Irregularly Irregular Stellate Incisions for Selective Reduction of Benign Facial Lesions.

Background: Cosmetic outcomes are among patients' top concerns when discussing treatment options for facial nevi. Benign lesions of the face often enlarge with time, and many patients seek care to minimize the perceived deformity. Complete excision remains the frontline treatment for facial lesions, but a choice must be made between the deformity from the lesion itself and scar deformity incurred from its removal. Traditional elliptical excision results in a linear scar that is often conspicuous, while alternatives to surgical excision seek to minimize scarring but possess their own disadvantages. We report a new application for nevus reduction (subtotal or near-total excision) to diminish deformity from the lesion itself while minimizing scar visibility with a novel "irregularly irregular stellate incision" approach. Methods: Incisions are made in a stellate pattern with irregularly irregular borders circumscribed within the lesion. Therefore, the scar is restricted to the lesion surface, while a reduction in area and projection off the skin surface can be tailored to fit the patient's wishes for any benign skin feature. Results: This technique has been employed with hundreds of facial lesions, with two representative cases shown. No significant complications have been observed and the method has been used on a wide variety of sizes and types of lesions. Conclusions: The technique presented meets the need for minimal scarring when reducing benign lesions of the face. The method is applicable to a wide range of presentations and can also function as a method to biopsy lesions, should there be concerns about pathology.

There is No "Axillary Tail": Rethinking the Assumption of James Spence.

Widely quoted, "the axillary tail of Spence" refers to a contiguous extension of adipose angling superolaterally from the primary breast into the axilla. Described anecdotally in 1871, the "tail of Spence" has been considered important to the fields of general surgery, oncology, plastic surgery, and anatomy ever since. Despite the ubiquitous presence of the concept in literature, clinical discussions, and educational settings, we argue against the very existence of Spence's "tail." While pinch-testing and topographically mapping 316 consecutive patients in preparation for breast and gynecomastia surgery, we found a consistent pattern of focal fat mounds without continuity between breast and axilla. The absence of an uninterrupted superolateral tail was reaffirmed while analyzing 20 research participants who were pinch-tested with calipers and topographically mapped, specifically to define fat pad anatomy. We documented that the axillary breast mound was always distinct from the primary breast and that all women and many men had an additional "lateral chest wall tail" that never angled toward the axilla. In most, rolling the shoulder girdle anteriorly created a visible groove between the axillary mound and the primary breast, with little or no pinchable fat beneath that crease. With all deference to Spence, we have established that the outer half of the chest is consistently defined by three focal adipose structures-an axillary mound, the primary breast mound, and a previously unnamed "lateral chest wall tail"-with no anatomic evidence of an "axillary tail" of fat extending superolaterally from breast to axilla.

Real Time HABs Mapping Using NASA Glenn Hyperspectral Imager.

The hyperspectral imaging system (HSI) developed by the NASA Glenn Research Center was used from 2015-2017 to collect high spatial resolution data over Lake Erie and the Ohio River. Paired with a vicarious correction approach implemented by the Michigan Tech Research Institute, radiance data collected by the HSI system can be converted to high quality reflectance data which can be used to generate near-real time (within 24 hours) products for the monitoring of harmful algal blooms using existing algorithms. The vicarious correction method relies on imaging a spectrally constant target to normalize HSI data for atmospheric and instrument calibration signals. A large asphalt parking lot near the Western Basin of Lake Erie was spectrally characterized and was determined to be a suitable correction target. Due to the HSI deployment aboard an aircraft, it is able to provide unique insights into water quality conditions not offered by space-based solutions. Aircraft can operate under cloud cover and flight paths can be chosen and changed on-demand, allowing for far more flexibility than space-based platforms. The HSI is also able to collect data at a high spatial resolution (~1 m), allowing for the monitoring of small water bodies, the ability to detect small patches of surface scum, and the capability to monitor the proximity of blooms to targets of interest such as water intakes. With this new rapid turnaround time, airborne data can serve as a complementary monitoring tool to existing satellite platforms, targeting critical areas and responding to bloom events on-demand.

Tracking cyanobacteria blooms: Do different monitoring approaches tell the same story?

Cyanobacteria blooms are a major environmental issue worldwide. Our understanding of the biophysical processes driving cyanobacterial proliferation and the ability to develop predictive models that inform resource managers and policy makers rely upon the accurate characterization of bloom dynamics. Models quantifying relationships between bloom severity and environmental drivers are often calibrated to an individual set of bloom observations, and few studies have assessed whether differences among observing platforms could lead to contrasting results in terms of relevant bloom predictors and their estimated influence on bloom severity. The aim of this study was to assess the degree of coherence of different monitoring methods in (1) capturing short- and long-term cyanobacteria bloom dynamics and (2) identifying environmental drivers associated with bloom variability. Using western Lake Erie as a case study, we applied boosted regression tree (BRT) models to long-term time series of cyanobacteria bloom estimates from multiple in-situ and remote sensing approaches to quantify the relative influence of physico-chemical and meteorological drivers on bloom variability. Results of BRT models showed remarkable consistency with known ecological requirements of cyanobacteria (e.g., nutrient loading, water temperature, and tributary discharge). However, discrepancies in inter-annual and intra-seasonal bloom dynamics across monitoring approaches led to some inconsistencies in the relative importance, shape, and sign of the modeled relationships between select environmental drivers and bloom severity. This was especially true for variables characterized by high short-term variability, such as wind forcing. These discrepancies might have implications for our understanding of the role of different environmental drivers in regulating bloom dynamics, and subsequently for the development of models capable of informing management and decision making. Our results highlight the need to develop methods to integrate multiple data sources to better characterize bloom spatio-temporal variability and improve our ability to understand and predict cyanobacteria blooms.

Gene transcript amplification from cell lysates in continuous-flow microfluidic devices.

Continuous-flow analysis, where samples circulate encapsulated in a carrier fluid is an attractive alternative to batch processing for high-throughput devices that use the polymerase chain reaction (PCR). Challenges of continuous-flow prototypes include the hydrodynamic and biological incompatibility of the carrier fluid, microchannel fouling, sample carryover and the integration of a nucleic acid extraction and reverse transcription step. We tested two homemade, continuous-flow thermocycler microdevices for amplification of reverse-transcribed messages from cell lysates without nucleic acid extraction. Amplification yield and specificity were assessed with state-of-the-art, real-time quantitative equipment. Carryover contamination between consecutive samples was absent. Amplification specificity and interference by genomic DNA were optimized by primer design. Robust detection of the low-copy transcript CLIC5 from 18 cells per microliter is demonstrated in cultured lymphoblasts. The results prove the concept that the development of micro-total analysis systems (micro-TAS) for continuous gene expression directly from cell suspensions is viable with current technology.