Photometric Comparison of Skin Color Match between Abdominal- and Thigh-Based Free Flaps for Breast Reconstruction in Caucasian Patients".

BACKGROUND: With the increasing demand for autologous breast reconstruction, different surgical techniques have emerged to provide patients with the best possible result tailored to their individual needs. The upper thigh provides an alternative tissue resource in patients where abdominal based flaps are not feasible. While surgical outcomes and donor-site morbidity demonstrate favorable results using abdominal as well as thigh based free flaps for autologous breast reconstruction, the differences in skin constitution and color between the two flap donor-sites have not been investigated. METHODS: From our flap data base, 60 patients who underwent unilateral secondary breast reconstruction with free DIEP or TMG flaps where randomly selected from our database. In both cohorts, postoperative pictures were used for photometric color evaluation of the reconstructed breast using the Delta E 2000 score at Time A (1.5 - 3 months), Time B (6 - 8 months) and Time C (12 - 20 months). Standard univariate descriptive statistics and group comparisons were performed. RESULTS: The DIEP flap demonstrated a better skin color match at Time A (p < 0.001), Time B (p = 0.003) and Time C (p = 0.009). Over time, both flaps showed improved Delta E 2000 values, and patient age was only associated with higher Delta E 2000 values in TMG flaps after 1.5 - 3 months (p = 0.021). CONCLUSION: The study provides the first objective analysis of skin color match in secondary autologous breast reconstruction. The DIEP flap reconstruction shows a preferable color match compared to the TMG flap. Both free flaps demonstrate an improved skin color match 12 - 20 months after secondary breast reconstruction.

Functional outcomes after single quadriceps muscle resection in patients with soft tissue sarcoma of the anterior compartment of the thigh.

BACKGROUND: Soft tissue sarcoma (STS) occurs most commonly in the anterior compartment of the thigh. Limb salvage surgery is the mainstay of treatment, however, resections frequently involve muscle sacrifice. This study determines the impact of a single quadriceps muscle sacrifice on daily living functions. This is to assist clinical decision-making relating to when a functional reconstruction should be offered over simple soft tissue coverage for these defects. METHODS: Patients who underwent single quadriceps resection as part of the management of STS between 2010 and 2020 were selected. Three functional tests were performed: Time Up and Go (TUG), Timed Up and Down Stairs (TUDS) and Toronto Extremity Salvage Score (TESS). The results were compared with age/sex matched healthy reference values and literature cohorts of lower limb STS patients. Correlations between the tests and age and follow-up duration were determined by the Spearman's test. RESULTS: The mean TESS, TUG and TUDS results of the 13 patients were 89.6%, 9.8 and 1.01 s/step, respectively. These scores were either similar or significantly better than the comparator values. The TESS score showed no statistical significance compared with patients with no muscle resection. TUG and TUDS scores showed significant positive correlation with each other (ρ = 0.885, P = <0.01) and with age (ρ = 0.646, P = 0.017 and ρ = 0.567, P = 0.043, respectively). CONCLUSION: This is the largest documented case series of single quadriceps resection for STS. The study suggests that this group of patients does not show a functional deficit and therefore does not require functional reconstruction.

A single centre audit: repeat pre-operative colonoscopy.

BACKGROUND: Repeat colonoscopy may be required for tumour localisation. The aim of the study is to explore the clinical settings it was used and benchmark the quality of initial colonoscopy against standardized guidelines for tumour localisation, tattooing and colonoscopy reporting amongst clinicians. METHODS: A retrospective study from 2016 to 2021 has been performed on patients who underwent elective colorectal cancer resections at the Northern Hospital. Patient demographics, colonoscopic and operative details were retrieved from the Bi-National Colorectal Cancer Audit (BCCA) Registry database and hospital medical records. PRIMARY OUTCOMES: changes in operative approach and delays to operation. SECONDARY OUTCOMES: reasons for a repeat colonoscopy and complications from repeat colonoscopy. RESULTS: A total of 339 patients were included in this study. 94 (28.6%) underwent a repeat colonoscopy. Re-scoping rate was 29.6% for surgeons, and 26.2% for non-operating endoscopists. Surgeons had a 5.9% localisation error rate, and non-operating endoscopist 6.95% (p = 0.673). Surgeons did not have a lower rate of repeat colonoscopy (p = 0.462). Repeat endoscopy was associated with a longer time to definitive operation (p < 0.001). No complications were associated with a repeat colonoscopy. CONCLUSION: There was no difference in localisation error rates or repeat colonoscopy amongst surgeons (29.6%) and non-operating endoscopists (26.2%) (p = 0.462). This could be explained by the standardized endoscopy training in Australia governed by a common training board. Lack of tattooing at index colonoscopy and inadequate documentation often led to a repeat endoscopy, which was associated with a longer time to definitive operation. Standardized guidelines in tattooing of lesions and colonoscopy reporting should be implemented.

Landscape Evolution and Simulation of Rural Settlements around Wetland Park Based on MCCA Model and Landscape Theory: A Case Study of Chaohu Peninsula, China.

As a transitional zone between urban and rural areas, the peri-urban areas are the areas with the most intense urban expansion and the most frequent spatial reconfiguration, and in this context, it is particularly important to reveal the evolution pattern of rural settlements in the peri-urban areas to provide reference for the rearrangement of rural settlements. The study takes five townships in the urban suburbs, and explores the scale, shape, spatial layout, and spatial characteristics of the urban suburbs of Hefei from 1980 to 2030 under the influence of urban-lake symbiosis based on spatial mathematical analysis and geographical simulation software. The study shows that: (1) the overall layout of rural settlements in the study area is randomly distributed due to the hilly terrain, but in small areas there is a high and low clustering phenomenon, and the spatial density shows the distribution characteristics of "high in the east and low in the west"; (2) since the reform and opening up, there are large spatial differences in the scale of rural settlements in the study area. (3) Different development scenarios have a strong impact on the future spatial pattern of rural settlement land use within the study area, which is a strong reflection of policy.

Spatiotemporal variations in the incidence of bacillary dysentery and long-term effects associated with meteorological and socioeconomic factors in China from 2013 to 2017.

Bacillary dysentery is a global public health problem that exhibits manifest spatiotemporal heterogeneity. However, long-term variations and regional determinant factors remain unclear. In this study, the Bayesian space-time hierarchy model was used to identify the long-term spatiotemporal heterogeneity of the incidence of bacillary dysentery and quantify the associations of meteorological factors with the incidence of bacillary dysentery in northern and southern China from 2013 to 2017. GeoDetector was used to quantify the determinant powers of socioeconomic factors in the two regions. The results showed that the incidence of bacillary dysentery peaked in summer (June to August), indicating temporal seasonality. Geographically, the hot spots (high-risk areas) were distributed in northwestern China (Xinjiang, Gansu, and Ningxia) and northern China (including Beijing, Tianjin, and Hebei), whereas the cold spots (low-risk areas) were concentrated in southeastern China (Jiangsu, Zhejiang, Fujian, and Guangdong). Moreover, significant regional differences were found among the meteorological and socioeconomic factors. Average temperature was the dominant meteorological factor in both northern and southern China. In northern and southern China, a 1 °C increase in the average temperature led to an increase of 1.01% and 4.26% in bacillary dysentery risk, respectively. The dominant socioeconomic factors in northern and southern China were per capita gross domestic product and the number of health technicians, with q statistic values of 0.81 and 0.49, respectively. These findings suggest that hot, moist, and overcrowded environments or poor health conditions increase the risk of bacillary dysentery. This study provides suggestions and serves as a basis for surveillance efforts. Further, the suggestions may aid in the control of bacillary dysentery and in the implementation of disease prevention policies.

Spatiotemporal heterogeneity of PM2.5 and its relationship with urbanization in North China from 2000 to 2017.

Fine particulate matter (PM2.5) pollution is becoming an increasing global concern due to rapid urbanization and socioeconomic development, especially in North China. Although North China experiences poor air quality and high PM2.5 concentrations, their spatial heterogeneity and relationship with the relative spatial risks of air pollution have not been explored. Therefore, in this study, the temporal variation trends (slope values) of the PM2.5 concentrations in North China from 2000 to 2017 were first quantified using the unitary linear regression model, and the Bayesian space-time hierarchy model was introduced to characterize their spatiotemporal heterogeneity. The spatial lag model was then used to examine the determinant power of urbanization and other socioeconomic factors. Additionally, the correlation between the spatial relative risks (probability of a region becoming more/less polluted relative to the average PM2.5 concentrations of the study area), and the temporal variation trends of the PM2.5 concentrations were quantified using the bivariate local indicators of spatial association model. The results showed that the PM2.5 concentrations increased during 2000-2017, and peaked in 2007 and 2013. Spatially, the cities at high risk of PM2.5 pollution were mainly clustered in southeastern Hebei, northern Henan, and western Shandong where the slope values were low, as demonstrated by the value of Moran's I (-0.56). Moreover, urbanization and road density were both positively correlated with PM2.5 pollution, while the proportion of tertiary industry was negatively correlated. Furthermore, a notable increasing trend was observed in some cities, such as Tianjin, Zaozhuang, Qingdao, and Xinyang. These findings can contribute to the development of effective policies from the perspective of rapid urbanization to relieve and reduce PM2.5 pollution.