Multivariate effect of inorganic wastewater matrix on the removal of pesticides by solar photo-Fenton.

An amount of works has reported the effect of wastewater matrix composition on pollutants removal by different AOPs. The biggest challenge is that each wastewater source has a challenging composition (organic and inorganic compounds, pollutants, etc.) and not only the concentration of all these species but also the interaction between them may affect the effectiveness of the studied process. This work has been carried out to evaluate the photo-degradation kinetics of six different pesticides (flutriafol, imidacloprid, myclobutanil, pirimicarb, thiamethoxam and triadimenol) by solar photo-Fenton (SPF) process at acidic pH. First, oxidant concentration (H2O2) was optimized with an actual WWTP effluent. Then, the process was validated with two different secondary and tertiary WWTP effluents, in which main intermediate transformation by-products were identified. Finally, the effect of the inorganic water matrix components (bicarbonate, chloride, sulphate, nitrate and phosphate) was evaluated by a multivariate analysis. Once H2O2 has been optimized at 30 mg L-1, the photo-degradation efficiency of pesticides in real wastewater samples was compared. DOC content of both secondary and tertiary WWTP effluents was dropped by 67%. The identification of the main intermediate transformation by-products (such as 1H-1,2,4-triazole, desmethyl-formamido pirimicarb, thiamethoxam urea, chloronicotinic acid and imidacloprid urea) was reviewed. Following, the multivariate analysis on pesticides photo-degradation, generally, predicted four significant effects in common for the studied pesticides: a positive effect (interaction bicarbonate/nitrate) and three negative ones (chloride, phosphate and the interaction chloride/sulphate); among others. In addition, optimum values of inorganic ion concentrations, to obtain an optimum desirability on studied pesticides removal by SPF at acidic pH, were also evaluated.

Remediation of pesticides in commercial farm soils by solarization and ozonation techniques.

Soil contamination by pesticides is a growing environmental problem. Even though nowadays numerous soil remediation technologies are available, most of them have not been tested at field scale. This study attempts to demonstrate the efficiency of solarization-ozonation techniques for the removal of twelve pesticides at full scale. Initial solarization and ozonation trials were conducted in plots located in a greenhouse using freshly and aged contaminated soils under controlled pilot conditions. The combination of solarization and ozonation treatment was efficient for all the studied pesticides both in freshly and in aged contaminated soils, being the lower degradation values found for the second type. This low removal suggests that the increase of pesticides' adsorption on soil resulting from ageing decreases their availability. Once the essays were carried out at pilot scale, the solarization-ozonation applicability was evaluated in a commercial farm soil. This trial was carried out in a greenhouse whose soil had previously been contaminated with some of the pesticides studied. A significant degradation (53.8%) was observed after 40 days of treatment. Pesticides' main metabolites were identified during the different remediation experiments. In addition, the cost of the combined solarization and ozonation technology was evaluated. Finally, our results suggest that this combination of techniques could be considered a promising technology to degrade pesticides in soil.

Remediation of triazole, anilinopyrimidine, strobilurin and neonicotinoid pesticides in polluted soil using ozonation and solarization.

This study aimed to investigate the effectiveness of ozonation and solarization techniques for the removal of different types of pesticides from soil during the summer season. The effect of two experimental parameters (temperature and ozone application mode) on the pesticide degradation was evaluated. The results showed that solarization (S), solarization with surface ozonation (SOS), and solarization with deep ozonation (SOD) enhanced pesticide degradation rates in comparison with the control (untreated soil, C). The triazole, anilinopyrimidine, strobilurin and neonicotinoid pesticides showed similar behaviour under S and SOS conditions. The highest decrease was found in SOD, indicating the significant effect of temperature and ozone application mode on the efficiency of the ozonation treatment. Thus, a higher soil temperature and a longer accumulated time at high temperature in treatments S, SOS and SOD were observed due to solarization process. In addition, the removal efficiency was enhanced with exposure time. Finally, the main 15 transformation products were identified during SOD treatment. The results suggest that solarization combined with ozonation techniques allows decontamination of soil containing pesticide residues.

Effect of antimony in soils of an Sb mine on the photosynthetic pigments and antioxidant system of Dittrichia viscosa leaves.

Antimony is a toxic element whose concentration in soil and water has been rising due to anthropogenic activities. This study focuses on its accumulation in leaves of Dittrichia viscosa growing in soils of an abandoned Sb mine, and the effect on oxidant/antioxidant systems and photosynthetic efficiency. The results showed leaves to have a high Sb accumulation capacity. The amount of total chlorophyll decreased depending on Sb concentration and of carotenoids increased slightly, with a consequent increase in carotenoid/chlorophyll ratio. Photosynthetic efficiency was unaffected. The amount of O 2 .- rose, although there was no increase in cell membrane damage, with lipid peroxidation levels being similar to normal. This response may be due to considerable increases that were observed in total phenolics, PPO activity, and enzymatic antioxidant system. SOD, POX, and DHAR activities increased in response to increased Sb amounts in leaves. The ascorbate/glutathione cycle was also affected, with strong increases observed in all of its components, and consequent increases in total contents of the ascorbate and glutathione pools. However, the ratio between reduced and oxidized forms declined, reflecting an imbalance between the two, especially that between GSH and GSSG. Efficient detoxification of Sb may take place either through increases in phenolics, carotenoids, and components of the glutathione-ascorbate cycle or through the enzymatic antioxidant system. Since Dittrichia viscosa accumulates large amounts of Sb without suffering oxidative damage, it could be used for phytoremediation.

Risk factors for major adverse cardiovascular events after osteoporotic hip fracture repair surgery.

Osteoporotic hip fracture (OHF) is an increasingly frequent age-related pathology, which results in high rates of functional loss and mortality within the first year after surgery. This study assessed whether preoperative levels of brain natriuretic peptide (NT-proBNP) and troponin I were related to early occurrence (30d) of major adverse cardio-vascular events (MACE) after OHF repair surgery. During a 6-month period, perioperative clinical and analytical data from consecutive patients, without known history of cardiovascular disease and undergoing surgery for OHF repair at a single centre, were prospectively collected. MACE was defined as acute myocardial ischaemia or infarction, acute heart failure or cardiovascular death. amongst the 140 patients included, 23 (16.4%) developed postoperative MACE (MACE group) and 117 did not (Control group). Compared to those from control group, patients from MACE group were older, had poorer physical status (ASA III-IV), received preoperative red blood cell transfusion (RBCT) more frequently, presented with lower haemoglobin concentrations and higher NT-proBNP, creatinine and troponin I concentrations. Overall, RBCT requirements and 30d mortality rate were also higher in MACE group. However, in multivariate analysis, only preoperative RBCT, creatinine >1 mg/dL and NT-proBNP >450 pg/mL remained as independent preoperative risks factors for postoperative MACE, while 95% confidence intervals of odds ratios were wide. Though our findings require confirmation in a larger multicentre cohort, identifying risk factors for early postoperative MACE after OHF repair surgery, might facilitate assessing patients' risk prior to and following surgery, and targeting them the appropriate preventive and/or therapeutic interventions.

Reclamation of agro-wastewater polluted with thirteen pesticides by solar photocatalysis to reuse in irrigation of greenhouse lettuce grown.

In Mediterranean countries, reuse of reclaimed water is essential for crop irrigation. The occurrence of pesticides in agro-wastewater may represent a risk for human health and environment owing to their release in soil and translocation to plants. The novelty of this work relies on the reuse of reclaimed agro-wastewater polluted with thirteen pesticides for lettuce irrigation. Removing of pesticide residues in agro-wastewater was carried out using natural sunlight and TiO2/Na2S2O8 in a pilot facility located in Murcia (SE of Spain). The studied pesticides were azoxystrobin, boscalid, chlorpropham, flutolanil, flutriafol, isoxaben, methoxyfenozide, myclobutanil, napropamide, prochloraz, propamocarb, propyzamide and triadimenol, which are commonly used in southeast Spain to treat lettuces grown. Different heterogeneous and homogeneous processes were studied and compared. Previously, the optimization of the process for the selection of the best catalytic system was performed at lab-scale. TiO2+ S2O82- was selected due to the greater effectiveness, achieving almost complete disappearance after about 400 kJ m-2 of cumulative UVA exposure. No significant differences were observed in quality parameters of lettuce grown using treated and non-treated agro-wastewater.

Solar reclamation of agro-wastewater polluted with eight pesticides by heterogeneous photocatalysis using a modular facility. A case study.

In this work, we have studied the removal of eight pesticides, commonly used in fruit crops, in agro-wastewater generated in commercial farms by the cleaning of trace of phytosanitary products in containers and tanks from treatment equipment. The studied pesticides were acetamiprid, cyproconazole, cyprodinil, difenoconazole, fenhexamid, hexythiazox, myclobutanil and thiamethoxam. The trials were performed in a pilot facility located in Murcia (SE of Spain), using natural sunlight and titanium dioxide (TiO2) in tandem with Na2S2O8. Five photocatalytic treatments were carried out during autumn 2017. Results show that the mean (n = 5) final amount was about 13% of the initial pesticide mass present in agro-wastewater. Therefore, we have proved that this technology could be used for tackling the elimination of pesticide residues in agro-wastewater and has favourable prospects of being applied in the water treatment sector.

Toxicity of TiO2, in nanoparticle or bulk form to freshwater and marine microalgae under visible light and UV-A radiation.

Use of titanium dioxide nanoparticles (TiO2 NPs) has become a part of our daily life and the high environmental concentrations predicted to accumulate in aquatic ecosystems are cause for concern. Although TiO2 has only limited reactivity, at the nanoscale level its physico-chemical properties and toxicity are different compared with bulk material. Phytoplankton is a key trophic level in fresh and marine ecosystems, and the toxicity provoked by these nanoparticles can affect the structure and functioning of ecosystems. Two microalgae species, one freshwater (Chlamydomonas reinhardtii) and the other marine (Phaeodactylum tricornutum), have been selected for testing the toxicity of TiO2 in NP and conventional bulk form and, given its photo-catalytic properties, the effect of UV-A was also checked. Growth inhibition, quantum yield reduction, increase of intracellular ROS production, membrane cell damage and production of exo-polymeric substances (EPS) were selected as variables to measure. TiO2 NPs and bulk TiO2 show a relationship between the size of agglomerates and time in freshwater and saltwater, but not in ultrapure water. Under two treatments, UV-A (6 h per day) and no UV-A exposure, NPs triggered stronger cytotoxic responses than bulk material. TiO2 NPs were also associated with greater production of reactive oxygen species and damage to membrane. However, microalgae exposed to TiO2 NPs and bulk TiO2 under UV-A were found to be more sensitive than in the visible light condition. The marine species (P. tricornutum) was more sensitive than the freshwater species, and higher Ti internalization was measured. Exopolymeric substances (EPS) were released from microalgae in the culture media, in the presence of TiO2 in both forms. This may be a possible defense mechanism by these cells, which would enhance processes of homoagglomeration and settling, and thus reduce bioavailability.

Effects of TiO2 nanoparticles and sunscreens on coastal marine microalgae: Ultraviolet radiation is key variable for toxicity assessment.

Given the large numbers of sunbathers on beaches, sunscreen compounds are being released into the coastal aquatic environment in significant amounts. Until now the effect of these potential pollutants on microbiota has been not well-known. Phytoplankton is a key component of the microbiota community. It forms the basis of the aquatic trophic networks, and any change in the natural population of phytoplankton can affect the structure of aquatic biota. This paper describes an experiment performed outdoors (in natural sunlight conditions including ultraviolet radiation (UVR) and with UVR blocked) on mixed microalgae populations (four species from different key marine taxonomic groups, Nannochloropsis gaditana, Chaetoceros gracilis, Pleurochrysis roscoffensis and Amphidinium carterae), for three days, exposed to a range of concentrations of three commercial sunscreens (with variable TiO2 concentrations: highest concentration for sunscreen C, followed by sunscreen A; and sunscreen B did not contain TiO2 in its composition). With regard to UVR effect, in the absence of sunscreens, the most sensitive species is the centric diatom, Chaetoceros gracilis, and the least is Nannochloropsis gaditana; this last species presented the same behavior in the absence of UVR and with high sunscreen concentrations. The toxicity gradient obtained for sunscreens and nanoparticles under UVR is: TiO2 NPs>Sunscreen C>Sunscreen A>Sunscreen B. The differential sensitivity of microalgae to sunscreens and TiO2 NPs can produce a change in the dynamics of phytoplankton populations and provoke undesirable ecological effects (such as giving dinoflagellates more prominence). The effects of UVR, commonly neglected in bioassays, could alter the results in important ways and should be considered when performing environmentally-relevant bioassays. The toxicity mediated by hydrogen peroxide production associated with the concentration of TiO2 NPs cannot be considered the only factor responsible for the toxicity: the organic compounds in the sunscreens must also be taken into account.

[Morbidity of bodylift. Evaluation of 111 patients over 5 years]. / Morbidité de la dermolipectomie abdominale circulaire. Série rétrospective de 111 patients sur 5 ans.

INTRODUCTION: The management of patients with weight loss sequelae, sometimes major, is increasingly well standardized. However, this surgery is not without risk. Complications of bodylift are more frequent than those of conventional abdominoplasties. The objective of this study was to evaluate the morbidity associated with this surgery through a retrospective, single-center study. MATERIALS AND METHODS: One hundred and eleven circular abdominaloplasties were conducted between June 2011 and September 2015 in the plastic surgery department of the university hospital of Toulouse. Minor and major complications were identified and analyzed. RESULTS: Frequency of postoperative complications was 44.1% in our series. Major complications have involved 15.3% of patients. Blood transfusions (9%) and hematoma requiring reoperation (7.2%) were the most frequent major complications. We found significantly more major complications in patients with important fat resection with a cut off at 3200 g (P=0.02). Men experienced significantly more major complications than women (P=0.005). The average delta-BMI (before and after weight loss) was significantly higher in the group of patients with the highest percentage of minor complications (P=0.045). Indeed, a high delta-BMI (greater than 19.5) was associated with an excess risk of minor complications in our population. CONCLUSION: Democratization and progress in the field of bodylift should not obscure the fact that it is, in reality, a procedure at risk. While we manage increasingly better cosmetic results and thromboembolic complications, it still persists many complications.

[Correction of congenital malformations by custom-made silicone implants: Contribution of computer-aided design. Experience of 611 cases]. / Chirurgie des malformations congénitales par implants sur mesure en silicone. Apport de la conception assistée par ordinateur (CAO). À propos d'une expérience de 611 cas opérés.

INTRODUCTION: Modern techniques of computer-aided design and tridimensional prototyping for manufacturing silicone elastomer custom implants are growing. They have widely modified the surgical indications in our unit. MATERIALS AND METHODS: By presenting their experience of 611 cases managed between 1993 and 2016, the authors describe the method of conception from CT-scans, the virtual image of the body and the manufacture of the custom-made implant perfectly adapted to the anatomy of each one. The operative techniques are described for the three main indications: the funnel chest or pectus excavatum (474 cases) according to a modified CHIN classification is corrected simply and very satisfactorily. This approach may render thoracic surgery techniques obsolete. Indeed, these operations remain risky and of doubtful functional utility; Poland syndrome (116 cases), where the use of a custom-made implant for compensation of muscle volume is frequently used, but can be improved by a transfer of adipose tissue or a classic breast implant; the leg atrophies (21 cases) receive custom elastomer implants introduced in a sub-fascial plane. RESULTS: The results are excellent for pectus excavatum but more difficult to optimize for the other two indications, requiring sometimes complementary techniques. Complications are rare and often benign, implants endure for life. Quality of life, psychological comfort and self-esteem have been improved with low morbidity and without having undergone a painful surgical experience. CONCLUSION: Reconstructive procedures of congenital malformations by custom-made silicone implants open a new field of activity for our surgical specialty with vast opportunities.

[Quality of publications in plastic surgery]. / Qualité des publications en chirurgie plastique.

INTRODUCTION: The objective of this study is to describe plastic surgery publications in terms of methodology, level of evidence, approval by institutional review board, method of consent, and subspecialty. METHODS: The 8 top-ranked plastic surgery journals were selected. We manually reviewed the last 40 original articles in each plastic surgery journal, to represent more than 2 months of publications for all journals (range: 3-17 months). Only clinical original articles on human subjects were included. Each article was read at least twice by two different reviewers to ensure accurate data transcription, and then graded by written criteria. One of the senior authors was asked to make a final decision in case of doubt. RESULTS: Among the articles reviewed, 320 were analyzed. The geographical origin of these publications were Asia (32.5%), Europe (30%), US (28.4%), South America (5.6%), Africa (2.5%), and finally Oceania (1%). Reconstructive surgery remains the specialty area most represented in the journals with almost half of the publications, followed by breast surgery (24%) and plastic surgery (19%). A total of 75.6% were retrospective studies. Nearly 80% of the studies were of low level of evidence. Only 3.5% were randomized trials. Less than 40% of the publications mentioned approval by an institutional committee, and 22.6% a patient's informed consent. CONCLUSION: This study aimed to analyze the quality of plastic surgery publications, taking into account the criteria of Evidence Based Medicine. This work showed that more than half of the studies did not mention an institutional review board approval (Ethics Committee), and that three quarter of the studies did not indicate the presence of patient's informed consent. Ultimately, over 80% of the studies were of low level of evidence. The top-ranked journals have already imposed guidelines corresponding to the methodology requirements to publish clinical studies in their pages, such as EQUATOR criteria for the PRS journal. Efforts are therefore to be done to raise the scientific level of the publications of our specialty.

[Lipofilling in breast reconstruction: is there any population with higher risk of local recurrence? Literature systematic review]. / Transfert de tissu adipeux en reconstruction mammaire: y a-t-il des populations à risque? Revue systématique de la littérature.

Safety of the autologous fat grafting (AFG) in the breast parenchyma remains a debated topic, particularly in reconstruction following breast cancer. This procedure still raises many questions, especially considering recent in vitro studies warning about the fact that lipofilling could promote tumor recurrence through increased neoangiogenesis, or facilitate metastasis. Through a systematic literature review on oncological risk and radiological follow-up, conducted from January 2010 to August 2014, we tried to identify populations at risk of recurrence after AFG. The study selection process was adapted from the Prisma statement. Out of the seven analysed patients cohorts, i.e. approximately 1500 AFG procedures, results on the risk of local recurrence appear reassuring after an average follow-up of 42 months. These results should be cautiously interpreted because of the heterogeneity of the studies. However, recurrences have been analysed based on the characteristics of the original tumor and many of them warn about population that seem more at risk of recurrence. Studies on radiological modifications after AFG emphasize the need for the radiologists to know the importance of radiological images induced by this procedure, however, AFG does not seem to interfere with radiological screening of local recurrence. In order to deliver clear information to patients receiving breast reconstruction by lipofilling, prospective studies focused on populations that seem to be most at risk of recurrence are required.

Occult cancer in specimens of reduction mammaplasty aimed at symmetrization. A multicentric study of 2718 patients.

Women who have undergone surgical treatment for breast cancer often benefit from a contralateral reduction mammaplasty (CRM) aimed at symmetrization of the contralateral breast unaffected by the initial cancer. In our 7-year multicentric study (12 centers) of 2718 patients, incidence of CRM cancers (CRMc) was 1.47% (n = 40) [95% CI 1.05%-2.00%]. The CRMc group had significantly more initial mammary cancers of invasive lobular carcinoma (ILC, 22.5% vs 12.0%) and ductal carcinoma in situ (DCIS, 35.0% vs 21.6%) types than the healthy CRM group (p = 0.017). 35.0% (n = 14) of patients had en bloc resection; 25.0% (n = 10) of surgical specimens were correctly oriented. En bloc resection and orientation of surgical specimens enable precise pinpointing of the CRMc. A salvage lumpectomy may be proposed as an option when margins are invaded. The histological distribution of the 40 CRMc (mean size 12.7 mm) was carcinoma in situ (CIS) 70%, ILC 12.5%, invasive ductal carcinoma (IDC) 12.5% and tubular carcinoma (TC) 5.0%.

[Adipose-derived stromal cells: history, isolation, immunomodulatory properties and clinical perspectives]. / Les cellules stromales mésenchymateuses du tissu adipeux : historique, isolement, propriétés immunomodulatrices et perspectives cliniques.

Over the last decade, the clinical use of adipose-derived stromal/stem cells (ASC) in regenerative medicine is rapidly increasing. ASC belong to the mesenchymal stromal cells initially obtained from the bone marrow. Their limited differentiation capacity in vivo into functional mature cells has led to a reassessment of their mechanisms of action. One of the major clinical interests appears related to paracrine effects through a temporary production of trophic and immunomodulatory factors. Our purpose is to provide a review on the latest knowledge in the field of ASC, mechanisms of action, mainly immunomodulatory/immunosuppressive properties, methods of obtention, with a focus on clinical perspectives particularly in the field of cellular therapy and fat grafting technique in plastic surgery.

Smoking and plastic surgery, part I. Pathophysiological aspects: update and proposed recommendations.

OBJECTIVES: Smoking patients undergoing a plastic surgery intervention are exposed to increased risk of perioperative and postoperative complications. It seemed useful to us to establish an update about the negative impact of smoking, especially on wound healing, and also about the indisputable benefits of quitting. We wish to propose a minimum time lapse of withdrawal in the preoperative and postoperative period in order to reduce the risks and maximize the results of the intervention. METHODS: A literature review of documents from 1972 to 2014 was carried out by searching five different databases (Medline, PubMed Central, Cochrane library, Pascal and Web of Science). RESULTS: Cigarette smoke has a diffuse and multifactorial impact in the body. Hypoxia, tissue ischemia and immune disorders induced by tobacco consumption cause alterations of the healing process. Some of these effects are reversible by quitting. Data from the literature recommend a preoperative smoking cessation period lasting between 3 and 8 weeks and up until 4 weeks postoperatively. Use of nicotine replacement therapies doubles the abstinence rate in the short term. When a patient is heavily dependent, the surgeon should be helped by a tobacco specialist. CONCLUSIONS: Total smoking cessation of 4 weeks preoperatively and lasting until primary healing of the operative site (2 weeks) appears to optimize surgical conditions without heightening anesthetic risk. Tobacco withdrawal assistance, both human and drug-based, is highly recommended.

Smoking and plastic surgery, part II. Clinical implications: a systematic review with meta-analysis.

OBJECTIVES: Tobacco addiction is a risk factor for complication in plastic surgery. The authors have assembled concrete arguments detailing the risks of perioperative and postoperative complication that are incurred by a patient with continued tobacco intoxication who wishes to undergo a surgical intervention. RESEARCH STRATEGY: Through application of the PRISMA criteria, we have carried out a systematic review of the literature, in which we explored five databases while using predefined keywords. We selected randomized, controlled observational studies on the perioperative and postoperative complications related to tobacco use in actively smoking, abstinent and non-smoking patients. DATA COLLECTION AND ANALYSIS: The levels of evidence for each article were evaluated. Risk of bias was assessed using the Newcastle-Ottawa Scale. Incidence parameters including the Odds Ratio and relative risk were calculated for each complication of which the number of occurrences had been indicated. Meta-analysis of the results was carried out. RESULTS: We included 60 observational studies. In the cosmetic surgery group, we calculated a combined Odds Ratio of 2.3 [1.51-3.54] P<0.001 for surgical site infections and 2.5 [1.49-4.08] P<0.001 for delayed wound healing. In the bariatric surgery sequelae group, we found a combined Odds Ratio of 3.3 [1.90-5.64] P<0.001 with regard to delayed wound healing and 3.1 [1.39-7.13] P=0.006 for cutaneous necrosis. No proof was provided as to the possible influence of tobacco on the success rate of free flap microsurgery, but it is difficult to extrapolate results on the latter to digital reimplantation. CONCLUSIONS: The review underlines the fact that patients with smoking habits run a significantly heightened risk of cutaneous necrosis, particularly in the event of major detachment (cervico-facial lift, skin-sparing mastectomy, abdominoplasty), of additionally delayed wound healing and of addition surgical site infections. Rigorous preoperative evaluation of smokers could help to diminish these risks.

The latest information on Macrolane™: its indications and restrictions.

INTRODUCTION: Hyaluronic acid has come to represent the most widely used injectable cosmetic product in the world. Brought into being by the Swedish company Q-Med, in 2007 Macrolane™ was authorized for use in France, and the year after, it received official European approval as a means of breast augmentation. Since then, however, numerous controversies pertaining to its side effects have led to its withdrawal from the worldwide breast augmentation market. The objective of this article is to carry out a review of the literature providing updated information on Macrolane™ and its recent indications. MATERIALS AND METHODS: We carried out a review of the literature on the PubMed and PubMed Central data bases through use of the keywords "Macrolane™", "NASHA", "hyaluronic acid" and "soft filler", and subsequently analyzed the levels of evidence and possible biases of the different publications. The official sites of the French, English, Spanish and American scholarly organizations of plastic surgery were likewise consulted. Perusal of the notifications and recommendations for use brought out by the Q-Med company completed our study. RESULTS: A large majority of the available clinical series on Macrolane™ with regard to not only breast augmentation, but also its other indications, offer an insufficient level of evidence and present a number of conflicts of interest. Since April 2012 Macrolane™ has been temporarily withdrawn by its distributors from the worldwide breast augmentation market. In point of fact, Macrolane™ injections have been found to interfere with breast imaging and screening for breast cancer. As regards the latest indications for this controversial product, it is not yet possible to step back and take stock. CONCLUSIONS: Present-day scientific data fail to justify the market reappearance of Macrolane™ breast augmentation products. Q-Med has shown full awareness of the problem by imposing worldwide restrictions on products aimed at penis as well as breast enlargement. Larger cohorts of female patients are more necessary than ever, as is an approach based on stepping back and taking stock.