High volume, drainless lipoabdominoplasty with progressive tension sutures -UK experience.

BACKGROUND: Lipoabdominoplasty is an established technique, however outcomes for high lipoaspirate volumes in large series are lacking. We present the UK experience of high-volume, drainless lipoabdominoplasty using progressive deep tension sutures. METHODS: 286 consecutive patients at a single centre underwent drainless lipoabdominoplasty with a lipoaspirate volume of 500 ml or greater between 2017 and 2023. Surgery was performed under total intravenous anaesthesia with SAFELipo©, MicroAire® and a superwet technique. Abdominoplasty was commenced via a low convex abdominal incision with multilayer rectus plication, and abdominal closure undertaken with progressive tension sutures. Logistic regression was used to determine the relationship between lipoaspirate volume and four primary outcomes - all complications, delayed healing, seroma, and need for revision. RESULTS: The mean lipoaspirate volume was 2392.4 ml (500-5900), and abdominal tissue resection weight 1392.0 g (346-3802). One third of patients had local complications - minor irregularities (14.0%), abdominal scar problems (12.9%), umbilical shape/scar (4.5%), localised infection (4.2%) and delayed healing (3.8%). One (0.3%) had a small area of localised necrosis successfully managed by further tissue advancement. There was one abdominal haematoma, and two systemic complications- venous thromboembolism (0.3%) and drug-induced hepatitis. Seroma rate was 3.1%. 16.0% of patients required revision under general anaesthesia, and 6.6% under local anaesthetic. There was no significant relationship between the lipoaspirate volume and any of the four primary outcome measures. CONCLUSIONS: High-volume liposuction can safely be performed simultaneously with abdominoplasty. Our complication rates are equivalent to, or lower than other published data on lipoabdominoplasy, challenging current concepts in body sculpting.

CATMoS: Collaborative Acute Toxicity Modeling Suite.

BACKGROUND: Humans are exposed to tens of thousands of chemical substances that need to be assessed for their potential toxicity. Acute systemic toxicity testing serves as the basis for regulatory hazard classification, labeling, and risk management. However, it is cost- and time-prohibitive to evaluate all new and existing chemicals using traditional rodent acute toxicity tests. In silico models built using existing data facilitate rapid acute toxicity predictions without using animals. OBJECTIVES: The U.S. Interagency Coordinating Committee on the Validation of Alternative Methods (ICCVAM) Acute Toxicity Workgroup organized an international collaboration to develop in silico models for predicting acute oral toxicity based on five different end points: Lethal Dose 50 (LD50 value, U.S. Environmental Protection Agency hazard (four) categories, Globally Harmonized System for Classification and Labeling hazard (five) categories, very toxic chemicals [LD50 (LD50≤50mg/kg)], and nontoxic chemicals (LD50>2,000mg/kg). METHODS: An acute oral toxicity data inventory for 11,992 chemicals was compiled, split into training and evaluation sets, and made available to 35 participating international research groups that submitted a total of 139 predictive models. Predictions that fell within the applicability domains of the submitted models were evaluated using external validation sets. These were then combined into consensus models to leverage strengths of individual approaches. RESULTS: The resulting consensus predictions, which leverage the collective strengths of each individual model, form the Collaborative Acute Toxicity Modeling Suite (CATMoS). CATMoS demonstrated high performance in terms of accuracy and robustness when compared with in vivo results. DISCUSSION: CATMoS is being evaluated by regulatory agencies for its utility and applicability as a potential replacement for in vivo rat acute oral toxicity studies. CATMoS predictions for more than 800,000 chemicals have been made available via the National Toxicology Program's Integrated Chemical Environment tools and data sets (ice.ntp.niehs.nih.gov). The models are also implemented in a free, standalone, open-source tool, OPERA, which allows predictions of new and untested chemicals to be made. https://doi.org/10.1289/EHP8495.

Machine Learning of Toxicological Big Data Enables Read-Across Structure Activity Relationships (RASAR) Outperforming Animal Test Reproducibility.

Earlier we created a chemical hazard database via natural language processing of dossiers submitted to the European Chemical Agency with approximately 10 000 chemicals. We identified repeat OECD guideline tests to establish reproducibility of acute oral and dermal toxicity, eye and skin irritation, mutagenicity and skin sensitization. Based on 350-700+ chemicals each, the probability that an OECD guideline animal test would output the same result in a repeat test was 78%-96% (sensitivity 50%-87%). An expanded database with more than 866 000 chemical properties/hazards was used as training data and to model health hazards and chemical properties. The constructed models automate and extend the read-across method of chemical classification. The novel models called RASARs (read-across structure activity relationship) use binary fingerprints and Jaccard distance to define chemical similarity. A large chemical similarity adjacency matrix is constructed from this similarity metric and is used to derive feature vectors for supervised learning. We show results on 9 health hazards from 2 kinds of RASARs-"Simple" and "Data Fusion". The "Simple" RASAR seeks to duplicate the traditional read-across method, predicting hazard from chemical analogs with known hazard data. The "Data Fusion" RASAR extends this concept by creating large feature vectors from all available property data rather than only the modeled hazard. Simple RASAR models tested in cross-validation achieve 70%-80% balanced accuracies with constraints on tested compounds. Cross validation of data fusion RASARs show balanced accuracies in the 80%-95% range across 9 health hazards with no constraints on tested compounds.

Three routine free flaps per day in a single operating theatre: principles of a process mapping approach to improving surgical efficiency.

BACKGROUND: Breast reconstruction is a multi-stage process, involving many individual procedures and many healthcare professionals which take the patient through from diagnosis of breast cancer to the completion of cancer treatment and ultimate breast reconstruction. With an experience of over 3,000 autologous breast reconstructions, we have refined both our surgical technique and overall approach to breast reconstruction to improve the efficiency in free flap based breast reconstruction surgery. METHODS: Through a process mapping approach similar to that employed by large-scale industry, we have broken down free flap based breast reconstruction into multiple smaller processes. By looking at various steps as a simple component of the whole, we have improved our theatre efficiency to maximize patient throughput and improve our outcomes for breast reconstruction patients. RESULTS: Since beginning free flap breast reconstruction surgery, we have improved overall efficiency by applying a process mapping approach. In our early experience, we undertook a single patient undergoing breast reconstruction with a free flap per theatre list, moving to two patients having breast reconstruction, and now carry out three free flap based reconstructions in a single theatre per day as a routine. Specific times are demonstrated, with no increased complication rate. CONCLUSIONS: Through clearly defined processes, operative efficiency in autologous breast reconstruction can achieve three free flaps per day in a single theatre.

Assessing the augmented breast: a blinded study comparing round and anatomical form-stable implants.

BACKGROUND: Controversy persists as to whether round or anatomical form-stable breast implants provide the most aesthetically pleasing results, and there is a paucity of evidence comparing cosmetic outcomes of these two implants. A blinded study comparing aesthetic outcomes was conducted in an attempt to address this issue. OBJECTIVES: The authors compare aesthetic outcomes between round and anatomical form-stable breast implants. METHODS: Pre- and postoperative photographs of 60 consecutive patients undergoing breast augmentation (33 round, 27 anatomical) by a single surgeon were reviewed by 22 plastic surgeons. Photographs were graded on a modified Likert scale (1, poor; 4, excellent) for overall aesthetic result, upper pole contour, and natural appearance. The panel was asked to determine implant shape. RESULTS: Anatomical implants scored higher for upper pole contour: anatomical 2.80 (±0.44 - standard deviation) vs round 2.60 (±0.38). With regard to natural appearance and overall aesthetic results, anatomical implants scored higher: 2.89 (±0.42) vs 2.56 (±0.36) and 2.86 (±0.41) vs 2.72 (±0.37), respectively. None of these differences achieved statistical significance, and 62.7% of round and 49% of anatomical implants were correctly identified. There was no significant difference in the body mass index (BMI) between the 2 groups (P = .21). CONCLUSIONS: No significant difference (P > .05) in the general and specific cosmetic points between round and anatomical implants was demonstrated; many on the panel were unable to identify implant shape correctly. Both techniques seem to yield good cosmetic results. Clearly the decision on which implant to use must be made on an individual patient basis because many factors influence overall aesthetic outcome. Anatomical implants should not be assumed to produce a more natural result. LEVEL OF EVIDENCE: 4 Therapeutic.

Abdominoplasty and seroma: a prospective randomised study comparing scalpel and handheld electrocautery dissection.

BACKGROUND: Seroma formation remains a significant problem in abdominoplasty procedures--the cause of which remains to be elucidated. It has been suggested that one of the causative factors for seroma formation is the use of handheld electrocautery as opposed to scalpel for abdominal flap dissection. METHODS: Prospective trial in 102 consecutive abdominoplasty patients randomised to have abdominal flap dissection with either handheld electrocautery device on 'coagulation setting' or sharp dissection with scalpel and monopolar electrocautery forceps for haemostasis. In all other aspects the surgical technique was identical between the two groups. All drains were removed at 48 h, irrespective of drain volume. Primary outcome measure is postoperative seroma formation on clinical examination, secondary outcome measures are drain volume, weight of tissue removed, effect of liposuction and patient BMI. RESULTS: Both study groups were similar in demographics with no significant difference in weight of tissue excised, BMI, drain output or post operative complictions. There was no significant difference in seroma formation rates between the handheld electrocautery group (17.2%) and the sharp dissection group (20.1%). Overall, the seroma rate was 18.6%. Liposuction to the flanks at the time of abdominoplasty was found to significantly increase the incidence of seroma, compared to patients having abdominoplasty alone. CONCLUSIONS: Use of handheld electrocautery rather than scalpel for tissue dissection does not lead to increased seroma formation in abdominoplasty patients. Concomitant liposuction at the time of abdominoplasty increases the risk of seroma formation compared to patients having abdominoplasty alone.

Water resource management in New Zealand: jobs or algal blooms?

New Zealand faces a choice between environmental improvement and dairy industry profitability and employment, since improved water quality in lakes and rivers may require measures that will reduce net farm profit. Environmental valuation studies often consider preferences for employment but rarely focus specifically on the effect of job losses on respondent preferences for environmental improvement. A choice experiment was used to investigate people's willingness to pay for water quality improvements in a typical dairy catchment in the Waikato region of New Zealand. It was found that respondents would be willing to pay for water that is safer for swimming with improvements in clarity and ecological health, but are concerned about job losses, even when they do not expect to be directly affected. This may be explained by the concept of sociality, whereby the influence of direct interpersonal interaction on human behaviour, affects choice behaviour. Findings from this study and ongoing research should allow decision makers to consider both the costs and the benefits of different levels of water quality improvements, so allowing policy makers to identify the most cost effective options for achieving any given improvement in water quality.

van der Waals interactions between nanotubes and nanoparticles for controlled assembly of composite nanostructures.

We have demonstrated that ubiquitous van der Waals forces are significant in controlling the interactions between nanoparticles and nanotubes. The adsorption of gold nanoparticles (AuNPs) on nanotubes (MWNTs) obeys a simple quadratic dependence on the nanotube surface area, regardless of the source of AuNPs and MWNTs. Changes in the geometric parameters of the components have pronounced effects on the affinity of nanoparticles for nanotubes, with larger, more polarizable nanostructures exhibiting stronger attractive interactions, the impact of which changes in the following order MWNT diameter > AuNP diameter > MWNT length.

Dynamic equilibria in solvent-mediated anion, cation and ligand exchange in transition-metal coordination polymers: solid-state transfer or recrystallisation?

The solution properties of a series of transition-metal-ligand coordination polymers [ML(X)(n)](infinity) [M=Ag(I), Zn(II), Hg(II) and Cd(II); L=4,4'-bipyridine (4,4'-bipy), pyrazine (pyz), 3,4'-bipyridine (3,4'-bipy), 4-(10-(pyridin-4-yl)anthracen-9-yl)pyridine (anbp); X=NO(3) (-), CH(3)COO(-), CF(3)SO(3) (-), Cl(-), BF(4) (-); n=1 or 2] in the presence of competing anions, metal cations and ligands have been investigated systematically. Providing that the solubility of the starting complex is sufficiently high, all the components of the coordination polymer, namely the anion, the cation and the ligand, can be exchanged on contact with a solution phase of a competing component. The solubility of coordination polymers is a key factor in the analysis of their reactivity and this solubility depends strongly on the physical properties of the solvent and on its ability to bind metal cations constituting the backbone of the coordination polymer. The degree of reversibility of these solvent-induced anion-exchange transformations is determined by the ratio of the solubility product constants for the starting and resultant complexes, which in turn depend upon the choice of solvent and the temperature. The extent of anion exchange is controlled effectively by the ratio of the concentrations of incoming ions to outgoing ions in the liquid phase and the solvation of various constituent components comprising the coordination polymer. These observations can be rationalised in terms of a dynamic equilibrium of ion exchange reactions coupled with Ostwald ripening of crystalline products. The single-crystal X-ray structures of [Ag(pyz)ClO(4)](infinity) (1), {[Ag(4,4'-bipy)(CF(3)SO(3))]CH(3)CN}(infinity) (2), {[Ag(4,4'-bipy)(CH(3)CN)]ClO(4) 0.5 CH(3)CN}(infinity) (3), metal-free anbp (4), [Ag(anbp)NO(3)(H(2)O)](infinity) (5), {[Cd(4,4'-bipy)(2)(H(2)O)(2)](NO(3))(2)4 H(2)O}(infinity) (6) and {[Zn(4,4'-bipy)SO(4)(H(2)O)(3)] 2 H(2)O}(infinity) (7) are reported.

Engineering a single-chain Fv antibody to alpha v beta 6 integrin using the specificity-determining loop of a foot-and-mouth disease virus.

The alpha v beta 6 integrin is a promising target for cancer therapy. Its expression is up-regulated de novo on many types of carcinoma where it may activate transforming growth factor-beta1 and transforming growth factor-beta 3, interact with the specific extracellular matrix proteins and promote migration and invasion of tumor cells. The viral protein 1 (VP1) coat protein of the O(1) British field strain serotype of foot-and-mouth disease virus is a high-affinity ligand for alpha v beta 6, and we recently reported that a peptide derived from VP1 exhibited alpha v beta 6-specific binding in vitro and in vivo. We hypothesized that this peptide could confer binding specificity of an antibody to alpha v beta 6. A 17-mer peptide of VP1 was inserted into the complementarity-determining region H3 loop of MFE-23, a murine single-chain Fv (scFv) antibody reactive with carcinoembryonic antigen (CEA). The resultant scFv (B6-1) bound to alpha v beta 6 but retained residual reactivity with CEA. This was eliminated by point mutation (Y100bP) in the variable heavy-chain domain to create an scFv (B6-2) that was as structurally stable as MFE-23 and reacted specifically with alpha v beta 6 but not with alpha 5 beta 1, alpha v beta 3, alpha v beta 5, alpha v beta 8 or CEA. B6-2 was internalized into alpha v beta 6-expressing cells and inhibited alpha v beta 6-dependent migration of carcinoma cells. B6-2 was subsequently humanized. The humanized form (B6-3) was obtained as a non-covalent dimer from secretion in Pichia pastoris (115 mg/l) and was a potent inhibitor of alpha v beta 6-mediated cell adhesion. Thus, we have used a rational stepwise approach to create a humanized scFv with therapeutic potential to block alpha v beta 6-mediated cancer cell invasion or to deliver and internalize toxins specifically to alpha v beta 6-expressing tumors.

Comparison of the stability of multiwalled carbon nanotube dispersions in water.

Continuous real-time monitoring of the nanotube concentration in aqueous solution using UV-Vis spectroscopy allows quantitative comparison of the stability of different types of nanotube dispersions. Systematic investigation of the effects of nanotube length and functionalisation for thin multiwalled carbon nanotubes (MWNT) has revealed that shorter MWNT form more stable dispersions than longer nanotubes of the same diameter. MWNT shortened to an average length of approximately 1 microm form stable dispersions in water with concentrations up to 0.013 mg ml(-1) in the absence of surfactants or solubilising functional groups. The introduction of carboxylic or thiol groups on the surface of shortened nanotubes further increases the stability of MWNT dispersions (up to 0.24 mg ml(-1)). The introduction of surfactant or surface charge on MWNT has contrasting effects on functionalised and non-functionalised nanotubes, destabilising and stabilising their dispersions, respectively.

Biological foreign body implantation in victims of the London July 7th suicide bombings.

On the morning of July 7, 2005, a co-ordinated attack by suicide bombers on the London public transport system resulted in four explosions at densely packed civilian targets. Of the victims of these attacks, 194 were treated at the Royal London Hospital, where among the most severely injured an unusual pattern of injury was seen. Bone fragments from other victims (or possible the bomber) were found embedded as biological foreign bodies within the soft tissues of several patients. We present case reports of five of these patients, and discuss problems arising from the management of their injuries. Allogenic bony foreign bodies, rarely reported in the medical literature, present unusual problems in their management, in particular the risk of transmitting blood borne diseases, which should be anticipated and addressed in a hospital's major incident planning.