Objective evidence for the use of polylactic acid implants in HIV-associated facial lipoatrophy using three-dimensional surface laser scanning and psychological assessment

The advent of highly active antiretroviral therapy (HAART) has dramatically improved the life expectancy of people infected with human immunodeficiency virus (HIV). Although patients often have excellent disease control with these combinations of antiretrovirals, they are at risk for the multiple toxicities associated with these drugs. Facial lipoatrophy is a particularly distressing complication of some HAART regimes. This disfigurement can lead to significant psychosocial stress, resulting in decreased treatment compliance. Polylactic acid (PLA) facial implants provide a potential method of restoring a normal appearance. One hundred consecutive patients had a course of PLA facial implants. All patients were assessed clinically and had photographs, facial surface laser scans and completed psychological questionnaires throughout the course of treatment. After a mean of 4.85 treatments per patient, there were improvements in all measures. The mean clinical scores improved from a moderate-severe grade to none-mild grade after treatment. Three-dimensional (3D) laser surface scans showed a volume increase of 2.81 cc over the treated area of the cheek. There were significant improvements in all of the psychological measures. This study shows clear objective evidence of the psychological and physical benefit of PLA implants in HIV-associated facial lipodystrophy. © 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons

Estimating the multi-decadal carbon deficit of burned Amazonian forests

Wildfires in humid tropical forests have become more common in recent years, increasing the rates of tree mortality in forests that have not co-evolved with fire. Estimating carbon emissions from these wildfires is complex. Current approaches rely on estimates of committed emissions based on static emission factors through time and space, yet these emissions cannot be assigned to specific years, and thus are not comparable with other temporally-explicit emission sources. Moreover, committed emissions are gross estimates, whereas the long-term consequences of wildfires require an understanding of net emissions that accounts for post-fire uptake of CO2. Here, using a 30 year wildfire chronosequence from across the Brazilian Amazon, we calculate net CO2 emissions from Amazon wildfires by developing statistical models comparing post-fire changes in stem mortality, necromass decomposition and vegetation growth with unburned forest plots sampled at the same time. Over the 30 yr time period, gross emissions from combustion during the fire and subsequent tree mortality and decomposition were equivalent to 126.1 Mg CO2 ha−1 of which 73% (92.4 Mg CO2 ha−1) resulted from mortality and decomposition. These emissions were only partially offset by forest growth, with an estimated CO2 uptake of 45.0 Mg ha−1over the same time period. Our analysis allowed us to assign emissions and growth across years, revealing that net annual emissions peak 4 yr after forest fires. At present, Brazil's National Determined Contribution (NDC) for emissions fails to consider forest fires as a significant source, even though these are likely to make a substantial and long-term impact on the net carbon balance of Amazonia. Considering long-term post-fire necromass decomposition and vegetation regrowth is crucial for improving global carbon budget estimates and national greenhouse gases (GHG) inventories for tropical forest countries