Unexpected and delayed fragmentation dynamics of the organometallic ferrocene induced by ion-collision

We have investigated the fragmentation dynamics of the organometallic ferrocene molecule after interaction with multiply charged ions using multicoincidence mass spectrometry and quantum chemistry calculations. We observed unexpected fragmentation dynamics of the two-body breakup channels from ferrocene dications revealing a charge screening effect from the iron atom and delayed fragmentation dynamics. These observations are rationalized through the population of a specific long-lived excited state, where one positive charge is located on each cyclopentadienyl ring.

Vibrationally Mediated Stabilization of Electrons in Nonpolar Matter

We explore solvation of electrons in nonpolar matter, here represented by butadiene clusters. Isolated butadiene supports only the existence of transient anions (resonances). Two-dimensional electron energy loss spectroscopy shows that the resonances lead to an efficient vibrational excitation of butadiene, which can result into the almost complete loss of energy of the interacting electron. Cluster-beam experiments show that molecular clusters of butadiene form stable anions, however only at sizes of more than 9 molecular units. We have calculated the distribution of electron affinities of clusters using classical and path integral molecular dynamics simulations. There is almost a continuous transition from the resonant to the bound anions with an increase in cluster size. The comparison of the classical and quantum dynamics reveals that the electron binding is strongly supported by molecular vibrations, brought about by nuclear zero-point motion and thermal agitation. We also inspected the structure of the solvated electron, finding it well localized.

Hübner's tarsomarginal grafts in eyelid reconstruction: 94 cases

BACKGROUND

Preserving the integrity of the eyelid margin in eyelid reconstruction remains a challenge for plastic surgeons. In 1976, Hübner described a technique to repair full-thickness eyelid defects using a tarsomarginal graft covered with a local flap. This simple technique addresses both functional and aesthetic requirements of eyelid reconstruction by using tissue from the contralateral eyelid. The aim of this study was to determine the appropriate role of this uncommon technique in eyelid reconstruction.

METHOD

In total, 94 tarsomarginal grafts were performed on 70 patients. Eight surgeons participated in this study. Data were retrospectively collected from patients' charts and all information regarding surgical indications, histology, defect size and topography, operative time, immediate result, and potential complications were recorded.

RESULTS

Only one of the patients suffered total necrosis. Partial wound dehiscence occurred in one case and partial necrosis occurred in 6 cases. No major sequelae were observed in the donor eyelids. In 100% of cases, eyelid margin integrity was otherwise preserved. Four patients required revision surgery for insufficient malignancy resection and 13 patients for long-term eyelid ectropion or scar retraction.

CONCLUSION

This simple and reliable technique ensured the closure of full-thickness eyelid defects covering up to 3/4 of the eyelid length. The procedure should be more widely used as it guarantees high-quality eyelid reconstruction.

[Light sources usable by the plastic surgeon in the absence of photographic studio]

Medical photography is an important part of the medical file and is widely used in medical communication, especially in our discipline. His practice has to be the most standardized and reproducible as possible, which distinguishes it from artistic photography. Photography fix the light reflecting from a subject, so surgeon have to control of the light source in any environment. In the absence of dedicated studio, using external cobra or ring flashes with special diffusers allow the surgeon to have light sources adapted to the different conditions encountered in daily practice.

Multiple electron capture from isolated protein poly-anions in collision with slow highly charged ions

Multiply charged ions very efficiently capture several electrons from trapped mass/charge selected protein poly-anions, producing dominantly charge-reduced proteins and small neutral losses.

Fragmentation of pure and hydrated clusters of 5Br-uracil by low energy carbon ions: observation of hydrated fragments

The fragmentation of the isolated 5-bromouracil (5BrU) molecule and pure and nano-hydrated 5BrU clusters induced by low energy ¹²C⁴⁺ ions has been studied.

Determination of Energy-Transfer Distributions in Ionizing Ion-Molecule Collisions

The ionization and fragmentation of the nucleoside thymidine in the gas phase has been investigated by combining ion collision with state-selected photoionization experiments and quantum chemistry calculations. The comparison between the mass spectra measured in both types of experiments allows us to accurately determine the distribution of the energy deposited in the ionized molecule as a result of the collision. The relation of two experimental techniques and theory shows a strong correlation between the excited states of the ionized molecule with the computed dissociation pathways, as well as with charge localization or delocalization.

Rapid onset of squamous cell carcinoma in a thin skin graft donor site

BACKGROUND

Squamous cell carcinomas are malignant tumours of epithelial origin that can appear on sites subjected to chronic inflammation after a period of several years. The rapid development of squamous cell carcinoma at the donor site for a thin skin graft is a rare and poorly understood situation.

PATIENTS AND METHODS

We report the case of a patient undergoing thin skin grafting to cover the area of removal of a vertex squamous cell carcinoma and in whom squamous cell carcinoma appeared at the donor site within 9 weeks.

DISCUSSION

In our case, we ruled out intraoperative contamination because two sets of surgical instruments were used. Given the number of cases reported in the literature, a chance event seems unlikely. The hypothesis of an acute inflammatory process caused by scarring of the thin skin graft site appears to us the most convincing. Development of cancer at the graft donor site may thus be added to the list of complications of thin skin grafting.

Site- and state-selected photofragmentation of 2Br-pyrimidine

The fragmentation of the 2Br-pyrimidine molecule following direct valence photoionization or inner shell excitation has been studied by electron-ion coincidence experiments. 2Br-pyrimidine has been chosen as a model for the class of pyrimidinic building blocks of three nucleic acids and several radiosensitizers. It is known that the site- and state-localization of energy deposition, typical of inner shell excitation, results in the enhancement of the total ion yield as well as in changes in the relative intensity of the different fragmentation channels. Here we address the question of the origin of this selective fragmentation by using electron-ion coincidence techniques. The results show that the fragmentation is strongly selective in the final singly charged ion state, independently of the process that leads to the population of that state, and the dominant fragmentation patterns correlate with the nearest appearance potential.

Formation of H2 from internally heated polycyclic aromatic hydrocarbons: excitation energy dependence

We have investigated the effectiveness of molecular hydrogen (H2) formation from Polycyclic Aromatic Hydrocarbons (PAHs) which are internally heated by collisions with keV ions. The present and earlier experimental results are analyzed in view of molecular structure calculations and a simple collision model. We estimate that H2 formation becomes important for internal PAH temperatures exceeding about 2200 K, regardless of the PAH size and the excitation agent. This suggests that keV ions may effectively induce such reactions, while they are unlikely due to, e.g., absorption of single photons with energies below the Lyman limit. The present analysis also suggests that H2 emission is correlated with multi-fragmentation processes, which means that the [PAH-2H](+) peak intensities in the mass spectra may not be used for estimating H2-formation rates.

Absolute fragmentation cross sections in atom-molecule collisions: scaling laws for non-statistical fragmentation of polycyclic aromatic hydrocarbon molecules

We present scaling laws for absolute cross sections for non-statistical fragmentation in collisions between Polycyclic Aromatic Hydrocarbons (PAH/PAH(+)) and hydrogen or helium atoms with kinetic energies ranging from 50 eV to 10 keV. Further, we calculate the total fragmentation cross sections (including statistical fragmentation) for 110 eV PAH/PAH(+) + He collisions, and show that they compare well with experimental results. We demonstrate that non-statistical fragmentation becomes dominant for large PAHs and that it yields highly reactive fragments forming strong covalent bonds with atoms (H and N) and molecules (C6H5). Thus nonstatistical fragmentation may be an effective initial step in the formation of, e.g., Polycyclic Aromatic Nitrogen Heterocycles (PANHs). This relates to recent discussions on the evolution of PAHNs in space and the reactivities of defect graphene structures.

[Endothelial function: role, assessment and limits]

For several years, detecting and preventing cardiovascular diseases have become a major issue. Different methods have been developed to evaluate endothelial function. Endothelial dysfunction is one of the first steps leading to atherosclerosis. This review presents an insight into endothelial function, the interests of its assessment and methods for studying endothelial function. To date, the vascular endothelium must be considered as a specific organ with its own functions that contribute to the homeostasis of the cardiovascular system. Endothelial dysfunction typically corresponds to a decrease of nitric oxide NO bioavailability. Biological or physico-chemical methods may be used to assess dysfunction. Biological methods allow measuring NO metabolites and pro-inflammatory and vasoconstrictor mediators released by the endothelium. The physico-chemical methods include intra-coronary injections, plethysmography, flow-mediated dilation (FMD), digital plethysmography and optical techniques using laser (laser Doppler single-point, laser Doppler imager, laser speckle contrast imaging) that can be coupled with provocation tests (iontophoresis, microdialysis, post-ischemic hyperemia, local heating). The principle of each technique and its use in clinical practice are discussed. Studying endothelial dysfunction is a particularly promising field because of new drugs being developed. Nevertheless, assessment methodology still needs further development to enable reliable, non-invasive, reproducible, and inexpensive ways to analyze endothelial dysfunction.

[Endothelial function: role, assessment and limits]

For several years, detecting and preventing cardiovascular diseases have become a major issue. Different methods have been developed to evaluate endothelial function. Endothelial dysfunction is one of the first steps leading to atherosclerosis. This review presents an insight into endothelial function, the interests of its assessment and methods for studying endothelial function. To date, the vascular endothelium must be considered as a specific organ with its own functions that contribute to the homeostasis of the cardiovascular system. Endothelial dysfunction typically corresponds to a decrease of nitric oxide NO bioavailability. Biological or physico-chemical methods may be used to assess dysfunction. Biological methods allow measuring NO metabolites and pro-inflammatory and vasoconstrictor mediators released by the endothelium. The physico-chemical methods include intra-coronary injections, plethysmography, flow-mediated dilation (FMD), digital plethysmography and optical techniques using laser (laser Doppler single-point, laser Doppler imager, laser speckle contrast imaging) that can be coupled with provocation tests (iontophoresis, microdialysis, post-ischemic hyperemia, local heating). The principle of each technique and its use in clinical practice are discussed. Studying endothelial dysfunction is a particularly promising field because of new drugs being developed. Nevertheless, assessment methodology still needs further development to enable reliable, non-invasive, reproducible, and inexpensive ways to analyze endothelial dysfunction.

[Aesthetic reconstructive surgery of the lip]

Lip reconstruction can be performed with numerous surgical techniques. The aim was here to present these usual techniques and to focus on the details that can be used to obtain the most favourable results. The goal of this surgery, that represents a compromise between function and aesthetic, has to be kept in mind to prevent mistakes that decrease the quality of the result.

[Cheek reconstruction]

We describe the different cheek reconstruction techniques with primary emphasis on the superficial layers. In addition to the clinical context, location and size of the lesion will be taken into account to choose the best method that will optimize the functional and aesthetic results while minimizing potential sequelae. Main evaluation criteria include absence of natural orifice deformation, scar location, skin cover quality and respect of volumes.

[Forehead and temple aesthetic reconstruction]

The purpose of this article is to address the techniques of reconstruction of the forehead and the temple trying to add an "aesthetic" dimension, as the fourth dimension introduced by Burget for the reconstructive surgery of the nose. Achieve "aesthetic" reconstruction is to have constant attention to details. This is how to choose the right indication depending on the age and the etiology of the defect. This is to place incisions to perfection. And it is to be humble and open oneself to criticism, always seeking to improve the quality of its results.

[Eyebrow reconstruction]

The eyebrow is an essential anatomical area, from a social point of view, so its reconstruction, in case of skin defect, must be as meticulous as possible, with the less residual sequela. Capillary density extremely varies from one person to another and the different methods of restoration of this area should absolutely take this into consideration. We are going to review the various techniques of reconstruction, according to the sex and the surface to cover.

Formations of dumbbell C118 and C119 inside clusters of C60 molecules by collision with α particles

We report highly selective covalent bond modifications in collisions between keV alpha particles and van der Waals clusters of C(60) fullerenes. Surprisingly, C(119)(+) and C(118)(+) are the dominant molecular fusion products. We use molecular dynamics simulations to show that C(59)(+) and C(58)(+) ions--effectively produced in prompt knockout processes with He(2+)--react rapidly with C(60) to form dumbbell C(119)(+) and C(118)(+). Ion impact on molecular clusters in general is expected to lead to efficient secondary reactions of interest for astrophysics. These reactions are different from those induced by photons.

[Schmid-Meyer fronto-temporal flap for nasal reconstruction]

INTRODUCTION

Many surgical techniques have already been described to repair full thickness defects of the inferior part of the nose. The Schmid-Meyer fronto-temporal flap procedure, a little known technique, is based on the old principle of autonomization of a cutaneous flap and uses a tailor-made composite cartilaginous graft placed in the temporal region. This graft is progressively detached and allows mucosal/cartilaginous/and cutaneous nasal repair. Can this technique still be used for nasal full-thickness reconstruction?

PATIENTS AND METHOD

Nine cases of nasal reconstruction using this procedure were performed. The 4-steps of the operative technique were described and the results were analyzed retrospectively.

RESULTS

This procedure allows, for some specific indications, excellent reconstruction of the ala, the columella or the nasal tip. In eight cases out of nine, the result was judged good or very good by both patients and physicians. In 78%, the reconstruction was performed under local anesthesia.

DISCUSSION

The Schmid-Meyer flap procedure may still be used for full-thickness reconstruction of the lower third of the nose because it allows a high quality of nasal reconstruction and few scar sequels.

[Eyelid, medial canthus and medial orbital wall reconstruction using a combination of Hübner and conchal grafts with two illustrative cases]

Post-ablative medial canthus and medial orbital wall reconstruction may involve various materials. Few articles present such reconstructions using cartilage homografts, and very few opt for conchal cartilage. In some cases of medial orbital wall excision, at least half of the eyelid must also be removed. We present two cases where we decided to use conchal cartilage to reconstruct the medial orbital wall and tarsomarginal Hübner grafts to reconstruct the eyelid. This combination offers several advantages: a very limited resorption, only one operative field and a reduced infection risk.

[Moldable titanium mesh for chest wall reconstruction, an elegant solution about a case report]

INTRODUCTION

Several surgical techniques are available for full thickness chest wall reconstruction. The choice has to be adapted to the size of the loss of tissue, its location, and must finally be accepted by the patient's. We propose a new and unpublished solution.

CASE REPORT

We have in our care a 54 years-old patient suffering from a previous loss of chest wall tissue measuring 7 cm(2) due to surgical treatment of mediastinal Hodgkin's disease with sternal and costal invasion. Because of the sequelae, the goal focused on aesthetic reconstruction. Heartbeat was visible under the skin due to a loss of secondary left breast tissue from an initial treatment with absorbable Vicryl(©) mesh followed by a local skin, and glandular flap. Our choice of reconstruction consisted of inserting a moldable titanium mesh followed by 200 g implants in each breast during the same operation. We did not experience any complications and the patient is satisfied with the results.

DISCUSSION

No example of reconstruction using only a moldable titanium mesh was found in the literature on chest wall reconstruction. Our elegant choice is innovative in our discipline. However, this reconstruction materiel is already part of therapy procedures in other specialized surgeries.

CONCLUSION

This case report illustrates the various facets of our speciality: bring a solution at once repair, aesthetic and unique according to the request of the patient. The use of a moldable titanium mesh allows the reconstruction of stable chest wall. The small size does not present any functional difficulties, but rather unsightly sequel.

[Screening strategy and diagnostic criteria for gestational diabetes. Proposals of the GGOLFB]

For nearly 50 years, the strategy of screening and the diagnostic criteria for gestational diabetes have been the subject of endless controversies. They differ between countries and from one center to another, mainly because of the lack of hard data allowing to define glycemic thresholds at which a therapeutic management is needed. Recently, a large observational study has demonstrated the existence of a robust relationship between maternal blood sugar and several fetomaternal perinatal complications. This relationship is linear, with no clear threshold that would define gestational diabetes unambiguously. Meanwhile, two randomized intervention trials have shown that the therapeutic management of mild gestational diabetes was associated with improved perinatal outcomes. Based on these data, the "International Association of Diabetes and Pregnancy Study Group" (IADPSG) released new recommendations on screening methods and diagnostic criteria for gestational diabetes. Although already endorsed by several international associations and implemented in some countries, these recommendations still raise questions and criticisms. This is why the "Groupement des Gynécologues Obstétriciens de Langue Française de Belgique" (GGOLFB) organized a meeting between diabetologists and gynecologists which allowed to reach a consensus on the strategy that we intend to implement in our respective centers. The purpose of this paper is to briefly overview the recent advances in gestational diabetes and more particularly to make our key conclusions known to the medical community. This will enable the standardization of the management of gestational diabetes in the French-speaking part of Belgium.

[Screening strategy and diagnostic criteria for gestational diabetes. Proposals of the GGOLFB]

For nearly 50 years, the strategy of screening and the diagnostic criteria for gestational diabetes have been the subject of endless controversies. They differ between countries and from one center to another, mainly because of the lack of hard data allowing to define glycemic thresholds at which a therapeutic management is needed. Recently, a large observational study has demonstrated the existence of a robust relationship between maternal blood sugar and several fetomaternal perinatal complications. This relationship is linear, with no clear threshold that would define gestational diabetes unambiguously. Meanwhile, two randomized intervention trials have shown that the therapeutic management of mild gestational diabetes was associated with improved perinatal outcomes. Based on these data, the " International Association of Diabetes and Pregnancy Study Group "(IADPSG) released new recommendations on screening methods and diagnostic criteria for gestational diabetes. Although already endorsed by several international associations and implemented in some countries, these recommendations still raise questions and criticisms. This is why the "Groupement des Gynécologues Obstétriciens de Langue Française de Belgique " (GGOLFB) organized a meeting between diabetologists and gynecologists which allowed to reach a consensus on the strategy that we intend to implement in our respective centers. The purpose of this paper is to briefly overview the recent advances in gestational diabetes and more particularly to make our key conclusions known to the medical community. This will enable the standardization of the management of gestational diabetes in the French-speaking part of Belgium.

[Conchal flap with a superior pedicle to reconstruct the middle or upper third of the auricle]

The middle or upper third of the auricle can be reconstructed with a composite chondro-cutaneous peninsular flap of the conchal part of the auricle. This peninsular flap is based on the anastomotic network between the posterior auricular and the superficial temporal artery. The authors report their experience about 24 clinical cases. Most of the cases were partial auricular amputations for squamous cell carcinoma. The surgical procedure allows a hidden cartilaginous donor site, the concha, allowing in a single operation a color- and texture-matched reconstruction. This flap represents an alternative to more complex surgical procedures, and can easily be realised under local anaesthesia.

NCIC-CTG MA.20: An intergroup trial of regional nodal irradiation in early breast cancer

LBA1003

Background: Randomized trials have demonstrated that locoregional radiation after mastectomy reduces locoregional recurrence and improves overall survival (OS) in women with node positive breast cancer treated with adjuvant systemic therapy. MA.20 evaluated the addition of regional nodal irradiation (RNI) to whole breast irradiation (WBI) following breast conserving surgery (BCS). Methods: Women with high risk node-negative or node-positive breast cancer treated with BCS and adjuvant chemotherapy and/or endocrine therapy were stratified by positive nodes, axillary nodes removed, chemo- and endocrine therapy and randomized to WBI (50Gy in 25 fractions +/- boost irradiation) or WBI plus RNI (45Gy in 25 fractions) to the internal mammary, supraclavicular, and high axillary lymph nodes. The primary outcome was OS. The Data Safety Monitoring Committee approved the analysis plan for the protocol specified interim analysis of relapse patterns, survival and toxicity at 5 years. Upon review of the data, they recommended release of the results. Results: Between March 2000 to March 2007, 1,832 women were randomly assigned to WBI+RNI (916) or WBI (916). Median follow-up was 62 months. Characteristics of the study population were: mean age, 53.3 years; node negative, 10%; 1-3 positive nodes, 85%; > 4 positive nodes, 5%; adjuvant chemotherapy, 91%; and adjuvant endocrine therapy, 71%. WBI+RNI in comparison to WBI alone was associated with an improvement in isolated locoregional disease free survival (DFS; HR=.59, p=.02, 5 year risk: 96.8% and 94.5% respectively), distant DFS (HR=.64, p=.002, 5 year risk: 92.4% and 87.0% respectively), DFS (HR=.68, p=.003, 5 year risk: 89.7% and 84.0% respectively) and OS (HR=.76, p=.07, 5 year risk: 92.3% and 90.7% respectively). WBI+RNI in comparison to WBI was associated with an increase in grade 2 or greater pneumonitis (1.3% and 0.2% respectively, p=.01), and lymphedema (7.3% and 4.1% respectively, p=.004). Conclusions: The majority of women with node positive breast cancer are now managed by BCS followed by WBI and adjuvant systemic therapy. Results from MA.20 demonstrate that additional RNI reduces the risk of locoregional and distant recurrence, and improves DFS with a trend in improved OS.

[Sensibility changes of the infraorbital nerve after primary surgery on patients with unilateral cleft lip according to J. Delaire]

OBJECTIVE

The aim was to determine the overall sensibility changes in the area of the infraorbital nerve on patients with unilateral clefts lips and unilateral clefts lips and palate who had undergone primary surgical correction according to the principles of Delaire.

PATIENTS AND METHOD

Twenty patients (7-20years) with unilateral cleft lips (and palate) who had undergone surgery in infancy according to Delaire were included. Cutaneous sensibilities of the nasolabial fold and of the upper lip were tested using four cutaneous modalities. A tactil superficial sensibility light touch test, a two-point discrimination test (McKinnon-Dellon Disk-Criminator), and the determination of cold and warm detection thresholds (Quantitative Sensory Testing, Medoc Thermal Sensory Analyser). The possible difference of the sensibility between operated and controlateral sides of the face were compared. Results were finally compared to a control group of twenty healthy volunteers.

RESULTS

No significant difference could be found between the operated and non-operated side of the cleft group. There was also no difference between the cleft and the control group. Specific difference of perception between nasolabial fold and lip encountered in the literature were confirmed by the experiments.

CONCLUSION

The large subperiostal approach according to Delaire during the primary surgical procedure have not affected long term infraorbital sensibility of patients with unilateral complete cleft lip.

Combination of batch experiments with continuous reactor data for ADM1 calibration: application to anaerobic digestion of pig slurry

Modelling anaerobic digestion processes is a key aspect of studying and optimizing digesters and related waste streams. However, for the satisfactory prediction of biogas production and effluent characteristics, some parameters have to be calibrated according to the characteristics of the substrates. This article describes a calibration procedure for the IWA 'Anaerobic Digestion Model no. 1' applied to the modelling of a digester for treatment of pig slurry. The most sensitive parameters were selected and calibrated combining results from a continuous digester and from batch trials run with the sludge sampled from the digester and the addition of specific substrates. According to the sensitivity analysis, acetoclastic methanogenesis, acetogenesis of propionate and acidogenesis of sugars were identified as the main sensitive steps in our case. The calibration procedure led us to modify slightly acetogenesis of propionate kinetic. However, acetoclastic methanogenesis and acidogenesis of sugars kinetics were significantly reduced by decreasing km and increasing Ks. Indeed, for instance, a decrease of km_ac from 8 to 7 day(-1) combined with an increase of Ks_ac from 0.15 to 1.5 kgCOD/m3 was necessary. After calibration, ADM1 provides an accurate simulation of the continuous reactor results.

Ions colliding with cold polycyclic aromatic hydrocarbon clusters

We report the first experimental study of ions interacting with clusters of polycyclic aromatic hydrocarbon (PAH) molecules. Collisions between 11.25 keV 3He+ or 360 keV 129Xe20+ and weakly bound clusters of one of the smallest PAH molecules, anthracene, show that C14H10 clusters have much higher tendencies to fragment in ion collisions than other weakly bound clusters. The ionization is dominated by peripheral collisions in which the clusters, very surprisingly, are more strongly heated by Xe20+ collisions than by He+ collisions. The appearance size is k=15 for [C ₁₄H₁₀](k)2+.

[Primitive neuroendocrine cancer of the breast. Post-traumatic discovery of a man]

We report a primitive neuroendocrine breast tumor (NET) in a male. This situation is uncommon by its mode of discovery. We have treated a 74-year-old man with a lesion in the left areola initially considered as an organized hematoma due to a severe trauma. The ablation was performed by direct access under local anesthesia. The analysis of the piece has showed a NET of the breast due to the positivity of the neuroendocrine, cytokeratin and hormone markers. No other NET lesion was found, excluding the secondary origin of the breast tumor. Complementary therapies associated mastectomy, lymphadenectomy, hormonotherapy. Male breast cancer is rare. NET are exceptional, only a dozen of male NET is reported. These tumors affect a specific population and have a better prognosis than infiltrating ductal carcinoma. In our case, no causal link can be demonstrated between trauma and tumor microenvironment necessary for the growth of quiescent cancer cells.

[The complete dorsum nasal island flap based on the superior alar artery]

The complete dorsal nasal aesthetic unit can be raised in a vascular island flap based on the superior alar artery, at the level of the nasalis muscle. This flap uses the vertical glabellar cutaneous laxity. It hides scars between the nasal aesthetics units and its distal rotation point allows a pure translation of the nasal skin without distortions encountered when using medial canthal rotation flaps. This local flap is reliable and had been successfully used for four patients without complications or secondary procedures. It allows large reconstructions for up to 25 mm defects leaving minimal scars. It represents an interesting alternative for the reconstruction of defects of the nasal tip or supra tip of the nose, and has also been used for alar reconstructions.

Stimulated Raman side scattering in laser wakefield acceleration

Stimulated Raman side scattering of an ultrashort high power laser pulse is studied in experiments on laser wakefield acceleration. Experiments and simulations reveal that stimulated Raman side scattering occurs at the beginning of the interaction, that it contributes to the evolution of the pulse prior to wakefield formation, and also that it affects the quality of electron beams generated. The relativistic shift of the plasma frequency is measured.

Transcutaneous oxygen pressure measurements in diabetic and non-diabetic patients clinically suspected of severe limb ischemia: a matched paired retrospective analysis

AIM

It was recently suggested that a 6 mmHg difference exists in both chest and foot transcutaneous oxygen pressure (TcPo2) between diabetic and non-diabetic volunteers apparently free from vascular disease. If a difference can also be found in diabetic and non-diabetic patients with clinically suspected critical limb ischemia (CLI), this may question the use of the same 30 mmHg threshold proposed by the "TASC" in the definition of CLI. We analyse whether a difference can be found for chest and foot TcPo2 respectively between diabetic and non-diabetic patients referred for clinically suspected CLI.

METHODS

A retrospective matched paired study was performed among 60 diabetic and 60 non-diabetic subjects with peripheral artery disease and suspected critical limb ischemia. Results are presented as median [25-75 centiles].

RESULTS

Groups were comparable in terms of gender, age, height, systolic blood pressure and treatments (except for renin-angiotensin inhibitors). Chest-TcPo2 was 53 [43-57] mmHg in diabetic and 60[49-65] mmHg in non-diabetic patients (P<0.01). Foot-TcPo2 was 12[3-34] mmHg in diabetic and 15[3-36] mmHg in non-diabetic patients (Non significant). A multi-parametric step by step regression analysis showed that chest-TcPo2 was inversely associated with weight, then with diabetes and gender.

CONCLUSIONS

TcPo2 is lower at the chest but not at the foot level in diabetic than in non-diabetic patients with suspected CLI. Then, the "30 mmHg threshold" proposed in the definition of lower-limb CLI is likely applicable in both diabetic and non-diabetic patients.

Adjuvant regional irradiation after breast-conserving therapy for early stage breast cancer: a survey of canadian radiation oncologists

AIMS

To document the use of adjuvant regional irradiation after breast-conserving therapy for early stage breast cancer by Canadian radiation oncologists and to identify the factors influencing their clinical decisions.

MATERIALS AND METHODS

We conducted a survey to assess the above aims. In April 2008, a questionnaire was sent to 167 members of the Canadian and Quebec Associations of Radiation Oncologists with interest in breast cancer management. The answers were obtained through a dedicated website, which collected the raw data collected for analysis.

RESULTS

In total, 67 radiation oncologists completed the survey, corresponding to a 40% response rate. Most respondents were experienced and high-volume providers. We identified several areas of variation in the decision-making regarding regional lymph node irradiation after breast-conserving therapy. Regarding the decision to combine regional nodal irradiation with irradiation of the breast, the number of positive nodes after axillary dissection (1-3 vs > or =4) was a crucial determinant. For patients with between one and three positive nodes and a nodal ratio of 50%, most respondents added regional irradiation. Similarly, the same nodal ratio of 50% was the main factor for inclusion of the axillary nodal region in the radiation field. However, few radiation oncologists have chosen to include the internal mammary chain in their treatment plan. The number of positive lymph nodes, the nodal ratio, the number of lymph nodes removed and the presence of extracapsular extension were the primary self-reported factors that directed the decision to offer regional radiotherapy.

CONCLUSIONS

This survey showed that there is a wide variation of practices among radiation oncologists in Canada. These results support the need for treatment guidelines and provide guidance on which factors should be included in a decision-making algorithm.