The axillary approach to raising the latissimus dorsi free flap for facial re-animation: a descriptive surgical technique

The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time

Remodelling a multi-anode ionisation chamber detector for accelerator mass spectrometry of 53Mn

Accelerator Mass Spectrometry (AMS) is a single-atom counting technique that measures the abundance of rare, long-lived radioisotopes using only milligrams of sample. The astrophysical radioisotopes 53Mn and 60Fe have been utilised for many applications including meteoritics, exposure dating, and the search for near-Earth supernovae. 53Mn measurements at the ANU have been limited to sensitivities above 10^-13 by insufficient suppression of the stable isobar, 53Cr. To expand the applications accessible to 53Mn analysis, a new detector was commissioned that will improve the available sensitivity. This thesis covers the implementation of the new Flexible Anti-Scatter Multi-Anode (FASMA) detector. Simulations were conducted to determine the optimal placement of the detector inside the gas-filled magnet, and to assist with the design of a new multi-anode configuration. The FASMA detector was successfully tested and full spectra were recorded. These preliminary results indicate an improvement in the achievable sensitivity, even without the suppression of scattered particles. With further work, the FASMA detector should reach a sensitivity at or below 10^-14, which is competitive with the best reported level in the field. Long-lived radionuclides, such as 53Mn and 60Fe, are important for extracting the exposure history of meteorites, both in space and on Earth, as well helping to identify their origin. In light of this, cosmogenic 53Mn and 60Fe ratios were measured in ten meteorite samples. Since the available data on live 53Mn and 60Fe is scarce, these measurements will improve the constraints on current production rate models for meteorites

Chemical Association via Exact Thermodynamic Formulations

It can be fruitful to view two-component physical systems of attractive monomers, A and B, ``chemically'' in terms of a reaction A + B C, where C = AB is an associated pair or complex. We show how to construct free energies in the three-component or chemical picture which, under mass-action equilibration, exactly reproduce any given two-component or ``physical'' thermodynamics. Order-by-order matching conditions and closed-form chemical representations reveal the freedom available to modify the A-C, B-C, and C-C interactions and to adjust the association constant. The theory (in the simpler one-component, i.e., A = B, case) is illustrated by treating a van der Waals fluid.Comment: 15 double-spaced pages (RevTeX), including 1 eps figur

Approaches to the management of synkinesis: a scoping review.

Post-paralysis facial synkinesis can develop in any facial palsy and is associated with significant functional and psychosocial consequences for affected patients. While the prevention of synkinesis especially after Bell's Palsy has been well examined, much less evidence exists regarding the management of patients with already established synkinesis. Therefore, the purpose of this review is to summarize the available literature and to provide an overview of the current therapeutic options for facial palsy patients with established synkinesis. A systematic literature review was undertaken, following the PRISMA 2020 guidelines. MEDLINE via PubMed and Cochrane Library were searched using the following strategy: ((facial palsy) OR (facial paralysis) OR (facial paresis)) AND (synkinesis) AND ((management) OR (guidelines) OR (treatment)). The initial search yielded 201 articles of which 36 original papers and 2 meta-analyses met the criteria for inclusion. Overall, the included articles provided original outcome data on 1408 patients. Articles were divided into the following treatment categories: chemodenervation (12 studies, 536 patients), facial therapy (5 studies, 206 patients), surgical (10 studies, 389 patients) and combination therapy (9 studies, 278 patients). Results are analyzed and discussed accordingly. Significant heterogeneity in study population and design, lack of control groups, differences in postoperative follow-up as well as the use of a variety of subjective and objective assessment tools to quantify synkinesis prevent direct comparison between treatment modalities. To date there is no consensus on how post-paralysis facial synkinesis is best treated. The lack of comparative studies and standardized outcome reporting hinder our understanding of this complex condition. Until higher-quality scientific evidence is available, it remains a challenge best approached in an interdisciplinary team. An individualized multimodal therapeutic concept consisting of facial therapy, chemodenervation and surgery should be tailored to meet the specific needs of the patient

Transcutaneous sentinel lymph node detection in cutaneous melanoma with indocyanine green and near-infrared fluorescence: A diagnostic sensitivity study.

Sentinel lymph node (SLN) biopsy with preoperative radiocolloid-based lymphoscintigraphy and blue dye injection is considered the standard procedure for staging nodal metastases in early-stage cutaneous melanoma patients with clinically uninvolved lymph nodes. While this combination renders good accuracy in SLN detection, radiation exposure and the frequent allergic reactions to the blue dye are considered drawbacks of this technique. Indocyanine green (ICG) is a water-soluble fluorescent dye that can be identified through near-infrared fluorescence imaging (NIRFI). The aim of this prospective diagnostic sensitivity study was to assess the feasibility of ICG and NIRFI to identify SLNs in melanoma transcutaneously ("before skin incision") and to analyze the various factors influencing detection rate, in comparison to lymphoscintigraphy. This study included 93 patients undergoing SLN biopsy for cutaneous melanoma. The region and the number of the SLNs identified with lymphoscintigraphy and with ICG were recorded. Patients' characteristics, as well as tumor details were also recorded preoperatively. One hundred and ninety-four SLNs were identified through lymphoscintigraphy. The sensitivity of ICG for transcutaneous identification of the location of the SLNs was 96.1% overall, while the sensitivity rate for the number of SLNs was 79.4%. Gender and age did not seem to influence detection rate, but a body mass index >30 kg/m2 was associated with a lower identification rate of the number of SLNs (P = .045). Transcutaneous identification of SLNs through ICG and NIRFI technology is a feasible technique that could potentially replace in selected patients the standard SLN detection methodology in cutaneous melanoma

Macrophage proliferation distinguishes 2 subgroups of knee osteoarthritis patients

Osteoarthritis (OA) is a leading cause of disability, globally. Despite an emerging role for synovial inflammation in OA pathogenesis, attempts to target inflammation therapeutically have had limited success. A better understanding of the cellular and molecular processes occurring in the OA synovium is needed to develop novel therapeutics. We investigated macrophage phenotype and gene expression in synovial tissue of OA and inflammatory-arthritis (IA) patients. Compared with IA, OA synovial tissue contained higher but variable proportions of macrophages (P < 0.001). These macrophages exhibited an activated phenotype, expressing folate receptor-2 and CD86, and displayed high phagocytic capacity. RNA sequencing of synovial macrophages revealed 2 OA subgroups. Inflammatory-like OA (iOA) macrophages are closely aligned to IA macrophages and are characterized by a cell proliferation signature. In contrast, classical OA (cOA) macrophages display cartilage remodeling features. Supporting these findings, when compared with cOA, iOA synovial tissue contained higher proportions of macrophages (P < 0.01), expressing higher levels of the proliferation marker Ki67 (P < 0.01). These data provide new insight into the heterogeneity of OA synovial tissue and suggest distinct roles of macrophages in pathogenesis. Our findings could lead to the stratification of OA patients for suitable disease-modifying treatments and the identification of novel therapeutic targets