in height of 1 m) and during 3D scans of the other anatomical regions. The radiation dosage was about 66% less with the DRP. Low values of scatter radiation were measured behind a radiation protection wall and with open doors in the adjacent rooms.

Conclusion

While performing a scan scatter radiation was measured everywhere in the operating room especially during 3D scans of the pelvic girdle. Therefore, settings with lower dosage should be used whenever possible. Personnel should stand behind a radiation safety wall or leave the operating room and close the doors. For this study, six behavioral rules to avoid radiation in a hybrid operating room were established.

ASPS/PSF Sponsored Symposia and Workshops

No abstract available

Breast Cancer following Augmentation Mammaplasty: A Case-Control Study

Background: The purpose of this study was to determine whether augmentation mammaplasty, implant type, and implant location affect breast cancer detection, stage, and treatment. Methods: An institutional case-control study was performed of patients with prior breast augmentation undergoing breast cancer treatment from 2000 to 2013. Controls were propensity matched and randomized, and data were retrospectively reviewed. Results: Forty-eight cases and 302 controls were analyzed. Palpable lesions were detected at a smaller size in augmentation patients (1.6 cm versus 2.3 cm; p

High-Resolution Magnetic Resonance Imaging of Aging Upper Face Fat Compartments: Correction

No abstract available

Reply: How to Preshape the Breast for a Successful Nipple-Sparing Mastectomy and Direct-to-Implant Breast Reconstruction in the Challenging Breast

No abstract available

Enhanced Recovery Pathway in Microvascular Autologous Tissue-Based Breast Reconstruction: Should It Become the Standard of Care?

Background: Enhanced recovery pathway programs have demonstrated improved perioperative care and shorter length of hospital stay in several surgical disciplines. The purpose of this study was to compare outcomes of patients undergoing autologous tissue–based breast reconstruction before and after the implementation of an enhanced recovery pathway program. Methods: The authors retrospectively reviewed consecutive patients who underwent autologous tissue–based breast reconstruction performed by two surgeons before and after the implementation of the enhanced recovery pathway at a university center over a 3-year period. Patient demographics, perioperative data, and 45-day postoperative outcomes were compared between the traditional standard of care (pre–enhanced recovery pathway) and enhanced recovery pathway patients. Multivariate logistic regression was performed to identify risk factors for length of hospital stay. Cost analysis was performed. Results: Between April of 2014 and January of 2017, 100 consecutive women were identified, with 50 women in each group. Both groups had similar demographics, comorbidities, and reconstruction types. Postoperatively, the enhanced recovery pathway cohort used significantly less opiate and more acetaminophen compared with the traditional standard of care cohort. Median length of stay was shorter in the enhanced recovery pathway cohort, which resulted in an extrapolated $279,258 savings from freeing up inpatient beds and increase in overall contribution margins of $189,342. Participation in an enhanced recovery pathway program and lower total morphine-equivalent use were independent predictors for decreased length of hospital stay. Overall 45-day major complication rates, partial flap loss rates, emergency room visits, hospital readmissions, and unplanned reoperations were similar between the two groups. Conclusion: Enhanced recovery pathway program implementation should be considered as the standard approach for perioperative care in autologous tissue–based breast reconstruction because it does not affect morbidity and is associated with accelerated recovery with reduced postoperative opiate use and decreased length of hospital stay, leading to downstream health care cost savings. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

How to Diagnose and Treat Breast Implant–Associated Anaplastic Large Cell Lymphoma

Learning Objectives: After reading this article, the participant should be able to: 1. Describe the diagnostic criteria for breast implant–associated (BIA) anaplastic large cell lymphoma (ALCL). 2. Appropriately evaluate a patient with suspected BIA-ALCL, including appropriate imaging, laboratory tests, and pathologic evaluation. 3. Understand the operative treatment of BIA-ALCL, and indications for systemic chemotherapy and/or radiation therapy in advanced disease. 4. Understand treatment outcomes and prognosis based on stage of disease. Summary: The goal of this continuing medical education module is to present the assessment of a patient with suspected breast implant–associated anaplastic large cell lymphoma, the evaluation and diagnosis, the preoperative oncologic workup, the formation and execution of a surgical treatment plan, and the inclusion of adjunct treatments when indicated. In addition, staging and disease progression for treatment of breast implant–associated anaplastic large cell lymphoma are discussed.

Discussion: Enhanced Recovery Pathway in Microvascular Autologous Tissue-Based Breast Reconstruction Should It Become the Standard of Care?

No abstract available

Indications for Prepectoral Breast Reconstruction

No abstract available

Low-Dose Insulin as an Antiscarring Therapy in Breast Surgery: A Randomized Controlled Trial

Background: The role of insulin in expediting wound healing is firmly established within the context of major trauma and burns; however, only limited clinical evidence exists as to its effects on scar formation. This study aims to build on previous laboratory work to examine the potential antiscarring properties of insulin in a clinical environment. Methods: Ninety-one patients undergoing bilateral aesthetic breast operations were recruited to receive low-dose insulin and placebo injections to the medial 3 cm of their submammary incisions within the context of a randomized, intrapatient, placebo-controlled trial, and scar quality was assessed at 3-, 6-, and 12-month reviews using the Manchester Scar Scale. Results: Across the cohort at 12-month review, the insulin-treated scars had lower scar scores (p = 0.055) compared with placebo. Subgroup analysis of individuals with heavier scars showed that median scar scores were significantly lower for the insulin-treated scars with regard to both scar contour (p = 0.048) and scar distortion (p = 0.045). Conclusions: Subcutaneous insulin injections reduced the appearance of scarring in this study compared with placebo. The greatest effect was seen in those participants who showed heavier scars and, as such, insulin has a role as an antiscarring therapy in individuals likely to be affected by heavier scarring. Further research is required to more precisely delineate which subjects may benefit most from this treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Cranial Nerve Coactivation and Implication for Nerve Transfers to the Facial Nerve

Summary: In reanimation surgery, effortless smile can be achieved by a nonfacial donor nerve. The underlying mechanisms for this smile development, and which is the best nonfacial neurotizer, need further clarification. The aim of the present study was therefore to further explore the natural coactivation between facial mimic muscles and muscles innervated by the most common donor nerves used in smile reanimation. The study was conducted in 10 healthy adults. Correlation between voluntary facial muscle movements and simultaneous electromyographic activity in muscles innervated by the masseter, hypoglossal, and spinal accessory nerves was assessed. The association between voluntary movements in the latter muscles and simultaneous electromyographic activity in facial muscles was also studied. Smile coactivated the masseter and tongue muscles equally. During the seven mimic movements, the masseter muscle had fewer electromyographically measured coactivations compared with the tongue (two of seven versus five of seven). The trapezius muscle demonstrated no coactivation during mimic movements. Movements of the masseter, tongue, and trapezius muscles induced electromyographically recorded coactivation in the facial muscles. Bite resulted in the strongest coactivation of the zygomaticus major muscle. The authors demonstrated coactivation between voluntary smile and the masseter and tongue muscles. During voluntary bite, strong coactivation of the zygomaticus major muscle was noted. The narrower coactivation pattern in the masseter muscle may be advantageous for central relearning and the development of a spontaneous smile. The strong coactivation between the masseter muscle and the zygomaticus major indicates that the masseter nerve may be preferred in smile reanimation.

5000 Free Flaps and Counting: A 10-Year Review of a Single Academic Institution’s Microsurgical Development and Outcomes

Background: The establishment of an effective clinical and academic culture within an institution is a multifactorial process. This process is cultivated by dynamic elements such as recruitment of an accomplished and diverse faculty, patient geographic outreach, clinical outcomes research, and fundamental support from all levels of an institution. This study reviews the academic evolution of a single academic plastic surgery practice, and summarizes a 10-year experience of microsurgical development, clinical outcomes, and academic productivity. Methods: A 10-year retrospective institutional review was performed from fiscal years 2006 to 2016. Microsurgical flap type and operative volume were measured across all microsurgery faculty and participating hospitals. Microvascular compromise and flap salvage rates were noted for the six highest volume surgeons. Univariate and multivariable predictors of flap salvage were determined. Results: The 5000th flap was performed in December of 2015 within this institutional study period. Looking at the six highest volume surgeons, free flaps were examined for microvascular compromise, with an institutional mean take-back rate of 1.53 percent and flap loss rate of 0.55 percent across all participating hospitals. Overall, 74.4 percent of cases were breast flaps, and the remaining cases were extremity and head and neck flaps. Conclusions: Focused faculty and trainee recruitment has resulted in an academically and clinically productive practice. Collaboration among faculty, staff, and residents contributes to continual learning, innovation, and quality patient care. This established framework, constructed based on experience, offers a workable and reproducible model for other academic plastic surgery institutions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Factors Affecting Women’s Success in Academic and Private Practice Plastic Surgery

Summary: Because plastic surgery trainees generally spend the majority of their training in academic centers and may have minimal exposure to other practice models, it can be difficult to decide which is the best route to achieve satisfaction and success. Surgeons need to be aware of benefits and challenges associated with different practice models and with workplace factors in general that contribute to happiness at work. This article reviews common practice models and provide specific and practical advice for the female surgeon.

Absorbable Antibiotic Beads Prophylaxis in Immediate Breast Reconstruction

Background: Breast reconstruction with tissue expanders is the most common mode of reconstruction following mastectomy. Infection necessitating tissue expander removal is a significant complication leading to patient distress and increased health care costs. Methods: Over 3 years, 127 breast reconstructions with tissue expanders were performed by a single surgeon. Fifty-nine of these reconstructions were performed using a standardized protocol in which patients washed with chlorhexidine several days before surgery and received intravenous antibiotics preoperatively. Intraoperatively, the submuscular pocket was irrigated with triple-antibiotic solution and the skin was prepared again with povidone-iodine before expander placement. This group was referred to as the preintervention group. Sixty-eight of the reconstructions were performed using the standardized protocol with the addition of biodegradable antibiotic beads (Stimulan with vancomycin and gentamicin) in the submuscular pocket. This group made up the postintervention group. The primary outcome was the rate of infection necessitating tissue expander removal. Results: The rate of tissue expander loss caused by infection was 11.9 percent in the preintervention group and 1.5 percent in the postintervention group (p = 0.024). Higher body mass index was associated with a statistically significant increase in infections necessitating expander removal. Conclusion: The use of absorbable antibiotic beads in the submuscular pocket reduced the risk of periprosthetic implant infection necessitating implant removal by 8-fold. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Antibiotic Prophylaxis after Immediate Breast Reconstruction: The Reality of Its Efficacy

Background: Numerous techniques are used to prevent infection after immediate implant-based breast reconstruction. Postoperative antibiotic prophylaxis is commonly prescribed to decrease the risk of reconstructive failure, despite conflicting evidence regarding its effectiveness. The authors studied whether postoperative antibiotic prophylaxis decreases the risk of infection-related explantation in the setting of immediate prosthesis-based breast reconstruction. Methods: Using Truven MarketScan databases, the authors identified all patients who underwent immediate implant reconstruction between January of 2010 and June of 2014 with at least 6 months of follow-up. Postoperative antibiotic prophylaxis was defined as any oral antibiotic course to be taken postoperatively based on prescriptions filled within 14 days preoperatively through 24 hours after discharge. Reconstructive failure, defined as explantation because of infection, was the primary outcome. Secondary outcomes of interest included wound complications, infection, and readmission for infection. Multivariable regression analyses controlled for demographic variables/comorbidities. Results: Of the 7443 patients, 6049 (81 percent) filled prescriptions for postoperative antibiotic prophylaxis. These patients were equally likely to develop a wound complication (OR, 0.93; 95 percent CI, 0.71 to 1.23) or infection (OR, 0.89; 95 percent CI, 0.70 to 1.14), undergo explantation because of infection (OR, 0.82; 95 percent CI, 0.57 to 1.18), or require readmission for infection (OR, 1.21; 95 percent CI, 0.82 to 1.78) compared with those who did not receive antibiotics. There was no significant difference in the risk of infection-related outcomes based on postoperative antibiotic prophylaxis duration. Conclusions: Postoperative antibiotic prophylaxis was not associated with a reduced risk of infection or explantation following prosthesis-based breast reconstruction. Given rising rates of antibiotic resistance, focusing instead on technical considerations and the management of comorbid conditions may more effectively enhance the safety of breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Reply: Validation of the Clinician-Graded Electronic Facial Paralysis Assessment

No abstract available

Trends in Physician Payments for Breast Reconstruction

Background: Prosthetic breast reconstruction rates have risen in the United States, whereas autologous techniques have stagnated. Meanwhile, single-institution data demonstrate that physician payments for prosthetic reconstruction are rising, while payments for autologous techniques are unchanged. This study aims to assess payment trends and variation for tissue expander and free flap breast reconstruction. Methods: The Blue Health Intelligence database was queried from 2009 to 2013, identifying women with claims for breast reconstruction. Trends in the incidence of surgery and physician reimbursement were characterized by method and year using regression models. Results: There were 21,259 episodes of breast reconstruction, with a significant rise in tissue expander cases (incidence rate ratio, 1.09; p

A New Composite Eyeball-Periorbital Transplantation Model in Humans: An Anatomical Study in Preparation for Eyeball Transplantation

Background: Vascularized composite allotransplantation offers a new hope for restoration of orbital content and perhaps vision. The aim of this study was to introduce a new composite eyeball-periorbital transplantation model in fresh cadavers in preparation for composite eyeball allotransplantation in humans. Methods: The composite eyeball-periorbital transplantation flap borders included the inferior border, outlined by the infraorbital rim; the medial border, created by the nasal dorsum; the lateral border, created by the lateral orbital rim; and the superior border, created by the superior part of the eyebrow. The pedicle of the flap included the facial artery, superficial temporal artery, and external jugular vein. The skin and subcutaneous tissues of the periorbital region were dissected and the bony tissue was reached. A coronal incision was performed and the frontal lobe of the brain was reached by means of frontal osteotomy. Ophthalmic and oculomotor nerves were also included in the flap. After a "box osteotomy" around the orbit, the dissection was completed. Methylene blue and indocyanine green injection (SPY Elite System) was performed to show the integrity of the vascular territories after facial flap harvest. Results: Adequate venous return was observed within the flap after methylene blue dye injection. Laser-assisted indocyanine green angiography identified a well-defined vascular network within the entire composite eyeball-periorbital transplantation flap. Conclusions: For the first time, a novel composite eyeball-periorbital transplantation model in human cadavers was introduced. Good perfusion of the flap confirmed the feasibility of composite eyeball-periorbital transplantation in the clinical setting. Although harvesting of the flap is challenging, it introduces a new option for reconstruction of the periorbital region including the eyeball.

Comparison of Cartilage-Scoring and Cartilage-Sparing Otoplasty: A Retrospective Analysis of Complications and Aesthetic Outcome of 1060 Ears

Background: Various techniques are used to correct prominent ears. The authors describe their experience with four different otoplasty techniques in 565 patients with congenital deformities of the ears (1060 ears) that were performed in their hospital during an 11-year period (2002 to 2012). Methods: The authors divided the techniques into two groups: group I, cartilage-sparing techniques (i.e., IA, Mustardé; and IB, Furnas); and group II, cartilage-cutting techniques (i.e., IIA, Chongchet; and IIB, concha shell reduction). The authors compared early and late and minor and major complications, recurrence rates, and revision surgery. Furthermore, aesthetic outcome was scored by three different groups (consultant plastic surgeons, plastic surgery residents, and laymen) on a visual analogue scale using a blinded random selection of preoperative and postoperative photographs. Results: The percentage of complications without the need for reoperation was 20 percent and 21 percent in the cartilage-sparing and cartilage-cutting groups, respectively (p = 0.44). In 6 percent of all cases, a reoperation of the otoplasty was required (7 percent and 6 percent in the cartilage-sparing and cartilage-cutting groups, respectively). Aesthetic postoperative results showed that the cartilage-cutting group scored significantly lower on postoperative shape (p = 0.04), result (p = 0.03), and satisfaction (p = 0.04) compared with the cartilage-sparing group. Conclusions: The study shows that patients who have undergone operations with cartilage-sparing or cartilage-cutting techniques have a similar rate of complications and need for reoperation. However, the cartilage-sparing techniques have a better aesthetic outcome, as judged by the different groups. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Patient-Reported Outcome Measures Used in Gender Confirmation Surgery: A Systematic Review

Background: The usefulness of patient-reported outcome measures is emphasized along with the development of patient-centered care. When implementing patient-reported outcome measures, evidence of the instrument's validity, reliability, and responsiveness in the target population is necessary to secure accurate reporting of the patient's experience. The aim of this study was to identify the literature in which structured patient-reported outcome measures have been used to evaluate the results of gender confirmation surgery, and to systematically evaluate the validity of these instruments. Methods: A systematic review of the current literature was performed to identify structured patient-reported outcome measures used to evaluate the outcome of gender confirmation surgery. The identified instruments' validity in the transgender population was assessed for adherence to international guidelines for development and validation of health outcomes instruments. Results: A total of 110 instruments were identified: 64 ad hoc; six generic; 24 evaluating psychiatric, social, or psychosocial aspects; nine evaluating function but only valid in other patient groups; five ad hoc with some formal development/validation; and two specific for gender dysphoria. Conclusions: There is a lack of patient-reported outcome measures that are valid for the transgender population and concurrently sensitive enough to evaluate gender confirmation surgery without the influence of other gender confirming interventions. Basing research on instruments without confirmed validity decreases the validity of the study itself; thus, previous research using patient-reported outcome measures to evaluate gender confirmation surgery can be considered to have a low level of evidence. To obtain valid patient-reported outcome measures, specific for evaluating the results of gender confirmation surgery, development of new instruments or adaptation of existing instruments is needed.

Critical Differences between Microscopic (MIFE) and Macroscopic (MAFE) Fat Embolism during Liposuction and Gluteal Lipoinjection

Background: Liposuction and gluteal lipoinjection are two of the most frequent surgical procedures in body contouring surgery, and two of the most important complications are microscopic (MIFE) and macroscopic (MAFE) fat embolism. Despite a high index of morbidity and mortality, few reports exist about these complications, and although they have the same causal agent, their etiopathogenesis, clinical evolution, treatment, prognosis, and prevention are totally different. Therefore, the authors performed a comprehensive review of the literature to exhaustively analyze both pathologic conditions and present the differences between them. Methods: A detailed search was carried out in PubMed of studies on humans from 1946 to March of 2017 in any language and including the keywords microscopic fat embolism and macroscopic fat embolism with either liposuction or gluteal lipoinjection. The articles found were selected according to the search criteria and were analyzed to provide the final data and recommendations. Results: Of the 1245 and 26 articles that were found on complications related to liposuction and gluteal lipoinjection, respectively, only 41 on liposuction and microscopic fat embolism and seven on gluteal lipoinjection and microscopic fat embolism met the specific criteria for inclusion in the analysis. Only two articles on liposuction and two on gluteal lipoinjection referred to macroscopic fat embolism as a complication. Conclusion: Although microscopic fat embolism and macroscopic fat embolism are pathologic conditions with high morbidity and mortality rates in association with liposuction and gluteal lipoinjection, few reports about them exist; therefore, the authors made recommendations based on this study for their diagnosis, prevention, and treatment.

Fermentation products in the cystic fibrosis airways induce aggregation and dormancy-associated expression profiles in a CF clinical isolate of Pseudomonas aeruginosa

Abstract

Pseudomonas aeruginosa is a well-known dominant opportunistic pathogen in cystic fibrosis (CF) with a wide range of metabolic capacities. However, P. aeruginosa does not colonize the airways alone, and benefits from the metabolic products of neighboring cells—especially volatile molecules that can travel between different parts of the airways easily. Here, we present a study that investigates the metabolic, gene expression profiles, and phenotypic responses of a P. aeruginosa clinical isolate to fermentation products lactic acid and 2,3-butanediol, metabolites that are produced by facultative anaerobic members of the CF polymicrobial community and potential biomarkers of disease progression. Although previous studies have successfully investigated the metabolic and transcriptional profiles of P. aeruginosa, most have used common lab reference strains that may differ in important ways from clinical isolates. Using transcriptomics and metabolomics with gas chromatography time of flight mass spectrometry (GCTOF-MS), we observe that fermentation products induce pyocyanin production along with expression of genes involved in P. aeruginosa amino acid utilization, dormancy and aggregative or biofilm modes of growth. These findings have important implications for how interactions within the diverse CF microbial community influence microbial physiology, with potential clinical consequences.

Effect of clarification pH of sorghum juice on the composition of essential nutrients for fermentation

Abstract

The growing demand to replace fossil fuels with renewable alternatives has generated an urgent and imminent global need to find new non-fossil sources. Sweet sorghum is widely recognized as a highly promising biomass energy crop with particular potential to complement sugarcane for ethanol production. Our aim in this study was to evaluate the influence of pH during the clarification method on the composition of essential nutrients in the sorghum juice and how this affects the efficiency of the ethanol fermentation process. We found that a higher pH directly affected residual concentrations of key nutrients (P, Ca, Zn, Mn) and as a consequence the efficiency of ethanol fermentation. In conclusion we recommend a clarification procedure at pH 6–6.5 in order not to significantly affect nutritional parameters important for the yeast fermentation process.

Effect of ethanol and butanol on autotrophic growth of model homoacetogens

Abstract

Research efforts aimed at increasing ethanol and butanol productivity from syngas are currently gaining attention. For most model carboxydotrophic bacteria, production rates, yields and maximum product titers have been studied in detail, but little is known on alcohol toxicity in these bacteria. The aim of this work was to investigate the inhibitory effects of ethanol and butanol on the growth of Clostridium ljungdahlii PETC, Clostridium carboxidivorans P7, and 'Butyribacterium methylotrophicum DSM3468'. Experiments to determine inhibitory effects due to product accumulation were carried out using a synthetic mixture of CO:CO₂:H₂ as a substrate. These conditions were chosen to mimic gaseous effluents of biomass and waste gasification plants. Inhibition effects were recorded as changes in growth parameters. No significant inhibition was observed for ethanol at concentrations below 15 g/L. The three species exhibited higher sensitivity to butanol. Half inhibition constants for butanol could be estimated for P7 (IC₅₀ = 4.12 g/L), DSM3468 (IC₅₀ = 1.79 g/L), and PETC (IC₅₀ = 9.75 g/L). In conclusion, at least for the tested strains, there is no urgent need to overcome alcohol inhibition in eventual industrial production of alcohols from syngas fermentation.

Autologous Fat Transfer as a Tool for Cosmetic and Reconstructive Purposes

In this issue of JAMA Facial Plastic Surgery, Krastev et al have presented a much needed systematic review and meta-analysis of 52 autologous fat transfer (AFT) studies for facial reconstructive surgery consisting of 1568 patients with the conclusion that there was very-high patient satisfaction (91%) and surgeon satisfaction (89%) only after 1.5 sessions with volume retention of 50% to 60% at 1 year. The use of AFT for reconstructive purposes has not been well documented, and this meta-analysis evaluates all of the indications for AFT for facial reconstruction including human immunodeficiency virus (HIV)-associated lipodystrophy (the most common indication), followed by congenital disorders, and then a heterogeneous mixture of trauma, cancer, scars, etc.

Autologous Fat Transfer in Facial Reconstructive Surgery

This systematic review and meta-analysis investigates the safety and efficacy of autologous fat transfer in facial reconstruction.

Dermocosmetics for Use in Rosacea: Guideline of the Society for Dermopharmacy

Rosacea is a widespread inflammatory skin disease that is chronically recurrent and affects predominately the central parts of the face. Affected individuals typically react to numerous cosmetics with redness, burning, and/or worsening of the complexion. Consequently, there is a high demand for dermocosmetics that do not provoke such reactions and are suitable for use in rosacea. The present guideline of the Society for Dermopharmacy describes the requirements that dermocosmetics for use in rosacea should meet. They include, inter alia, methods to prove the efficacy of and tolerance to these cosmetics, as well as the product documentation that the manufacturer or the distributing company should make available to professionals, like dermatologists and pharmacists, counseling patients with rosacea.
Skin Pharmacol Physiol 2018;31:147–154

Pre-Bombing Population Density in Hiroshima and Nagasaki: Its Measurement and Impact on Radiation Risk Estimates in the Life Span Study of Atomic Bomb Survivors

Abstract

In the Life Span Study of atomic bomb survivors, differences in urbanicity between high-dose and low-dose survivors could confound the association between radiation dose and adverse outcomes. We obtained data on the pre-bombing population distribution in Hiroshima and Nagasaki, and quantified the impact of adjustment for population density on radiation risk estimates for mortality (1950–2003) and incident solid cancer (1958–2009). Population density ranged from 4,671–14,378 and 5,748–19,149 people/km² in urban regions of Hiroshima and Nagasaki, respectively. Radiation risk estimates for solid cancer mortality were attenuated by 5.1%, but those for all-cause mortality and incident solid cancer were unchanged. There was no overall association between population density and adverse outcomes, but there was evidence that the association between density and mortality differed by age at exposure. Among survivors 10–14 years old in 1945, there was a positive association between population density and risk of all-cause mortality (relative risk, 1.053 per 5,000 people/km² increase, 95% confidence interval: 1.027, 1.079) and solid cancer mortality (relative risk, 1.069 per 5,000 people/km² increase, 95% confidence interval: 1.025, 1.115). Our results suggest that radiation risk estimates from the Life Span Study are not sensitive to unmeasured confounding by urban-rural differences.

Increasing water productivity, nitrogen economy, and grain yield of rice by water saving irrigation and fertilizer-N management

Abstract

The looming water resources worldwide necessitate the development of water-saving technologies in rice production. An open greenhouse experiment was conducted on rice during the summer season of 2016 at Huazhong Agricultural University, Wuhan, China, in order to study the influence of irrigation methods and nitrogen (N) inputs on water productivity, N economy, and grain yield of rice. Two irrigation methods, viz. conventional irrigation (CI) and "thin-shallow-moist-dry" irrigation (TSMDI), and three levels of nitrogen, viz. 0 kg N ha⁻¹ (N₀), 90 kg N ha⁻¹ (N₁), and 180 kg N ha⁻¹ (N₂), were examined with three replications. Study data indicated that no significant water by nitrogen interaction on grain yield, biomass, water productivity, N uptake, NUE, and fertilizer N balance was observed. Results revealed that TSMDI method showed significantly higher water productivity and irrigation water applications were reduced by 17.49% in TSMDI compared to CI. Thus, TSMDI enhanced root growth and offered significantly greater water saving along with getting more grain yield compared to CI. Nitrogen tracer (¹⁵N) technique accurately assessed the absorption and distribution of added N in the soil crop environment and divulge higher nitrogen use efficiency (NUE) influenced by TSMDI. At the same N inputs, the TSMDI was the optimal method to minimize nitrogen leaching loss by decreasing water leakage about 18.63%, which are beneficial for the ecological environment.

Corrigenda

British Journal of Dermatology, Volume 178, Issue 3, Page 815-816, March 2018.

Light on fumaric acid esters therapy for psoriasis

British Journal of Dermatology, Volume 178, Issue 3, Page 586-587, March 2018.

Interleukin‐36 in hidradenitis suppurativa: evidence for a distinctive proinflammatory role and a key factor in the development of an inflammatory loop

British Journal of Dermatology, Volume 178, Issue 3, Page e241-e241, March 2018.

Efficacy and safety of autologous haematopoietic stem cell transplantation in systemic sclerosis: a systematic review of the literature

British Journal of Dermatology, Volume 178, Issue 3, Page e239-e239, March 2018.

Ixekizumab treatment for psoriasis: integrated efficacy analysis of three double‐blinded, controlled studies (UNCOVER‐1, UNCOVER‐2, UNCOVER‐3)

British Journal of Dermatology, Volume 178, Issue 3, Page e242-e242, March 2018.

Towards global consensus on core outcomes for hidradenitis suppurativa research: an update from the HISTORIC consensus meetings I and II

British Journal of Dermatology, Volume 178, Issue 3, Page e243-e243, March 2018.

Image Gallery: Symmetric reticular scarring of the cheeks

British Journal of Dermatology, Volume 178, Issue 3, Page e229-e229, March 2018.

Image Gallery: A hard ‘pebbly’ plaque stuck on the upper eyelid

British Journal of Dermatology, Volume 178, Issue 3, Page e226-e226, March 2018.

Is new better than tried and tested? Topical atopic dermatitis treatment in context

British Journal of Dermatology, Volume 178, Issue 3, Page 583-584, March 2018.

Image Gallery: Dermatophytic pseudomycetoma caused by Microsporum canis

British Journal of Dermatology, Volume 178, Issue 3, Page e228-e228, March 2018.

在系统性硬化病中进行自身造血干细胞移植的功效和安全性:文献的系统性评述

British Journal of Dermatology, Volume 178, Issue 3, Page e253-e253, March 2018.

Corrigenda

British Journal of Dermatology, Volume 178, Issue 3, Page 814-814, March 2018.

Corrigenda

British Journal of Dermatology, Volume 178, Issue 3, Page 815-815, March 2018.

伊赛珠单抗对银屑病的治疗:三项双盲对照研究的综合药效分析(发现‐1、发现‐2、发现‐3)

British Journal of Dermatology, Volume 178, Issue 3, Page e256-e256, March 2018.

化脓性汗腺炎中的IL‐36:独特的促炎性作用的证据和炎症循环发展的关键因素

British Journal of Dermatology, Volume 178, Issue 3, Page e255-e255, March 2018.

化脓性汗腺炎研究的核心结果的全球共识:历史性共识会议I和II的更新

British Journal of Dermatology, Volume 178, Issue 3, Page e257-e257, March 2018.

Cell delivery using microneedle devices: a new approach to treat depigmenting disorders

British Journal of Dermatology, Volume 178, Issue 3, Page 588-589, March 2018.

黑素原生成的旁分泌调节

British Journal of Dermatology, Volume 178, Issue 3, Page e248-e248, March 2018.

The heterogeneous mutational landscape of pustular psoriasis

British Journal of Dermatology, Volume 178, Issue 3, Page 589-590, March 2018.

Corrigenda

British Journal of Dermatology, Volume 178, Issue 3, Page 814-815, March 2018.

Behandlung dermaler Depressionen bei Cellulite

Zusammenfassung

Hintergrund

Durch die präzise, standardisierte Subzision („tissue stabilized-guided subcision"/TS-GS) fibröser Septen werden dermale Depressionen, sog. Cellulite-Dellen, entspannt. Dieses neuartige Verfahren bei Cellulite galt es, in einer Ästhetikpraxis in Deutschland zu untersuchen.

Methoden

Prospektive, strukturierte Datenevaluationen einer einmaligen Behandlung von Cellulite-Dellen mit Cellfina® gemäß Behandlungsempfehlungen an Gesäß und Oberschenkeln wurden vor und 6 Monate nach der TS-GS durchgeführt. Verwendete Skalen und Evaluationsparameter waren: Global Aesthetic Improvement Scale (GAIS), Vorher-Nachher-Fotos, Cellulite Severity Scale (CSS), Patientenzufriedenheit und Verträglichkeit.

Ergebnisse

15 Frauen im Alter von 30 bis 51 Jahren (Mittelwert: 38,9) wurden mit Cellfina® behandelt. Sechs Monate nach einer einmaligen TS-GS betrug die Patientenzufriedenheit 93,3 %, wobei 40 % sehr zufrieden und 53,3 % zufrieden waren. Im ärztlichen Urteil (GAIS) wurde die Cellulite mit 100 % verbessert bewertet. Der Cellulite-Schweregrad nahm im Mittel von 2,33 auf 0,26 Punkte ab. Unerwartete Nebenwirkungen traten nicht auf. Blutergüsse dauerten 12 bis 21 Tage, bei 11 Patientinnen traten leichte bis moderate Schmerzen nach der Behandlung auf. Alle Nebenwirkungen waren reversibel.

Diskussion

Diese Daten zu Cellfina® (TS-GS), die in einer Ästhetikpraxis in Deutschland erhoben wurden, stehen in Einklang mit den Ergebnissen aus klinischen Studien und Anwendungen in den USA. Die minimalinvasive Behandlung wurde gut vertragen und war bereits nach einmaliger Anwendung effektiv. Die präzise Trennung fibröser Septen erzielte eine anhaltende Verbesserung der Cellulite-Dellen und damit eine hohe Arzt- und Patientenzufriedenheit.

A new approach to the renewable energy-growth nexus: evidence from the USA

Abstract

The climate change is one of the leading problems in the today's world. The rise of the renewable energy meets the sustainable growth objectives since it can decelerate the climate change. For this purpose, this paper investigates the relationship between the renewable energy consumption and the economic growth in the United States (USA). Theoretically, the paper constructs the growth model that captures the effects of the economic complexity indicator as a measure of capabilities and productivity for exporting the "complex" (high value-added) products. Empirically, the paper uses the Autoregressive Distributed Lag (ARDL) estimations and observes that both the economic complexity and the renewable energy consumption lead to a higher rate of economic growth in the USA for the period from 1965 to 2016. The paper also discusses the potential policy implications of the results for achieving the sustainable growth objectives.

Buccal Fat Pad-Derived Stem Cells for Repair of Maxillofacial Bony Defects

Abstract

Aim

The purpose of this study was to evaluate the use of buccal fat pad-derived stem cells (BFPSCs) as a source for full thickness bone defect repair secondary to pathology in maxilla or mandible.

Methods

Fat-derived stem cells were isolated from buccal fat pad, differentiated into osteocytes in osteogenic medium, and seeded onto human bone defects. Autologous buccal fat pad was harvested and BFPSCs cultured within 4–6 weeks. Bone defects secondary to enucleation of pathologic cyst or tumors were reconstructed with osteogenically differentiated fat-derived stem cells. Hematoxylin and eosin staining, immunohistochemical staining for osteocalcin, alkaline phosphatase and genotypic and phenotypic marker analysis, and histomorphometric measurements of new bone were performed.

Results

Maxillofacial bone defects were successfully reconstructed by BFPSCs, which after implantation at an in vivo site yielded faster osseous regeneration. BFPSCs were associated with superior bone density formation, better blending of margins with enhanced bone trabecular formation, well-organized and well-vascularized lamellar bone with Haversian channels and osteocytes resulting in superior functional and cosmetic results with better quality of life and with significant decrease in secondary complications.

Conclusion

Buccal fat pad is an ideal tool in the hands of an oral and maxillofacial surgeon for tissue engineering and clinical use requiring bone tissue growth and repair, secondary to large osseous defects. This study demonstrates the feasibility of reconstructing bony defects with fat-derived stem cells.

Explaining the accelerated degradation of ciprofloxacin, sulfamethazine, and erythromycin in different soil exposure scenarios by their aqueous extractability

Abstract

Antibiotics are frequently introduced into agricultural soils with the application of sewage sludge or farm organic fertilizers. Repeated exposure of soils to a pollutant can enrich for microbial populations that metabolize the chemical, reducing its environmental persistence. In London, Canada, soils from a long-term field experiment have received different concentrations of antibiotics annually for several years. The purpose of the present study was to assess the bioavailability of sulfamethazine, erythromycin, or ciprofloxacin through aqueous extractions with borax or EDTA solutions and their biodegradation following different soil exposure scenarios. Control soils and soils treated annually in the field with 10 mg antibiotics per kg were sampled, supplemented in the laboratory with radiolabeled antibiotic either added directly or carried in dairy manure. Sulfamethazine and erythromycin were initially more bioavailable than ciprofloxacin, with aqueous extractabilities representing 60, 36, and 8%, respectively. Sulfamethazine and erythromycin were degraded in soils, with a larger fraction mineralized in the long-term exposed soil (20 and 65%, respectively) than in control soil (0.4 and 3%, respectively) after 7 days of incubation. In contrast, ciprofloxacin was not mineralized neither in control nor long-term exposed soils. The mineralized fractions were similar for antibiotics added directly to soil or carried in dairy manure.

An analysis of the dust deposition on solar photovoltaic modules

Abstract

Solid particles impair the performance of the photovoltaic (PV) modules. This results in power losses which lower the efficiency of the system as well as the increases of temperature which additionally decreases the performance and lifetime. The deposited dust chemical composition, concentration and formation of a dust layer on the PV surface differ significantly in reference to time and location. In this study, an evaluation of dust deposition on the PV front cover glass during the non-heating season in one of the most polluted European cities, Kraków, was performed. The time-dependent particle deposition and its correlation to the air pollution with particulate matter were analysed. Dust deposited on several identical PV modules during variable exposure periods (from 1 day up to 1 week) and the samples of total suspended particles (TSP) on quartz fibre filters using a low volume sampler were collected during the non-heating season in the period of 5 weeks. The concentration of TSP in the study period ranged between 12.5 and 60.05 μg m⁻³ while the concentration of PM10 observed in the Voivodeship Inspectorate of Environmental Protection traffic station, located 1.2 km from the TSP sampler, ranged from 14 to 47 μg m⁻³. It was revealed that dust deposition density on a PV surface ranged from 7.5 to 42.1 mg m⁻² for exposure periods of 1 day while the measured weekly dust deposition densities ranged from 25.8 to 277.0 mg m⁻². The precipitation volume and its intensity as well as humidity significantly influence the deposited dust. The rate of dust accumulation reaches approximately 40 mg m⁻²day⁻¹ in the no-precipitation period and it was at least two times higher than fluxes calculated on the basis of PM10 and TSP concentrations which suggest that additional forces such as electrostatic forces significantly influence dust deposition.

Purifying arsenic and fluoride-contaminated water by a novel graphene-based nanocomposite membrane of enhanced selectivity and sustained flux

Abstract

A novel graphene-based nanocomposite membrane was synthesized by interfacial polymerization (IP) through chemical bonding of the graphene oxide (GO) layer to polyethersulfone surface. Detailed characterization of the composite membrane through AFM, SEM, ATR-FTIR, XRD analysis, and Raman spectroscopy indicates strong potential of the membrane in highly selective removal of the toxic contaminants like arsenic and fluoride while permeating the essential minerals like calcium and magnesium. This makes the membrane suitable for production of safe drinking water from contaminated water. The membrane applied in a flat-sheet cross-flow module succeeded in removal of more than 98% arsenic and around 80% fluoride from contaminated water while selectively retaining the useful calcium and magnesium minerals in drinking water. A sustained pure water flux of around 150 LMH (liter per square meter per hour) during operation over long hours (> 150 h) with only 3–5% drop in flux indicates antifouling character of the membrane module.

Immediate and long-term results of unsintered hydroxyapatite and poly L-lactide composite sheets for orbital wall fracture reconstruction

Publication date: Available online 28 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Keishi Kohyama, Yoko Morishima, Koki Arisawa, Yuko Arisawa, Hisakazu Kato
IntroductionBone defect reconstruction in orbital wall fractures with absorbable alloplastic, such as unsintered hydroxyapatite and poly L-lactide composite (u-HA/PLLA), is gaining popularity. This material is osteoconductive and osteosynthetic. However, quantitative, long-term outcome data after use for orbital wall fractures are lacking.Patients and MethodsWe retrospectively analyzed 115 patients who underwent surgical repair of orbital wall fractures with a u-HA/PLLA sheet from 2011 to 2016. A chart review was performed, and the time-dependent changes at fracture sites were assessed via imaging. The immediate postoperative and the latest follow-up bony orbital volumes of the affected side were compared.ResultsThere were 70 eligible patients in this study (mean age, 44.6 ± 22.1 years; 48 men and 22 women; mean follow-up period, 29.7 ± 12.8 months). Except for one case of hematoma, there were no postoperative wound complications. Although 10/70 patients had postoperative diplopia and 2/70 had enophthalmos, they were presumably caused by the extension and severity of the fracture. Satisfactory reduction of the entire orbital wall, without pathological changes, was demonstrated. There were no significant differences in the mean bony orbital volumes of the affected side immediately after surgery (24.774 ± 3.092 cm³⁾, and at the latest follow-up (24.749 ± 3.205 cm³⁾ (p=0.756).ConclusionThe u-HA/PLLA sheet is useful for orbital wall fracture reconstruction because of its desirable handling characteristics, initial mechanical strength, long-term maintenance of structural stability, radiopacity, and few associated complications. Future randomised controlled trials to compare u-HA/PLLA with other conventional materials need to be performed.

Targeted muscle reinnervation for pain control in an elective transradial amputation

Publication date: Available online 28 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): P. Sadigh, D. Reissis, A. Sadri, D. Nikkhah

The forgotten aspects of the quality of life of significant others of patients with a peripheral facial palsy

Publication date: Available online 27 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Robin E. Luijmes, Sjaak Pouwels, Stan J. Monstrey, Koen J.A.O. Ingels, Carien H.G. Beurkens

“Descending genicular artery. branching patterns and measuring parameters: a systematic review and meta-analysis of several anatomical studies. ”

Publication date: Available online 28 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Thomas Ziegler, Lars-Peter Kamolz, Anna Vasilyeva, Michael Schintler, Maximilian Neuwirth, Daryousch Parvizi
BackgroundThe medial femoral condyle (MFC) flap is based on the descending genicular artery (DGA), a vessel with different variations in its course and branching patterns. Many studies have dealt with the vascular anatomy of the medial femoral condyle. However, the results of their investigations differ markedly.MethodsThe authors performed a systematic literature research in MEDLINE for articles published until May 2017 on the vascular anatomy of the descending genicular artery. After the screening, 23 relevant studies with a similar topic were included into this comprehensive analysis.ResultsThe systematic review examined the lengths and diameters of the individual arteries with regard to the vascularized bone flap of the medial femoral condyle. The descending genicular artery is present in 94% of cases with an average length of 1.8 cm. In 63% of the investigated cases it divides into 3 terminal branches. The articular branch has an average length of 7.7 cm, the saphenous branch of 10.7 cm and the muscular branch of 3.2 cm.ConclusionIn order to ensure a secured survival of this free flap, the convoluted vascular anatomy above the medial femoral condyle must be understood in detail. For the systematic classification of anatomical patterns of the DGA, we recommend the Dubois-classification.We present a summary of all anatomical studies dealing with the vascular supply of this area and the descending genicular artery to date.

A retrospective investigation of abdominal visceral fat, body mass index (BMI), and active smoking as risk factors for donor site wound healing complications after free DIEP flap breast reconstructions.

Publication date: Available online 28 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Floyd W. Timmermans, Pèdrou B. Westland, Stefan Hummelink, Joep Schreurs, Marijn Hameeteman, Dietmar J.O. Ulrich, Nicholas Slater
BackgroundThe deep inferior epigastric artery perforator (DIEP) flap is one of the most common techniques for breast reconstruction. Body Mass Index (BMI) is considered an important predictor of donorsite healing complications such as wound dehiscence. The use of computed tomography (CT) techniques has shown a more precise and objective method to assess visceral adipose tissue. It remains unclear whether quantified visceral fat results in more accurate predictions of abdominal wound healing complications than BMI.Patients and MethodsA total of 97 DIEP flap patients were retrospectively evaluated. The patient's abdominal visceral fat (AVF) was quantified on CT angiography (CTA). Patients were postoperatively assessed for abdominal wound healing complications. We analyzed for the correlations between AVF, BMI, and dehiscence and established a logistic regression model to assess the potential high profile predictors in anatomic and patient characteristics such as weight, smoking and diabetes.ResultsWe included 97 patients, which resulted in 24 patients (24.7%) with some degree of abdominal dehiscence. No significant differences were seen between the dehiscence group and the non-dehiscence group, except for smoking (P=0.002). We found a significant correlation between AVF and BMI (R=0.282, p=0.005), but neither was significant in predicting donor site dehiscence. Smoking greatly increased the likelihood of developing wound dehiscence (OR 11.4, p=<0.0001).ConclusionsAVF and BMI were not significant in predicting abdominal wound healing complications after DIEP flap reconstruction. This study significantly established the contributing risk factor of active smoking (OR 11.4, p=<0.001) for the development of abdominal wound dehiscence in DIEP-patients.

Should microsurgery move away from our binary measures of success and is it time to embrace reconstructive failure as a true measure of our patient outcomes?

Publication date: Available online 28 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): D.B. Saleh

Anthropometrics in preoperative prediction of resection weight in reduction mammaplasty: is it really accurate?

Publication date: Available online 28 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): A.O. Wamalwa, J.K. Wanjeri, F.W. Nangole, S.O. Khainga
Preoperative determination of breast weight to be removed aids plastic surgeons in counseling the patient, application for insurance coverage and ensures optimal postoperative breast symmetry. Predicted weight deviations from the actual weight of breast tissue excised were compared between four anthropometric-based formulas using repeated measures ANOVA at 95% confidence interval. We discuss the findings of the study.

Pyoderma gangrenosum after breast surgery: a systematic review

Publication date: Available online 28 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Denis C. Ehrl, Paul I. Heidekrueger, P. Niclas Broer
BackgroundPost-surgical pyoderma gangrenosum (PSPG) is a rare inflammatory skin disorder of unknown etiology. Given its similar presentation to wound infection and lack of reliable diagnostic tests as well as pathognonic clinical features, PSPG is difficult to diagnose. Aim of this review was to identify factors contributing to PSPG in order to aid with timely diagnosis and appropriate therapy.MethodsA systematic literature review was performed following PRISMA guidelines, focusing on PSPG after reconstructive and aesthetic breast surgery. The online databases PubMed, Medline, EMBASE, Scopus, and Cochrane were used and additionally a Google© search was performed.ResultsA total of 68 articles describing 87 cases of PSPG following aesthetic and reconstructive breast surgery were found. The majority of PSPG (44%) occurred after breast reduction surgery and microsurgical breast reconstruction (16%). Most common associated conditions were malignancies in 37%, and autoimmune deficiencies in 17%. Microbiological examinations were found to be negative in 90%. The median time from initial presentation with symptoms to correct diagnosis of PG lasted on average 12.5 days, with unsuccessful first-line therapy on average for 20.0 days. After the diagnosis of PG, medical therapy most commonly involved steroids in 84% and/or Cyclosporine A in 22% of the cases. On average, the duration of this therapy lasted 4.7 months.ConclusionPSPG remains challenging to diagnose. However, according to the presented review, several distinct clinical signs in combination with lack of treatment response should prompt further investigation in order to promote timely diagnosis and correct treatment of this potentially debilitating disease.

How to decide which patient-reported outcome measure to use? A practical guide for plastic surgeons

Publication date: Available online 28 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Thomas Dobbs, Sarah Hughes, Nicholas Mowbray, Hayley A. Hutchings, Iain S. Whitaker
The use of patient-reported outcome measures (PROMs) is rising across all medical specialties as their importance to patient care is validated. They are likely to play a particularly important role in plastic and reconstructive surgery where outcomes are often subjective, and the recent guidance from the Royal College of Surgeons of England advising their use in cosmetic surgery highlight this. In order to drive their routine use across our specialty it is important that clinicians are able to understand the often complex and confusing language that surrounds their design and validation. In this article we describe the process of PROM design and validation, and attempt to 'demystify' the language used in the health outcome literature. We present the important steps that a well-designed PROM must go through and suggest a straightforward guide for selecting the most appropriate PROMs for use in clinical practice. We hope that this will encourage greater use of PROM data across plastic and reconstructive surgery and ultimately help improve outcomes for our patients.

Denervation leads to volume regression in breast cancer

Publication date: Available online 28 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Elisabeth Artemis Kappos, Patricia Esther Engels, Mathias Tremp, Patricia Sieber, Stefanie von Felten, Srinivas Madduri, Moritz Meyer zu Schwabedissen, Arne Fischmann, Dirk Johannes Schaefer, Daniel Felix Kalbermatten
The nervous system plays a key role in controlling dynamic functions of multicellular complex organisms. Although peripheral nerves are supposed to play a pivotal role in tumor growth and dissemination, little experimental evidence exists to date. We assessed the effect of denervation on breast cancer growth by magnetic resonance imaging (MRI) in rats. Human breast cancer cells were implanted into adipofascial flaps with intact or surgically excised supplying nerve. Tumor volumes were measured two and eight weeks after implantation by in vivo MRI. Results were validated by histology. Two and eight weeks postoperatively tumor volume was 76 % (95 % CI: 22-93 %) lower in the denervated groups. Tumor area as determined histologically was reduced by 70 % (95 % CI: 60-78 %). Thus, peripheral denervation may be an effective surgical approach for the palliative treatment of locally progressing or non-controllable breast cancer.

Long-term outcome of patients with or without osseointegrated implants after resection of mandibular ameloblastoma and reconstruction with vascularized bone graft: functional assessment and quality of life

Publication date: Available online 28 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Marco Pappalardo, Chung-Kan Tsao, Man Lung Tsang, Jie Zheng, Yang-Ming Chang, Chi-Ying Tsai
BackgroundThe optimal management after the resection of mandibular ameloblastoma has been very challenging to surgeons. The aim of this study is to evaluate the functional, aesthetic, and life quality outcomes of patients who had a segmental mandibular resection and immediate reconstruction with or without osseointegrated implants.MethodsPatients' demographics, tumour characteristics, treatment and complications were retrieved. Patients were divided into two groups: dental rehabilitated versus non-dental rehabilitated based on the placement of osseointegrated implants followed by an implanted-retained prosthesis. Functional outcomes and quality-of-life were assessed using the Performance Status Scale, the University of Washington Quality-of-Life (UW-QOL) and the 14-item Oral Health Impact Profile (OHIP-14). Aesthetic outcome was evaluated by patients using a Visual Analogue Scale.ResultsThirty-four patients were reviewed. Twenty-two patients were included in the dental rehabilitated group, and twelve were the non-dental rehabilitated group. No recurrence of the tumour was found during the average follow-up period of 7.4-years. While both groups reported similar satisfaction in appearance, dental rehabilitated patients scored significantly higher in masticatory function and 'eating in public' (p<0.01). In the UW-QOL there were significant differences (p<0.05) regarding 'chewing', 'activity' and 'anxiety'. Indeed, dental rehabilitated patients showed a definitively better outcome in the OHIP-14 'physical disability' and 'psychological discomfort' dimensions.ConclusionVascularized bone graft reconstruction followed by immediate or delayed placement of osseointegrated implants showed as an ideal and predictable treatment modality for patients with ameloblastoma. The results suggested that patients with osseointegrated implants had a significantly better masticatory function, improved quality-of-life, and less psychological consequences.

Effect of hydration status on pesticide uptake in anurans following exposure to contaminated soils

Abstract

In this study, the impact of hydration status on dermal uptake of pesticides in two species of amphibians is examined. Absorption of pesticides in anurans occurs primarily through a highly vascularized dermal seat patch; however, pesticides can also enter through the superficial dermis following exposure. Despite the growing body of literature on dermal exposure in amphibians, little is known on how hydration status influences uptake. Thus, the objective of this study was to investigate the influence of hydration status on absorption of pesticides (atrazine, triadimefon, metolachlor, chlorothalonil, and imidacloprid) in southern leopard frogs (Lithobates sphenocephala) and Fowler's toads (Anaxyrus fowleri). Amphibian treatments included dehydration periods of 0, 2, 4, 6, 8, or 10 h prior to exposure to pesticide-contaminated soils for 8 h. Following exposure, soil and whole-body homogenates were extracted and analyzed by LC-MS/MS. Dehydration time was then regressed against post-exposure concentrations to infer the impact of dehydration on dermal pesticide uptake. Increased dehydration time resulted in significantly lowered pesticide concentrations in both species (F_{6, 293} = 67.66, p = 0.007) for the five pesticides studied. This phenomenon could be due to an energy and/or dilution effect.

Effect on human health of the arsenic pollution and hydrogeochemistry of the Yazır Lake wetland (Çavdır-Burdur/Turkey)

Abstract

In this study, the physicochemical parameters, major ions and arsenic (As) contents of water resources in the Yazır lake wetland, were evaluated. In addition, water resources in this region were investigated from the point of water quality and health risk assessment. Thirty water samples were collected from the area in dry and wet seasons. Ca-Mg-HCO₃ and Ca-HCO₃ were the dominant water types. The Gibbs diagram suggests that most of the samples fall in rock-dominance zone, which indicates the groundwater interaction between rock chemistry. When compared to drinking water guidelines established by World Health Organization and Turkey, much greater attention should be paid to As, Fe, and Mn through varied chemicals above the critical values. According to the pH-ORP diagram, the predominant species is arsenate (H₂AsO₄⁻²). The high concentrations of As in the surface water and groundwater are related to oxidative and reductive dissolution reaction of Fe and Mn hydroxides within the Kızılcadağ ophiolite and melange. In addition, the seasonal changes in As concentrations depend on the increase in pH of water samples. The major toxic and carcinogenic chemical within water samples is As for groundwater and surface water. From the results of hazard index, it is verified that As which is taken by ingestion of water was the main contaminant, and toxic human risk in the study area. The obtained results will help define strategies for As problems in the water resources in future.

An eco-friendly method for heavy metal removal from mine tailings

Abstract

One of the serious environmental problems that society is facing today is mine tailings. These byproducts of the process of extraction of valuable elements from ores are a source of pollution and a threat to the environment. For example, mine tailings from past mining activities at Giant Mines, Yellowknife, are deposited in chambers, stopes, and tailing ponds close to the shores of The Great Slave Lake. One of the environmentally friendly approaches for removing heavy metals from these contaminated tailing is by using biosurfactants during the process of soil washing. The objective of this present study is to investigate the effect of sophorolipid (SL) concentration, the volume of washing solution per gram of medium, pH, and temperature on the efficiency of sophorolipids in removing heavy metals from mine tailings. It was found that the efficiency of the sophorolipids depends on its concentration, and is greatly affected by changes in pH, and temperature. The results of this experiment show that increasing the temperature from 15 to 23 °C, while using sophorolipids, resulted in an increase in the removal of iron, copper, and arsenic from the mine tailing specimen, from 0.25, 2.1, and 8.6 to 0.4, 3.3, and 11.7%. At the same time, increasing the temperature of deionized water (DIW) from 15 to 23 °C led to an increase in the removal of iron, copper, and arsenic from 0.03, 0.9, and 1.8 to 0.04, 1.1, and 2.1%, respectively. By increasing temperature from 23 to 35 °C, when using sophorolipids, 22% reduction in the removal of arsenic was observed. At the same time while using DI water as the washing solution, increasing temperature from 23 to 35 °C resulted in 6.2% increase in arsenic removal. The results from this present study indicate that sophorolipids are promising agents for replacing synthetic surfactants in the removal of arsenic and other heavy metals from soil and mine tailings.

Emergency Treatment of Blast, Shell Fragment and Bullet Injuries to the Central Midface Complex

Abstract

Purpose

Current ballistics and high-energy explosion possess unnoticed, new and significant biophysics and pathophysiology wounding effects that are unique in comparison with civilian trauma. The primary blast wave effects of compressed air due to explosion lead to tattered and crushed eggshell injuries to the upper central midface (UCM). High-energy shell fragments of various shapes and sizes cause extensive destruction and are different from assault rifle's bullets that cause high energy transfer to the tissue by creating a temporary cavitation.

Methods

Twenty-one patients with unquantifiable war injuries were selected. The emergency managment of lifesaving facial war injuries starts with life threatening hemorrahge or air compramise. This article describes immediate management of medial canthal tendon (MCT), intercanthal region and severe nasal war injuries.

Results

The utilized procedure obtained good results compared to the results of cases treated only by applying a classic approach of civilian fractures.

Conclusion

Treatments of UCM injuries are the most difficult since UCM includes the esthetic, physiologic, and anatomical regions of the face. The proposed technique provides immediate excellent stability for soft tissues, bone, and cartilage and is well tolerated in the long term by both the tissue and the patient. Most of the times, victims are treated with limited resources, deficient subspecialty, massive injuries, during mass casualties, and a single surgeon must have to handle all these within a short period of time. UCM injuries are really concerning since this region is the core of facial esthetic and function.