Can we reduce excision margins for head and neck melanoma? A 12-year retrospective study.

Although wide local excision is the standard treatment for primary melanoma, the surgical margin remains controversial. Melanomas of the head and neck exhibit higher recurrence rates and worse prognosis than lesions in other body locations, and their close proximity to critical anatomical and functional structures means that wide excision margins are often not feasible. Surgeons must therefore achieve a balance of oncological safety and functional and aesthetic needs. The aim of this study was to retrospectively analyse melanoma data over a 12-year period at a large skin surgery unit to identify potential differences in outcomes in patients who had reduced wide local excision margins for primary head and neck melanoma. The study would provide further evidence for the need for large randomised prospective trials to reduce excision margins for head and neck melanoma. Local cancer network data were retrospectively analysed over a period of 12 years (2008-2019). Data included site, initial stage, multidisciplinary team (MDT) meeting recommendations for excision margins and the actual wide local excision margin taken, recurrence rate, and disease-specific and absolute survival. A total of 222/305 patients (73%) had the recommended excision margin, while in 27% margins were reduced due to anatomical or functional considerations. Recurrence rates were similar (recommended 11.7% vs narrow 13.3% excision margins) (p = 0.64). The mean follow-up time for all patients was 48.5 months. In aesthetically and functionally sensitive areas of the head and neck, wide local excision margins need to be carefully considered after MDT discussion and discussion with the patient. This study suggests the need for further multicentre trials to address the uniqueness of head and neck melanoma.

Upgrading constructed wetlands phosphorus reduction from a dairy effluent using electric arc furnace steel slag filters.

In 2003, a subsurface flow constructed wetlands (SSF-CW) system was built at the University of Vermont (UVM) Paul Miller Dairy Farm as an alternative nutrient management approach for treating barnyard runoff and milk parlour waste. Given the increasing problem of phosphorus (P) pollution in the Lake Champlain region, a slag based P-removal filter technology (PFT) was established (2004) at the CW with two objectives: (i) to test the filters' efficiency as an upgrade unit for improving P removal performance via SSF-CW (ii) to investigate the capacity of filters technology to remove P as a "stand alone" unit. Six individual filters (F1-F6) were filled with electric arc furnace (EAF) steel slag, each containing 112.5 kg of material with a pore volume of 21 L. F1-F4, fed with CW treated water, received approximately 2.17 g DRP kg(-1) EAF steel slag (0.25 kg DRP total) during the 259 day feeding period. F1-F4 retained 1.7 g DRP kg(-1) EAF steel slag, resulting in an average P removal efficiency of 75%. The addition of filters improved CW DRP removal efficiency by 74%. F5 and F6, fed non-treated water, received 1.9 g DRP kg(-1) EAF steel slag (0.22 kg DRP in total) and retained 1.5 g DRP kg(-1) resulting in a P removal efficiency of 72%. The establishment of the EAF slag based PFT is the first in-field evaluation of this technology to reduce P from dairy farm effluent in Vermont.

Synovial chondromatosis of the temporomandibular joint with extension into the middle cranial fossa and internal carotid canal.

This report presents the case of an extensive synovial chondromatosis of the temporomandibular joint (TMJ), with extension into the middle cranial fossa, middle ear, and carotid canal. Synovial chondromatosis of the TMJ is rare, particularly when associated with intracranial involvement. This case is unique owing to its size and the involvement with the internal carotid artery. The importance of a multidisciplinary approach in the surgical management of such a rare and complex form of this condition is highlighted.

Experimental study on dieless drawing of Nickel-Titanium alloy.

The effect of a dieless drawing process on commercial grade Nickel-Titanium rods, of 5 mm diameter, was investigated by varying the established critical process parameters of temperature, cooling rate, drawing velocity, and heating/cooling velocity. The rods were successfully dieless drawn with a maximum steady state reduction in cross-sectional area of 54%. The thermal and mechanical loading profiles of the rod during processing, and the resulting changes in microstructure and hardness, have been investigated. Uniform levels of stress and strain resulted in uniform reduction of the rod cross-sectional area. The grain structure was highly deformed in the drawing direction and increased porosity was observed as a result of the process. The longitudinal section hardness of the rod was significantly reduced as a result of the dieless drawing process. Any failures that arose were due to discontinuities within the material microstructure caused by a high necking rate, shorter exposure time to the process temperature and low heating and cooling rates. A uniform oxidation layer was observed on the surface of the processed rods as a result of processing in atmospheric conditions. This oxidation layer has the potential to aid in the lubrication of subsequent cold working operations of the dieless drawn rods. Coupling the thermomechanical effects of the dieless drawing process with a cold drawing processing step has the potential to produce a NiTi wire in fewer passes, and therefore at a reduced cost.