Identification and characterization of the WOX Gene Family revealed two WUS Clade Members associated with embryo development in Cunninghamia lanceolata.

The WUSCHEL-related homeobox (WOX) gene family is vital for plant development and stress response. In this study, we conducted a comprehensive analysis of WOX genes in Cunninghamia lanceolata (C. lanceolata) and subsequently explored the potential roles of two ClWOX genes within the WUS clade. In total, six ClWOX genes were identified through a full-length transcriptome analysis. These genes, exhibiting conserved structural and functional motifs, were assigned to the ancient clade and Modern/WUS clade, respectively, through a phylogenetic analysis. Our expression analysis indicated that these ClWOX genes were highly expressed in the middle and late developmental stages of zygotic embryos in C. lanceolata. Moreover, only ClWOX5 and ClWOX6 within the Modern/WUS clade exhibited transcriptional activity, and their expressions were also induced in response to auxin and wounding. Overexpression of ClWOX5 and ClWOX6 in Arabidopsis caused a partially sterile phenotype, resulting in a very low seed setting rate. Transcriptomic analysis revealed that expressions of many embryo-defective (EMB) genes, phytohormone-related genes, and transcription factors (TFs) were dramatically altered in ClWOX5 and ClWOX6 transgenic plants, which suggested that ClWOX5 and ClWOX6 may play specific important roles in embryo development via complex gene networks. In addition, overexpression of ClWOX5 and ClWOX6 in leaf segments promoted shoot regeneration in tobacco, indicating that ClWOX5 and ClWOX6 can promote plant regeneration and could be used to improve genetic transformation. In conclusion, these results help to elucidate the function of the WOX gene and provide a valuable basis for future studies of the developmental regulation and applications of WOX genes in C. lanceolata.

The N-LVA Study: effectiveness and cost-effectiveness of lymphaticovenous anastomosis (LVA) for patients with cancer who suffer from chronic peripheral lymphoedema - study protocol of a multicentre, randomised sham-controlled trial.

INTRODUCTION: Cancer-related lymphoedema is one of the most debilitating side-effects of cancer treatment with an overall incidence of 15.5%. Patients may suffer from a variety of symptoms, possibly resulting in a diminished health-related quality of life (HRQoL). A microsurgical technique known as lymphaticovenous anastomosis (LVA) might be a promising treatment option. The objective of this study is to evaluate whether LVA is effective and cost-effective compared with sham surgery in improving the HRQoL. METHODS AND ANALYSIS: A multicentre, double-blind, randomised sham-controlled trial conducted in three university hospitals in the Netherlands. The study population comprises 110 patients over the age of 18 years with unilateral, peripheral cancer-related lymphoedema, including 70 patients with upper limb lymphoedema and 40 patients with lower limb lymphoedema. A total of 55 patients will undergo the LVA operation, while the remaining 55 will undergo sham surgery. The follow-up will be at least 24 months. Patients are encouraged to complete the follow-up by explaining the importance of the study. Furthermore, patients may benefit from regular monitoring moments for their lymphoedema. The primary outcome is the HRQoL. The secondary outcomes are the limb circumference, excess limb volume, changes in conservative therapy, postoperative complications, patency of the LVA and incremental cost-effectiveness. ETHICS AND DISSEMINATION: The study was approved by the Medical Ethical Committee of Maastricht University Medical Center on 20 September 2023 (NL84169.068.23). The results will be presented at scientific conferences and published in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER: NCT06082349.

A sensitive and versatile electrochemical sensor based on hybridization chain reaction and CRISPR/Cas12a system for antibiotic detection.

A sensitive electrochemical platform was constructed with NH2-Cu-MOF as electrochemical probe to detect antibiotics using CRISPR/Cas12a system triggered by hybridization chain reaction (HCR). The sensing system consists of two HCR systems. HCR1 occurred on the electrode surface independent of the target, generating long dsDNA to connect signal probes and producing a strong electrochemical signal. HCR2 was triggered by target, and the resulting dsDNA products activated the CRISPR/Cas12a, thereby resulting in effective and rapid cleavage of the trigger of HCR1, hindering the occurrence of HCR1, and reducing the number of NH2-Cu-MOF on the electrode surface. Eventually, significant signal change depended on the target was obtained. On this basis and with the help of the programmability of DNA, kanamycin and ampicillin were sensitively detected with detection limits of 60 fM and 10 fM (S/N = 3), respectively. Furthermore, the sensing platform showed good detection performance in milk and livestock wastewater samples, demonstrating its great application prospects in the detection of antibiotics in food and environmental water samples.

Polytherapy versus monotherapy in the treatment of tibial non-unions: a retrospective study.

BACKGROUND: Treating tibial non-unions efficiently presents a challenge for orthopaedic trauma surgeons. The established gold standard involves implanting autologous bone graft with adequate fixation, but the addition of biologicals according to the so-called diamond concept has become increasingly popular in the treatment of non-unions. Previous studies have indicated that polytherapy, which involves implanting mesenchymal stem cells, bioactive factors and osteoconductive scaffolds, can improve bone healing. This study aims to evaluate the efficacy of polytherapy compared with monotherapy in treating tibial non-unions of varying severity. MATERIALS AND METHODS: Data from consecutive tibial non-unions treated between November 2014 and July 2023 were retrospectively analysed. The Non Union Scoring System (NUSS) score before non-union surgery, and the Radiographic Union Score for Tibial fractures (RUST), scored at 1, 3, 6, 9, 12 and 18 months post-surgery, were recorded. Initially, a comparison was made between the polytherapy and monotherapy groups. Subsequently, patients receiving additional surgical non-union treatment were documented, and the frequency of these treatments was tallied for a subsequent per-treatment analysis. RESULTS: A total of 34 patients were included and divided into a polytherapy group (n = 15) and a monotherapy group (n = 19). The polytherapy group demonstrated a higher NUSS score (44 (39, 52) versus 32 (29, 43), P = 0.019, z = -2.347) and a tendency towards a higher success rate (93% versus 68%, P = 0.104) compared with the monotherapy group. For the per-treatment analysis, 44 treatments were divided into the polytherapy per-treatment group (n = 20) and the monotherapy per-treatment group (n = 24). The polytherapy per-treatment group exhibited a higher NUSS score (48 (43, 60) versus 38 (30, 50), P = 0.030, z = -2.173) and a higher success rate (95% versus 58%, P = 0.006) than the monotherapy per-treatment group. Within the monotherapy per-treatment group, the NUSS score displayed excellent predictive performance (AUC = 0.9143). Setting the threshold value at 48, the sensitivity and specificity were 100.0% and 70.0%, respectively. CONCLUSIONS: Polytherapy is more effective than monotherapy for severe tibial non-unions, offering a higher success ratio. The NUSS score supports decision-making in treating tibial non-unions. LEVEL OF EVIDENCE: Level III.

Label-free electrochemical sensing platform for sensitive detection of ampicillin by combining nucleic acid isothermal enzyme-free amplification circuits with CRISPR/Cas12a.

The residue of ampicillin (AMP) in food and ecological environment poses a potential harm to human health. Therefore, a reliable system for detecting AMP is in great demand. Herein, a label-free and sensitive electrochemical sensor utilizing NH2-Co-MOF as an electrocatalytic active material for methylene blue (MB) was developed for rapid and facile AMP detection by combining hybridization chain reaction (HCR), catalytic hairpin assembly (CHA) with CRISPR/Cas12a. The surface of glassy carbon electrode modified with NH2-Co-MOF was able to undergo HCR independent of the AMP, forming long dsDNA complexes to load MB, resulting in strong original electrochemical signal. The presence of AMP could trigger upstream CHA circuit to activate the CRISPR/Cas12a system, thereby achieving rapid non-specific cleavage of the trigger ssDNA of HCR on the electrode surface, hindering the occurrence of HCR and reducing the load of MB. Significant signal change triggered by the target was ultimately obtained, thus achieving sensitive detection of the AMP with a detection limit as low as 1.60 pM (S/N = 3). The proposed sensor exhibited good stability, selectivity, and stability, and achieved reliable detection of AMP in milk and livestock wastewater samples, demonstrating its promising application prospects in food safety and environmental monitoring.

Breast Cancer in the Tissue of the Contralateral Breast Reduction.

Breast cancer is the most prevalent malignancy among women worldwide, and the increasing number of survivors is due to advances in early diagnosis and treatment efficacy. Consequently, the risk of developing contralateral breast cancer (CBC) among these survivors has become a concern. While surgical intervention with lumpectomy is a widely used primary approach for breast cancer, post-operative breast asymmetry is a potential concern. Many women opt for symmetrizing reduction procedures to improve aesthetic outcomes and quality of life. However, despite careful radiological screening, there is a chance of accidentally finding CBC. To address this, tissue excised during symmetrizing surgery is examined pathologically. In some cases, CBC or in situ lesions have been incidentally discovered in these specimens, prompting a need for a more thorough examination. Resection in pieces and the absence of surgical marking and pathological inking of the margin have made it challenging to precisely identify tumor location and assess tumor size and margin status, hampering adjuvant treatment decisions. A new protocol introduced in July 2022 aims to enhance the precision of CBC diagnosis, allowing for tailored treatment plans, including re-excision, systemic adjuvant therapy, or radiation therapy.

Tourmaline mediated enhanced autotrophic denitrification: The mechanisms of electron transfer and Paracoccus enrichment.

Autotrophic denitrification (AD) without carbon source is an inevitable choice for denitrification of municipal wastewater under the carbon peaking and carbon neutrality goals. This study first employed sulfur-tourmaline-AD (STAD) as an innovative nitrate removal trial technique in wastewater. STAD demonstrated a 2.23-fold increase in nitrate­nitrogen (NO3--N) removal rate with reduced nitrite­nitrogen (NO2--N) accumulation, effectively removing 99 % of nitrogen pollutants compared to sulfur denitrification. Some denitrifiers microorganisms that could secrete tyrosine, tryptophan, and aromatic protein (extracellular polymeric substances (EPS)). Moreover, according to the EPS composition and characteristics analysis, the secretion of loosely bound extracellular polymeric substances (LB-EPS) that bound to the bacterial endogenous respiration and enriched microbial abundance, was produced more in the STAD system, further improving the system stability. Furthermore, the addition of tourmaline (Tm) facilitated the discovery of a new genus (Paracoccus) that enhanced nitrate decomposition. Applying optimal electron donors through metabolic pathways and the microbial community helps to strengthen the AD process and treat low carbon/nitrogen ratio wastewater efficiently.

Oxygen-doped carbon nanotubes with dual active cites to enhance •OH formation through three electron oxygen reduction.

The electro-Fenton (EF) process generates H2O2 through the 2e- oxygen reduction reaction (ORR), which is subsequently activated to •OH by iron-based catalysts. To alleviate the potential risk of external Fe-based catalysts, along with metal dissolution in acidic or neutral environments, in this study we employed oxygen-doped carbon nanotubes (OCNT) as a bifunctional, metal-free cathode to establish a metal-free EF process for organic pollutant degradation. The results demonstrate that the metal-free electrode has excellent H2O2 accumulation (12 mg L-1 cm-1) and degrades sulfathiazole (STZ) with 97.05 % efficiency in 180 min with an explanation kinetic of 0.0189 min-1. For the first time, this enhancement came from the dual active site centers in OCNT: Ⅰ) -COOH and defects active sites were responsible for H2O2 production, Ⅱ) then -CO triggered H2O2 into •OH, avoiding the introduction of metal-based catalysts. These findings suggest that the EF system with in situ oxygen-doped cathodes have great potential for treating antibiotic wastewater.

[Characteristics and Influencing Factors of Greenhouse Fluxes from Urban Lawn].

As an important component of urban green spaces, greenhouse gas uptake or emissions from urban lawns cannot be ignored. However, studies of greenhouse gas fluxes from subtropical urban lawns are relatively sparse. The static chamber-gas chromatography method was applied to monitor the ground-air exchange fluxes of various greenhouse gases(CO2, CH4, N2O, and CO) in typical urban lawns of Hangzhou City. Our results showed that the average fluxes had significant seasonal cycles but ambiguous diurnal variations. The grassland and the soil(naked soil without vegetation coverage) acted as sources of atmospheric N2O, with the average fluxes of (0.66±0.17) and (0.58±0.20) µg·(m2·min)-1 for N2O, respectively; however, they were also sinks of CH4 and CO, with the average fluxes of (-0.21±0.078) and (-0.26±0.10) µg·(m2·min)-1 for CH4 and (-6.36±1.28) and (-6.55±1.69) µg·(m2·min)-1 for CO, respectively. The average CO2emission fluxes of urban grassland and soil were(5.28±0.75) and (4.83±0.91) mg·(m2·min)-1, respectively. The correlation analysis indicated that the CO2 and N2O fluxes of grassland and soil were negatively correlated with precipitation, whereas the CH4 and CO fluxes were positively correlated with it. There was no significant correlation between grassland CH4 fluxes and soil temperature, and N2O fluxes had a significant negative correlation with soil temperature; the other greenhouse gas fluxes showed a significant positive correlation with soil temperature. In addition, the seasonal variation in CO2 (R2=0.371 and 0.314) and N2O(R2=0.371 and 0.284) fluxes from both grassland and soil was affected by precipitation, whereas CO fluxes (R2=0.290 and 0.234) were mainly driven by soil temperature compared with the other greenhouse gases.

Polystyrene microplastics trigger adiposity in mice by remodeling gut microbiota and boosting fatty acid synthesis.

Microplastic (MP) pollution has become a global environmental problem, with particular concerns for its harmful effects on human health. Several studies have demonstrated that MP can penetrate animals and humans resulting in tissue dysfunction, but their influences on metabolism remain poorly understood. In this study, we investigated the impact of MP exposure on metabolism and the results showed that different treatment doses produce a bidirectional modulatory effects on mice. When exposed to high concentrations of MP, mice lost significant weight, while those in the lowest concentration treatment group showed little change, but those treated at relatively low concentrations became overweight. There was excessive lipid accumulation in these heavier mice, with a better appetite and lower activity level. Transcriptome sequencing revealed that MPs increased fatty acid synthesis in the liver. In addition, the gut microbiota composition of the MPs-induced obese mice was remodeled, which would enhance the nutrient absorption capacity of the intestine. Our results uncovered an MP dose-dependent lipid metabolism in mice and a non-unidirectional model of the physiological responses to different MP concentrations was proposed. These results provided new insights into the seemingly contradictory effects of MP on metabolism in the previous study.

Research highlight: surgical outcomes of gluteal VY plasty after extensive abdominoperineal resection or total pelvic exenteration.

OBJECTIVE: To describe a suitable alternative technique for reconstruction of the pelvic floor after extensive resection. To review our outcomes of gluteal VY plasty in the reconstruction of the pelvic floor after extensive abdominoperineal resection (conventional or extralevator abdominoperineal resection, total pelvic exenteration, or salvage surgery). DESIGN: Retrospective cohort study. SETTING: An academic hospital and tertiary referral centre for the treatment of locally advanced or locally recurrent rectal cancer, and salvage surgery in The Netherlands. PATIENTS: Forty-one consecutive patients who underwent a pelvic floor reconstruction with gluteal VY plasty at Maastricht University Medical Centre between January 2017 and February 2021 were included. The minimum duration of follow-up was 2 years. MAIN OUTCOME MEASURES: Perineal herniation is the primary outcome measure. Furthermore, the occurrence of minor and major postoperative complications and long-term outcomes were retrospectively assessed. RESULTS: Thirty-five patients (85.4%) developed one or more complications of whom twenty-one patients experienced minor complications and fourteen patients developed major complications. Fifty-seven percent of complications was not related to the VY reconstruction. Six patients (14.6%) recovered without any postoperative complications during follow-up. Three patients developed a perineal hernia. CONCLUSIONS: A gluteal VY plasty is a suitable technique for reconstruction of the pelvic floor after extensive perineal resections resulting in a low perineal hernia rate, albeit the complication rate remains high in this challenging group of patients.

First-in-Human Integrated Use of a Dedicated Microsurgical Robot with a 4K 3D Exoscope: The Future of Microsurgery.

Innovative techniques can help overcome the limitations of the human body. Operating on very small structures requires adequate vision of the surgical field and precise movements of sophisticated instruments. Both the human eye and hand are limited when performing microsurgery. Conventional microsurgery uses operation microscopes to enhance the visualization of very small structures. Evolving technology of high-definition 3D cameras provides the opportunity to replace conventional operation microscopes, thereby improving ergonomics for surgeons. This leaves the human hand as a limiting factor in microsurgery. A dedicated robot for microsurgery has been developed to overcome this limitation and enhance the precision and stability of the surgeons' hands. We present the first-in-human case in reconstructive microsurgery where both technologies are integrated using a dedicated microsurgical robot in combination with a 4K 3D exoscope.

Critical Review on the Mechanisms of Fe2+ Regeneration in the Electro-Fenton Process: Fundamentals and Boosting Strategies.

This review presents an exhaustive overview on the mechanisms of Fe3+ cathodic reduction within the context of the electro-Fenton (EF) process. Different strategies developed to improve the reduction rate are discussed, dividing them into two categories that regard the mechanistic feature that is promoted: electron transfer control and mass transport control. Boosting the Fe3+ conversion to Fe2+ via electron transfer control includes: (i) the formation of a series of active sites in both carbon- and metal-based materials and (ii) the use of other emerging strategies such as single-atom catalysis or confinement effects. Concerning the enhancement of Fe2+ regeneration by mass transport control, the main routes involve the application of magnetic fields, pulse electrolysis, interfacial Joule heating effects, and photoirradiation. Finally, challenges are singled out, and future prospects are described. This review aims to clarify the Fe3+/Fe2+ cycling process in the EF process, eventually providing essential ideas for smart design of highly effective systems for wastewater treatment and valorization at an industrial scale.

Activated carbon filled in a microporous titanium-foam air diffusion electrode for boosting H2O2 accumulation.

In the electro-Fenton process, there still suffers concern of low H2O2 generation caused by inadequate mass transfer of oxygen and low selectivity of oxygen reduction reaction (ORR). To solve it, in this study, various particle sizes (850 µm, 150 µm, and 75 µm) of granular activated carbon filled in a microporous titanium-foam substate was used to develop a gas diffusion electrode (AC@Ti-F GDE). This facile-prepared cathode has seen a 176.15% improvement in H2O2 formation compared to the conventional one. Aside from a much higher oxygen mass transfer by creating gas-liquid-solid three-phase interfaces coupled with much high dissolved oxygen, the filled AC played a significant role in H2O2 accumulation. Among these particle sizes of AC, the one in 850 µm has observed the highest H2O2 accumulation, reaching 1487 µM in 2 h electrolysis. Because there is a balance between chemical nature for H2O2 formation and micropore-dominant porous structure for H2O2 decomposition, resulting in an electron transfer of 2.12 and H2O2 selectivity of 96.79% during ORR. In a word, the facial AC@Ti-F GDE configuration is promising for H2O2 accumulation.

A mechanism in boosting H2 generation: nanotip-enhanced local temperature and electric field with the boundary layer.

The sluggish kinetics of oxygen evolution reaction (OER) is the bottleneck of water splitting. Hence, we designed a nanowire Co3O4@nickel foam (Co3O4-NW@NF) electrode to boost OER utilizing the locally enhanced interfacial Joule heating and electric field within the diffusion layer. Results show that the morphology of Co3O4@NF could be regulated in nanowires, nanosheets, and nanoclusters by controlling the doping amount of fluoride ions (F-). F- served as a complexing agent to regulate the rate of crystal nucleus, and then morphologies could be tuned. compared to others, nanowire structures have a much lower potential (298 mV vs. RHE, 10 mA cm-2) and Tafel slope (48.11 mV dec-1). This better electrochemical performance was confirmed by the Density Functional Theory (DFT) that the (311) facet with oxygen vacancies of Co3O4 has a low onset potential (0.36 V) for the kinetic rate of OER. A much better mass transfer by the nanowire-enhanced interfacial Joule heating and electric field within the diffusion layer also accounted for superior OER activity, confirmed by COMSOL simulation. In a word, the design of the nanotip structure offers a novel way to boost the OER rate by enhancing electron transfer and mass transport simultaneously.

A rapid and simplified method for evaluating the performance of fungi-algae pellets: A hierarchical analysis model.

Microbial pellets technology has undergone extensive research recently and has increasingly matured, showing significant promise. However, the performance of microbial pellets cannot be predicted quickly by the current evaluating methods because they are complicated to operate, take a long time, and pose a risk to the environment. In this study, a representative microbial pellet, fungi-algae pellet, was selected as the research object. Eight evaluation parameters and four evaluation indices were chosen to construct the performance evaluation system of the fungal-algal pellets using the analytic hierarchy process (AHP) and weighting method. Combining the correlation analysis and expert opinion, we found that among the eight parameters selected, the adsorption saturation rate of mycelial pellets on algae had the most significant influence weight on the performance of fungi-algae pellet, followed by algal culture time and fungal incubation time. This research proposes and validates the Performance Evaluation Value (PEV) of fungi-algae pellet and its calculation method. We also discuss the effectiveness of this new evaluation system in saving time, cost, and emission reductions. The results of this paper enable the rapid evaluation of fungi-algae pellets and promote the better development of fungi-algae pellets technology and even other multi-microbial symbiotic pellet technologies.

Mott Schottky CoSx-MoOx@NF heterojunctions electrode for H2 production and urea-rich wastewater purification.

The sluggish kinetics of oxygen evolution reaction (OER) is the bottleneck of alkaline water electrolysis. The urea oxidation reaction (UOR) with much faster kinetics was to replace OER. To further promote UOR, a heterojunction structure assembled of CoSx and MoOx was established, and then its superior catalytic activity was predicted by DFT calculation. After that, an ultra-thin CoSx-MoOx@nickel foam (CoSx-MoOx@NF) electrode with a Mott-Schottky structure was prepared via a facile hydrothermal method, followed by a low-temperature vulcanization. Results highlighted CoSx-MoOx@NF electrode presented a superior performance toward UOR, OER, and H2 evolution reaction (HER). Notably, it exhibited excellent electrocatalytic performance for OER (1.32 V vs. RHE, 10 mA cm-2), UOR (1.305 V vs. RHE, 10 mA cm-2), and urea-assisted overall water splitting with a low voltage (1.38 V, 10 mA cm-2) when CoSx-MoOx@NF electrode served as both anode and cathode. It is promising to use CoSx-MoOx@NF in an electrochemical system integrated with H2 generation and urea-rich wastewater purification.

Chest wall reconstruction after the Clagett procedure and other types of open-window thoracostomy: a narrative review.

Background and Objective: The Clagett procedure is one of the last treatment options for chronic stage pleural empyema. It involves the formation of an open-window in the thoracic wall to allow for continuous drainage and irrigation of the pleural cavity. Once the empyema has been resolved, reconstruction of the chest wall is sometimes challenging. This review aims to identify and summarize the options for reconstructing soft tissue defects of the chest wall following the Clagett procedure and other types of open-window thoracostomy. Methods: A narrative review was performed of the literature on PubMed, Cochrane Library, ClinicalTrials.gov, and Google Scholar, including all relevant studies published until January 2023. Key Content and Findings: This review contains an overview of the reconstruction methods and the outcomes of the included studies on reconstructive options after the Clagett procedure and other types of open-window thoracostomy. A subdivision was made based on reconstruction type: pedicled flaps, free flaps, and the use of a vacuum-assisted closure (VAC) device. The advantages of pedicled flaps are reliable vascularization, better tissue match, reduced scarring, and shorter operation time compared to free flaps. However, when pedicled flaps are not available due to damage during previous surgeries or offer insufficient volume to obliterate the cavity, free flaps might be a solution. Conclusions: In cases where an open-window thoracostomy necessitates chest wall reconstruction, a pedicled flap is the preferred choice, followed by free flaps. Additionally, vacuum-assisted negative pressure wound therapy (VANPWT) techniques have shown potentially promising results (as an adjunct to surgical treatment).

Delphi survey of intercontinental experts to identify areas of consensus on the use of indocyanine green angiography for tissue perfusion assessment during plastic and reconstructive surgery.

BACKGROUND: In recent years, indocyanine green angiography (ICG-A) has been used increasingly to assist tissue perfusion assessments during plastic and reconstructive surgery procedures, but no guidelines exist regarding its use. We sought to identify areas of consensus and non-consensus among international experts on the use of ICG-A for tissue-perfusion assessments during plastic and reconstructive surgery. METHODS: A two-round, online Delphi survey was conducted of 22 international experts from four continents asking them to vote on 79 statements divided into five modules: module 1 = patient preparation and contraindications (n = 11 statements); module 2 = ICG administration and camera settings (n = 17); module 3 = other factors impacting perfusion assessments (n = 10); module 4 = specific indications, including trauma debridement (n = 9), mastectomy skin flaps (n = 6), and free flap reconstruction (n = 8); and module 5 = general advantages and disadvantages, training, insurance coverage issues, and future directions (n = 18). Consensus was defined as ≥70% inter-voter agreement. RESULTS: Consensus was reached on 73/79 statements, including the overall value, advantages, and limitations of ICG-A in numerous surgical settings; also, on the dose (0.05 mg/kg) and timing of ICG administration (∼20-60 seconds preassessment) and best camera angle (61-90o) and target-to-tissue distance (20-30 cm). However, consensus also was reached that camera angle and distance can vary, depending on the make of camera, and that further research is necessary to technically optimize this imaging tool. The experts also agreed that ambient light, patient body temperature, and vasopressor use impact perfusion assessments. CONCLUSION: ICG-A aids perfusion assessments during plastic and reconstructive surgery and should no longer be considered experimental. It has become an important surgical tool.

Salvage of a DIEP Flap after Injury to the Inferior Epigastric Vessels after Laparoscopic Surgery.

The problem of previous laparoscopic scars specifically endangering the DIEP flap harvest for breast reconstruction has not been described yet. Even though in our center, preoperative imaging by means of an magnetic resonance angiography (MRA) is routinely performed before a bilateral DIEP-flap reconstruction, it may not correspond with the intraoperative findings. This case was presented to increase awareness among plastic surgeons about the complications after laparoscopic surgery and to emphasize the importance of thorough history taking when performing a DIEP flap breast reconstruction after previous laparoscopic procedures.