Microsurgical replantation after forehead avulsion - success or failure? A case report.

In this article we would like to present, to our best knowledge, the very first published replantation of a forehead/part of a forehead as a single unit. The patient is a 57-year-old male smoker who sustained an avulsion forehead injury after a dog bite. Replantation was performed using microanastomosis of the supratrochlear vessels with restoration of good blood circulation after the procedure. Unfortunately, 5 days after the surgery, ischemia of the flap occurred followed by successful acute revision surgery. Nevertheless, the day after the ischemia reoccurred due to the time that passed, circumstances and unfavorable conditions affecting the sutured vessels, no further revision surgery was indicated. Observation continued and eventual wound necrosis after demarcation was left to be treated with skin grafting or per secundam intentionem. Only partial necrosis of the flap occurred, approximately 50%, which was subsequently treated with a full-thickness skin graft with very good results leading to the satisfaction of the patient.

No drains in reduction mammaplasty - a systematic review.

Breast reduction mammaplasty is the only effective therapeutic intervention for patients with symptomatic breast hypertrophy. In this procedure, closed suction drains have become a standard of care, while the literature supporting use of drains is lacking. In fact, with emerging data we found out that drains might not be so necessary. This review aimed to systematically compare the number of complications in drained and undrained breasts and to evaluate the safety of omitting drains in reduction mammaplasty in clinical practice. A systematic review of literature was conducted identifying all studies on drainage in reduction mammaplasty. The analysed databases revealed 13 eligible studies to be included in this review. There were 308 drained breasts and 859 undrained breasts in total in patients from 16 to 73 years of age. The resected tissue weight per side fluctuated from 108 to 1,296 grams. In total, there was only 2.4% incidence of haematoma complications in undrained breasts and 3.9% in drained breasts. Closed suction drains are still being routinely used in reduction mammaplasty, although aborting drain use is proven to be not only safe, but advantageous. The clear benefit is increased patient comfort, shortened hospital stay, decreased cost of the procedure and nurse care, and decreased rate of complications.

Heat-stable whey protein isolate made using isoelectric precipitation and clarification.

Residual lipids (RL) in whey protein isolate (WPI) are detrimental to optimal functional applications (like foaming and low turbidity) and contribute to off-flavor development during powder storage. The objective of this research was to prepare an experimental WPI by removing RL without using the traditional microfiltration (MF) process and compare its properties with commercially available WPIs made using MF and some other whey powders. We hypothesize that by adjusting the pH of whey to < 5.0, we would be close to the isoelectric point of any remaining denatured proteins (DP) and phospholipoproteins (PLP), and therefore reduce electrostatic repulsion between these molecules. Further, demineralization of the acidified whey protein solution by ultrafiltration (UF) combined with diafiltration (DF) should reduce ionic hindrance to aggregation and thereby help with the aggregation of these denatured proteins as well as most RL; centrifugation or clarification could be used to remove these materials. Calcium should also be more extensively removed by this approach, which should improve the heat stability of the experimental WPI. Demineralization was achieved on a pilot scale by acidifying liquid (cheese) whey protein concentrate (WPC-34) to pH 4.5 using HCl, and UF the whey protein solution along with extensive DF using acidified (pH∼3.5) reverse osmosis filtered (RO) water. Demineralized whey protein solution was adjusted to various combinations of pH (4.1 to 4.9), conductivities (500 to 2000 µS.cm-1), and protein concentrations (1 to 7%) and then centrifuged at 10,000 × g for 10 min. The effective sedimentation (precipitation) of RL in these treatments was estimated by measuring the turbidity of the supernatants. Maximum precipitation was observed at pH 4.5-4.7. Reducing conductivity via UF/DF increased the precipitation of RL due to reduced ionic hindrance to aggregation Maximum sedimentation of RL was observed at protein concentrations ≤3% because of a higher density difference between the precipitate and serum phase. SDS-PAGE analysis confirmed the sedimentation of PLPs, caseins, and DPs upon isoelectric precipitation at pH ∼4.5, while native whey proteins or undenatured whey proteins remained soluble in the supernatant, unaffected by the pretreatment. To scale up the process, 750 L of fluid WPC34 was acidified and demineralized by UF (volume concentration factor = 1.35) and DF until the permeate solids reached 0.1% (when desired demineralization was achieved), clarified using a pilot-scale desludging clarifier to remove RL, neutralized, ultrafiltered to concentrate the protein, and then spray-dried to produce an experimental WPI (91% protein and 1.8% fat db). In another trial, demineralized UF concentrate was clarified by gravity sedimentation and the supernatant was neutralized, ultrafiltered, and spray-dried to produce a second experimental WPI (91% protein and < 1% fat db). These experimental WPI powders were compared with several commercially available WPI powders to assess functional properties like solubility, heat stability, foamability and foam strength, gelation, and sensory attributes over accelerated storage. Experimental WPI had excellent functional properties, had low turbidity, were highly heat stable and only developed very slight to slight off-flavors upon accelerated storage, their properties were comparable to the WPI manufactured commercially using MF even after accelerated storage.

Partial enrichment of phospholipids by enzymatic hydrolysis and membrane filtration of whey protein phospholipid concentrate.

Whey protein phospholipid concentrate (WPPC) contains high amounts of phospholipids (PL; 4.5 ± 1%) but there is interest in further enriching the PL content for nutritional and functional applications. Chemical methods were unsuccessful in separating PL from proteins due to the presence of protein-fat aggregates. Instead, we explored hydrolysis of the proteins to peptides with the objective of removing peptides, thereby concentrating the PL fraction. We used microfiltration (MF) with a pore size of 0.1 µm to help reduce protein/peptide retention. Hydrolyzing proteins should facilitate passage of low molecular weight peptides through the MF membrane, while concentrating fat and PL in the MF retentate. Bench-top experiments were performed to select the proteolytic enzyme that resulted in the most extensive hydrolysis of proteins in WPPC from among 5 different commercial proteases. Sodium dodecyl sulfate-PAGE analysis was performed to measure the extent of protein hydrolysis over a period of 4 h. Alcalase enzyme was found to exhibit the highest proteolytic activity at conditions of pH 8 and temperature 55°C. The intensity of major protein bands (milkfat globule membrane proteins, caseins, ß-lactoglobulin) in WPPC decreased in sodium dodecyl sulfate-PAGE profiles as hydrolysis progressed, along with the appearance of low molecular weight bands. Pilot-scale MF production, coupled with diafiltration (DF), of the hydrolyzed sample aided in the removal of peptides that caused an ~18% reduction in protein content with the final retentate having a total PL content of 9.3% dry basis (db) with protein and fat contents at approximately 43.8 ± 0.4% (db) and 48.9 ± 1.2% (db), respectively. The MF permeate had minimal fat content, indicating that there was no transmission of lipids or PL through the membrane during the MF/DF process. Confocal laser scanning microscopy and particle size analysis of enzyme hydrolyzed solution revealed that protein aggregates were still present after 1 h of hydrolysis. Complete removal of proteins and peptides was not achieved by this process, suggesting that a combination of enzymes would be needed for further hydrolysis of protein aggregates in WPPC solution to further enrich the PL content.

Slower proteolysis in Cheddar cheese made from high-protein cheese milk is due to an elevated whey protein content.

A growing number of companies within the cheese-making industry are now using high-protein (e.g., 4-5%) milks to increase cheese yield. Previous studies have suggested that cheeses made from high-protein (both casein and whey protein; WP) milks may ripen more slowly; one suggested explanation is inhibition of residual rennet activity due to elevated WP levels. We explored the use of microfiltration (MF) to concentrate milk for cheese-making, as that would allow us to concentrate the casein while varying the WP content. Our objective was to determine if reducing the level of WP in concentrated cheese milk had any impact on cheese characteristics, including ripening, texture, and nutritional profile. Three types of 5% casein standardized and pasteurized cheese milks were prepared that had various casein:true protein (CN:TP) ratios: (a) control with CN:TP 83:100, (b) 35% WP reduced, 89:100 CN:TP, and (c) 70% WP reduced, 95:100 CN:TP. Standardized milks were preacidified to pH 6.2 with dilute lactic acid during cheese-making. Composition, proteolysis, textural, rheological, and sensory properties of cheeses were monitored over a 9-mo ripening period. The lactose, total solids, total protein, and WP contents in the 5% casein concentrated milks were reduced with increasing levels of WP removal. All milks had similar casein and total calcium levels. Cheeses had similar compositions, but, as expected, lower WP levels were observed in the cheeses where WP depletion by MF was performed on the cheese milks. Cheese yield and nitrogen recoveries were highest in cheese made with the 95:100 CN:TP milk. These enhanced recoveries were due to the higher fraction of nitrogen being casein-based solids. Microfiltration depletion of WP did not affect pH, sensory attributes, or insoluble calcium content of cheese. Proteolysis (the amount of pH 4.6 soluble nitrogen) was lower in control cheeses compared with WP-reduced cheeses. During ripening, the hardness values and the temperature of the crossover point, an indicator of the melting point of the cheese, were higher in the control cheese. It was thus likely that the higher residual WP content in the control cheese inhibited proteolysis during ripening, and the lower breakdown rate resulted in its higher hardness and melting point. There were no major differences in the concentrations of key nutrients with this WP depletion method. Cheese milk concentration by MF provides the benefit of more typical ripening rates.

Antibiotic therapy in the treatment of skin abscess meta-analysis.

Skin abscess is one of the most common infections of skin and soft tissues. Incision and drainage under local anesthesia is the mainstay of treatment. Although previous small-scale studies failed to show a benefit of antibiotics in patients with simple abscesses, the use of antibiotic therapy is still encountered in the treatment of uncomplicated skin abscesses in our practice. The purpose of our study was to evaluate existing data assessing the effect of adjuvant antibiotic therapy on abscess management. Although as indicated by two recent multicenter studies, antibiotics may provide a positive effect in the management, it is important to consider the risk of resistance associated with antibiotic overuse and to approach each case individually.

A study of various chemical pretreatments to fractionate lipids from whey protein phospholipid concentrate.

Dairy-derived lipids such as phospholipids (PL) have been gaining interest due to their functional and nutritional properties. Our research goal was to develop a separation process (nonsolvent based) to produce an enriched dairy lipid fraction from whey protein phospholipid concentrate (WPPC). Various chemical pretreatments (i.e., adjustment of pH, calcium, or temperature) were applied to rehydrated commercial WPPC solutions. These treatments were done on a bench-top scale to aid in the precipitation of proteins or PL. The chemically treated solutions were centrifuged and fractionated into the following 3 layers: (1) top fat layer, (2) supernatant in the middle zone, and (3) sediment at the bottom of the centrifuge tubes. The thickness and size of the layers varied with the treatment parameters. Compositional analysis of each layer showed that the proteins, fat, and PL always appeared to fractionate in similar proportions. The proteins in each layer were characterized using sodium dodecyl sulfate-PAGE under reducing and nonreducing conditions. Different proteins including whey proteins, caseins, and milk fat globule membrane proteins and lipoproteins were identified, and no specific type of protein had an affinity for either the top or bottom layer. All types of proteins were present in each of the layers after centrifugation, and there were no major differences in fractionation of the proteins between layers with respect to the chemical treatment applied. The microstructure of protein and fat in WPPC was investigated using confocal laser scanning microscopy. Dual staining of the rehydrated WPPC solution with Fast Green FCF (proteins) and Nile Red (lipids) showed the presence of very large protein aggregates that varied in size from 20 to 150 µm, with fat trapped within these aggregates. The confocal laser scanning microscopy images of liquid WPPC revealed fine strands of a weak protein network surrounding the fat globules. This indicated that there were specific interactions between the proteins, as well as between the fat and proteins in WPPC. Sodium dodecyl sulfate treatment was performed to understand the nature of the interactions between protein and fat. We found that about 35% of the fat present in WPPC was in the form of free fat, which was only physically entrapped within the protein aggregates. The remaining fat had some form of association with the proteins in WPPC. Other fractionation techniques would be needed to obtain an enriched dairy lipid fraction.

Effects of the depletion of whey proteins from unconcentrated milk using microfiltration on the yield, functionality, and nutritional profile of Cheddar cheese.

Some European dairies use low concentration factor microfiltration (MF) in their cheese plants. Removal of whey protein (WP) from milk before cheesemaking using microfiltration without concentration provides the opportunity to produce a value-added by-product, milk-derived whey. However, few studies have focused on the effects on cheese properties caused by the depletion of WP from cheese milk. Most studies have concentrated cheese milk using MF in addition to depletion of WP. In our approach, cheese milk was not concentrated during WP depletion using MF. We wanted to quantify residual WP levels in cheese made from MF milk and to explore whether WP depletion from milk would influence functionality, nutritional profile, and cheese quality during ripening. Casein (CN) contents for all milks were kept at ∼2.5%, to eliminate the confounding factor of concentration of CN, which was observed in some previous MF studies. Cheese milks had similar ratios of CN to fat. Three standardized milks were produced with various CN:true protein (TP) ratios: (a) control with a CN:TP ratio of 83:100, (b) 35% WP depletion, 89:100 CN:TP, and (c) 70% WP depletion, 95:100 CN:TP. Cheddar cheeses were made from MF milk with various WP depletion levels and aged for 9 mo, and their functionality was evaluated during ripening. We found no major differences in cheese composition or pH values between samples. Cheese yield, solids recovery, and nitrogen recovery were slightly higher in the 95:100 CN:TP cheeses compared with the control. These enhanced recoveries reflect that MF-treated milk started with a higher fraction of CN-based protein solids, rather than WP solids. The standardized milk from the 95:100 CN:TP treatment also had a slightly higher fat content compared with the control, likely helping to increase cheese yield. Rheological properties of cheeses during heating were similar between treatments. Hardness initially decreased with age for all cheeses due to proteolysis or solubilization, or both, of calcium phosphate. Maximum loss tangent (LT), an index of cheese meltability, was slightly lower for the control cheese until 30 d of ripening, but after 30 d, all treatments exhibited similar maximum LT values. The temperature where LT = 1 (crossover temperature), an index of softening point during heating, was slightly lower for MF cheese compared with the control cheeses during ripening. Microfiltration treatment had no significant influence on proteolysis. Sensory properties were similar between the cheeses, except for bitterness. Bitterness intensity was slightly lower in the MF cheeses than in the control cheeses and increased in all cheeses during ripening. We detected no major differences in the concentrations of key nutrients or vitamins between the various cheeses. Depletion of WP in cheese milk by MF did not negatively affect cheese quality, or its nutritional profile, and resulted in similar cheesemaking yields.

Breast implant rupture: A sports trauma report.

OBJECTIVE: Breast augmentation is one of the most commonly performed plastic surgery procedures worldwide. Because of the quality of the implant material, implant rupture may first occur about 10 years after implantation. Ruptured breast implants caused by competitive sport events are rare but should be considered in women athletes as a potential risk factor. The authors report a noteworthy case of this kind. DESIGN: Literature overview and case report. SETTING: Department of Plastic and Obstetrics and Gynaecology 1st faculty of Charls University, Bulovka hospital, Prague. METHODS: Evaluation of the literature and an observational study. CONCLUSION: Breast implant ruptures are generally at high risk in competitive contact sports. We do not recommend the use of breast implants in women competing in contact sports such as boxing.

The CD34+ Cell Number Alone Predicts Retention of the Human Fat-Graft Volume in a Nude Mouse Model.

Prediction of the final transferred fat volume is essential for the success of fat grafting, but remains elusive. Between 20 and 80 % of the initial transplanted volume can be reabsorbed. Although graft survival has many determinants, CD34+ progenitor cells from the vascular stroma of adipose tissue play a central role by promoting growth of blood vessels and adipocytes. We aimed to verify the hypothesis that a higher proportion of total CD34+ cells in the transplant is associated with better preservation of the graft volume. Human lipoaspirates from 16 patients were processed by centrifugation and two grafts per donor were subcutaneously injected into 32 nude mice in 1 ml volumes in the right upper flank area. The volume of each graft was measured using a preclinical MRI scanner immediately after grafting and at three months. The percentage of CD34+ cells in the graft before implantation was determined by flow cytometry. The final graft volume at three months after implantation directly correlated with the percentage of CD34+ cells in the grafted material (r = 0.637, P = 0.019). The minimum retention of the fat graft was 28 % and the maximum retention was 81 %, with an average of 54 %. Our study found that fat retention after fat transfer directly correlated with the fraction of CD34+ cells in the graft. The simple and fast determination of the CD34+ cell percentage on site can help predicting outcomes of fat transplantation.

[Treatment Options for Inveterate Injuries of Deep Finger Flexors - Primary Transplantation with Tendon Graft]. / Moznosti osetrení u zastaralých poranení hlubokých flexoru prstu ruky ­ primární transplantace slachovým stepem.

Injuries of the flexor finger apparatus are very common. Primarily, it is routinely treated by suture of the tendon. Isolated deep flexor injuries, when the flexion restriction only reaches the DIP joint, are sometimes overlooked by the surgeon or by the patients themselves, especially if the deep flexor is injured, after a closed rupture or cutaneous injury with a small skin wound. The patient is then sent to a department specializing in hand surgery after a few weeks. Subsequent shortening of the tendon apparatus makes flexor suture more difficult or sometimes even impossible. Many ways of suturing the tendons and subsequent treatment are described. The treatment results vary immensely. It depends on the mechanism of injury, injury zone, the suture suture technique used, time that has elapsed since primary treatment, surgeon experience and subsequent postoperative and rehabilitative care. One of them is reconstruction of the flexor apparatus by primary transplantation of an autologous tendon graft. Most commonly, the tendon graft is taken from the palmaris longusfrom the same hand. The tendon graft can subsitute the entire area of zones I and II. The tendon suture is made in the palm proximal to the A1 pulley outside the tendon sheath in the area where the muscular belly of thelumbricalis is located on the tendon of the deep flexor. The distal end is reinserted to the base of the distal phalanx. The primary use of the autologous tendon graft can be used in the reconstruction of obsolete deep-flexor injuries in Zone II, but also in primary treatments. This type of treatment has a number of advantages. Performing the reinforcement of the tendon at the base of the distal phalanxand the suture in the palm of the hand completely eliminates the complications caused by the tendon suture in zone II. There is no injury to the tendon sheath, or the need for intersection of the tendons. The transplanted tendon is smaller in diameter than the deep flexor, so it can also be used for older injuries when the tendon sheath is in partially missing. It removes painful palmar resistance by restoring the right position and a tension of tendon of lumbricalis and the tendon of the deep flexor. This type of reconstruction allows immediate active or semi-rehabilitation of the hand and fingers. Key words:tendon, injury, hand, transplantation, surgery, flexor, reconstruction, rupture, treatment.

Effect of processing methods and protein content of the concentrate on the properties of milk protein concentrate with 80% protein.

In recent years, a large increase in the production of milk protein concentrates (MPC) has occurred. However, compared with other types of milk powders, few studies exist on the effect of key processing parameters on powder properties. In particular, it is important to understand if key processing parameters contribute to the poor solubility observed during storage of high-protein MPC powders. Ultrafiltration (UF) and diafiltration (DF) are processing steps needed to reduce the lactose content of concentrates in the preparation of MPC with a protein content of 80% (MPC80). Evaporation is sometimes used to increase the TS content of concentrates before spray drying, and some indications exist that inclusion of this processing step may affect protein properties. In this study, MPC80 powders were manufactured by 2 types of concentration methods: membrane filtration with and without the inclusion of an evaporation step. Different concentration methods could affect the mineral content of MPC powders, as soluble salts can permeate the UF membrane, whereas no mineral loss occurs during evaporation, although a shift in calcium equilibrium toward insoluble forms may occur at high protein concentration levels. It is more desirable from an energy efficiency perspective to use higher total solids in concentrates before drying, but concerns exist about whether a higher protein content would negatively affect powder functionality. Thus, MPC80 powders were also manufactured from concentrates that had 3 different final protein concentrations (19, 21, and 23%; made from 1 UF retentate using batch recirculation evaporation, a similar concentration method). After manufacture, powders were stored for 6 mo at 30°C to help understand changes in MPC80 properties that might occur during shelf-life. Solubility and foaming properties were determined at various time points during high-temperature powder storage. Inclusion of an evaporation step, as a concentration method, resulted in MPC80 that had higher ash, total calcium, and bound calcium (of rehydrated powder) contents compared to concentration with only membrane filtration. Concentration method did not significantly affect the bulk (tapped) density, solubility, or foaming properties of the MPC powders. Powder produced from concentrate with 23% protein content exhibited a higher bulk density and powder particle size than powder produced from concentrate that had 19% protein. The solubility of MPC80 powder was not influenced by the protein content of the concentrate. The solubility of all powders significantly decreased during storage at 30°C. Higher protein concentrations in concentrates resulted in rehydrated powders that had higher viscosities (even when tested at a constant protein concentration). The protein content of the concentrate did not significantly affect foaming properties. Significant changes in the mineral content are used commercially to improve MPC80 solubility. However, although the concentration method did produce a small change in the total calcium content of experimental MPC80 samples, this modification was not sufficiently large enough (<7%) to influence powder solubility.

TRANSPLANTATION OF VASCULARIZED COMPOSITE ALLOGRAFTS. REVIEW OF CURRENT KNOWLEDGE.

Transplantation in reconstructive surgery has been performed for more than 20 years, although the official beginning of these procedures is considered the first successful transplantation of the hand in 1998. The original name "Composite Tissue Transplantation" has been used less frequently; more common is the term "Vascularized Composite Allotransplant", which better describes the basis of the procedure. There have been so far approximately 180 transplantations performed, the exact number is difficult to find. The most known transplantation from this group include transplantation of the hand and face, the other, such as transplantation of the abdominal wall, joints, bones, trachea, larynx, tongue, penis, uterus, etc. are less common and less well known. The common characteristics is that they are not used for salvage or prolongation of life, but to improve its quality. The quality of life is a value, which cannot be objectively measured and the opinions regarding its importance significantly differ. Therefore there is still an unsolved ethical issue regarding these procedures, which is based on the justification to use immunosuppressive therapy with its serious risks in cases when the procedure is not needed for salvage or preservation of life.

NUMERICAL EVALUATION OF SCAR AFTER BREAST RECONSTRUCTION WITH ABDOMINAL ADVANCEMENT FLAP.

BACKGROUND: The treatment of breast cancer has developed a lot during the last decade, nevertheless it still remains a considerable social and economical problem all over the world. The choice of the surgical procedure depends on a patients protocol and the surgeons preferences. The aim of this study is to evaluate the stress on the scar after breast reconstruction. METHODS: Mathematical modeling of the sutured skin flap used for breast implant placement was divided into the following two steps. At first, material model of the selected silicone implant was identified. Afterwards, the mathematical model of the breast and implant was performed. RESULTS: Maximal geometrical deviation for anatomical and round implant is placed on the lower surface of the breast and upper surface of the breast, while in the area of lateral geometry and the area around the nipple the agreement reaches very high level. The maximal tension is located in two median stitches. The maximal force reaches 0.025 N. The Cauchy stress equivalent is located around the nipple and reaches the value of 380 kPa. CONCLUSION: From our results it can be seen, that the anatomical and round breast implants do not result in the same stress on the scar. The maximal value difference reaches 13.4% between stress values for these two breast implants and the round implant results in higher loaded scar compared to the anatomical implant.

PULMONARY EMBOLISM AFTER ABDOMINOPLASTY - ARE WE REALLY ABLE TO AVOID ALL COMPLICATIONS? CASE REPORTS AND LITERATURE REVIEW.

Pulmonary embolism is a potentially lethal complication in plastic surgery patients. About 34% of the members of American Society of Plastic Surgery have diagnosed pulmonary embolism in their patients, and 7% had experienced at least 1 death due to this complication. The American Society of Plastic Surgeons Executive Committee approved the Venous Thromboembolism Task Force Report. The members agreed that there was not enough evidence to make all-inclusive recommendations for plastic surgery deep vein thrombosis and pulmonary embolism prophylaxis, but released the 2005 Caprini Scale accompanied by the Task Force recommendations for use in plastic surgery. It is generally strongly advised to use appropriate prophylactic measures against venous thromboembolism in all surgical procedures. However, even then we cannot completely avoid this serious complication.

TRACHEAL ALLOTRANSPLANTATION AND REGENERATION.

Non-malignant and malignant obstruction of the tracheal airway causes significant morbidity and mortality. With increased use of artificial airways, benign and iatrogenic complications are increasing. A tracheal stenosis that is less than 5 cm in length can be resected with end-to-end anastomosis. Longer tracheal lesions can be treated in a palliative way by placement of a stent to secure airway lumen patency. The management of tracheal defects is an evolving field. Tracheal transplantation and tracheal regeneration may provide major treatment advances to cases with long-segment tracheal involvement. This review examines the current possibilities and future prospects in the area of tracheal transplantation and regeneration.

Effect of standardizing the lactose content of cheesemilk on the properties of low-moisture, part-skim Mozzarella cheese.

The texture, functionality, and quality of Mozzarella cheese are affected by critical parameters such as pH and the rate of acidification. Acidification is typically controlled by the selection of starter culture and temperature used during cheesemaking, as well as techniques such as curd washing or whey dilution, to reduce the residual curd lactose content and decrease the potential for developed acidity. In this study, we explored an alternative approach: adjusting the initial lactose concentration in the milk before cheesemaking. We adjusted the concentration of substrate available to form lactic acid. We added water to decrease the lactose content of the milk, but this also decreased the protein content, so we used ultrafiltration to help maintain a constant protein concentration. We used 3 milks with different lactose-to-casein ratios: one at a high level, 1.8 (HLC, the normal level in milk); one at a medium level, 1.3 (MLC); and one at a low level, 1.0 (LLC). All milks had similar total casein (2.5%) and fat (2.5%) content. We investigated the composition, texture, and functional and sensory properties of low-moisture, part-skim Mozzarella manufactured from these milks when the cheeses were ripened at 4°C for 84d. All cheeses had similar pH values at draining and salting, resulting in cheeses with similar total calcium contents. Cheeses made with LLC milk had higher pH values than the other cheeses throughout ripening. Cheeses had similar moisture contents. The LLC and MLC cheeses had lower levels of lactose, galactose, lactic acid, and insoluble calcium compared with HLC cheese. The lactose-to-casein ratio had no effect on the levels of proteolysis. The LLC and MLC cheeses were harder than the HLC cheese during ripening. Maximum loss tangent (LT), an index of cheese meltability, was lower for the LLC cheese until 28d of ripening, but after 28d, all treatments exhibited similar maximum LT values. The temperature where LT=1 (crossover temperature), an index of softening point during heating, was higher for MLC and LLC cheese at 56 and 84d of ripening. The LLC cheese also had lower blister color and less stretch than MLC and HLC cheese. Adjusting the lactose content of milk while maintaining a constant casein level was a useful technique for controlling cheese pH, which affected the texture, functionality, and sensory properties of low-moisture, part-skim Mozzarella cheese.

PIP IMPLANTS--CURRENT KNOWLEDGE AND LITERATURE REVIEW.

Non-compliance with the production process and use of non-certified materials du- ring production of PIP implants opened an extensive debate regarding regulation and control mechanisms during their production, but the question of health safety of breast implants in general was also reopened. Production of breast implants is subject to various control mechanisms in each country and it is necessary to unify and coordinate such mechanisms. PIP implants were on the market for more than 15 years and in this period the production process and used materials were being changed purposely and without control, which resulted in production of implants with poor quality capsule filled with non-certified silicon gel. There were around 600,000 of these erroneous implants produced. Despite demonstrable harmfulness of the PIP implants, the current studies were not able to reliably confirm health hazard of these implants. Financial costs together with the inability to demonstrate health risk of PIP implants is the reason why the question to widely replace these implants was not solved and each state has a different opinion on this issue.

The history and safety of breast implants.

Breast implants are medical devices used for augmentation of the breast, to reconstruct the breast after mastectomy and to correct breast asymmetry. The breast prostheses are likely the most frequently used medical implants. The evolution of modern silicone breast implants was not straightforward and is characterised with a lot of medical, forensic and public attention. Currently it is sufficiently established that implants are safe and can be used for breast reconstruction and aesthetic augmentation. Prosthesis can rupture and produce local symptoms but there is no evidence that silicone breast implants can be of any health hazards for the patients.

Superiority of topical negative pressure over closed irrigation therapy of deep sternal wound infection in cardiac surgery.

AIM: We sought to compare clinical outcomes, in-hospital mortality and 1-year survival of two different treatment modalities of deep sternal wound infection, topical negative pressure and the closed irrigation therapy. METHODS: Retrospective analysis of 66 consecutive patients treated for deep sternal infection at our institution. A total of 28 patients (February 2002 through September 2004) underwent primarily closed irrigation therapy, and 34 patients (November 2004 through December 2007) had the application of topical negative pressure. Four patients (July 2004 through December 2004) who underwent a combination of both strategies were excluded from the study. Clinical and wound care outcomes were compared, focusing on therapeutic failure rate, in-hospital stay and the 1-year mortality of both treatment strategies. RESULTS: Topical negative pressure was associated with a significantly lower failure rate of the primary therapy (P<0.05), shortening of the intensive care unit stay (P<0.001), a particular decrease in the in-hospital stay (P<0.05) and the 1-year mortality (P<0.05) in comparison with closed irrigation therapy. Comparable overall length of the therapy, in-hospital stay and the risk of wire-related fistulas after chest reconstruction were found. CONCLUSION: Topical negative pressure is a superior method of treatment for deep sternal wound infection, which is based on lower therapeutic failure rate, significant decrease in-hospital stay, and the decrease of the 1-year mortality rate, compared with primarily applied closed irrigation.