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INTRODUCTION The vascularized submental lymph node (VSLN) flap has become a popular choice for the treatment of lymphedema. Despite its favorable characteristics, anatomic variability exists, making the harvest of this flap challenging. Knowledge and characterization of anatomic variability can aid the surgeon in safe and effective flap harvest. METHODS A prospective analysis of all patients who underwent VSLN flap transfer for lymphedema was performed. Demographics, operative details, and post-operative recovery were analyzed for included patients. Intraoperative videography and detailed anatomic drawings of each case were reviewed to accurately account for anatomic variability and details. RESULTS Forty-two patients were identified during the study period. Arteriovenous anatomic variability (A1-A2 and V1-V4) existed, with most patients having the artery and vein present superior to the submandibular gland (A1V1; 31%), with other combinations occurring less frequently. Flap harvest time was found to be significantly increased with an intraglandular arterial course (P

Background and Objectives Due to its consistent vascular and lymphatic anatomy, the vascularized submental lymph node flap is a reliable option for lymphedema treatment. Despite these advantages, flap harvest requires resection of platysma, which may cause a marginal mandibular nerve pseudo-paralysis. The aim of this study was to investigate the donor site morbidity of an innovative platysma-sparing vascularized submental lymph node flap transfer for treating extremity lymphedema. Methods Ten patients undergoing platysma sparing submental lymph-node flap harvest were prospectively enrolled in the study and compared with a control group of 10 patients who underwent standard submental lymph-node flap harvest. Photogrammetry analysis was used to assess donor site morbidity with regards to marginal mandibular nerve pseudo-paralysis. Results All flaps survived. No necrosis of the skin paddle was observed in both groups. There were no marginal mandibular nerve palsies in both group. There were no cases of marginal mandibular nerve pseudo-paralysis in the platysma sparing group. Conclusions The platysma sparing submental flap, while offering comparable functional improvement for extremity lymphedema, has the advantages of maximizing nerve and muscular preservation, significantly reducing donor site morbidity. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.

Background Vascularized submental lymph node (VSLN) transfer is an emerging approach for extremity lymphedema. This study investigated the long-term outcome and venous complications of VSLN for unilateral lower extremity lymphedema. Methods Between 2010 and 2018, patients who underwent VSLN for unilateral lower extremity lymphedema were retrospectively evaluated. Patient demographics, operative records, complications, circumferential improvement, and episodes of cellulitis were analyzed. Further comparisons were performed between different types, numbers, and techniques of venous anastomoses. Results A total of 75 VSLNs in 70 patients survived, giving a 100% success rate. Six flaps (8%) had venous complications (VC group) and 69 flaps (92%) did not (No-VC group). There were no statistical differences in types, numbers, and techniques of anastomoses between two groups (P = .65, 1, and .56, respectively). At a mean follow-up of 32.0 ± 23.0 months, mean circumferential improvement and episodes of cellulitis between two groups did not statistically differ significantly (P = .31 and .09, respectively). Conclusions VSLN is an effective treatment for lower extremity lymphedema. The types, numbers of veins, and techniques of venous anastomoses did not statistically affect the venous complication rates. Functional outcomes of the VSLNs were not compromised if venous complications were salvaged promptly.

OBJECTIVES This study aimed to identify the cognitive factors associated with the professional healthcare advice (PHCA) seeking behavior in breast cancer-related lymphedema (BCRL). METHODS From January 2018 to December 2018, patients with BCRL were prospectively enrolled for a cross-sectional survey of lymphedema-related perceived risks, lymphedema quality of life (LYMQoL), knowledge scale of lymphedema, and PHCA behavior at first clinical visit, 3 and 6 months postbaseline. RESULTS A total of 180 patients including 100 (55.6%) patients underwent a vascularized lymph node transfer (VLNT) and 80 (44.4%) patients received compressive decongestive therapy (CDT) were enrolled. At 6 months of follow-up, mean episodes of cellulitis (from 2.2 to 0.2 times/year), mean circumferential difference (7.8 ± 3.9%), wearing compression garments (from 29% to 0 %) in the VLNT group were statistically reduced than those in the CDT group (p = .01

Introduction Patients with pre-existing lymphedema who undergo total knee arthroplasty (TKA) for osteoarthritis (OA) are at high risk for periprosthetic joint infection. This complication usually requires removal of the implant. This study aimed to investigate whether surgical treatment of lymphedema reduces the rate of prosthesis removal in such patients. Materials and methods We retrospectively reviewed our prospective database of patient information collected between January 2009 and December 2018. A total of 348 cases of lower extremity lymphedema were reviewed, and those who underwent total knee TKA for OA of the knee were included. Patient demographics, clinical data, lymphedema surgical history, and TKA surgical history including any episodes of removal were collected and analyzed. Results There were nine of 15 lymphedema patients with knee OA who subsequently underwent TKA. The mean patient age was 70.4 ± 7.1 years. A total of 18 TKAs were performed in nine patients. The knee prosthesis removal rate was 66.7% (12/18). The prosthesis removal rate was 40% (2/5) in patients who underwent lymphedema microsurgery vs 76.9% (10/13) for those who did not (P = .03). Conclusions Pre-existing lymphedema is associated with a high rate of knee prosthesis removal. Lymphedema microsurgery reduced the removal rate of knee prostheses. We recommend that lymphedema microsurgery be considered for patients who require TKA as a treatment for of the knee.

Background The profunda feomris artery perforator (PAP) flap was recently revisited and gains popularity as an alternative method of autologous breast reconstruction. The purpose of this article is to demonstrate that PAP flap can be used reliably for reconstruction of various soft tissue defects. Methods A total of 55 free PAP flaps and 16 pedicle PAP flaps were transferred in 63 patients. Each case was reviewed to verify a PAP flap was performed identifying defect location, flap size, flap design, and postoperative complications. Results Seven flaps in five patients underwent breast reconstructions, 48 patients underwent head and neck reconstructions using free PAP flaps. The mean perforator number was 1.9, and the average pedicles length was 9.7 cm. The majority of perforators were musculocutaneous, and the others were septocutaneous. The mean ischemia time was 121.4 min. Minor complications included wound poor healing, flap partial necrosis, and pedicle vessels problems. Sixteen pedicle PAP flaps were transferred in 10 patients for vulvar reconstruction. Minor complications included urinary tract infection, poor wound healing, wound infection, hematoma. Conclusions The anatomy and number of perforators of PAP flap are reliable with adequate pedicle length. This flap can be an excellent option for reconstruction of most soft tissue defects. J. Surg. Oncol. 2016;114:193–201. © 2016 Wiley Periodicals, Inc.

Purpose This study was to investigate intraoperative assessment of side-to-end lymphovenous anastomosis (LVA) with indocyanine green (ICG) and the correlation between its patency and surgical outcome. Methods LVA was applied to five patients with early-stage lower extremity lymphedema. Side-to-end anastomosis and then end-to-end anastomosis were created as a second alternative. Immediately after the anastomosis, ICG was used to confirm its patency. Results The mean number of anastomoses was 2.0 ± 0.7, and the types of anastomoses were primarily side-to-end and secondarily end-to-end. The mean reduction rate was 63.8 ± 20.2% after LVA at 10 ± 6.4 months of follow-up. In all cases, the affected extremities became soft immediately after surgery, and no cellulitis episodes were observed. Conclusion Side-to-end LVA can be an effective treatment for early-stage lower extremity lymphedema. ICG lymphodynamic assessment is useful not only in the preoperative identification of functional lymphatics but also in the intraoperative visualization of new drainage routes in LVA surgery. © 2015 Wiley Periodicals, Inc. Microsurgery 36:310–315, 2016.

Bromoform (CHBr3; 11–486 fmol L21 h21), dibromomethane (CH2Br2; 0–9.4 fmol L21 h21), and low amounts of chloride-substituted chlorobromomethanes were produced from southern California coastal surface seawater upon the addition of algal bromoperoxidase (BrPO) and hydrogen peroxide. Production was greater from water collected near shore than 16 km offshore, presumably reflecting the difference in the reactive dissolved organic matter (DOMreact) concentrations. In the spring, there was an increase in phytoplankton abundance, and CHBr3 production from BrPO incubations was greater, presumably due to increased DOMreact. In the winter, CH2Br2 production was enhanced, although still lower than CHBr3, suggesting a qualitative change in DOM composition due to terrestrial runoff. During the month of the highest precipitation, CHBr3 and CH2Br2 production was enhanced in samples obtained from the mouth of an urban river, suggesting a higher concentration of DOMreact of terrestrial origins. DOM was fractionated by ultrafiltration and subject to the BrPO incubation. The higher molecular weight fractions contained a higher concentration of DOM that was susceptible to BrPO bromination, yielding polybromomethanes. Polybromomethane and iodomethane production associated with phytoplankton blooms results from the reaction between the surrounding DOM, and hypobromous acid (HOBr) and hypoiodous acid released from extracellular (apoplastic) BrPO. The reaction of HOBr and DOM (biological bleaching) could represent a significant DOM degradation pathway. Cell-free BrPO, derived from dead cells, could remain catalytically active in seawater and produce low amounts of polyhalomethanes prior to biological degradation.

Objectives/Hypothesis: This study was designed to investigate the anatomical features and applications of the ulnar forearm flap in head and neck reconstructive surgery. Study Design: A prospective study was designed to include 50 ulnar forearm free flap transplants in 50 patients. Patient defects requiring reconstructive surgery involved the buccal mucosa, tongue, floor of the mouth, upper or lower gums, lips, soft palate, and scalp. Twenty ulnar forearm flaps were analyzed along the entire ulnar artery to determine the anatomy and distribution of the ulnar artery septocutaneous perforators. Results: All 50 flaps were successfully transplanted into their respective sites. The mean diameters of the ulnar artery and vein were 2.3 ± 0.6 mm and 1.7 ± 0.6 mm, respectively. Arterial and venous size mismatch was experienced in 12 and 33 flaps, respectively. The mean number of sizable perforators was 4.3 ± 1.2, and most of the first perforators were located within 5 cm of the proximal wrist crease. None of the patients experienced long-term complications concerning the ulnar nerve. Conclusions: The ulnar forearm flap is a reliably consistent source of free flap transfer because it harbors constant septocutaneous perforators and produces minimal donor site morbidities for head and neck reconstructive surgery. Laryngoscope, 2012

A nanostructured poly(5-amino-2-naphthalene sulfonic acid) (nanostructured PANS) electrode has been prepared using cetyltrimethyl ammonium bromide (CTAB) as a soft template by potentiodynamic method. The effect of CTAB at various concentrations was analyzed during electrochemical synthesis of the PANS electrode. As the concentration was near to cmc of CTAB, well growth and nanostructured PANS electrode was obtained. The formation mechanism and the reason for the increase of the peak current of the nanostructured PANS electrode are discussed. The surface morphology of PANS electrode was investigated using scanning electron microscopy (SEM) and a nanoribbon like structured PANS polymer was obtained near cmc of CTAB. The electrochemical properties of nanostructured PANS electrode were studied. The catalytic utility of nanostructured PANS electrode was investigated and it exhibited electrocatalytic activity for the reduction of iodate with a low potential. The amperometric detection of iodate was tested at nanostructured PANS electrode. Linear range and detection limit were found to be 0.1 to 0.4 µM and 0.1 µM, respectively. The present work involves a simple, and one-step approach to fabricate a nanostructured PANS film with unique electrochemical properties, which can have great potential in various applications such as sensors, and energy source systems.

Decoding operation reduction algorithms on min-sum layered low-density parity-check (LDPC) decoders are proposed in this paper. Our algorithm freezes selected operations in high reliable nodes to reduce power while preserving error correcting performance. Both memory accesses and active node switching activities can be reduced. A novel node refresh mechanism reactivates frozen nodes to minimize coding gain degradation. We propose three decoding operation reduction algorithm variations to trade-off complexity and operation reduction for LDPC decoders with different degrees of parallelism and memory requirement. Simulation results show that the number of LDPC decoding operations is reduced across all SNR ranges. The decoding convergence speed is not affected. Hardware architecture and FPGA implementation for IEEE 802.16e LDPC codes are presented. Copyright © 2011 John Wiley & Sons, Ltd.

This prospective study was designed to compare the accuracy rate between remote smartphone photographic assessments and in-person examinations for free flap monitoring. One hundred and three consecutive free flaps were monitored with in-person examinations and assessed remotely by three surgeons (Team A) via photographs transmitted over smartphone. Four other surgeons used the traditional in-person examinations as Team B. The response time to re-exploration was defined as the interval between when a flap was evaluated as compromised by the nurse/house officer and when the decision was made for re-exploration. The accuracy rate was 98.7% and 94.2% for in-person and smartphone photographic assessments, respectively. The response time of 8 ± 3 min in Team A was statistically shorter than the 180 ± 104 min in Team B (P = 0.01 by the Mann-Whitney test). The remote smartphone photography assessment has a comparable accuracy rate and shorter response time compared with in-person examination for free flap monitoring.

This study reports the characteristics of gel-type dye-sensitized solar cells (DSSCs), fabricated with gel-type electrolyte containing poly-1,1′-(methylenedi-4,1-phenylene)bismaleimide (PBMI), or poly-1,1′-(3,3′-dimethyl-1,1′-biphenyl-4,4′-diyl)bismaleimide (PDBBMI), or poly-N,N′-(4-methyl-1,3-phenylene)bismaleimide (PMPBMI), prepared by in situ polymerization of the corresponding monomer without an initiator at 30 °C. Incorporating 0.3 wt % content of exfoliated alkyl-modified nanomica (EAMNM) into PBMI-gelled electrolyte leads to higher short-circuit current density (Jsc = 17.14 mA cm−2) and efficiency (η = 7.02%) than that of neat PBMI-gel electrolyte (Jsc = 15.32 mA cm−2, η = 6.41%). Incorporating 0.3 wt % EAMNM into PBMI-gelled electrolyte results in remarkably stable device performance under continuous light soaking under one sun (100 mW cm−2) at 55 °C. The efficiency of DSSCs based on PBMI/0.3 wt % EAMNM-gelled electrolyte drops by only 1.7% (η = 6.93%) after 500 h of continuous light soaking. © 2010 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem, 2010

Maps of disease rates (and other quantities) often must contend with variance associated with variable population sizes and low incidence within spatial units. These characteristics can lead to substantial statistical noise that can mask underlying spatial variation. As Gelman and Price illustrated, most conventional mapping methods fail to address this problem, and in fact can introduce statistical artefacts; mapped quantities can show spatial patterns even when there are no spatial patterns in the underlying parameter of interest. Kafadar evaluated the performance of the headbanging algorithm for spatial smoothing (Tukey and Tukey, Hansen) for eliminating small scale variation and preserving edge structure. Here we perform a simulation study to investigate the artefacts of maps smoothed by unweighted and weighted headbanging. We find substantial artefacts that depend on the spatial structure of the statistical variation (for example, the spatial pattern of sample sizes) and on the details of the spatial distribution of geographic units. The methods used here could readily be adapted to study other spatial smoothers; we choose headbanging because (i) it is an important method used in practice, and (ii) its heavily computational nature is naturally studied using simulation (in contrast to the analytical methods used by Gelman and Price).

There is an increase in the prevalence of obesity and its related health problems. While dietary management and exercise help reduce the accumulation of body fat, recently attention has also been d...