A novel approach to identify priority areas for optimal nutrient management in mixed land-use watersheds through nutrient budget assessment.

Excessive nutrient supply in agricultural regions has led to various environmental issues, thereby requiring concentrated management owing to its persistent upward trend. Nutrient budgets (NBs), a vital agricultural environmental indicator, are employed for nutrient management in agricultural areas, using data surveyed by administrative agencies. However, the spatial extent of nutrient data for nutrient budgeting is limited by administrative boundaries according to the surveying organization, posing challenges in interpreting spatial patterns at the watershed level. In this study, a novel approach was developed to identify priority nutrient management areas by applying hot spot spatial analysis to watershed-level NBs, considering hydrological characteristics. This method was applied to approximately 850 subwatersheds across the Republic of Korea, where land cover characteristics are complex. Reassessing nutrient budgets at the watershed scale, accounting for overlapping administrative boundary areas and crop cultivation ratios, indicated similar levels between the two methods. Hot spot analysis revealed that watersheds with elevated NBs mirrored the spatial patterns of livestock excreta and cropland. The spatial distribution characteristics of watersheds with high nutrient levels in rivers corresponded with the concentration characteristics of industrial and commercial areas. Therefore, applying watershed-level NBs based on land cover ratios that consider nutrient input characteristics in agricultural regions is deemed appropriate for selecting priority nutrient management areas. Collectively, this study presents a method for selecting nutrient management priority areas by simultaneously considering the spatial characteristics of various environmental factors, such as land cover, livestock excreta, river water quality, and land area-based watershed-specific NBs. The proposed approach, considering mixed land cover characteristics, is anticipated to be valuable for selecting priority management areas in watersheds with diverse pollution sources. Future research is needed to explore nutrient budgets within watersheds, the influence of land use on pollution sources, and their correlation with water quality.

Measurement of the thickness and refractive index of a thin film by analyzing reflected interference fringes.

We propose a novel, to the best of our knowledge, method to estimate the thickness and refractive index of a thin film by analyzing the reflectance as a function of the incidence angle. In most cases, interference fringes cannot be obtained from a film within a practical angular range unless it is much thicker than the wavelength. This problem was solved by adopting a high-index material as the medium of incidence, in which case several cycles of interference fringes were observed within a small range of incidence angles near the critical angle, allowing a fringe analysis. Consequently, the thicknesses, as well as the refractive indices of dielectric thin films, could be estimated. Our proposed method gave uncertainties of 20 nm and 0.0004 for the thickness and refractive index measurements, respectively.

Chemical Sterilization of Lipoplasty Cannula and Nontuberculous Mycobacteria Disinfection: An Experimental Study.

BACKGROUND: Nontuberculous mycobacteria are commonly found pathogens; however, skin and soft tissue infections due to nontuberculous mycobacteria are often associated with surgical procedures, particularly after lipoplasty. Although nontuberculous mycobacteria are resistant to some chemical disinfectants, glutaraldehyde, peracetic acid, povidone iodine, alcohol, and chlorine are still used for the sterilization of medical instruments. This study investigated the efficacy of various disinfectants in a fatty environment with adipose and a bloody environment without adipose. In addition, this study was also used to identify the most effective disinfectant against nontuberculous mycobacteria. METHODS: Three nontuberculous mycobacteria (Mycobacterium avium, M. abscessus, and M. fortuitum), pathogens frequently found in skin and soft tissue infections, were used. Seven chemical disinfectants were tested in both fatty and bloody environments. The disinfectants used were considered to have a sterilization effect when the log10 reduction factor exceeded 5. RESULTS: Most disinfectants had some sterilizing effects against nontuberculous mycobacteria; however, glutaraldehyde was the most effective against all 3. Chlorhexidine and povidone iodine also displayed sterilizing effects. Of the disinfectants tested, only alkyldiaminoethylglycine hydrochloride showed a diminished effect with statistical significance, specifically against M. fortuitum in a fatty environment, whereas it had effective results in a bloody environment. CONCLUSIONS: Glutaraldehyde showed the greatest sterilizing effect on nontuberculous mycobacteria with a log10 reduction factor >5 in both fatty and bloody environments. However, some chemical disinfectants did not show sufficient sterilizing effects in a fatty environment and, therefore, should be used with caution for the sterilization of nontuberculous mycobacteria. LEVEL OF EVIDENCE: Level II.

Late-Onset Inflammation in Asian Rhinoplasty Using Alloplastic Implants.

BACKGROUND: Late-onset inflammation is a rare complication that may occur several months to years after undergoing an uneventful rhinoplasty using alloplastic implants and an uneventful postoperative course. Studies to determine the pathophysiological mechanisms of late-onset inflammation related to implants used in rhinoplasty are limited. The purpose of the study was to analyze differences between non-healthy capsules (NHC) with late-onset inflammation and healthy capsules (HC) without inflammation as controls to determine the possible cause of the inflammation. METHODS: Between April 2009 and May 2018, 39 patients who underwent rhinoplasty with alloplastic implants underwent histological studies. Twenty-one patients in the NHC group showed late-onset inflammation, while 18 patients in the HC group did not display late-onset inflammation. Capsules around the alloplastic implants were harvested, and histological studies using hematoxylin and eosin, Masson's trichrome, colloidal iron, and CD31 staining were performed and compared between the NHC and HC groups. RESULTS: In hematoxylin and eosin and Masson's trichrome staining, edematous granulation tissues, inflammatory cellular contents, and a disorganized collagen layer were increased in the NHC group compared to the HC group. The colloidal iron staining revealed mucin deposition in the NHC group. CD31-positive cells were observed lining the capsule in both groups; however, the lining cells were damaged in the NHC group. CONCLUSION: Granulation tissues, inflammatory reaction, collagen degeneration, mucin deposition, and endothelial lining cell damage were greater in the NHC group compared to the HC group. Damaged capsules may play a crucial role in late-onset inflammation. 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 .

Aesthetic Comparison of Abdominal Donor Site Scar Between Absorbable Dermal Staple and Subcutaneous Suture after Autologous Breast Reconstruction: A Prospective Randomized Controlled, Double-Blinded Study.

BACKGROUND: Abdominal tissue transfer has become the most commonly used tool for breast reconstruction. However, a secondary operator is often responsible for donor closure, which leaves dissatisfaction to patients due to inconsistent donor scars. Now, an absorbable dermal stapler is popularized worldwide and currently used for wound closure in many surgical fields. In this study, we aim to evaluate the abdominal donor site scar in using an absorbable dermal staple compared to a conventional suture. METHODS: This is a prospective, randomized controlled and double-blinded study. Between January 2018 and April 2019, a total of 30 patients who underwent breast reconstruction using abdominal flap were included. Donor sites were divided into equal halves, and the each dermal layer was sutured with either dermal staples or traditional suturing, respectively. At 1, 3 and 6 months after operation, the scar was evaluated by two blinded plastic surgeons by using the modified Manchester scar scale (MSS). RESULTS: An averaged sum of modified MSS was lower for the side sutured with a dermal stapler at the first month (11.76 ± 2.12 vs. 12.28 ± 2.03, p = 0.097), third month (12.17 ± 1.86 vs. 12.62 ± 2.31, p = 0.301) and sixth month (11.28 ± 2.63 vs. 12.14 ± 2.76, p = 0.051). Also, the dermal stapler side scored significantly higher for patient satisfaction than did the suture side (4.03 ± 0.98 vs 3.66 ± 0.97, p < 0.05). CONCLUSION: The objective outcome of the scar closed by an absorbable dermal stapler was not statistically superior to conventional suturing. (p > 0.05) In the subjective outcome, however, it showed a significantly higher patients' satisfaction (p < 0.05). LEVEL OF EVIDENCE III: 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 .

The Outcome of Early Ablative Fractional Laser Treatment for Thyroidectomy Scars.

BACKGROUND AND OBJECTIVES: Ablative fractional laser (AFL) systems are commonly used to treat various scars, and recent research has indicated that early treatment with AFL may have a preventive effect on scars. This study was designed to evaluate the efficacy of early treatment with a 10,600 nm carbon dioxide (CO2 ) AFL on thyroidectomy scars and compare it to late (conventional) treatment for the same and untreated controls. STUDY DESIGN/MATERIALS AND METHODS: We performed a prospective, evaluator-blinded, split-scar study on fresh thyroidectomy scars between July 2014 and July 2017. Scars were divided into two equal portions. Early AFL treatment had begun 1 month after surgery; five sessions on the right half of the scar was performed at 1-month intervals. Late AFL treatment followed for 1 month after the final early treatment session on the left half of the scar at the same interval. The scars were evaluated at 6 and 11 months postoperatively using scar analysis scales and patient questionnaires. RESULTS: Twenty-four out of 28 patients completed the study. The mean decrease in Vancouver Scar Scale (VSS) scores was significantly higher for the early treated right halves of the scars both at the 6th month (vs. untreated controls) and at the 11th month (vs. late treated controls). The VSS subset analysis showed that the early treated sides had significantly greater improvement in pliability and height than the control sides at each point of evaluation. CONCLUSIONS: Early postoperative AFL treatment is safe and effective in improving linear surgical scars, such as thyroidectomy scars, and may be a promising option for scar prevention. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Immediate Reconstruction of Amputated Ear With Fascia Flap.

BACKGROUND: Various surgical methods have been used for reconstruction of an amputated ear, including microsurgical replantation and delayed reconstruction using synthetic material or autologous rib cartilage. The authors share our experience of immediate reconstruction using amputated cartilage and discuss the advantages compared to other techniques of reconstruction. MATERIALS AND METHODS: The authors retrospectively reviewed the medical records of 3 patients who underwent immediate reconstruction of amputated ear by a single operator. In the cases, the amputees were washed; the skin and cartilage were separated. The ear cartilage was fixed to its original position with non-absorbable suture. Regional fascia flap was elevated and covered the ear cartilage. The amputee skin was redraped to cover the fascia flap. Several months after the operation, photographic assessment was done. RESULTS: All 3 cases showed well-defined convolution, tolerable skin color, and patient satisfaction without any major complications. A patient showed mild temporal incision site alopecia. CONCLUSION: The above immediate reconstruction method can achieve reliable and favorable result with minimal complications.

Clinical Experience with Treatment of Aquafilling Filler-Associated Complications: A Retrospective Study of 146 Cases.

BACKGROUND: Aquafilling filler is used for breast and buttock augmentation, which are the most commonly performed cosmetic surgery procedures. However, complications after using Aquafilling filler for breast augmentation have been reported, and there are concerns regarding its use in large areas, such as the buttocks. We provide our experience with complications after breast augmentation and buttock augmentation using Aquafilling filler. METHODS: This observational cohort study analyzed the data of 399 patients treated for filler-related complications at our institutes from September 2015 to November 2019. Of these patients, 146 underwent surgery to remove Aquafilling filler from the breast or buttock. RESULTS: The mean time between Aquafilling filler use and complication onset was 38.5 ± 10.2 months. The average amount of filler material removed from one side of the breast or buttock was 285.5 ± 95.8 mL (range 150-750 mL). The most common complications were induration and masses (83.6%), followed by pain (52.1%), firmness (24.7%), asymmetry (10.3%), migration (8.2%), mastitis (6.8%), dimpling (6.2%), fever (3.4%), and sepsis (n = 1). After treatment, there was no recurrence of infection, and the patient satisfaction level based on the visual analogue scale was 8.0 ± 0.9. CONCLUSIONS: Although Aquafilling filler is easily injectable and has long-term clinical effects, complications can occur. Furthermore, there are concerns regarding its toxicity and influence on the surrounding tissues. Hence, further research studies on Aquafilling filler and evidence regarding its long-term safety are needed. 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 .

Endoscope-Assisted Transoral Fixation of Mandibular Condyle Fractures: Submandibular Versus Transoral Endoscopic Approach.

In recent years, endoscope-assisted transoral approach for condylar fracture treatment has attracted much attention. However, the surgical approach is technically challenging: the procedure requires specialized instruments and the surgeons experience a steep learning curve. During the transoral endoscopic (TE) approach several instruments are positioned through a narrow oral incision making endoscope maneuvering very difficult. For this reason, the authors changed the entry port of the endoscope from transoral to submandibular area through a small stab incision. The aim of this study is to assess the advantage of using the submandibular endoscopic intraoral approach (SEI).The SEI approach requires intraoral incision for fracture reduction and fixation, and 4 mm size submandibular stab incision for endoscope and traction wires. Fifteen patients with condyle neck and subcondyle fractures were operated under the submandibular approach and 15 patients with the same diagnosis were operated under the standard TE approach.The SEI approach allowed clear visualization of the posterior margin of the ramus and condyle, and the visual axis was parallel to the condyle ramus unit. The TE approach clearly shows the anterior margin of the condyle and the sigmoid notch. The surgical time of the SEI group was 128 minutes and the TE group was 120 minutes (P >0.05). All patients in the TE endoscope group were fixated with the trocar system, but only 2 lower neck fracture patients in the SEI group required a trocar. The other 13 subcondyle fractures were fixated with an angulated screw driver (P <0.05). There were no differences in complication and surgical outcomes.The submandibular endoscopic approach has an advantage of having more space with good visualization, and facilitated the use of an angulated screw driver.

Effects of platelet-rich plasma, adipose-derived stem cells, and stromal vascular fraction on the survival of human transplanted adipose tissue.

Traditional adipose tissue transplantation has unpredictable viability and poor absorption rates. Recent studies have reported that treatment with platelet-rich plasma (PRP), adipose-derived stem cells (ASCs), and stromal vascular fraction (SVF) are related to increased survival of grafted adipose tissue. This study was the first simultaneous comparison of graft survival in combination with PRP, ASCs, and SVF. Adipose tissues were mixed with each other, injected subcutaneously into the back of nude mice, and evaluated at 4, 8, and 12 weeks. Human adipocytes were grossly maintained in the ASCs and SVF mixtures. Survival of the adipose tissues with PRP was observed at 4 weeks and with SVF at 8 and 12 weeks. At 12 weeks, volume reduction in the ASCs and SVF mixtures were 36.9% and 32.1%, respectively, which were significantly different from that of the control group without adjuvant treatment, 51.0%. Neovascular structures were rarely observed in any of the groups. Our results suggest that the technique of adding ASCs or SVF to transplanted adipose tissue might be more effective than the conventional grafting method. An autologous adipose tissue graft in combination with ASCs or SVF may potentially contribute to stabilization of engraftment.

Precaruncular approach for the reconstruction of medial orbital wall fractures.

To reconstruct medial orbital wall fractures with a clear, least dissection, an alternative method, precaruncular approach, has been performed. We reviewed 36 patients with medial blowout fractures treated with this technique. The incision was made between the caruncle and medial canthal skin at the mucocutaneous junction, and was continued along the conjunctival fornix superiorly and inferiorly. An extended conjunctival incision was carried for additional access to the orbit floor. The dissection continued medially and proceeded along the preseptal plane. The clinical results were assessed by postoperative computed tomographic scan and by reviewing postoperative complications. Postoperatively, computed tomographic scans demonstrated adequate reduction of soft tissues and correct positioning of the inserted implant without surgical complications. In most cases, the edema resolved within 24 to 48 hours after surgery. The precaruncular approach is a good option in reconstructing medial orbital wall fractures because it provides satisfactory exposure with superior cosmetic result.

Influence of smartphone Wi-Fi signals on adipose-derived stem cells.

The use of smartphones is expanding rapidly around the world, thus raising the concern of possible harmful effects of radiofrequency generated by smartphones. We hypothesized that Wi-Fi signals from smartphones may have harmful influence on adipose-derived stem cells (ASCs). An in vitro study was performed to assess the influence of Wi-Fi signals from smartphones. The ASCs were incubated under a smartphone connected to a Wi-Fi network, which was uploading files at a speed of 4.8 Mbps for 10 hours a day, for a total of 5 days. We constructed 2 kinds of control cells, one grown in 37°C and the other grown in 39°C. After 5 days of Wi-Fi exposure from the smartphone, the cells underwent cell proliferation assay, apoptosis assay, and flow cytometry analysis. Three growth factors, vascular endothelial growth factor, hepatocyte growth factor, and transforming growth factor-ß, were measured from ASC-conditioned media. Cell proliferation rate was higher in Wi-Fi-exposed cells and 39°C control cells compared with 37°C control cells. Apoptosis assay, flow cytometry analysis, and growth factor concentrations showed no remarkable differences among the 3 groups. We could not find any harmful effects of Wi-Fi electromagnetic signals from smartphones. The increased proliferation of ASCs under the smartphone, however, might be attributable to the thermal effect.

Active offset-frequency control of optical frequency comb via sum-frequency mixing of passively mode-locked laser and continuous-wave laser.

We propose a method for actively controlling the frequency of an optical frequency comb (OFC) using sum-frequency generation (SFG) with a nonlinear crystal. For the first time, OFC generation was experimentally demonstrated via sum-frequency mixing of a narrowband continuous wave (CW) laser and a passively mode-locked fiber laser. By adjusting the optical frequency of the CW laser, we successfully controlled the offset-frequency of the SFG-OFC, which was mapped from the OFC of the pulse pump laser. Furthermore, by comparing the spectral widths of the SFG-OFC modes generated from two CW lasers with different spectral widths, we confirmed that the spectral characteristics of the SFG-OFC modes depended on the spectral features of the CW laser.

VGG19 demonstrates the highest accuracy rate in a nine-class wound classification task among various deep learning networks: a pilot study.

BACKGROUND: Current literature suggests relatively low accuracy of multi-class wound classification tasks using deep learning networks. Solutions are needed to address the increasing diagnostic burden of wounds on wound care professionals and to aid non-wound care professionals in wound management. OBJECTIVE: To develop a reliable, accurate 9-class classification system to aid wound care professionals and perhaps eventually, patients and non-wound care professionals, in managing wounds. METHODS: A total of 8173 training data images and 904 test data images were classified into 9 categories: operation wound, laceration, abrasion, skin defect, infected wound, necrosis, diabetic foot ulcer, chronic ulcer, and wound dehiscence. Six deep learning networks, based on VGG16, VGG19, EfficientNet-B0, EfficientNet-B5, RepVGG-A0, and RepVGG-B0, were established, trained, and tested on the same images. For each network the accuracy rate, defined as the sum of true positive and true negative values divided by the total number, was analyzed. RESULTS: The overall accuracy varied from 74.0% to 82.4%. Of all the networks, VGG19 achieved the highest accuracy, at 82.4%. This result is comparable to those reported in previous studies. CONCLUSION: These findings indicate the potential for VGG19 to be the basis for a more comprehensive and detailed AI-based wound diagnostic system. Eventually, such systems also may aid patients and non-wound care professionals in diagnosing and treating wounds.

Comparing Complications of Biologic and Synthetic Mesh in Breast Reconstruction: A Systematic Review and Network Meta-Analysis.

Background In breast reconstruction, synthetic meshes are frequently used to replace acellular dermal matrix (ADM), since ADM is expensive and often leads to complications. However, there is limited evidence that compares the types of substitutes. This study aimed to compare complications between materials via a network meta-analysis. Methods We systematically reviewed studies reporting any type of complication from 2010 to 2021. The primary outcomes were the proportion of infection, seroma, major complications, or contracture. We classified the intervention into four categories: ADM, absorbable mesh, nonabsorbable mesh, and nothing used. We then performed a network meta-analysis between these categories and estimated the odds ratio with random-effect models. Results Of 603 searched studies through the PubMed, MEDLINE, and Embase databases, following their review by two independent reviewers, 61 studies were included for full-text reading, of which 17 studies were finally included. There was a low risk of bias in the included studies, but only an indirect comparison between absorbable and non-absorbable mesh was possible. Infection was more frequent in ADM but not in the two synthetic mesh groups, namely the absorbable or nonabsorbable types, compared with the nonmesh group. The proportion of seroma in the synthetic mesh group was lower (odds ratio was 0.2 for the absorbable and 0.1 for the nonabsorbable mesh group) than in the ADM group. Proportions of major complications and contractures did not significantly differ between groups. Conclusion Compared with ADM, synthetic meshes have low infection and seroma rates. However, more studies concerning aesthetic outcomes and direct comparisons are needed.

Conscious Sedation Methods for Blepharoplasty in Day Surgery.

Midazolam and fentanyl, in combination, are the most commonly used medications for conscious sedation in day aesthetic surgeries. Dexmedetomidine is popularly used in the sedation protocol of our hospital due to its reduced respiratory depression. However, its sedation benefits in facial aesthetic surgeries, like blepharoplasty, have not been well-evaluated. We retrospectively compared individuals sedated with midazolam and fentanyl bolus injection (N = 137) and those sedated with dexmedetomidine infusion (N = 113) to determine which is more suitable for blepharoplasty with a mid-cheek lift. The total amount of local anesthetic (p < 0.001), postoperative pain (p = 0.004), ketoprofen administration (p = 0.028), and the number of hypoxia episodes (p < 0.001) and intraoperative hypertension (p = 0.003) were significantly lower in the dexmedetomidine group. Hypoxia severity (p < 0.001) and minor hematoma formation (p = 0.007) were also significantly lower in the dexmedetomidine group. Sedation with dexmedetomidine infusion is associated with less hematoma formation than sedation with midazolam and fentanyl bolus pattern due to hemodynamic stability and analgesic effects. Dexmedetomidine infusion may be a good alternate sedative for lower blepharoplasty.

Lymphatic complex transfer as combined lymph vessel and node transfer for advanced stage upper extremity lymphedema.

OBJECTIVE: Lymphedema, especially in the advanced stage, is a growing challenge in extremity reconstruction, with few applicable surgical methods. Despite its importance, no consensus has been reached regarding a single surgical method yet. Herein, the authors introduce a novel concept of lymphatic reconstruction yielding promising results. METHODS: We included 37 patients with advanced-stage upper extremity lymphedema who underwent lymphatic complex transfers, consisting of both lymph vessel and node transfers, from 2015 to 2020. We compared the preoperative and postoperative (last visit) mean circumferences and volume ratios between the affected and unaffected limbs. Changes in the Lymphedema Life Impact Scale scores and complications were also investigated. RESULTS: The circumference ratio (affected to unaffected limbs) improved at all measuring points (P < .05), while the volume ratio showed a decrease from 1.54 to 1.39 (P < .001). The mean Lymphedema Life Impact Scale decreased from 48.1 ± 15.2 to 33.4 ± 13.8 (P < .05). No donor site morbidities, including iatrogenic lymphedema or any other major complications, were observed. CONCLUSIONS: A new technique for lymphatic reconstruction, lymphatic complex transfer, may be useful in cases of advanced stage lymphedema because of its effectiveness and the low possibility of donor site lymphedema.

Neovascular potential of adipose-derived stromal cells (ASCs) from diabetic patients.

We explored the vascular biology of adipose-derived stromal cells (ASCs) from diabetic patients and applied these cells to a murine ischemic flap model to assess the comparative angiogenic potentials between normal and diabetic human ASCs. ASCs were obtained from diabetic patients (n = 5) and controls (n = 5). Secretion and expression of angiogenic cytokines were measured under normoxic and hypoxic condition in vitro. Conditioned media harvested from ASC cultures were assessed for their ability to stimulate human umbilical vein endothelial cell proliferation and tubulization. The control and diabetic ASCs were injected into the murine ischemic flaps, and the surviving area was measured. Diabetic adipose-derived stromal cells showed a lower level of vascular endothelial growth factor expression and cell proliferation rates than the control cells (p < 0.05). However, vascular endothelial growth factor, hepatocyte growth factor secretion, tubulogenesis, and cell proliferation in diabetic conditioned media were increased in response to hypoxic stimuli (p < 0.05), and it was similar to those of control cells. In an animal study, diabetic and normal ASCs significantly increased flap survival (p < 0.05); however, the functional difference was not found between the two groups. Diabetic ASCs were impaired in their ability to produce vascular endothelial growth factors and to induce cellular proliferation under hypoxic conditions. However, diabetic ASCs showed similar flap salvaging effect compared with controls. These findings may be important in the context of future study of autologous cell-based therapy in diabetic patients.