Stromal Vascular Fraction Gel (SVF-Gel) Combined with Nanofat for Tear Trough Deformity.

BACKGROUND: Tear trough deformity makes patients appear tired. Patients with less severe tear trough deformity prefer a less invasive method to correct the deformity. The infraorbital area is a multilayered tissue, and the aging of various components leads to tear trough deformity. To this end, we utilized the different characteristics of different fat derivatives to correct tear trough deformity. METHODS: Thirty-two patients with Barton Grade I/II tear trough deformity were enrolled in this study between September 2020 and March 2021. We injected Stromal Vascular Fraction Gel (SVF-Gel) into the suborbicularis oculi fat layer and Nanofat into the subcutaneous. After 12 months of follow-up, we evaluated the changes using standardized clinical photogrammetric techniques, volume, global aesthetic improvement scale, and patient self-evaluation. RESULTS: There were no major complications in any of the 32 patients. The measured data points demonstrated improvements in all aesthetic parameters. The width of the tear trough and the distance from the pupil to the tear trough improved. The Global Aesthetic Improvement Scale (GAIS) showed a high score (2.45±0.64 points), with patient self-assessment showing satisfactory results. CONCLUSION: SVF-Gel combined with Nanofat injection can effectively correct tear trough deformities. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Midface Rejuvenation With Autologous Fat Grafting.

BACKGROUND: Midface rejuvenation is important to restore a youthful and appealing appearance. However, there are several problems existed in the treatment of fat grafting, including low fat retention and undesired aesthetic outcomes. OBJECTIVE: To objectively evaluate the efficacy of midface fat grafting, and analyze the problems encountered in this process to increase patient satisfaction. METHODS: Thirty-two patients who underwent autologous fat grafting for midface augmentation were included. Facial analysis was performed based on preoperative and postoperative photographs. Satisfaction outcome was assessed by the patient, the surgeon, and a layperson postoperatively. RESULTS: After treatment, 87.5% of the patients were assessed as satisfactory and mostly satisfactory based on facial proportion and complications. The postoperative medial cheek projection was 1.92±0.26 times the height of the preoperative one ( P <0.01). A smooth lid-cheek junction, a single convex, and ameliorated nasolabial groove were obtained. The dark coloration and wrinkles in lower eyelid were improved. The most common complication was overcorrection, which could be resolved with further treatments. CONCLUSIONS: Autologous fat grafting remains an optimal option for midface rejuvenation with satisfactory results. Most of the complications are preventable and optimal outcomes can be obtained through correct comprehension of aesthetic features and proper operations.

Experimental Study on the Biological Outcome of Auricular Cartilage and Costal Cartilage at Different Time Periods After Autologous Cartilage Rhinoplasty.

Since autologous cartilage is a good transplant material, it is widely used in various fields of clinical medicine. In this study, we collected clinical specimens obtained at different numbers of years after transplantation and used histologic staining to explore the post-transplantation changes in auricular cartilage and costal cartilage. A retrospective analysis was performed on patients who underwent primary autologous cartilage rhinoplasty and secondary rhinoplasty from 2017 to 2021, and the remaining autologous cartilage tissue after surgery was used for histologic testing. As time progressed after transplantation, the density of costal chondrocytes decreased first and then increased, while the secretion of type II collagen and extracellular matrix both decreased slightly. There was a clear boundary between the cartilage tissue and the surrounding connective tissue, and there was no ingrowth of blood vessels in the cartilage. Auricular cartilage showed a decrease in the integrity of the matrix edge. Moreover, local fibrosis was visible, and vascular ingrowth was observed at the edge of the cartilage. The content of type II collagen first increased and then decreased, and the cell secretion function was lower than that of normal chondrocytes. The results of the study suggest that the histologic outcome of elastic cartilage after transplantation is significantly different from that of hyaline cartilage. Moreover, costal cartilage was more stable than auricular cartilage after transplantation.

Biological Changes of Autologous Auricular Cartilage in Rhinoplasty.

Autologous auricular cartilage is used extensively as a good graft material in rhinoplasty. In this study, clinical specimens from patients who underwent revision rhinoplasty with auricular cartilage grafts were collected to compare the changes before and after auricular cartilage transplantation with the use of histologic, immunohistochemical, and quantitative assays. Patients who underwent revision rhinoplasty from 2018 to 2022 were analyzed. Fresh auricular cartilage left after surgery and auricular cartilage graft tissue were examined and compared. Compared with fresh auricular cartilage, local fibrosis was seen in the transplanted auricular cartilage with a slight decrease in elastic fibers, type II collagen, and extracellular matrix secretion. Quantitative assays showed a decrease in glycosaminoglycan, DNA, and total collagen content in the transplanted auricular cartilage tissue. The results of the study suggest that the histologic characteristics, cell functionality, and biochemical composition of the grafted cartilage changed to a certain extent after autologous auricular cartilage graft rhinoplasty. These results provide insights into the selection of graft/filler materials for rhinoplasty and what changes to expect.

Study on the Influence of CaO on the Electrochemical Reduction of Fe2O3 in NaCl-CaCl2 Molten Salt.

The presence of calcium-containing molten salts in the electrolysis of oxides for metal production can lead to the formation of CaO and, subsequently, the generation of intermediate products, affecting the reduction of metals. To investigate the impact of CaO on the reduction process, experiments were conducted using a Fe2O3-CaO cathode and a graphite anode in a NaCl-CaCl2 molten salt electrolyte at 800 °C. The electrochemical reduction kinetics of the intermediate product Ca2Fe2O5 were studied using cyclic voltammetry and I-t curve analysis. The phase composition and morphology of the electrolysis products were analyzed using XRD, SEM-EDS, and XPS. The experimental results demonstrate that upon addition of CaO to the Fe2O3 cathode, Ca2Fe2O5 is formed instantly in the molten salt upon the application of an electrical current. Research conducted at different voltages, combined with electrochemical analysis, indicates that the reduction steps of Ca2Fe2O5 in the NaCl-CaCl2 molten salt are as follows: Ca2Fe2O5 ⟶ Fe3O4 ⟶ FeO ⟶ Fe. The presence of CaO accelerates the electrochemical reduction rate, promoting the formation of Fe. At 0.6 V and after 600 min of electrolysis, all of the Ca2Fe2O5 is converted into Fe, coexisting with CaCO3. With an increase in the electrolysis voltage, the electrolysis product Fe particles visibly grow larger, exhibiting pronounced agglomeration effects. Under the conditions of a 1 V voltage, a study was conducted to investigate the influence of time on the reduction process of Ca2Fe2O5. Gradually, it resulted in the formation of CaFe3O5, CaFe5O7, FeO, and metallic Fe. With an increased driving force, one gram of Fe2O3-CaO mixed oxide can completely turn into metal Fe by electrolysis for 300 min.

Analysis of Factors Affecting Postoperative Drainage After Comprehensive Rhinoplasty.

This study aimed to explore and analyze the factors influencing the drainage volume after comprehensive rhinoplasty. The clinical data of 102 patients who underwent comprehensive rhinoplasty at Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine from August 2019 to August 2021 were retrospectively analyzed. The effects of age, sex, body mass index, whether an osteotomy was performed, and whether a nasal septum flap was obtained on the indwelling time of the drainage tube after the operation were analyzed by single factor analysis and multiple logistic regression analysis. Age, body mass index, whether it was a primary rhinoplasty, whether an osteotomy was performed, and whether a nasal septum flap was obtained were the influencing factors for drainage time after augmentation rhinoplasty ( P <0.05). Sex had little effect on the drainage time after comprehensive rhinoplasty ( P >0.05). Body mass index, whether an osteotomy was performed and whether a nasal septum flap was obtained were the independent influencing factors for the postoperative drainage time ( P <0.05). For patients with multiple independent influencing factors, individualized management during the perioperative period should be promoted, and reasonable treatment strategies should be formulated, so as to reduce the indwelling time of the drainage tube after the operation.

Eyelid Lymphatics: An Anatomical Study by Microdissection.

OBJECTIVE: To obtain further understanding of the eyelid lymphatic anatomy. METHOD: Thirty-two halves of eyelids from 16 fresh fetus cadavers were studied by microdissection using a mixture of 3% Prussian blue and chloroform to visualize the lymphatic vessels. RESULTS: Three layers of lymphatic plexuses were demonstrated in the eyelids: a superficial or preorbicularis muscle plexus; a pretarsal or postorbicular muscle plexus; and a deep or posttarsal plexus. Furthermore, communicating branches among these plexuses were also spotted. CONCLUSIONS: The study results demonstrated the topographic distribution of the eyelid lymphatic vessels and confirmed the existence of communicating branches. This discovery will be conducive to understanding the route and mechanism by which inflammation of the eyelid spreads and cancer disseminates. It also provides anatomical insights to apply during eyelid surgery with regard to the prevention of possible eyelid lymphatic injury.

Emulsified Fat Grafting Accelerates Tissue Expansion: An Experimental Study in a Rat Model.

INTRODUCTION: Tissue expansion has been applied in tissue repair and reconstruction of large soft tissue defects. Stromal vascular fraction (SVF) transplantation is a promising treatment in raising expansion efficiency. However, the clinical utilization of SVF is limited because of its conventional collagenase-based production. The aim of this study was to evaluate the effect of emulsified fat (EF), SVF obtained by using mechanical method, on accelerating tissue expansion. MATERIALS AND METHODS: The microstructure of EF fragments and the proportion of mesenchymal stem cells (MSCs; CD45-/CD34+) in EF were detected. Wistar rats were divided into the following 3 groups randomly: the 1-mL EF group, the 0.5-mL EF group, and the control group. The tissue expansion was carried out twice a week to maintain the capsule pressure at 60 mm Hg. After 4 weeks, inflation volume and histological changes, which includes collagen content, cell proliferation, and capillary density, were observed to evaluate the effect of EF on tissue expansion. RESULTS: Mechanical emulsification effectively destroyed the mature adipocytes in adipose tissue. The proportion of MSCs population in the EF fragments was 12.40 ± 0.86%. After expansion, the inflation volume and the levels of collagen deposition, cell proliferation, and capillary density of the expanded tissue in the 1-mL EF group were significantly higher than that in the 0.5-mL EF group and the control group (P < 0.05). However, all these regenerative indicators in the 0.5-mL EF group showed no statistical difference from the control group (P > 0.05). The thickness of epidermal and dermal layers showed no significant difference among the 3 groups (P > 0.05). CONCLUSIONS: Our findings suggested that EF grafting can be used as a new alternative to increase tissue expansion efficiency.

Magnetic Resonance Lymphography of Lymphatic Vessels in Upper Extremity With Breast Cancer-Related Lymphedema.

BACKGROUND: Magnetic resonance lymphangiography (MRL) has been proven to be able to visualize pathological lymphatic networks and accompanying complications through subcutaneous injection of commonly used contrast agents. However, no comprehensive prior studies have previously been reported regarding MRL for the evaluation of upper extremity lymphedema in patients with breast cancer-related lymphedema (BCRL). In this study, we establish a novel MRL protocol to characterize the normal and abnormal characteristics of different clinical stages of BCRL in patients using high-spatial-resolution MRL. METHODS: Fifty females with unilateral upper extremity BCRL underwent MRL. Lymphatic vessel morphology in normal and affected limbs was compared. The appearance, distribution pattern, morphologic characteristics, and maximum transversal diameter of the lymphatic vessels, dermal backflow, and regeneration of lymphatic vessels were analyzed. RESULTS: Lymph fluid was retained in the subcutis of the affected limbs, and no edema was observed in the subfascial compartment. In stage 1, tortuous and dilated lymphatic vessels exhibited a beaded appearance, and their diameters were larger than those in the contralateral forearm (P < 0.05). In stage 2, the dilated lymphatic vessels exhibited larger diameters. "Dermal backflow" and tiny regenerated lymphatic vessels appeared. The thickened subcutaneous tissue showed a honeycomb pattern induced by soft tissue fibrosis and adipose hypertrophy. In stage 3, disordered and unrecognizable affected lymphatic vessels were observed with many small regenerated lymphatics and confluent dermal backflow; the tissue fibrosis was more serious. CONCLUSIONS: Each stage presents different characteristics, and the deformity degree of the lymphatic network is consistent with the severity of the disease. Magnetic resonance lymphangiography could provide adequate information for clinical staging in patients with BCRL.

IL-7 enhances the differentiation of adipose-derived stem cells toward lymphatic endothelial cells through AKT signaling.

Our study was designed to investigate the effects of IL-7 during the differentiation process of adipose-derived stem cells (ADSCs) toward lymphatic endothelial cells (LECs). IL-7 was added to the traditional induced medium, which was called the IL-7 (+) group, while the group that used traditional induced medium was called the IL-7 (-) group. After 7 days of induction of ADSCs, a comprehensive analysis was conducted between these two groups. We examined the changes in Prox1, LYVE-1, Podoplanin and VEGFR-3 on the RNA and protein level and found that the expression of LEC markers in the IL-7 (+) group was higher than in the IL-7 (-) group. The characteristics of differentiated cells were confirmed by flow cytometry and immunofluorescence. At the same time, we detected the MAPK/ERK and PI3K/AKT pathway involved in the differentiation process, and we found that the phosphorylation of AKT increased, however the expression of ERK was not significantly changed. In conclusion, our study found that IL-7 could improve the differentiation efficiency of ADSCs toward LECs through AKT signaling pathways.

Safe extensive tumescent liposuction with segmental infiltration of lower concentration lidocaine under monitored anesthesia care.

Tumescent anesthesia makes it feasible to perform liposuction in an office setting. There are often patients who desire extensive liposuction on approximately 30% of total body surface area, which means the lidocaine total dose might be over the dosing recommendation. So the segmental infiltration is applied, although the concentration of lidocaine in tumescent fluid is gradually reduced to 0.0252%. Moreover, supplemental intravenous (IV) sedation using monitored anesthesia care is usually applied concurrently to help alleviate discomfort and pain of the patients during tumescent anesthetic infusion and fat extraction which in turn increases the risks of potential lidocaine toxicity due to possible drug interactions. This study was to demonstrate the safety of segmental infiltration of tumescent fluid with lower lidocaine concentration combined with IV sedation in extensive liposuction and determine whether the risk of lidocaine toxicity is increased in this protocol. Ten female patients who requested the extensive liposuction participated in the study. The targeted areas were divided into 2 segments and treated in turn in 1 session. Lidocaine (1600 mg) was infiltrated into the first segment, and approximately 928 mg lidocaine was subsequently infiltrated after accomplishment of the first segment operation. Serum levels of lidocaine were taken every 4 hours during the first 24 hours after the second infiltration. The average time of the procedure is 222 (33) minutes. The dose and total amount of lidocaine injected are 40.7 (5.8) mg/kg and 2528.2 (155.2) mg, respectively. The total volume of the infusates and aspirates are 9918.1 (494) and 6325 (1461.6) mL, respectively, the ratio of total infusates to total aspirates is 1.66 (0.45). The total aspirated fat and fluids are 3280 (1051.8) and 3045 (824.1) mL, respectively. The peak lidocaine levels [2.18 (0.63) µg/mL] occurred after 12 to 20 hours [16.4 (2.27) hours]. No significant correlation between dose per kilogram body weight or total dose of lidocaine infiltrated and its peak levels or time existed. The extensive liposuction covering the 30% total body surface areas was well tolerated by the patients under tumescent anesthesia in combination with the supplemental IV sedation. Our previous study on the fluid management has demonstrated the risk of hypovolemia or fluid overload is very low with this technique, although the patients who received only maintenance fluid (500 mL) in the operating room and could discharge and resume oral intake after 6 hours of recovery room stay. The adequate anesthesia support is available in our office-based setting with adequate recovery facilities in place. It has a high margin of safety, without increasing of lidocaine toxicity or adverse cardiopulmonary sequelae while using a segmental tumescent infiltration with lower concentration of lidocaine.

Coimplanted endothelial cells improve adipose tissue grafts' survival by increasing vascularization.

BACKGROUND: With goal of improving fat graft survival, many studies have focused on supplementing cells in the graft fat. In these studies, enhanced vascularization is considered the most important mechanism for the improved graft survival. Endothelial cells (ECs) are essential in vessel formation of the vascularization. Therefore, in this study, we coimplanted ECs with adipose tissue to investigate whether the ECs can enhance graft survival in a cell concentration-dependent manner. METHODS: Endothelial cells were isolated from stromal vascular fraction derived from human liposuction aspirates, and the EC characteristics were confirmed by CD31 immunofluorescence staining, measuring acetylated low-density lipoprotein uptake, and observing the formation of capillary-like tubular structures in Matrigel. During the animal experiment, the isolated ECs were labeled, then added to 0.5-mL fat grafts at different numbers (0.5 × 10(6), 1 × 10(6), 2 × 10(6), and 4 × 10(6) cells) before subcutaneous implantation in nude mice. Grafts were harvested at 1 week, 1 month, and 2 months after -transplantation, and graft survival and vascularization were evaluated based on weight measurements, histological assessment, and vascular gene expression. RESULTS: Stromal vascular fraction-derived vascular cells exhibited typical EC characteristics. The observed differences in explanted graft weight, vessel density, vascular gene expression, and cell tracking result indicated that coimplantation with ECs accelerated vascularization that increased graft survival in a concentration-dependent manner. Over the experimental period, fat grafts implanted with 4 × 10(6) ECs showed no weight loss and the greatest increases in measures of vascularization. CONCLUSIONS: Endothelial cells can effectively enhance vascularization in fat grafts, and higher EC concentrations (eg, 4 × 10(6) ECs/0.5 mL adipose tissue) may best support graft survival.

Emergency management of traumatic total scalp avulsion with microsurgical replantation.

Total scalp avulsion is a rare but serious injury often resulting in defects of the hair-bearing skin, and it may even be life-threatening. Microsurgical hair-bearing scalp replantation is the first choice for the treatment of scalp avulsion. In this article, we describe the microsurgical replantation of two cases with total scalp avulsion. The avulsed scalp involved the hairy scalp, forehead, eyelids, ears, and part of the face. Initial management in the emergency department (ED) included correction of hemorrhagic shock with early blood transfusion, intravenous rehydration, and wound compression after rapid physical examination. A full trauma and preoperative workup prior to attempts at replantation needs to be performed to exclude any associated life-threatening injuries. Good form and function of the completely avulsed tissues and organs were achieved in both cases. Successful replantations can achieve the best esthetic and functional results when compared with other procedures. In addition to the microsurgical technique, preoperative evaluation and preparation in the ED are considered to be an important part of the successful salvage of the avulsed scalp.

Liposculpture and fat grafting for aesthetic correction of the gluteal concave deformity associated with multiple intragluteal injection of penicillin in childhood.

BACKGROUND: The gluteal concave deformity, a complication of repeated intragluteal injections in childhood, is a relatively common complaint of many young women in China. This issue could be addressed by lipofilling, as the method could produce aesthetically acceptable results in correcting soft tissue contour defects. METHODS: Twelve patients with bilateral gluteal concave deformities associated with repeated intragluteal injections were operated on from June 2006 to June 2010. The deformities were classified as major or minor. Overall satisfaction with body appearance after gluteal fat grafting and liposculpture was rated on a scale of 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). The evaluation was performed at 3-44 months after surgery. RESULTS: The average volume of fat injected was 196.9 ± 41.4 ml. No serious adverse events occurred. One patient with major deformity had one additional fat grafting procedure. One patient developed cellulitis in the feet and lower legs, upon which the grafted areas were incised and drained on suspicion of infection but with negative cultures. The patient recovered uneventfully with intravenous antibiotic application for 7 days. At the office visit nine cases judged that their appearance after the operation as "very good" (4) to "excellent" (5) and three cases responded that their contour was "good." Improvement in skin texture and alleviation of the pigmentation in the concave area were observed in all cases during the 3-44-month follow-up intervals after the fat grafting, and softening of the hypertrophic scar was also observed as early as 1 month after the fat grafting and continuously improved during the 12-month follow-up. CONCLUSION: Autologous lipografting for gluteal concave deformity, combining a liposculpture procedure adjacent to the defects, accomplishes good aesthetic results with high patient satisfaction. The key to success is complete release of fibrosis adhesion, meticulous manipulation of fat grafts, and multitunnel and multiplane injections to ensure maximum take of the grafts. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Buttock Augmentation with Fat Grafting.

Refined buttock augmentation with fat grafting in Chinese women during the past decade is introduced. The ideal buttock contouring outcome and figure silhouette come from the proper individualized plan and meticulous maneuvers through fat grafting to the buttocks combined with liposuction procedures on the surrounding areas of the buttocks as well as on the other body parts. The fat grafts are collected, filtered, and condensed by gravitation in a sterilized canister during liposuction. It is recommended that fat grafts were only transplanted into the subcutaneous layers and with no injection into the musculatures of the buttocks. High patients' satisfaction was obtained with no major complications and fewer minor complications.

Novel method for correcting cephalic rotation in Asian nasal tip plasty.

BACKGROUND: To correct nasal tip cephalic rotation, SEG made of cartilage or Medpor are often used in rhinoplasty. These techniques require extensive experience for the surgeon, and not all patients can accept this procedure. In this research, we introduce a new method to correct nasal tip cephalic rotation that is relatively simple and rapid. METHODS: Fifty-nine patients who had rhinoplasty using our scaffold were enrolled in the study between January 2020 and January 2021. The authors evaluated the change of nasolabial angel by photogrammetry using standardized clinical photogrammetric techniques. Patients' satisfaction regarding postoperative results was also surveyed. RESULTS: The mean postoperative follow-up duration was 12 months. No complication (infection, extrusion, and displacement) was happened in all patients. Analysis showed our scaffold can correct nasal tip cephalic rotation effectively (98.61±1.21 preoperatively and 89.68±0.99 postoperatively, P<0.0001). And the patient satisfaction rate is 98%. CONCLUSION: We constructed an integrated scaffold by simply folding and suturing a high-density polyethylene sheet (Su-Por) sheet to correct nasal tip cephalic rotation. Using the scaffold we designed, we did not need to alter the structure of the nasal septum, which reduced the operative duration and simplified the surgical procedure.

Long-term volume retention after fat processing with cotton gauze rolling and centrifugation: A comparative study in nude mice.

BACKGROUND: Autologous fat grafting for correcting soft-tissue defects in cosmetic and reconstructive procedures has grown in popularity. Fat processing is implicated as a variable affecting quality, viability, and subsequent graft retention. This study aimed to identify a better fat processing technique for optimal outcomes. METHODS: Fresh human aspirated fat was processed with cotton gauze rolling or centrifugation and named rolled fat (RF) and centrifuged fat (CF), respectively. Processed fat grafts were analyzed in vitro to determine yield, stromal vascular fraction (SVF) content, and viability. Then, RF and CF were transplanted subcutaneously to different flanks of every nude mouse. Fat samples were weighed to evaluate the volume retention 3 months post-transplantation. Tissue structure, densities of vessels, and CD68-positive macrophages were examined by histological staining. RESULTS: The compression rate of lipoaspirate by cotton gauze rolling was 25%, which was more effective than the rate of 50% by centrifugation. The numbers of SVF cells per gram of RF and CF were (1.02 ± 0.14) ×106 and (0.65 ± 0.26)×106, respectively (P < 0.05). Long-term graft retention was significantly higher in the RF group than in the CF group. Histological analysis of all implants revealed intact adipose tissue and equivalent vascularity. The number of CD68-positive macrophages in the RF group was much less than in the CF group on day 7. CONCLUSION: The results of this animal experiment showed that, compared with centrifugation, processing with cotton gauze rolling produces more condensed fat, higher SVF content, and decreased inflammatory response, thereby improving long-term volume retention. Further explorations are required to verify the superiority of cotton gauze rolling in clinical settings.

Horizontal and vertical distribution of microplastics in dam reservoir after impoundment.

In freshwater ecosystems, microplastics (MPs) are commonly found in reservoirs. However, limited information is available on the distribution of MPs in the reservoirs. In this study, we investigated the horizontal and vertical distribution characteristics of MPs in the Guanyingyan reservoir (the upper reaches of the Yangtze River, China) after impoundment and the influence of free-floating plant residues on the distribution of MPs. Results indicated that the MPs abundance in the horizontal distribution of the reservoir decreased significantly while the distance from the dam increased. The abundance of MPs in shoreline waters (average: 8.45 items L-1) was significantly higher than that in central waters (average: 4.80 items L-1). As for the vertical distribution, the percentages of fibers in the three water layers (surface, intermediate, and deep) have less variation when compared to other types of MPs. Besides, MPs who are less than 0.5 mm in size are the majority. With deeper underwater, there would be more MPs with particles smaller than 200 µm in size. At the same time, there would be fewer MPs with particles ranging from 200 to 500 µm in size. PS, PP, and PE are the main polymer types of surface water, while PVC, PE, and PET are the common type in deep water. In shoreline water, the dry weight of floating plant residues showed a positive correlation with microplastic abundance in different layers. As above said, this study confirmed that MPs in reservoirs after impoundment would tend to accumulate in the front section of the reservoir and the shoreline water. Besides, free-floating plant residues would accumulate in reservoirs, resulting in the sinking of MPs.

Tumescent liposuction: partitioning of lidocaine at a lower dose (252 mg/l).

BACKGROUND: The popularity of large-volume liposuction and the toxicity of lidocaine have led to a reduction of lidocaine dosage in tumescent liposuction. We have gradually reduced the concentration of lidocaine from 500 to 252 mg/l over the past decade. OBJECTIVE: To evaluate the partitioning and the recovery of lidocaine at a lower concentration in tumescent liposuction. METHODS: 10 consecutive patients' aspirate samples were analysed for the lidocaine concentration in the fat and the fluid component, the percentage of injected lidocaine removed by aspiration and its partition coefficient in fat versus fluid. RESULTS: 7.5% of the injected lidocaine was removed; its partition coefficient was 0.21. CONCLUSION: 7.5% of the total lidocaine was aspirated in tumescent liposuction. The fat uptake of lidocaine was lower than in previous reports, which was of particular interest for future studies on lidocaine toxicity for the safety of the patients undergoing tumescent liposuction.

Surgical reconstruction of massive scrotal lymphedema associated with hidradenitis suppurativa: a case report.

Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory cutaneous disease affecting apocrine glands. It can be associated with lymphedema of the surrounding tissues and most commonly affects scrotum. As a debilitating complication of HS, lymphedema can cause significant morbidity and further exacerbate HS condition, thus causing a vicious cycle. Surgery was reported to be the most common treatment for this complication. Here, we present a 41-year-old patient with massive scrotal lymphedema following a 2-year history of HS. To reduce the volume of the scrotal mass and improve the appearance and function of the scrotum, we modified the Charle's procedure by complete excision of the affected tissue while retaining the scrotal septum, preserving the subcutaneous lymphatic tissue flap, turnover of the perididymis, and primary closure. We found that this approach achieved satisfactory cosmetic results, maintained cutaneous sensation and restored erections. There was no adverse event following surgery. No recurrence occurred over 6-month of follow-up. We believe that this modified Charles' procedure can improve the morphology and lymphatic function of the scrotum and recommend its use whenever possible. While rare, HS associated lymphedema should alert clinician to the potential consequence of an advanced disease situation. Collaborative approach with surgery in the management of this condition should be considered at early stage.