Patterns of Recurrence After Poor Response to Neoadjuvant Chemotherapy in Gastric Cancer and the Role for Adjuvant Radiation.

BACKGROUND: Improved treatment strategies are needed for patients with locally advanced gastric cancer with poor response to neoadjuvant chemotherapy. We aimed to describe patterns of failure for patients with no or partial response (NR, PR) to preoperative chemotherapy. PATIENTS AND METHODS: We analyzed patients with locally advanced gastric cancer treated from 2008 to 2022 with preoperative chemotherapy followed by surgery with D2 resection. We excluded patients who received radiation. Cumulative incidence of locoregional failure (LRF) and distant metastases (DM) were calculated. For patients with recurrent abdominal disease, hypothetical radiation clinical treatment volumes (CTV) were contoured on postoperative scans and compared with patterns of recurrence. RESULTS: A total of 60 patients were identified. The most used preoperative chemotherapy was FLOT (38.6%), followed by FOLFOX (30%) and ECF/ECX/EOX (23.3%). Four (6.7%), 40 (66.7%), and 9 patients (15%) had a complete pathologic response (CR), PR, and NR to neoadjuvant therapy, respectively. Among patients without a CR, 3-year overall and progression-free survival rates were 62.3% (95% CI 48-76.6%) and 51.3% (95% CI 36.9-65.7%), respectively. Three-year cumulative incidence of LRF and DM were 8.4% (95% CI 0.4-16.4%) and 41.0% (95% CI 26.3-55.4%), respectively. Absolute rates of patients having the first site of recurrence encompassed by a postoperative radiation CTV was 2.0% for patients without a CR and 0% for patients with NR. CONCLUSIONS: Patients with locally advanced gastric cancer with less than a CR to chemotherapy have poor outcomes due to high rates of DM. Adjuvant locoregional therapy such as radiation is unlikely to affect survival.

Rich essential properties of silicon-substituted graphene nanoribbons: a comprehensive computational study.

The diverse structural, electronic, and magnetic properties of silicon (Si)-substituted armchair and zigzag graphene nanoribbons (AGNRs and ZGNRs) were investigated using spin-polarized density functional theory (DFT) calculations. Pristine AGNRs belong to a nonmagnetic semiconductor with a direct bandgap of 1.63/1.92 eV determined by PBE/HSE06 functionals. Under various Si substitutions, nonmagnetic bandgaps were tuned at 1.49/1.87, 1.06/1.84, 0.81/1.45, 1.04/1.71, 0.89/1.05, and 2.38/3.0 eV (PBE/HSE06) in the single Si edge-, single Si non-edge-, double Si ortho-, double Si meta-, double Si para-, and 100% Si-substituted AGNR configurations, respectively. Meanwhile, pristine ZGNRs displayed antiferromagnetic semiconducting behavior with a spin degenerate bandgap of 0.52/0.81 eV (PBE/HSE06) and becomes a ferromagnetic semimetal in the single Si configurations or an unusual ferromagnetic semiconductor in the 100% Si configuration. Under the developed first-principles theoretical framework, the formation of quasi π (C-2pz and Si-3pz) and quasi σ (C-2s, -2pxy and Si-3s and -3pxy) bands was identified in the Si-substituted configurations. These quasi π and quasi σ bands showed weak separation, resulting in weak quasi sp2 hybridization in Si-C bonds, in which the identified hybridization mechanism was a strong evidence for the formation of stable planar 1D structures in the Si-substituted configurations. Our complete revelation of the essential properties of Si-substituted GNRs can provide a complete understanding of their chemically doped 1D materials for various practical applications.

Spectrum of WAS gene mutations in Vietnamese patients with Wiskott-Aldrich syndrome.

BACKGROUND: WAS gene mutational analysis is crucial to establish a definite diagnosis of Wiskott-Aldrich syndrome (WAS). Data on the genetic background of WAS in Vietnamese patients have not been reported. METHODS: We recruited 97 male, unrelated patients with WAS and analyzed WAS gene mutation using Sanger sequencing technology. RESULTS: We identified 36 distinct hemizygous pathogenic mutations, with 17 novel variants, from 38 patients in the entire cohort (39.2%). The mutational spectrum included 14 missense, 12 indel, five nonsense, four splicing, and one non-stop mutations. Most mutations appear only once, with the exception of c.37C>T (p.R13X) and c.374G>A (p.G125E) each of which occurs twice in unrelated patients. CONCLUSION: Our data enrich the mutational spectrum of the WAS gene and are crucial for understanding the genetic background of WAS and for supporting genetic counseling.

Stereotactic radiosurgery for distant brain metastases secondary to esthesioneuroblastoma: a single-institution series.

OBJECTIVE: Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare, malignant tumor of neuroectodermal origin that arises from the olfactory neuroepithelium. In this study the authors present the first series in the literature on distant brain metastases (BMs) secondary to ENB that were treated with stereotactic radiosurgery (SRS), to evaluate the safety and effectiveness of SRS for this indication. METHODS: A retrospective analysis of clinical and radiological outcomes of patients with ENB who underwent CyberKnife (CK) SRS at a single center was conducted. The clinical and radiological outcomes of patients, including progression-free survival, overall survival, and local tumor control (LTC) were reported. RESULTS: Between 2003 and 2022, 32 distant BMs in 8 patients were treated with CK SRS at Stanford University. The median patient age at BM diagnosis was 62 years (range 47-75 years). Among 32 lesions, 2 (6%) had previously been treated with surgery, whereas for all other lesions (30 [94%]), CK SRS was used as their primary treatment modality. The median target volume was 1.5 cm3 (range 0.09-21.54 cm3). CK SRS was delivered by a median marginal dose of 23 Gy (range 15-30 Gy) and a median of 3 fractions (range 1-5 fractions) to a median isodose line of 77% (range 70%-88%). The median biologically effective dose was 48 Gy (range 21-99.9 Gy) and the median follow-up was 30 months (range 3-95 months). The LTC at 1-, 2-, and 3-year follow-up was 86%, 65%, and 50%, respectively. The median progression-free survival and overall survival were 29 months (range 11-79 months) and 51 months (range 15-79 months), respectively. None of the patients presented adverse radiation effects. CONCLUSIONS: In the authors' experience, SRS provided excellent LTC without any adverse radiation effects for BMs secondary to ENB.

Identify Primary Air Pollution Sources of BTEX by Using Positive Matrix Factorization (PMF): A Case Study of Ho Chi Minh City, Vietnam.

Ho Chi Minh City (HCMC) is one of the main socioeconomic and financial centers of Vietnam. The city also faces serious air pollution. However, the city polluted with benzene, toluene, ethylbenzene, and xylene (BTEX) has rarely been studied. We used positive matrix factorization (PMF) to analyze BTEX concentrations measured at two sampling locations to identify the main sources of BTEX in HCMC. The locations represented residential area (i.e., To Hien Thanh) and industrial area (i.e., Tan Binh Industrial Park). At the To Hien Thanh location, the average concentrations of benzene, ethylbenzene, toluene, and xylene were 6.9, 14.4, 4.9, and 12.7 µg/m3, respectively. At the Tan Binh location, the average concentrations of benzene, ethylbenzene, toluene, and xylene were 9.8, 22.6, 2.4, and 9.2 µg/m3, respectively. The results showed that PMF was a reliable model for source apportionment in HCMC. Traffic activities were the main sources of BTEX. Besides, industrial activities also contributed to BTEX emissions, especially the location near the industrial park. The majority of BTEXs at the To Hien Thanh sampling site come from traffic sources accounting for 56.2%. Activities from traffic and photochemical reactions (42.7%) and industrial sources (40.5%) were the main sources affecting BTEX emissions at the sampling site of Tan Binh Industrial Park. This study can be used as a reference for mitigation solutions to reduce the BTEX emission in HCMC.

CNN-Based Facial Expression Recognition with Simultaneous Consideration of Inter-Class and Intra-Class Variations.

Facial expression recognition is crucial for understanding human emotions and nonverbal communication. With the growing prevalence of facial recognition technology and its various applications, accurate and efficient facial expression recognition has become a significant research area. However, most previous methods have focused on designing unique deep-learning architectures while overlooking the loss function. This study presents a new loss function that allows simultaneous consideration of inter- and intra-class variations to be applied to CNN architecture for facial expression recognition. More concretely, this loss function reduces the intra-class variations by minimizing the distances between the deep features and their corresponding class centers. It also increases the inter-class variations by maximizing the distances between deep features and their non-corresponding class centers, and the distances between different class centers. Numerical results from several benchmark facial expression databases, such as Cohn-Kanade Plus, Oulu-Casia, MMI, and FER2013, are provided to prove the capability of the proposed loss function compared with existing ones.

Ultra-Deep Sequencing of Plasma-Circulating DNA for the Detection of Tumor- Derived Mutations in Patients with Nonmetastatic Colorectal Cancer.

Identification of tumor-derived mutation (TDM) in liquid biopsies (LB), especially in early-stage patients, faces several challenges, including low variant-allele frequencies, interference by white blood cell (WBC)-derived mutations (WDM), benign somatic mutations and tumor heterogeneity. Here, we addressed the above-mentioned challenges in a cohort of 50 nonmetastatic colorectal cancer patients, via a workflow involving parallel sequencing of paired WBC- and tumor-gDNA. After excluding potential false positive mutations, we detected at least one TDM in LB of 56% (28/50) of patients, with the majority showing low-patient coverage, except for one TDM mapped to KMT2D that recurred in 30% (15/30) of patients.

Spectrum of HBB gene mutations among 696 ß-thalassemia patients and carriers in Southern Vietnam.

BACKGROUND: Thalassemias are common inherited blood disorders that have been extensively studied in Asia. Thus far, data on mutations of the HBB gene in Vietnamese patients with ß-thalassemia are limited to small studies. METHODS: We recruited 696 ß-thalassemia patients and carriers in southern Vietnam and analyzed for the HBB gene mutations using Sanger sequencing technology. RESULTS: We documented 27 types of known mutations and 10 types of novel variants on 737 alleles out of 1392 surveyed alleles. The three most common mutations, which account for more than ¾ of all mutant alleles, were c.79G > A (HbE), c.124_127delTTCT, and c.52A > T. The novel variants were mainly located in 5' untranslated region (c.-92delC and c.-67A > G) and 3' untranslated region (c.*4C > T, c.*116_*117insA, c.*142 T > C, c.*156G > C, c.*176_*177insA, and c.*247 T > C), except for one in intron 2 (c.316-99 T > G) and one in exon 3 (c.385delG). CONCLUSION: We provide here a comprehensive mutation spectrum of the HBB gene in Southern Vietnam, which is crucial for carrier screening and prenatal diagnosis in the future.

Impact of a dam construction on the intertidal environment and free-living nematodes in the Ba Lai, Mekong Estuaries, Vietnam.

The impact of high siltation and accumulation of organic and waste material in the intertidal of the dammed Ba Lai River in Vietnam as part of the Mekong estuarine system was investigated by means of marine free-living nematodes. Nutrients content (nitrate, ammonium, total phosphorus, total nitrogen), total suspended solids, total organic carbon, coliform, bacteria E. coli, pH, dissolved oxygen, total dissolved solids, methane and hydrogen sulfide concentration, and the nematode communities were characterized in sediment at selected stations along the river above and below the dam. Our results found elevated methane concentrations at the upstream side of the dam while hydrogen sulfide concentrations found to be highest in the downstream side of the dam. Furthermore, methane and hydrogen sulfide concentrations were correlated to nematode community characteristics such as trophic composition densities and genera composition. There was a clear difference between the communities above and below the dam. The discontinuous nematode community distribution indicated that the Ba Lai River is impacted by dam construction. Potentially the high deposition and eutrophication could turn the area into a methane-rich area related to predicted impact on nematodes.

Impact of biomass burnings in Southeast Asia on air quality and pollutant transport during the end of the 2019 dry season.

At the end of the dry season, March and April in Southeast Asia (SEA), agricultural refuse burnings occur over the region, mainly in the countries of Myanmar, Thailand, Laos, Cambodia and Vietnam, in preparation for the wet rice plantation. In this study, the impact of biomass burnings at the height of the burning period in March 2019 in mainland SEA on air quality and pollutant transport is modelled using the Weather Research Forecast WRF-Chem air quality model with emission input from the National Center for Atmospheric Research (NCAR) Fire Emission Inventory from NCAR (FINN). FINN is derived from satellite remote sensing data and species emission factors. A simulation of the dispersion of pollutants from biomass burnings from 13 to 19 March 2019, when the burnings was most intense, was performed. Validation of the model prediction using observed meteorological and pollutant data such as AOD measurements on ground from AERONET (Aerosol Robotic Network) and data from MODIS and CALIPSO satellites is carried out at various sites in the region. The results show that impact on air quality was most pronounced in Thailand and Laos but the effect of biomass burnings in mainland SEA at the end of the dry season is widespread in terms of pollutant dispersion and population exposure over the whole region and beyond. It is also shown that the transport of pollutants from biomass burnings in SEA to southern China, Taiwan and beyond is facilitated by the Truong Son mountain range, when under westerly wind, acting as a launching pad to uplift the pollutant plumes to higher altitude which then can be dispersed widely and transported farther from the biomass burning sources in Thailand and Laos.

Lipofilled Mini Dorsi Flap: An Efficient Less Invasive Concept for Immediate Breast Reconstruction.

INTRODUCTION: The traditional extended latissimus dorsi flap technique, in addition to lipofilling, has been one of the main procedures used for breast reconstruction after mastectomy. However, to obtain excellent results, this technique requires a large muscle harvest and further lipofilling sessions. The lipofilled mini dorsi flap technique, performed in a single operation, appealed to us as a way to improve the traditional technique.We present our experience with the lipofilled mini dorsi flap technique in a new scenario. MATERIALS AND METHODS: We performed breast reconstruction with a lipofilled mini dorsi flap in female patients with breast cancer who underwent mastectomy and immediate breast reconstruction with a lipofilled mini dorsi flap. The operative technique is detailed in this article. The results were evaluated by the patients and the surgical team. RESULTS: We performed 72 lipofilled mini dorsi flap procedures during breast reconstruction surgery from May 2017 to January 2019. Fifty-nine (81.9%) cases were immediate reconstructions. Complications, such as infection or necrosis of the flap, were not observed in this study. We noticed seroma and 1 case of infected lymphocele, which was drained.Body mass index (BMI) was directly related to postoperative dorsal seroma. The authors reported that greater BMI was associated with a higher seroma volume.Most patients evaluated their reconstruction as satisfactory. The surgical team evaluated most of the results as very satisfactory or satisfactory. There were no cases of unsatisfactory results reported either by the patients or the surgical team. CONCLUSIONS: The lipofilled mini dorsi flap technique is an efficient, elegant, and less invasive solution that is more easily and quickly performed and achieves excellent long-term results in the immediate breast reconstruction scenario. For the first time to our knowledge, lipofilling was used to reduce the extent of latissimus dorsi dissection. The postoperative follow-up was better tolerated by patients. This technique may be offered to patients regardless of oncological treatment. In our experience, the lipofilled mini dorsi flap method has become the primary technique for immediate breast reconstruction.

Bazex syndrome in a patient with head and neck malignancy.

Bazex syndrome (acrokeratosis paraneoplastica) is an uncommon dermatologic condition associated with an underlying malignancy, most commonly squamous cell carcinomas of the head and neck. This article describes Bazex syndrome in a 56-year-old woman who presented with bilateral cervical lymphadenopathy and a mass at the base of her tongue.

[Reconstruction of proximal nasal defect after deep carcinological resection. Interest to combine titane mesh with fat grafting]. / Reconstruction de la racine du nez après exérèse carcinologique profonde. Intérêt de combiner implants de titane et greffe de tissu graisseux.

INTRODUCTION: The mucosal cylindroma or adenoid cystic carcinoma is the second sinonasal non-epithelial malignant tumor frequency argument. Due to the achievement of the nasal mucosa and a late diagnosis reconstructions are often complex. We report the case of a mucous cylindroma recurrence of nasal septum requiring a wide and deep excision of the root of the nose with nasal reconstruction. CASE REPORT: A patient aged 66 years whose history resection two years ago with a mucous adenoid cystic carcinoma of the right side of the nasal septum, had a local recurrence T2NOM0 imposing a wide excision with amputation nasal septum own bones of nose, the anterior portion of the triangular cartilages. The reconstruction was carried out in three areas: a musculocutaneous forehead flap to the mucosal level, a titanium plate to the bone plane, nasal native skin to skin level. Histological examination confirmed the existence of a recurrence cylindroma infiltrating the bone. The surgical margins were however in sano. Adjuvant radiotherapy to 60Gy dose of the surgical area was indicated after surgery. The consequences of surgery and radiotherapy were simple. However local changes to show a progressive refinement of the nasal skin due to irradiation leading to a small titanium plate exposure revision surgery with coverage by a glabellar flap associated with a time of lipomodeling unexposed areas have improved and trophism of soft tissue. Two further lipomodeling sessions have yielded a good quality and stable skin. From an oncological point of view, no recurrence was detected with a decline of 10 years. Aesthetic and functional point of view the results were highly satisfactory. DISCUSSION: Oncologic resections subtotal nasal pyramid are complex, we will see the benefits and disadvantages of the different techniques used in the different stages. CONCLUSION: This case report illustrates the difficulties of reconstruction after wide excision of mucosal lesions root of the nose carrying the mucous plan and nasal bones. It stresses the importance of bone reconstruction titanium plate and innovative element, the efficiency of fat transfer to restore the quality and trophicity soft tissue. Fat transfer in addition to reconstructions by titanium plates and splints may thus expand the indications of these types of techniques in complex facial and cranial reconstructions.

Surgical Management of Benign and Borderline Phyllodes Tumors of the Breast.

Phyllodes tumors (PT) are uncommon fibroepithelial breast neoplasms and there is currently no clear consensual treatment for these tumors. The aim of our study was to evaluate the surgical management and outcome of benign and borderline PT. We retrospectively assessed 76 cases of benign or borderline PT managed at the Leon Berard comprehensive cancer center in Lyon, France between July 2003 and December 2013. The mean age at diagnosis was 37.9 years and the median follow-up was 58 months. Seventy-five patients (99%), with a mean tumor size of 27 mm, underwent a breast-conserving procedure. The tumor margins were considered positive (when the tumor was present at the inked surgical section) in seven of 76 cases (9%) and negative in 65 out of 76 cases (86%). We observed the presence of small negative surgical margins <10 mm in 89% and <1 mm in 71% of the patients. Although no re-excision was performed to increase these margins, we did not see any increase in the local recurrence rate (4%) when compared to recurrence rates reported in the literature. We thus suggest that systematic revision surgery for close or positive surgical margins for benign PT should not be systematically performed. However, as recurrences occur within 2 years of initial excision, we recommend a regular clinical and imaging follow-up especially during this period for which patient's compliance is essential.

Modelling and prediction of air pollutant transport during the 2014 biomass burning and forest fires in peninsular Southeast Asia.

During the dry season, from November to April, agricultural biomass burning and forest fires especially from March to late April in mainland Southeast Asian countries of Myanmar, Thailand, Laos and Vietnam frequently cause severe particulate pollution not only in the local areas but also across the whole region and beyond due to the prevailing meteorological conditions. Recently, the BASE-ASIA (Biomass-burning Aerosols in South East Asia: Smoke Impact Assessment) and 7-SEAS (7-South-East Asian Studies) studies have provided detailed analysis and important understandings of the transport of pollutants, in particular, the aerosols and their characteristics across the region due to biomass burning in Southeast Asia (SEA). Following these studies, in this paper, we study the transport of particulate air pollution across the peninsular region of SEA and beyond during the March 2014 burning period using meteorological modelling approach and available ground-based and satellite measurements to ascertain the extent of the aerosol pollution and transport in the region of this particular event. The results show that the air pollutants from SEA biomass burning in March 2014 were transported at high altitude to southern China, Hong Kong, Taiwan and beyond as has been highlighted in the BASE-ASIA and 7-SEAS studies. There are strong evidences that the biomass burning in SEA especially in mid-March 2014 has not only caused widespread high particle pollution in Thailand (especially the northern region where most of the fires occurred) but also impacted on the air quality in Hong Kong as measured at the ground-based stations and in LulinC (Taiwan) where a remote background monitoring station is located.

Breast reconstruction with fat grafting and BRAVA(®) pre-expansion: Efficacy evaluation in 45 cases.

INTRODUCTION: Fat grafting for breast surgery, in reconstruction or aesthetics, gained a lot of popularity over the last years. As an addition to breast reconstruction with flaps or prosthesis, lipofilling improved the aesthetic result, increasing the patients' satisfaction rate. The demand for breast reconstruction using only fat grafting increased, because patients want a natural result in breast reconstruction and also the body contouring associated with liposuction of specified fat areas. The pre-expansion BRAVA(®) system has been used for several years in the United States to prepare the receiving site for lipofilling. We wanted to gain our own experience in associating BRAVA-lipofilling in breast reconstruction. The aim of our study is to evaluate the BRAVA efficiency as an adjuvant for fat grafting in breast surgery. MATERIAL AND METHODS: A retrospective study was undertaken, using a homogenous series of consecutive patients, operated by one surgeon (the first author), that had breast reconstruction using only fat grafts associated with BRAVA(®). RESULTS: The retrospective homogenous study identified 45 cases of breast surgery associating fat grafting alone with BRAVA(®) assistance. The number of intervention of fat grafting associating BRAVA(®) was 1 or 2 for conservative treatment sequelae or for flap reconstruction improvement, and 2 to 4 for immediate and delayed breast reconstruction. The total volume of fat grafting was 205 cc for the contralateral balancing, 317 cc for flap reconstructions, 531 cc for the conservative treatment sequelae, 790 cc for the immediate breast reconstruction and 1165 cc for the delayed breast reconstruction. The satisfaction rate of the surgical team and the patients was satisfying and very satisfied in 82% of cases, average in 8% of cases, and insufficient in 10% of cases. CONCLUSIONS: Breast reconstruction with fat grafting alone is, in our experience, a reliable and reproducible technique, that gives excellent and stable results. The high satisfaction rate of patients is explained by the supple and natural consistency of the new breast, with no added scars, associating the benefits of liposuction of the donor sites. The BRAVA(®) system seems to be, in cases with good indications, an adjuvant for receiving site preparation, making the reconstruction easier for the surgeon and for the patient. We believe that breast reconstruction with fat grafting alone is going to become more popular in the future. Associating fat grafting with BRAVA(®) creates a new way of natural breast reconstruction for the patients with mastectomy that want a stable result with less aggressive procedures. It is a new tool that is going to increase the autologous breast reconstruction in France.

[How to treat fat necrosis after lipofilling into the breast?]. / Comment gérer les lésions de cytostéatonécrose mammaire après transfert graisseux ?

INTRODUCTION: Fat necrosis is a phenomenon that has been known for a long time in surgery. The fat necrosis is produced because of tissue ischemia and it is also known as cytosteatonecrosis. These lesions can appear with different manifestations: indurations or cysts. Fat necrosis develops in breast aesthetic surgery (breast reduction) or reconstructive breast surgery (after abdominal flaps like TRAM or DIEP). In our department we have been using fat grafting into the breast since 1998 and it has really improved the aesthetic results in breast surgery. Also the fat necrosis lesions can appear after fat grafting, and they should be identified in order to avoid worrying the patient and other doctors that are treating her. The purpose of this article is to present different aspects of fat necrosis after surgery and therapeutic approaches to these problems. MATERIAL AND METHODS: The two authors have noticed the frequency of fat necrosis in the breast after fat grafting into the breast in aesthetic surgery (asymmetry, deformity, lipoaugmentation, improvement of aesthetic sequelae) and reconstructive surgery (after total mastectomy or to improve the aspect of sequelae after conservative surgery). A retrospective study was performed including a homogenous series of consecutive cases that needed breast lipofilling, operated by the two authors. Fat was harvested with cannula after infiltration. The adipose tissue was preparated with a short centrifugation. Fat grafting was realized as backward injections. The tolerance of the performed technique has been studied with the discovery of the fat necrosis lesions after surgery up to one-year follow-up evaluation. RESULTS: Between 1998 and 2013, 2236 fat transfers have been performed by the two authors and were included in a series of consecutive homogenous cases treated by using the same surgical technique. The fat necrosis incidence after lipofilling in the breast shows two frequency curves: the first one with a frequency of 15% (the first 50 cases) and then decreases and stabilizes at about 3%. A second frequency curve appears after 500 cases and fat necrosis has a frequency of 10%. The clinical symptoms are variable. The oil cysts are the most frequent and the earliest manifestation. They can be treated in consultation by punction. The cysts with thick yellow filling and the indurate areas of fat necrosis are rare and can be treated by lipofragmentation using a canula. CONCLUSIONS: The fat necrosis lesion is a classic phenomena, and can be a source of inconveniences for the patients and the surgeons after breast surgery. All the efforts should be directed to avoid fat necrosis. However, fat necrosis is not rare and the surgeon should learn to resolve it without worrying the patient or asking for expensive exams.

Volumetric evaluation of fat resorption after breast lipofilling.

INTRODUCTION: The fat transfer or the lipofilling is a technique that had a major impact on the breast surgery results. We have been using this technique since 1998 as an adjuvant in breast reconstruction. The transferred fat is partially resorbed in the first three months after fat grafting. Literature shows that fat resorption varies from 30 to 80% and the experimental studies register a variation between 50 and 90%. The difficulty of the lipomodeling consists in anticipating the fat resorption rate in order to obtain breast symmetry. The purpose of this article is to evaluate the resorption rate of the transferred fat in the reconstructed breast by means of volumetric imaging 3 months after fat grafting. MATERIAL AND METHODS: A prospective study was undertaken including breast reconstructions with total autologous latissimus dorsi. All the surgical procedures have been done by the same surgeon (1st author). It focused on the second stage of breast reconstruction: the lipofilling. We registered the average harvested volumes, the volumes obtained after centrifugation and the transferred volumes for every reconstructed breast. The intramuscular volume in the reconstructed breast was measured by volumetric imaging on the third day after lipofilling (D3) and three months after lipofilling (M3). The volumetry was performed by using an after treatment console SIEMENS (SOMATOM definition AS 2*64 barettes). The average intramuscular volume was registered at D3 and M3. The average volume difference was calculated in order to obtain the exact resorption rate. RESULTS: This prospective study was undertaken on 32 reconstructed breasts by total autologous latissimus dorsi flap. The average age was 52 years, the average BMI was 24.7 kg/m(2). The average harvested fat volume for the breast lipofilling was 560 cc and the volume obtained after centrifugation was evaluated at about 371 cc, the average fat volume transferred being 291 cc. The volumetric study showed that intramuscular volume at D3 was measured at 284 cc and at M3 about 223 cc, of a resorption intramuscular rate of 21.5%. CONCLUSION: In our study, the rate of resorption of the fat transferred to the muscle in the reconstructed breast was measured at 21.5%. The low resorption rate found in our study, lower than those in the literature, sustains the supposition that the muscle is an excellent receiving matrix for the fat tissue. In order to obtain this percentage, a learning curve is necessary. Once acquired, this technique produces a major improvement of the breast surgery results.

[Dynamic reconstruction of Achilles tendon by free composite perforator flap with functional assessment]. / Reconstruction dynamique de tendon d'Achille par lambeau perforant composite avec évaluation fonctionnelle.

INTRODUCTION, DEFECTS: Achilles tendon are common in patients after immobilization, therefore the reconstruction of a ruptured Achilles tendon with defects remains a surgical challenge. The ideal characteristics are a thin layer of skin, a strong tendon component, combined with a reliable blood supply and minimal morbidity at the donor site. We present a reconstructive technique using a composite anterolateral thigh perforator free flap, meeting these criteria, for the treatment of rupture of Achilles tendon with cutaneous and tendon defect. METHODS: A 34-year-old patient presenting a third rupture of his left Achilles tendon with 4cm composite defect was reconstructed with a contralateral anterolateral thigh perforator flap with part of the fasciae latae. The latter was raised by dissecting one intramuscular perforating artery from a descending branch of the lateral circumflex femoral artery. The postoperative observation period was one year. The functional outcome was determined by clinical scores (IKDC, OAK and Lysholm-Tegner). RESULTS: The healing time was 21 days. At six months, the aesthetic and functional result was satisfactory without delayed healing or secondary rupture. The aesthetic discomfort at the donor site was considered negligible by the patient. At one year, there is a continuing stability with no recurrence. The functional result was considered good with a clinical score of 75/100. CONCLUSION: Therefore, this method seems to be a good option for complex reconstruction of Achilles meeting the requirements of reconstruction with good stability at a distance.