Pesticide residue profiles in bee bread and pollen samples and the survival of honeybee colonies—a case study from Luxembourg

Abstract

Pesticide residues (112 compounds) were quantified by GC-MS/MS or LC-MS/MS in 85 bee bread samples and 154 pollen samples obtained from five apiaries each with three or four colonies (genotype Buckfast) in Luxembourg over the period 2011–2013. Thiacloprid, chlorfenvinphos, tebuconazole, and methiocarb were found most frequently in bee bread while thiacloprid, permethrin-cis, and permethrin-trans were detected most frequently in the pollen samples. Three neonicotinoid insecticides (clothianidin, imidacloprid, and thiamethoxam) that were restricted by an EU regulation in 2013 after our sampling campaign was finished were each found in less than 8% of the pollen or bee bread samples. The maximum concentrations of thiacloprid, metazachlor, and methiocarb measured in the pollen collected by a group of honeybee colonies (n = 5) without survivors within the 3-year period of observation were 86.20 ± 10.74 ng/g, 2.80 ± 1.26 ng/g, and below the limit of quantification, respectively. The maximum concentrations of the same compounds measured in the pollen collected by a group of honeybee colonies with significantly (P = 0.02) more survivors (7 out of 9) than expected, if the survivors had been distributed randomly among the groups of colonies, were 11.98 ± 2.28 ng/g, 0.44 ± 0.29 ng/g, and 8.49 ± 4.13 ng/g, respectively. No honeybee colony that gathered pollen containing more than 23 ng/g thiacloprid survived the 3-year project period. There was no statistically significant association between pesticide residues in the bee bread and the survival of the colonies. Actions already taken or planned and potential further actions to protect bees from exposure to pesticides are discussed.

Sonocatalytic removal of methylene blue from water solution by cobalt ferrite/mesoporous graphitic carbon nitride (CoFe 2 O 4 /mpg-C 3 N 4 ) nanocomposites: response surface methodology approach

Abstract

In this study, cobalt ferrite/mesoporous graphitic carbon nitride (CoFe₂O₄/mpg-C₃N₄) nanocomposites were successfully synthesized by using a two-step protocol. Firstly, monodispersed CoFe₂O₄ nanoparticles (NPs) were synthesized via thermal decomposition of metal precursors in a hot surfactant solution and then they were assembled on mpg-C₃N₄ via a liquid phase self-assembly method. The sonocatalytic performance of as-synthesized CoFe₂O₄/mpg-C₃N₄ nanocomposites was evaluated on the methylene blue (MB) removal from water under ultrasonic irradiation. For this purpose, response surface methodology (RSM) based on central composite design (CCD) model was successfully utilized to optimize the MB removal over CoFe₂O₄/mpg-C₃N₄ nanocomposites. Analysis of variance (ANOVA) was applied to investigate the significance of the model. The results predicted by the model were obtained to be in reasonable agreement with the experimental data (R² = 0.969, adjusted R² = 0.942). Pareto analysis demonstrated that pH of the solution was the most effective parameter on the sonocatalytic removal of MB by CoFe₂O₄/mpg-C₃N₄ nanocomposites. The optimum catalyst dose, initial dye concentration, pH, and sonication time were set as 0.25 g L⁻¹, 8 mg L⁻¹, 8, and 45 min, respectively. The high removal efficiency of MB dye (92.81%) was obtained under optimal conditions. The trapping experiments were done by using edetate disodium, tert-butyl alcohol, and benzoquinone. Among the reactive radicals, ^•OH played a more important role than h⁺ and \( {O}_2^{-\bullet } \) in the MB dye removal process. Moreover, a proposed mechanism was also presented for the removal of MB in the presence of CoFe₂O₄/mpg-C₃N₄ nanocomposites under the optimized sonocatalytic conditions. Finally, a reusability test of the nanocomposites revealed a just 9.6% decrease in their removal efficiency after five consecutive runs.

Adsorption of heavy metal tolerance strains to Pb 2+ and Cd 2+ in wastewater

Abstract

The functional strains with high tolerance to heavy metal Pb²⁺ and Cd²⁺ were screened from soil obtained in a heavy metal waste accumulation area. The immobilized biological adsorbent was made by embedding method and used for treatment of wastewater containing heavy metals. The effects of initial concentration of heavy metals, adsorption time, pH value of wastewater, and dosage of adsorbent on adsorption performance were investigated. The study showed (1) the strains tested were Brevibacterium and their maximum tolerable concentrations for Pb²⁺ and Cd²⁺ were 2200 and 700 mg/L, respectively; (2) the maximum adsorption rate for Pb²⁺ and Cd²⁺ was 87.77% and 57.50% respectively when the dosage of adsorbent was 10 g/L and the pH value of wastewater was 6; (3) Pb²⁺ and Cd²⁺ could be adsorbed in the equilibrium solution for 40 min and the maximum adsorption capacity reached 114.36 mg/g and 82.12 mg/g, respectively; and (4) when the initial pH value of the wastewater was 5–7, the adsorption rate decreased with the increase of the concentration, and the initial concentration of Pb²⁺ had a greater effect on the adsorption rate than Cd²⁺. Langmuir and Freundlich equation showed that the adsorption of Pb²⁺ and Cd²⁺ was mainly on the surface of monolayer. And the pseudo-second-order kinetic equation indicates that Cd²⁺ has a relatively greater adsorption rate than Pb²⁺ does.

Fabrication of manganese-based Zr-Fe polymeric pillared interlayered montmorillonite for low-temperature selective catalytic reduction of NO x by NH 3 in the metallurgical sintering flue gas

Abstract

A series of Zr-Fe (Zr/Fe = 4:0, 3:1, 2:2, 1:3, 0:4) polymeric pillared interlayered montmorillonite loading 10 wt.% MnO_x (Mn/Zr-Fe-PILM) were investigated for the selective catalytic reduction of NO_x by NH₃ (NH₃-SCR) in metallurgical sintering flue gas. The X-ray diffraction (XRD), N₂ adsorption-desorption isotherm, scanning electron microscope (SEM), and ammonia temperature-programmed desorption (NH₃-TPD) were used to analyze the physicochemical property. The Fe polymerized with Zr exchanged to montmorillonite can improve the Mn/Zr-Fe-PILM low-temperature NO_x conversion and N₂ selectivity. The Mn/Zr-Fe-PILM (1:3) shows the highest NO_x conversion between 140 and 180 °C. The XRD results suggest that the growth of crystalline ZrO₂ phase is intensely restrained for the Fe₂O₃ migration into the ZrO₂ lattice. The ZrO₂ and MnO_x have an excellent dispersion in montmorillonite. The N₂ adsorption result illustrates that the increase of Fe molar content in the Zr-Fe-PILM support increases the catalyst-specific surface area. The NH₃-TPD results elucidate that the Mn/Zr-Fe-PILM (1:3) has the most total acid sites. Therefore, the low-temperature catalytic activity of the Mn/Zr-Fe-PILM (1:3) has been assigned to the large specific surface area, abundant acid sites, and the dispersion of metallic oxides.

Organic matter facilitates the binding of Pb to iron oxides in a subtropical contaminated soil

Abstract

The bioavailability and potential uptake of heavy metals by crops is fundamentally influenced by the forms of metals in soils. Organic matter plays an important role in controlling the transformation of heavy metal fractionations in soils. However, long-term effects of organic matter on heavy metal speciation remains highly uncertain. In this study, rice straw was introduced to a subtropical Pb-contaminated soil for 2-year period so as to clarify the redistribution of Pb fractions and their correlations with soil properties. By combining sequential extraction and X-ray absorption fine structure spectroscopy, we find that lead is predominantly presented in Fe oxide-bound, surface adsorbed, and residual fractions in the soil. The incorporation of rice straw can effectively reduce the labile species of Pb by promoting the binding of Pb to iron oxides. Furthermore, aging leads to the transfer of considerable amounts of Pb to the association with Fe oxides and this transformation is enhanced by the presence of organic matter. Organic matter input and soil aging tend to shift Pb to amorphous Fe oxides than crystalline Fe oxides. The correlation analysis shows that Fe oxide fractions play vital roles in controlling the forms of Pb in soil. This study presents the first result regarding the long-term effect of organic matter on the redistribution of Pb in naturally polluted soil, which is useful for understanding the fate of Pb and developing remediation strategies for Pb-polluted soils.

A Systematic Review and Meta-analysis: Do Absorbable or Non-Absorbable Suture Materials Differ in Cosmetic Outcomes in Patients Requiring Primary Closure of Facial Wounds?

Surgeons are often judged on the cosmetic appearance of any scar after surgery rather than the functional outcome of treatment, especially when considering facial wounds.

Clobetasol pretreatment to reduce or prevent injection site dermatitis from biologic agents

Answer to the comment concerning our article “Risk of skin cancer in HIV-infected patients: a Danish nationwide cohort study”

Use of Immortal time within survival analysis

Reply to: “Risk of skin cancer in HIV-infected patients: a Danish nationwide cohort study”

Impact of migraine on the clinical presentation of insomnia: a population-based study

Insomnia and migraine are closely related; insomnia aggravates migraine symptoms. This study was conducted to investigate the impact of migraine on the clinical presentation of insomnia symptoms.

Nasal Elongation with Septal Half Extension Graft: Modification of Conventional Septal Extension Graft Using Minimal Septal Cartilage

Abstract

Background

In Asian rhinoplasty, a septal extension graft can be used for both tip projection and derotation of the alar cartilage. However, patients often do not have enough harvestable septal cartilage to create the septal extension graft. We therefore devised a method with which to fix the derotated alar cartilage with a small amount of septal cartilage.

Methods

From January 2012 to December 2016, 23 patients underwent short nose correction with a septal half extension graft made of septal cartilage and were postoperatively monitored for at least 6 months. The alar cartilage was completely separated from the adjacent structures, especially the scroll area and hinge complex, for caudal derotation. The septal half extension graft was then harvested from the septal cartilage and secured to the caudal septum and the lateral crura of the alar cartilage. Photographs of the patients were compared immediately before surgery and 1 year after surgery.

Results

Of the 23 patients, 21 (91%) had satisfactory results without short nose recurrence. Two (9%) patients developed recurrence: undercorrection and poor tip projection in one patient each. Aesthetic assessment of short nose correction was performed by comparing the columellar labial angle before and after surgery. Our method reduced the columellar labial angle by 6.2% (paired t test, p < 0.05, t = 31.698).

Conclusion

In patients who cannot undergo conventional septal extension graft due to insufficient amounts of septal cartilage, the septal half extension graft could be a promising alternative technique for short nose correction with minimal septal cartilage harvesting.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Bad Company: Microenvironmentally Mediated Resistance to Targeted Therapy in Melanoma

Pigment Cell &Melanoma Research, Volume 0, Issue ja, -Not available-.

Serum fatty acid‐binding protein 4 level is inversely correlated with serum thymus and activation‐regulated chemokine level in psoriatic patients achieving clear skin by biologics

The Journal of Dermatology, EarlyView.

Adjustable V-Flap Epicanthoplasty Based on Desired Eyelid Morphology

Abstract

Eyelid shape is one key distinctive feature of the Asian eye. The presence of epicanthal folds is a common eyelid defect of Asians. Different surgical techniques have been developed to correct epicanthal folds. However, potential problems with these techniques are emerging, such as difficulty in design, recurrence and/or prominent scarring after surgery, and restricted application together with double eyelidplasty. An improved epicanthoplasty technique with high simplicity and flexibility is imperative. From October 2000 to March 2017, we performed V-flap epicanthoplasty procedures on 423 Asian patients. The whole procedure, including V-shaped skin incision, myotomy and pilication of the medial canthal ligament was performed layer by layer. A similar palpebral fissure distance and inner canthal distance were acquired with this surgical operation. Besides, this surgical technique will not cause limitations on double eyelid morphology when a double blepharoplasty is performed at the same period. The V-flap epicanthoplasty we described here is able to fully correct the epicanthal folds with a simple and flexible design, and the surgery can be adjusted according to patient needs for desired double eyelid shape. Satisfactory results were ideally achieved with no recurrence and finer scar.

Level of evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266.

Does clinical testing support the current guidance definition of prolonged contact for nickel allergy?

Contact Dermatitis, EarlyView.

Adsorption of ionic liquids onto an activated carbon: kinetic modeling studies

Abstract

In this study, the uptake of hydrophobic bromide-based ionic liquids (ILs) (imidazolium, pyrrolidinium, and pyridinium) from aqueous solutions onto granulated and fabric-based microporous activated carbons (ACs). Surface characterization study shows that both ACs have basic pHpzc, like 8.7 for granulated AC and 8.0 for fabric AC. Granulated AC have ten times higher phenolic groups 0.2 meq g⁻¹ compared to fabric AC which is 0.03 meq g⁻¹. The kinetics of adsorption was remarkably slower for ILs on granulated/fabric AC than milled one. We also studied the effect of AC size on the rate of adsorption in the operating conditions. In order to improve the adsorption kinetics of ILs with ACs, different phenomenological and empirical kinetic models like as pseudo-first order, Boyd model, pseudo-second-order diffusion model and Elovich were applied on the kinetic experimental data. The analysis of kinetic specified that the adsorption mechanism of ILs onto ACs is controlled mainly by the mass transfer through the pores of ACs. So, the selection of appropriate adsorbent particle size of AC plays a main role for the development of viable IL adsorption.

Graphical abstract

ᅟ

Necrobiosis lipoidica associated with sarcoidosis

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.

Diffuse papulopustular eruption in a newborn

Pediatric Dermatology, Volume 35, Issue 5, Page 683-684, September/October 2018.

Enlarging verrucous plaques in a teenager

Pediatric Dermatology, Volume 35, Issue 5, Page 671-672, September/October 2018.

Red‐brown macules in a linear distribution on the arm

Pediatric Dermatology, Volume 35, Issue 5, Page 685-687, September/October 2018.

Skin lesions in a 5‐year‐old boy with recent unusual course of pneumonia

Pediatric Dermatology, Volume 35, Issue 5, Page 673-675, September/October 2018.

Response to “Doing the math: A simple approach to topical timolol dosing for infantile hemangiomas”

Pediatric Dermatology, Volume 35, Issue 5, Page 700-700, September/October 2018.

Child with flagellate skin eruptions

Pediatric Dermatology, Volume 35, Issue 5, Page 676-677, September/October 2018.

An infant with a capillary malformation on the lower lip

Pediatric Dermatology, Volume 35, Issue 5, Page 681-682, September/October 2018.

A hair out of place in a 6‐year‐old boy

Pediatric Dermatology, Volume 35, Issue 5, Page 669-670, September/October 2018.

A comprehensive next‐generation sequencing assay for the diagnosis of epidermolysis bullosa

Pediatric Dermatology, Volume 35, Issue 5, Page 732-735, September/October 2018.

A rapidly‐growing, exophytic papule on the nose of a 9‐year‐old Native American boy

Pediatric Dermatology, Volume 35, Issue 5, Page 678-680, September/October 2018.

Comment on “Doing the math: A simple approach to topical timolol dosing for infantile hemangiomas”

Pediatric Dermatology, Volume 35, Issue 5, Page 698-699, September/October 2018.

Patient Perspectives: What is Diaper Rash?

Pediatric Dermatology, Volume 35, Issue 5, Page 667-668, September/October 2018.

Comment on “Excellent response to ustekinumab in a 9‐year‐old girl with severe psoriasis”

Pediatric Dermatology, Volume 35, Issue 5, Page 701-701, September/October 2018.

Issue Information

Pediatric Dermatology, Volume 35, Issue 5, Page 541-546, September/October 2018.

Society for Pediatric Dermatology 43rd Annual Meeting Poster Presentations July 2018 | Lake Tahoe, California

Pediatric Dermatology, Volume 35, Issue 5, Page 702-731, September/October 2018.

Agricultural environmental total factor productivity in China under technological heterogeneity: characteristics and determinants

Abstract

With limited resources, growing environment constraints and downward pressure on the economy, increasing agricultural environmental total factor productivity (AETFP) and its contribution to agricultural growth is significant for transforming agricultural development to make it more resource efficient and environment-friendly. This paper considered technological heterogeneity in different regions of China and measured AETFP in 30 provinces from 1997 to 2015 using the Metafrontier Malmquist-Luenberger (MML) productivity index. Multi-dimensional analysis was made on temporal and spatial characteristics, evolution patterns, and influencing factors of AETFP in China. The results showed that: (1) AETFP increased in the Ninth, Tenth, Eleventh, and Twelfth Five-Year Plan periods, with average annual growth rates of 0.76%, 0.88%, 1.17%, and 0.87%, respectively. (2) The average annual growth rate of AETFP in the eastern, central, and western regions decreased successively. The eastern region generally had played a leading role. The central region had a catch-up effect on environmental production technologies from the eastern region, while the western region lacked the catch-up effect. (3) The dynamic evolution of AETFP had prominent features. For the whole nation, the kernel density curve of AETFP continuously moved to the right. The main peak value continuously decreased and the width of the main peak continuously increased. The internal differences of AETFP in the eastern and western regions exhibited an increasing trend, while the internal differences of AETFP in the central region showed little change. (4) There was an inverted U-shaped relationship between agricultural economic growth and AETFP. Both the disaster rate and planting structure had a negative impact on AETFP with varying degrees of significance. Income gaps between urban and rural areas can partially offset the role of urbanization in promoting the growth of AETFP. The greater the income differences between urban and rural areas, the weaker the role of urbanization in promoting the growth of AETFP. These findings can help the government determine policies to change the agricultural development mode and formulate effective measures to improve AETFP.

Polymorphisms in P53 and VEGFA genes in different subtypes of periorbital hyperpigmentation in a Malaysian Chinese population

Australasian Journal of Dermatology, EarlyView.

A challenging case: Multiple and Blaschkoid hair follicle naevi or supernumerary accessory tragi?

Australasian Journal of Dermatology, EarlyView.

Angina bullosa haemorrhagica‐like lesions in pemphigus vulgaris

Australasian Journal of Dermatology, EarlyView.

Les indications cliniques et morphologiques des reconstructions mammaires différées

Publication date: Available online 13 September 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): C. Bruant Rodier, F. Bodin, L. Ruffenach, C. Depoortere, C. Dissaux

Résumé

Les techniques de reconstructions mammaires sont nombreuses et toutes doivent pouvoir être proposées au sein d'une équipe, des plus simples aux plus compliquées. Le choix de la technique se fait simplement au cours de la consultation par discussion entre chirurgien et patiente. Seul un angioscanner peut s'avérer nécessaire au choix du DIEP. Le chirurgien se base sur l'examen clinique des tissus en zone mammaire et des sites potentiellement donneurs de lambeaux ou de graisse. La patiente exprime ses désirs et ses attentes en termes de volume, de forme, de suivi, de risques encourus. Le chirurgien propose et à la lumière informations données, la patiente prendra la décision finale. Le chirurgien doit s'appliquer à trouver la technique la plus adaptée à la demande individuelle de chaque patiente. Une indication finement posée est garant d'une satisfaction qui constitue le seul but de la reconstruction mammaire. Ce dialogue et le cheminement vers le choix final de l'indication sont volontairement présentés ici sous un format ludique et original.

Summary

A full range of breast reconstructions procedures exists and had to be proposed within a surgical team, from the simplest to the most complex. The choice of the technique is simply based on the discussion between the surgeon and the patient during a consultation. A computed tomographic angiography might be required in the case of DIEP flap reconstruction. The surgeon bases his decision on a clinical exam of the breast area, the quality of the tissues and looks for potential flaps or fat donor sites. The patient expresses her expectations in terms of breast volume, form and is clearly informed about potential risks and follow-up. Thus the surgeon could propose the most adequate procedure in the case of the patient, who will take the final decision. The surgeon should ensure to find the most adapted procedure to each individual. A well-determined indication will lead to a truly satisfied patient, which is the main goal of breast reconstruction. We decided to present this dialogue and the path towards the final choice in a fun and original format.

Historique du traitement du cancer du sein

Publication date: Available online 13 September 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): J. Bardot, G. Magalon, R.F. Mazzola

Résumé

En six pages de dessins les auteurs résument l'histoire du traitement du cancer du sein, puis les étapes de la reconstruction. Ils mettent l'accent sur la variété des techniques qui ont été employées et sur les débats autour des indications de la reconstruction après cancer.

Summary

The authors summarize in those six pages of drawings the history of breast cancer reconstruction treatment. The focus is on the variety of techniques available for breast reconstruction and on the debates around different indications.

Investigation of antibiotics in sea cucumbers: occurrence, pollution characteristics, and human risk assessment

Abstract

Occurrence and distribution of 24 antibiotics from 7 categories were screened in sea cucumbers (Echinodermata: Holothuroidea) collected from different coastal regions of China. The samples were simultaneously extracted and purified using accelerated solvent extraction with in-cell clean-up and analyzed by ultra-performance liquid chromatography-tandem mass spectrometry. A total of ten antibiotics were detected in the sea cucumbers with concentrations ranging from not detected to 32.8 μg/kg (dry weight). Sulfonamides are predominant antibiotics with a mean concentration of 11.5 μg/kg (dry weight), followed by macrolides (11.3 μg/kg, dry weight) and fluoroquinolones (11.2 μg/kg, dry weight). High concentrations of the antibiotics were found in the samples from the South China Sea, implying that the antibiotic pollution in sea cucumbers was geographical region-dependent, which was further confirmed by principal component analysis. It was also found that the antibiotic levels are slightly higher in instant sea cucumbers than in the dried ones. Hazard quotient calculation suggested no obvious human health risks associated with the consumption of sea cucumbers regarding antibiotics.

Treatment of 1,4-dioxane and trichloroethene co-contamination by an activated binary persulfate-peroxide oxidation process

Abstract

The efficacy of a binary oxidant system, hydrogen peroxide (H₂O₂) and persulfate, was investigated for treatment of 1,4-dioxane (dioxane) and trichloroethene (TCE) co-contamination. Batch experiments were conducted to examine the catalytic efficiency of Fe²⁺ and NaOH-based activation, oxidant decomposition rates, contaminant degradation effectiveness, and competitive degradation effects. For NaOH activation, the oxidant decomposition rate was moderate and sustained during the entire test period of 96 h. However, dioxane degradation was limited (~ 33%). Conversely, the oxidants were depleted within 24 h for the Fe²⁺-activated system, and dioxane degradation was complete within 4 h. The activation and radical generation processes were different between Fe²⁺ and NaOH activation. Both dioxane and TCE underwent complete degradation in the co-contaminant experiment. The results of this study indicate that the Fe²⁺-catalyzed binary hydrogen peroxide-persulfate oxidant system is effective for oxidation of the tested contaminants separately and as co-contaminants.

Resistance of alfalfa and Indian mustard to Cd and the correlation of plant Cd uptake and soil Cd form

Abstract

Phytoremediation of heavy metal-contaminated soil is considered to be one ecological environmental protection way that is effective and economical. The selection of suitable hyperaccumulators is a key issue for phytoremediation of heavy metal-contaminated soil. Pot experiments were conducted to study the effects of different Cd levels (0, 75, 150, 300, and 600 mg kg⁻¹ Cd) on the dry weight, antioxidant enzyme activities, malondialdehyde (MDA) contents, Cd concentration, Cd accumulation, and soil Cd form distribution ratio (FDC) of alfalfa (Medicago sativa L.) and Indian mustard (Brassica juncea L.). The correlations between Cd concentration in shoots and roots of alfalfa and Indian mustard and soil Cd form were also investigated. The results showed that with the increase of soil Cd levels, dry weight of shoot and root of alfalfa and Indian mustard significantly decreased, which decreased by 50.0–71.8% and 29.6–59.3% (alfalfa), 59.6–89.0% and 64.3–74.8% (India mustard), respectively, compared with the control. With the increase of soil Cd level, superoxide dismutase (SOD) activity in shoot of alfalfa significantly increased. Catalase (CAT) activity and malondialdehyde contents in shoots and roots of alfalfa and Indian mustard, as well as superoxide dismutase activity in the roots of alfalfa and Indian mustard increased first and then decreased with the increase of soil Cd level. With increasing Cd stress, Cd concentration in shoots and roots of alfalfa and Indian mustard significantly increased. At soil Cd level of 75 mg kg⁻¹, Cd concentrations in shoots of alfalfa and Indian mustard exceeded the critical value of Cd-hyperaccumulator (100 mg kg⁻¹), which was 356.46 mg kg⁻¹ and 308.74 mg kg⁻¹, respectively. Cadmium concentrations in shoots and roots of plants were in the order of that of alfalfa > Indian mustard; total Cd accumulation in the aboveground tissues and roots of the plants was in the order of that of Indian mustard > alfalfa at the same Cd level. With increasing soil Cd level, Cd concentrations of exchangeable form (EXC-Cd), carbonate-bound form (CAB-Cd), iron-manganese oxide-bound form (FeMn-Cd), organic-bound form (OM-Cd), and residual form (RES-Cd) showed an increasing trend. The form distribution ratio of soil Cd forms in alfalfa's rhizosphere was in the order of that of exchangeable form Cd > carbonate-bound form Cd > iron-manganese oxide-bound form Cd > residual form Cd > organic-bound form Cd. Except for organic-bound form Cd, soil Cd forms were significantly positively correlated with Cd concentration in shoot and root (P < 0.01). Comprehensively considering the biomass and Cd accumulation, Indian mustard is more suitable as remediation material for soil Cd pollution.

Future intensification of summer hypoxia in the tidal Garonne River (SW France) simulated by a coupled hydro sedimentary-biogeochemical model

Abstract

Projections for the next 50 years predict a widespread distribution of hypoxic zones in the open and coastal ocean due to environmental and global changes. The Tidal Garonne River (SW France) has already experienced few episodic hypoxic events. However, predicted future climate and demographic changes suggest that summer hypoxia could become more severe and even permanent near the city of Bordeaux in the next few decades. A 3D model, which couples hydrodynamic, sediment transport, and biogeochemical processes, is applied to assess the impact of factors submitted to global and regional climate changes on oxygenation in the turbidity maximum zone (TMZ) of the Tidal Garonne River during low-discharge periods. The model simulates an intensification of summer hypoxia with an increase in temperature, a decrease in river flow or an increase in the local population, but not with sea level rise, which has a negligible impact on dissolved oxygen. Different scenarios were tested by combining these different factors according to the regional projections for 2050 and 2100. All the simulations showed a trend toward a spatial and temporal extension of summer hypoxia that needs to be considered by local water authorities to impose management strategies to protect the ecosystem.

Personal Dust Exposure and Its Determinants among Workers in Primary Coffee Processing in Ethiopia

Abstract

Background

Coffee processing has been shown to cause high dust exposure among the workers, but there are few studies from primary processing of coffee, and none of them is from Ethiopia. The aim of this study was to assess dust exposure and its determinants among workers in primary coffee processing factories of Ethiopia.

Methods

A total of 360 personal 'total' dust samples were collected from the breathing zone of workers in 12 primary coffee processing factories in Ethiopia. Dust sampling was performed with 25-mm three piece conductive cassettes with cellulose acetate filters attached to pumps with flow rate of 2 l min⁻¹ for an average sampling duration of 410 min. The dust samples were analysed gravimetrically using a standard microbalance scale. An observational checklist was used to collect information about possible determinants of dust exposure in the work environment. Linear mixed effect regression models were used to identify significant determinants of total dust exposure.

Results

Personal total dust exposure levels varied between the three main job groups with a geometric mean (GM) of 12.54 mg m⁻³ for the machine room workers, 12.30 mg m⁻³ for the transport workers, and 1.08 mg m⁻³ for hand pickers. In these three groups, 84.6%, 84.1% and 2.6% of the samples exceeded the occupational exposure limit for organic total dust of 5 mg m⁻³, respectively. The mixed-effects model for the machine room workers explained 21% of the total variance in total dust exposure, and showed that vigorously pouring coffee from a dropping height was associated with an about two times increase in exposure. For the transport workers, the mixed-effects model that included pouring method of coffee beans, number of huller machine in the room, mixing coffee, and feeding hopper explained 32% of total variance in personal total dust exposure.

Conclusion

About 84% of the dust samples among machine room and transport workers in primary coffee processing factories were above the occupational exposure limit value for organic dust. Proper control measures are necessary to reduce the exposure.

Advanced Basal Cell Cancer: Concise Review of Molecular Characteristics and Novel Targeted and Immune Therapeutics

Abstract

Metastatic basal cell carcinoma is an ultra-rare manifestation of a common disease, appearing in 0.0028% to 0.5% of basal cell carcinomas. Initial therapeutic efforts focused on cytotoxic chemotherapy administration. However, it is now known that the Hedgehog signaling pathway is crucial for basal cell proliferation and Hedgehog pathway mutations may lead to tumorigenesis; thus, small molecule inhibitors of alterations in the components of this pathway, including smoothened (SMO) and GLI, have been the focus of recent therapeutic developments. Indeed, the European Medicines Agency (EMA) and the Food and Drug Administration (FDA) have approved the SMO inhibitors, vismodegib and sonidegib, with additional GLI inhibitors currently in clinical trials. Molecular profiling of these tumors has revealed other potential targets for therapy, including high tumor mutational burden and PD-L1 amplification, which predict response to immune checkpoint blockade (PD-1 and PD-L1 inhibitors). An illustrative patient with a giant, advanced, unresectable basal cell carcinoma who obtained an ongoing complete remission after treatment with a combination of an immune checkpoint inhibitor (due to the tumor's high mutational burden) and the Hedgehog inhibitor vismodegib is described. A fuller understanding of the genomic portfolio of these patients can assist in developing novel, rational therapeutic approaches that should continue to improve responses and outcomes.

Reply to: “Risk of skin cancer in HIV-infected patients: a Danish nationwide cohort study”

Publication date: Available online 14 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Matthew D. Mansh, Dustin H. Marks

Clobetasol pretreatment to reduce or prevent injection site dermatitis from biologic agents

Publication date: Available online 14 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Deede Liu, Dominic J. Wu, Anand Rajpara, Ting Wang, Daniel J. Aires

Answer to the comment concerning our article “Risk of skin cancer in HIV-infected patients: a Danish nationwide cohort study”

Publication date: Available online 14 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): S.H. Omland, L.H. Omland

Hyperhidrose – Ätiopathogenese, Diagnostik, Klinik und Therapie

Zusammenfassung

Die Hyperhidrose tritt meist als primäre, selten als sekundäre symptomatische Hyperhidrose auf. Die primäre Hyperhidrose wird als komplexe neuropathische Dysregulation mit genetischer Disposition verstanden, die ein pathologisches Schwitzverhalten mit vermehrter Schweißsekretion über mindestens 6 Monate bedingt und mindestens 4 der folgenden Diagnosekriterien erfüllt: Betroffenheit der Axillae und/oder der Handinnenflächen und/oder der Fußsohlen und/oder des Stirnbereiches, symmetrisches Auftreten, kein nächtliches Schwitzen, Häufigkeit des Auftretens mindestens wöchentlich, Beginn der Erkrankung vor dem 25. Lebensjahr, positive Familienanamnese sowie Beeinträchtigung der täglichen Aktivitäten. Zur Therapie der primären Hyperhidrose werden v. a. topisch Aluminiumsalze und Anticholinergika, Leitungswasseriontophorese sowie intrakutan Botulinumtoxin angewendet. In der systemischen Therapie kommen ebenfalls verschiedene Anticholinergika zum Einsatz. Meist als Ultima-Ratio-Therapie werden chirurgische Verfahren angewendet. Außerdem sind Verfahren zur Thermolyse entwickelt worden.

Propositions on the cheap

Abstract

According to the classical account, propositions are sui generis, abstract, intrinsically-representational entities and our cognitive attitudes, and the token states within us that realize those attitudes, represent as they do in virtue of their propositional objects. In light of a desire to explain how it could be that propositions represent, much of the recent literature on propositions has pressured various aspects of this account. In place of the classical account, revisionists have aimed to understand propositions in terms of more familiar entities such as facts, types of mental or linguistic acts, and even properties. But we think that the metaphysical story about propositions is much simpler than either the classical theorist or the revisionist would have you believe. In what follows, we argue that a proper understanding of the nature of our cognitive relations to propositions shows that the question of whether propositions themselves represent is, at best, a distraction. We will argue that once this distraction is removed, the possibility of a very pleasing, minimalist story of propositions emerges; a story that appeals only to assumptions that are (or, at least ought to be) shared by all theorists in the relevant debate.

Testing EKC hypothesis with energy and sustainable development challenges: a fresh evidence from belt and road initiative economies

Abstract

Diverse impact of greenhouse gasses (GHGs) over the landscape of environment is generally believed in literature. As CO2 emission acutely leads to GHGs is a major contributor for global warming, it creates a serious pressure on natural resources and ecological settings. Similarly, low-carbon (CO2) economy, plenty of energy resources, and sustainable growth are a big ask for worldwide economies in this era of mechanization. This paper analyzes the Environmental Kuznets Curve (EKC) hypothesis, for Belt and Road Initiative (BRI) economies, to contend the role of mega projects in BRI as an attribute for ecological detriments. The on-hand study engages fresh data information ranging from 1981 to 2016 holding with heterogeneity and cross-sectional dependence as a special deliberation. The calculated outcomes expose that, mean group estimator provides strong evidence and favor the existence of EKC approximately in every region. The long-run influence is measured by pooled mean group estimators, which shows significant outcomes in every region; additionally, the EKC hypothesis affirmed in the long run especially for developed economies. Mega projects, i.e., BRI requisite immense energy sources to accomplishing the enclosed projects efficiently and effectively. The positive association between carbon emission and energy consumption troubled the governments to make policies for restraining the magnitude of carbon emission and controls energy usage for enduring environment to its original position. Next, the valuations depicted the dense recommendations for state administrations in capacity of rigorous level supremacy, trash managing campaigns, renewable energy reliance, and advance for desirable judgments to sterilize the atmosphere.

Metal wet deposition in the Three Gorges Reservoir (TGR) region of Southwest China

Abstract

Metal wet deposition has become an environmental concern because of its threats to soil or water quality and human health. This study was to collect rainfall waters in 2016 from seven sites, representing urban, town, rural, and wetland, within the Three Gorges Reservoir (TGR) region of Southwest China, determine the metal concentration and flux (Zn, Mn, Cu, As, Cd, Pb), and identify their possible sources. Results indicated that Zn was the most abundant metal with a concentration of 16.92 μg L⁻¹ in fall and 19.91 μg L⁻¹ in winter and flux of 4.71 mg m⁻² in fall, while Cd was the least with a monthly mean concentration of 0.02–0.37 μg L⁻¹. Among the seven sites, urban (FL) had the highest values of both concentrations of metals (Zn, Cu, Pb) and fluxes of metals (Mn, As), which significantly differed from the other sites. Component and redundancy analysis suggested that fossil fuel and biomass combustion be a potential metal source. Enrichment factors, box model, and potential ecological risk index showed that the TGR water quality could face a high risk due to wet metal deposition, especially Cd. Data could provide a valuable aid in mitigating metal pollution, developing the best watershed management practices, as well as safeguarding water quality and human health in the TGR region or other reservoir regions.

Nimbolide ameliorates fibrosis and inflammation in experimental murine model of bleomycin-induced scleroderma

Abstract

Background

Clinical manifestations of skin fibrosis are very variable and ambiguous, making its management quite critical and challenging. The lack of appropriate established pharmacological interventions make its treatment even more complicated. Intricate details of the underlying pathogenesis are thus imperative to further explore different treatment possibilities. Of note, the TGF-β/Smad signaling axis and epithelial to mesenchymal transition (EMT) are the principal offenders in this fibrotic disorder.

Objective

Our current study is aimed at demonstrating the antifibrotic and anti-inflammatory potential of nimbolide, a triterpene derived from Indian traditional plant neem, in a murine model of Bleomycin-induced scleroderma.

Methods

Male C57BL/6 mice were administered with Bleomycin injections subcutaneously, daily for 28 days, at a constant site on the dorsum of the mice. Treatment with nimbolide lasted from day 1 to day 28. At the time of study termination, the injected sites were collected and stored suitably to conduct further molecular experiments and protein expression studies.

Results and conclusion

The results of our study show that nimbolide can significantly intervene in the TGF-β/Smad signaling axis and the consequent EMT process, thus attenuating deposition of extracellular matrix. Nimbolide also profoundly caused the regression of established inflammation-driven fibrosis, thus demonstrating both antifibrotic and anti-inflammatory activities. Another commendable finding of this study is that nimbolide was able to decrease the levels of LOXL2, a collagen cross-linker, which is aberrantly expressed in scleroderma. Although further mechanistic studies are required, our study displays nimbolide for the first time as a potent antifibrotic agent which can be used as a pharmacological intervention for the treatment of scleroderma.

Germanium in the soil-plant system—a review

Abstract

Germanium (Ge) is widespread in the Earth's crust. As a cognate element to silicon (Si), Ge shows very similar chemical characteristics. Recent use of Ge/Si to trace Si cycles and changes in weathering over time, growing demand for Ge as raw material, and consequently an increasing interest in Ge phytomining have contributed to a growing interest in this previously rather scarcely considered element in geochemical studies. This review deals with the distribution of Ge in primary minerals and surface soils as well as the factors influencing the mobility of Ge in soils including the sequestration of Ge in secondary mineral phases and soil organic matter. Furthermore, the uptake and accumulation of Ge in plants and effects of plant-soil relationships on the availability of Ge in soils and the biogeochemical cycling of Ge are discussed. The formation of secondary soil minerals and soil organic matter are of particular importance for the concentration of Ge in plant-available forms. The transfer from soil to plant is usually low and shows clear differences between species belonging to the functional groups of grasses and forbs. Possible uptake mechanisms in the rhizosphere are discussed. However, the processes that are involved in the formation of plant-available Ge pools in soils and consequently its biogeochemical cycling are not yet well understood. There is, therefore, a need for future studies on the uptake mechanisms and stoichiometry of Ge uptake under field conditions and plant-soil-microbe interactions in the rhizosphere as well as the chemical speciation in different plant parts.

Cobalt and nickel content in Hydrocharis morsus-ranae and their bioremoval from single- and binary solutions

Abstract

Aquatic macrophytes are known to remove trace metals from surrounding water. In the present study, an attempt was made to evaluate the phytofiltration capacity of Hydrocharis morsus-ranae and to show competition between cobalt (Co) and nickel (Ni) for the better understanding of metal bioaccumulation in the species. In a laboratory experiment, H. morsus-ranae was exposed to separate (single) and binary solutions of these metals: Ni 10.7, 18.7, 32.7, 57.1, and 100 (μg L⁻¹); Co 5.33, 9.32, 16.3, 28.6, and 50.0 (μg L⁻¹); and 10.7 Ni + 5.33 Co, 18.7 Ni + 9.32 Co, 32.7 Ni + 16.3 Co, 57.1 Ni + 28.6 Co, 100 Ni + 50.0 Co (μg L⁻¹). The content of Co and Ni in the plant increased with the increasing concentration in the growth medium. Competition between the metals was seen during uptake in binary solutions. Ni interfered with the accumulation of Co, resulting in a lower Co content than in plants cultivated in Co solutions. A particularly high Co content (up to 155 mg kg⁻¹ dry weight [d.w.]) and high efficiency of Ni uptake (Bioaccumulation Factor (BF) 2572–7239) makes the species a very good accumulator of these metals. The high content of both trace metals in plant tissues (up to 511 mg kg⁻¹ d.w. Ni and 155 mg kg⁻¹ d.w. Co) did not affect its growth, indicating tolerance of these toxicants. The plant showed excellent ability in removing Co (up to 98.6% in solution with 5.33 μg L⁻¹ Co) and Ni (up to 91.4% in solution with 57.1 μg L⁻¹ Ni and 28.6 μg L⁻¹ Co) from nutrient solution. The results suggest that H. morsus-ranae may be useful for the phytoremediation of water bodies contaminated with Co and Ni.

“Reporting Time Horizons in Randomized Controlled Trials in Plastic Surgery: A Systematic Review.”

Background: Current guidelines for randomized controlled trial (RCT) reporting do not require authors to justify their choice of time horizon. This is concerning, as the time horizon when an outcome is assessed has important implications for the interpretation of study results, and resources allocated to an investigation. Therefore, this study seeks to examine the standards of time horizon reporting in the plastic surgery literature. Methods: This is a systematic review of plastic surgery RCTs published within the last 4 years. The MEDLINE database was searched to yield relevant studies. All studies included were English language, prospective, non-pharmaceutical RCTs, comparing two plastic surgical interventions. Studies were classified into plastic surgery domains, and information regarding study population, time horizon reporting, and justification of chosen time horizons, was extracted. Results: The search retrieved 720 articles, of which 103 were eligible for inclusion. Time horizons were reported as either a standardized time point at which all patients were assessed, a follow-up duration range, or were not reported at all. Although most studies (85.4%) reported a standardized time horizon, the majority (85.4%) failed to provide a valid justification to support their selection of time horizons. Conclusion: Clinical investigators failed to justify their choice of time horizons in the majority of published RCTs. To limit heterogeneity, time horizons for given interventions should be standardized to improve validity of outcome assessments, enable future pooling of results, and increase research efficiency. The authors have no financial interests to declare. Corresponding Author: Achilleas Thoma, MD, MSc, 101-206 James Street South, Hamilton, ON L8P 3A9, Canada. athoma@mcmaster.ca, ©2018American Society of Plastic Surgeons

Compact and Economical Microsurgical Training made possible with Virtual Reality

No abstract available

Understanding platelet function in microsurgical arterial anastomosis: the Charing Cross Clamp Technique

No abstract available

Improvement of ternary fuel combustion with various injection pressure strategies in a toroidal re-entrant combustion chamber

Abstract

The present experimental work focuses on the influence injection pressure and toroidal re-entrant combustion chamber in a single cylinder diesel engine fuelled with ternary fuel (diesel-biodiesel-ethanol) blend. Ternary fuel (TF) is prepared by blending 70% diesel, 20% biodiesel, and 10% ethanol blends and its fuel properties were investigated and compared with diesel fuel. Since the physic-chemical properties of TF are well behind the diesel fuel, it is proposed to be blended with 20 ppm alumina nano additives which act as an ignition enhancer and catalytic oxidizer. The resulting fuel mixture (TF + 20 ppm alumina additive) is named as high performance fuel (HPF). Experimentations were conducted on HPF subjected to various injection pressures of 18 MPa, 20 MPa, 22 MPa, and 24 MPa respectively and are operated in toroidal re-entrant chamber geometry (TG) at an injection timing of 22 ^obTDC. From experimentation, it was identified that, for TG-HPF, higher injection pressure of 22 MPa ensued highest BTE (Brake Thermal Efficiency) of 35.5% and lowest BSEC (Brake Specific Fuel Consumption) of 10.13 MJ/kWh owing to the pooled effect of higher swirl formation, improved atomization enhanced evaporation rate, and better air-fuel mixing. Emission wise TG-HPF operated at 22 MPa lowered the HC (hydrocarbon), CO (carbon monoxide), and smoke emissions by 18.88%, 7.19%, and 5.02%, but with marginally improved NOx (oxides of nitrogen) and CO₂ (carbon dioxide) emissions by 3.92% and 3.89% respectively. In combustion point of view, it is observed that injection pressure increased the cylinder pressure, heat release rate (HRR), and cumulative heat release rate (CHRR) by 5.35%, 5.08%, and 3.38% respectively indicating improved combustion rate as a result of enhanced atomization, evaporation, and high turbulence inducement. Overall, it is concluded that operating the ternary fuel at 22 MPa injection pressure at toroidal re-entrant combustion chamber results in improved performance and minimized emissions.

The Evolution of Iliac Bone Graft Donor Site Analgesia in Cleft Patients: Transversus Abdominis Plane Block Is Safe and Efficacious

Background The transversus abdominis plane (TAP) block has been increasingly used as a means of abdominal wall analgesia. This study aims to determine if TAP block analgesia provides a benefit in cleft patients undergoing alveolar bone grafting with iliac crest cancellous bone graft. Methods Two groups of 20 consecutive patients undergoing alveolar bone grafting with iliac crest cancellous bone with either TAP block or indwelling catheter pain pump were examined in a retrospective fashion. Demographic data, pharmacologic use, and hospital length of stay were examined. Results Mean lengths of stay were identical between both groups. Patients in both groups received similar cumulative doses of morphine equivalents, codeine, ibuprofen, and ondansetron at 6 and 24 hours postoperatively. Transversus abdominis plane block patients received greater amounts of Tylenol at both 6 and 24 hours (P = 0.0015 and P = 0.0106). Pain scores did not differ significantly across our groups at 6 or 24 hours postoperatively. No adverse events were reported with the TAP block procedure. Conclusions Patients undergoing TAP blocks receive the benefit of a single stage procedure without an indwelling catheter and similar 6- and 24-hour morphine usage. Given the safety profile of the procedure, its effectiveness and comfort without indwelling catheter, we advocate for TAP block analgesia as an adjunct therapy in the management of postoperative pain in this population.

Discrepancies Between Surgical Oncologists and Plastic Surgeons in Patient Information Provision and Personal Opinions Towards Immediate Breast Reconstruction

Background Immediate breast reconstruction (IBR) may improve quality of life of patients receiving mastectomy. However, a significant hospital variation exists in the use of IBR due to various reasons. To better understand this variation, the present study investigated preoperative information provision to patients and personal opinions of surgical oncologists and plastic surgeons towards potential contra-indications for IBR. Methods An online survey (35 questions) was developed including questions on respondent demographics, information provision to the patient about IBR and potential contra-indications by IBR technique. Results One-hundred-eighty-nine physicians participated: 118 surgical oncologists and 71 plastic surgeons. All clinicians discussed the possibility of IBR with their patients. Complications (79% versus 100%, P 75 years, breast size >D-cup, BMI >40 kg/m2, smoking (for implant reconstruction), pulmonary/cardiac comorbidities (for autologous reconstruction) and radiotherapy were considered a contra-indication more frequently by plastic surgeons. In contrast, surgical oncologists reported tumor stage (≥cT3), nodal stage (≥cN2) and chemotherapy more frequently to be a contra-indication for IBR. Conclusion We observed that all respondents discussed the possibility of IBR with their patients, whereas patient-tailored information was given more frequently by plastic surgeons. Physicians differed in their opinions towards contra-indications for IBR, with plastic surgeons reporting patient-related risk factors for wound healing problems and surgical oncologists reporting oncological contra-indications more frequently. Consensus between physicians regarding contra-indications for IBR may optimize patient counseling and shared decision-making.

The Effect of the Histone Deacetylase Inhibitor Suberoylanilide Hydroxamic Acid and Paclitaxel Treatment on Full-Thickness Wound Healing in Mice

Introduction Neoadjuvant chemotherapy prior to lumpectomy or mastectomy for breast cancer challenges wound healing. Suberoylanilide hydroxamic acid (SAHA), a histone deacetylase inhibitor, has been shown to work synergistically with paclitaxel in vitro and in preclinical studies. In addition, our laboratory has demonstrated that SAHA treatment decreases paclitaxel-associated stem cell toxicity, modulates inflammatory response, and promotes wound healing in injured fibroblast cells. Our goal was to determine if combined SAHA and paclitaxel treatment would improve wound healing in an in vivo full-thickness murine model, without altering antitumor effect. Methods Thirty-two nude athymic mice received intraperitoneal injections of paclitaxel (20 mg/kg), SAHA (25 mg/kg), paclitaxel + SAHA (20 mg/kg + 25 mg/kg), or no treatment for 2 weeks prior to surgery. Under general anesthesia, 8-mm full-thickness dorsal wounds were created in all animals, and a silicone splint was attached to minimize wound contraction. The wounds were measured twice a week with a surgical caliper until healing was complete. To evaluate the in vivo effect of drug treatment, 16 athymic nude mice with MDA-MB-231 xenografts received the treatments described previously, following which tumor volumes were compared between groups. Results Average wound healing time was prolonged in mice treated with paclitaxel (20 ± 1.9 days), and combination SAHA + paclitaxel therapy improved average wound healing time (17.0 ± 1.8 days). In the xenograft model, the antitumor effect of SAHA and paclitaxel (average tumor volume 43.9 ± 34.1 mm3) was greater than paclitaxel alone (105.8 ± 73.8 mm3). Conclusions The addition of SAHA to taxane chemotherapy improves the therapeutic effect on triple-negative breast cancer while decreasing the detrimental effect of paclitaxel on wound healing. This may have substantial implications on improving outcomes in breast reconstruction following chemotherapy.

Book Review: Hand Trauma Illustrated Surgical Guide of Core Procedures

No abstract available

Reconstruction of Soft Tissue Defects Around the Knee With Pedicled Perforator Flaps

Purpose To study the availability and effects for application of 4 kinds of perforator flaps in repairing skin and soft tissue defects in different positions around the knee joints. Methods The present study included 26 cases (16 males and 10 females) with soft tissue defects with ages from 7 to 82 years who came to our hospital during September 2012 to August 2016. The wound size ranged from 6 × 3 cm to 15 × 12 cm, and the exposed area ranged from 4 × 2 cm to 10 × 8 cm. Patients were treated with different perforator flaps (descending genicular artery perforator flap, sural neurocutaneous flap, lateral superior genicular artery perforator flap, and lateral popliteal artery perforator flap) and were followed up for 6 months. Results All the transplanted flaps survived well without advent events. Exposed bone, ligament, and skin and soft tissue defects healed well. In the early period, flaps were locally bloated. In the later period, the appearance of flaps was good and close to normal, with abrasion-resistant surfaces. All patients were satisfied with the flap appearance and functional recovery. No secondary necrosis, ulcers, deep infection, or nonunion of bone occurred during the follow-up. Conclusions These 4 kinds of perforator flaps are available methods to repair the skin and soft tissue defects around the knee joints. Suitable perforator flaps should be chosen for different locations of wounds. Level of Evidence Therapeutic study, level IV.

Book Review: Anatomy An Essential Textbook, 2nd Edition

No abstract available

Classification and Treatment of Adult Buried Penis

No abstract available

Preoperative Implant Size Is Strongly Associated With Alternations of Implant Size During Secondary Breast Augmentation

Background Breast augmentation is one of the most popular cosmetic surgeries performed worldwide. In turn, there has been an increasing number of secondary breast augmentation procedures in recent years. Implant selection at secondary breast augmentation can be a challenge and is affected by a number of factors. The aim of this study was to assess the main factors affecting the decision-making process with regard to implant volume determination prior to implant exchange. Methods Women who underwent elective breast implant exchange between 2012 and 2016 were included in this study. Medical records were used to acquire implant and patient data. The patient's desires, as well as medical considerations, were taken into account during the implant selection process. Results Two hundred forty-five women with an average age of 43 years (range, 21–69 years) were included in the study. The mean time between primary augmentation and implant exchange was 10 ± 5.7 years. Overall, 192 implants (38.9%) were exchanged with larger implants, 84 implants (17%) were exchanged with smaller implants, and 218 implants (44.1%) were exchanged with implants similar to the preoperative size (±25 mL). In patients who received smaller implants, the mean reduction in implant volume was found to be 78.88 mL. Women were more likely to receive a smaller implant during implant exchange if the preoperative implant volume was larger than 367 mL (P = 0.00006). Among patients who received larger implants, no correlation was found between preoperative and postoperative implant size. A positive correlation was found between the implant age and a reduction in implant size (P = 0.036). However, no correlation was found between the patient's age and the decision to reduce or enlarge implant size upon revision. Conclusions Almost half of patients receive similarly sized implants during elective implant exchange. Among those who did decide to change their implant size, more than twice as many patients opted for a larger implant as opposed to a smaller one. Relatively large preoperative implant size and longer time since primary augmentation were associated with the selection of smaller implants during exchange. Further studies should be conducted to reinforce these results.

Long-term Outcomes After Pediatric Free Flap Reconstruction

Introduction Whereas free tissue transfer has evolved to minimize morbidity in adults, less is known about outcomes after free flaps in children. This study sought to assess short- and long-term outcomes after microvascular reconstruction in the pediatric population. Methods Short- and long-term outcomes of free tissue transfer were assessed using chart-review and quality-of-life surveys. The Pediatric Outcomes Data Collection Instrument was used to evaluate overall health, pain, and ability to participate in normal daily and more vigorous activities. Patient or parent responses were compared against normative data. Results Forty-two patients underwent 48 flap reconstructions at a mean age of 8 years. Median follow-up was 14.9 years. Indications included congenital nevi (n = 19, 42%), lymphatic/vascular malformations (n = 8, 19%), and trauma/burns (n = 6, 14%). There were 21 fasciocutaneous (44%), 19 muscle/myocutaneous (40%), 6 fascial/peritoneal (13%), and 2 osteocutaneous flaps (4%). Major flap complications were observed in 4 patients (9%), whereas major donor-site complications occurred in 2% (1 patient). Valid contact information was available for 25 patients; 16 of these completed surveys (64%). Pediatric Outcomes Data Collection Instrument scores for mobility (median, 52), sports/physical functioning (median, 56), happiness (median, 50), and pain/comfort (median, 56) were not significantly different from normative population score of 50. Similarly, median global functioning score was 99 (maximum, 100) and did not differ between flap types. Discussion Free tissue transfer in the pediatric population is reliable and well-tolerated over time. Surgeons should not hesitate to use free flaps when clinically indicated for pediatric patients.

Aesthetic Refinement in the Creation of the Clitoris, Its Preputial Hood, and Labia Minora in Male-to-Female Transsexual Patients

Background In male-to-female genital sex reassignment surgery, the clitoris, its prepuce, and the labia minora remain among the most difficult structures to construct. We describe the authors' clitoroplasty and vulvoplasty technique. Methods All patients who underwent male-to-female sex reassignment surgery at a single center, between June 2012 and June 2016, were prospectively included. The standard pedicled island neurovascular flap of the glans penis was harvested in a letter M fashion with attached preputial skin. The central triangle of the M was used for the neoclitoris formation. Labia minora and the clitoral prepuce were created with both legs of the M and the preputial skin attached to it. Tactile and erogenous sensitivity was evaluated. Results Ninety-seven patients were included (mean age, 32 years; range, 17–54 years). All clitoroplasties and vulvoplasties were completed in the same surgical stage as the vaginoplasty. There were no cases of deep or total flap necrosis. Eight patients developed partial and superficial skin necrosis of the flap; one presented an abscess in labia majora, and another patient had urethral hematoma; both required drainage. None of the complications left any sequelae. At 6 months' follow-up all patients maintained tactile and erogenous sensitivity. Conclusions The proposed technique represents an aesthetic refinement of the previously described pedicled glans penis flap by allowing the creation of a sensate neoclitoris, its preputial hood, and labia minora with excellent outcomes in the same surgical stage as the sex reassignment.

A Comparative Clinical Study of Flap Thickness: Medial Sural Artery Perforator Flap Versus Anterolateral Thigh Flap

Introduction The purpose of this study is to measure flap thicknesses of anterolateral thigh (ALT) and medial sural artery perforator (MSAP) flaps in healthy subjects by Doppler ultrasonography and compare the results in relation to sex and body mass index (BMI). Method The perforators of ALT and MSAP flaps were marked on 30 healthy subjects. The thickness of skin and subcutaneous tissue was measured in millimeters at the site of the perforator using Doppler ultrasonography. Results The mean ± SD age of the participants was 36.4 ± 10.5, the mean ± SD BMI was 25.2 ± 3.9 (19.4–32.5). The mean ± SD flap thickness was 11.55 ± 4.38 mm for ALT and 8.31 ± 3.6 mm mm for MSAP (P

Breast Reconstruction May Improve Work Ability and Productivity After Breast Cancer Surgery

Objective The aim of this study was to evaluate work ability and productivity in women who had undergone different types of surgical treatment for breast cancer, as well as breast reconstruction after mastectomy. Methods This cross-sectional study assessed 152 women between 30 and 60 years of age, who worked outside the home in formal or informal jobs, or as self-employed. Thirty-eight of them had no history of breast cancer (control group), and 114 had undergone surgical treatment for breast cancer at least 1 year before their enrollment in the study, and were allocated as follows: mastectomy group (n = 38), breast-conserving surgery group (n = 38), or breast reconstruction breast reconstruction group (n = 38). The validated Brazilian versions of the Work Productivity and Activity Impairment-General Health questionnaire and Work Limitations Questionnaire were self-administered. Results The groups were homogeneous regarding age, education level, and other sociodemographic characteristics. Patients in the mastectomy and breast-conserving surgery groups showed reduced work performance and productivity compared with women in the breast reconstruction and control groups (P = 0.0004 and P = 0.0006, respectively). In addition, women in the mastectomy group had more difficulty in performing activities of daily living compared with those in other groups (P = 0.0121). Conclusions Women who had undergone mastectomy or breast-conserving surgery had decreased work ability and productivity compared with women without a history of breast cancer and to those who had undergone breast reconstruction.

Disparities in Postmastectomy Breast Reconstruction: A Systematic Review of the Literature and Modified Framework for Advancing Research Toward Intervention

Background As the United States' population diversifies, eliminating disparities in health and healthcare has become increasingly important across all disciplines of medicine, including plastic and reconstructive surgery. This is evidenced by the growing body of literature in recent years focusing on disparities in postmastectomy breast reconstruction. No study to date has evaluated whether this research is progressing appropriately to promote tangible evidence-based interventions to reduce these disparities. Methods A systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was performed to identify studies focusing on disparities in postmastectomy breast reconstruction. A previously established public health framework for advancing health disparities research was used to inform analysis of the quality and progression of the included studies. This triphasic framework categorizes disparities research as follows: detecting (identifies and measures disparities in vulnerable populations), understanding (establishes determinants of disparities), or reducing (proposes and evaluates interventions for eliminating disparities). Results Ninety-five studies were identified between 1979 and 2016, with 61 (64.2%) published after 2010. The majority of studies (51.6%) were retrospective cohort or case-control studies (American Society of Plastic Surgery level III evidence). Fifty-eight (63.7%), 31 (34.1%), and 2 (2.2%) studies provided detecting-, understanding- and reducing-phase disparities research, respectively. Non–plastic and reconstructive surgery journals accounted for 70.5% of all articles and for most higher phase research articles, publishing 83.9% and 100% of second and third phase studies, respectively. Disparity categories investigated included race/ethnicity, age, income, insurance status/type, geography, and education level, with race/ethnicity being the most common (73.7%). The most commonly measured outcome was percent of subpopulation receiving reconstruction (63, 66.3%), followed by reconstruction type (14, 16.7%). Patient-, provider-, system-, and research-level factors were all identified as potential targets for interventions to reduce disparities. Conclusions Despite a recent increase in literature focusing on postmastectomy breast reconstruction disparities, the majority focuses on identifying vulnerable populations with inadequate progression to second (understanding) and third (reducing) phases. Increasing research funding, availability of language-concordant and culturally concordant educational materials, and advocacy and sociopolitical awareness within the plastic surgery community is necessary to advance research on postmastectomy breast reconstruction and, ultimately, eliminate it.

Low-Temperature Burn on Replanted Fingers and Free Flaps in Hand

Background Patients who have undergone microsurgery for reconstruction with a free flap or finger replantation are vulnerable to heat injury. Moreover, some of these injuries can occur at low temperatures. Although the temperature does not reach the threshold to cause burns in the adjacent normal tissues, burns can occur in the areas that underwent microsurgery. On the other hand, this type of burn is not completely understood and there are few reports of the clinical prognosis. Methods The medical records of patients who received warm therapy using an infrared heat lamp with the appropriate temperature after hand surgery from January 2009 to December 2016 were reviewed. The patients were classified into 2 groups. Group A comprised patients who underwent free flap or replantation surgery of the hand. Group B comprised patients who underwent other hand surgeries without microsurgery, such as tenorrhaphy, tenolysis, or joint surgery. Through the medical records, all patients with second- or third-degree thermal burns were selected. The relationship between the 2 types of surgery and thermal injury and the timing of the burn after microsurgery were analyzed. Results Groups A and B were composed of 370 (mean age, 48.2 years) and 7010 patients (mean age, 44.5 years), respectively. Burns requiring treatment occurred in 4 patients in group A and in 1 patient in group B. The proportion of low-temperature burns was 4 of 370 in group A and 1 of 7010 in group B. The occurrence of low-temperature burns was more associated with patients who had undergone microsurgery for a hand reconstruction with free flap or finger replantation (P

Commentary Regarding “Abdominal Wall Reconstruction and Patient Comorbidities”

No abstract available

Outcome Analysis of Metacarpal and Phalangeal Fixation Techniques at Bellevue Hospital

Purpose Phalangeal fractures represent a significant portion of upper extremity injuries but are not well studied as a single entity. We define our approach at a level 1 trauma center and determine whether plating or lag screws (ie, rigid fixation) have superior functional outcomes compared with Kirschner wire fixation for phalangeal or metacarpal fractures. Methods We performed a systematic review of all surgically managed hand fracture cases at Bellevue Hospital during 2012 and 2013. Demographics, type of fixation, length of operation, period of immobilization, range of motion, time to return to work, and complications including reoperation were noted. Comparisons were assessed for significance using Student t tests and Fisher exact test (P 0.05). Total active motion and return to work were similar regardless of type of intervention in both fracture types. No patients treated with rigid fixation required reoperation. Conclusions To our best knowledge, this is the first review to study phalangeal fractures concurrently but also separately from metacarpal fractures. Despite shorter periods of immobilization, rigid fixation does not appear to lead to improved total active motion or time to return to work.

Medial Plantar Venous Flap: Classic Donor Site Modification for Hand Defects

Background Destruction of digits from trauma results in a much more significant influence on patients' mental state and quality of life than do injuries to other parts. The purpose of this study was to describe a novel modification of medial plantar venous flap for soft tissue defects in the hands and digits. Methods Nine patients received medial plantar venous flap to resurface soft tissue defects in the hands or digits between January 2015 and February 2017. This flap can be used either in a free-island pattern or in a flow-through pattern through the medial branch of the great saphenous vein. All patient data including preoperative statues and follow-up examinations (flap survival rates, complication rates, total active motion, static 2-point discrimination, and Semme-Weinstein test score) were analyzed. Results We included 6 men and 3 women, with a mean age of 34.2 years. The medial plantar venous flaps were used for vascularization in 5 patients because of segmental defects of bilateral digit arteries. Eight flaps survived uneventfully in this study. One flap partially failed (20% of the flap area) because of venous congestion. The functional outcomes and sensory restoration were satisfied for all 9 flaps. Conclusions Compared with the traditional medial plantar flap, the medial plantar venous flap involves a simpler surgical procedure and allows for revascularization of distal areas using the flow-through technique. Furthermore, the medial plantar area presents a sensitive, glabrous skin with proper bulkiness and allows for movement of the underlying structure.

Surgical Resection of Occult Subungual Glomus Tumors: Cold Sensitivity and Sonographic Findings

Purpose We surgically treated subungual masses that were suspected glomus tumors, although definitive clinical and radiological findings were lacking. We report the outcomes of a retrospective case series. Methods Of 42 patients treated by surgical resection between March 1996 and December 2015, 7 who met our inclusion/exclusion criteria were evaluated. At least 1 symptom of the typical triad (temperature sensitivity, severe pain, and localized tenderness) was absent, and computed tomography (CT) and magnetic resonance imaging (MRI) findings were normal. After ultrasonographic evaluation, we resected the masses using a transungual approach or a nail-preserving method. After pathological confirmation of the diagnosis, we followed all patients for at least 2 years to evaluate tumor recurrence and nail deformity. Results In 5 patients, cold sensitivity was the only symptom; no physical finding was suggestive of a glomus tumor. Tenderness was evidenced by the 2 patients who lacked cold sensitivity. None of the 7 patients exhibited CT or MRI abnormalities, but small acoustic shadows were evident in 4 patients, and blood-rich nodules were noted in 2 patients. The mean diameter of the 7 tumors was 2.1 mm, and pathological examination revealed typical glomus bodies. No major surgery-associated complication developed during follow-up. The final mean visual analog scale score (assessing pain) improved to 0.3 from the mean preoperative value of 3.6. Conclusions Small glomus tumors exhibit few traditional symptoms and signs and no definitive radiological CT/MRI finding. However, cold sensitivity alone is a powerful surgical indication, and occasionally, ultrasonographic findings are useful even in the absence of CT/MRI findings.

A Systematic Review of Zosteriform Rash in Breast Cancer Patients: An Objective Proof of Flap Reinnervation and a Management Algorithm

Background Zosteriform rash in cancer patients provides objective clues to the process of reinnervation of the reconstructed breast. This rash should also raise suspicion for metastasis, which can be confused with herpes zoster. Objectives The aims of this study were to explain the reconstruction flap sensory reinnervation mechanism based on the clinical findings and provide a diagnostic and management algorithm of zosteriform rash in breast cancer patients. Methods On November 15, 2017, we conducted a search of published articles in MEDLINE and Cochrane databases. All the articles describing a zosteriform rash in a patient with a history of breast cancer were included in this review. Results Eleven articles from the literature and 1 case from our practice were selected for inclusion in this systematic review. Five patients had a breast reconstruction with a flap. The flap skin was affected by the rash in 4 of these patients, providing an objective proof of the reinnervation of the reconstructed breast. In 6 patients, the presentation was typical, and the diagnosis of herpes zoster was made without additional diagnostic testing. In 4 cases, the eruption was atypical, and a biopsy was done to confirm the diagnosis of a cancer metastasis. In 2 patients, the rash was multidermatomal, and a polymerase chain reaction was done to confirm the diagnosis of disseminated herpes zoster. Conclusions Zoster reactivation in breast reconstructed patients is an objective proof of the reinnervation of the skin flap. Moreover, zosteriform rash in cancer patients should raise suspicion for metastasis, which can be confused with herpes zoster.

Long-term Outcomes of Cranioplasty: Titanium Mesh Is Not a Long-term Solution in High-risk Patients

Background Titanium mesh is a popular material for cranioplasty. However, long-term outcomes of these reconstructions remain unknown. We aimed to compare long-term outcomes between patients undergoing both (1) skull reconstruction with titanium mesh and other commonly used cranioplasty materials and (2) scalp reconstructions with locoregional flaps and free tissue transfers. Methods A retrospective review of patients treated with 466 cranioplasties (401 patients) between 2002 and 2014 was performed. Results Materials used for reconstructions included nontitanium alloplast (52.0%), titanium mesh (38%), and autologous bone (10%). Median cranial defect size was 58.4 cm2. Eighty-three reconstructions (18%) included full-thickness scalp defect with a median area of 155.4 cm2. Median follow-up was 3.9 years. Retention rate for isolated cranioplasty was 90%, 89.9%, and 77.1% for titanium mesh, nontitanium alloplast, and autologous bone, respectively (P > 0.05). In composite defect cases, retention rate for autologous bone was comparable, 81.8% (P > 0.05), whereas for titanium mesh and nontitanium alloplast it was significantly lower, 46.8% and 72.0%, respectively (P