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Herein, we successfully incorporated pnictogen-Au@AgNR composites, produced by mixing shear exfoliated pnictogen nanosheets with silver shell, gold core nanorods (Au@AgNRs), as novel electrode materials towards the development of a non-enzymatic electrochemical glucose sensor. The findings of this study conceptually prove the feasibility of incorporating pnictogen-based composites for future development of electrochemical sensors.

Transition metal carbides, known as MXenes, are generated via the selective etching of "A" layers from their layered, ternary parent compounds, MAX phases, where M corresponds to early d -transition metal, A being a main group sp -element from either Group 13 or 14 and carbon or nitrogen being denoted by X. MXenes are being recognized as a new and uprising class of 2D materials with extraordinary physical and electrochemical properties. The huge specific surface area and outstanding electrical conductivity of MXenes, make them ideal candidates for sensing and energy applications. Herein, we demonstrated the successful incorporation of pristine MXene, Ti 3 C 2 produced via HF etching and subsequent delamination with TBAOH, as a transducer platform toward the development of a second generation electrochemical glucose biosensor. Chronoamperometric studies demonstrate that the proposed biosensing system exhibits high selectivity and excellent electrocatalytic activity toward the detection of glucose, spanning over wide linear ranges of 50-27 750 μM and possess a low limit of detection of 23.0 μM. The findings reported in this study conceptually proves the probable applications of pristine MXenes toward the field of biosensors and pave ways for the future developments of highly selective and sensitive electrochemical biosensors for biomedical and food sampling applications.

We describe a case of the combined use of acellular dermal matrix and pedicled buccal fat pad (BFP) in a wide U-shaped cleft palate repair. Acellular dermal matrix was used as a "patch" repair for the nasal mucosa defect as opposed to the conventional inlay graft. The advantages include reduced cost and a smaller avascular graft load. Lateral relaxing incisions were made to ensure tension-free closure of oromucosa at midline. Lateral oromucosa defect closure with well-vascularized pedicled BFP ensures enhanced healing, less palatal contracture and shortening, and reduced infection. The palate healed with mucosalization at 2 weeks, and no complications were noted at 6 months follow-up.

Background: One-third of infants have ear anomalies, and less than one-third self-correct. Correction of ear deformities by molding exploits the plasticity of the auricular cartilage because of circulating maternal estrogen during infancy. In this study, the authors assess the efficacy of the EarWell Infant Correction System in the correction of ear deformities and determine the factors that affect its outcome., Methods: The authors conducted a single-center prospective study over a 3-year period. Consecutive full-term infants who underwent ear molding with the EarWell system were recruited. Primary outcome was successful correction of ear anomaly. Secondary outcomes included complications and maintenance of ear shape. Factors identified included type of anomaly, age at application, duration of application, and breastfeeding., Results: Sixty-seven patients with a total of 105 ears were recruited. The anomalies were classified into deformations (66.7 percent) and malformations (33.3 percent). The median age group at presentation was 0 to 7 days (67 percent). Average duration of application was 4.1 weeks. Successful correction was achieved in 86 percent of patients. Ear deformations achieved a significantly higher rate of successful outcome (98 percent) compared with malformations (64 percent) (p < 0.001). Skin complications were common (46 percent) and attributed to our tropical climate. Patients with complications were of a higher mean age (22.1 days) compared with patients with no complications (10.6 days) (p = 0.037)., Conclusions: The EarWell system is an effective nonsurgical option for the treatment of ear anomalies. The type of anomaly was the only predictor of successful correction, whereas age at application, duration of molding, and breastfeeding were not. Complications were more common in older infants., Clinical Question/level of Evidence: Therapeutic, IV.

The experimental achievement of phosphorene, which exhibits superior electronic, physical, and optical properties has spurred recent interest in other Group 15 elemental 2D nanomaterials such as arsenene, antimonene, and bismuthene. These unique and superior properties of the pnictogen nanosheets have spurred intensive research efforts and led to the discovery of their diversified potential applications; for instance, optical Kerr material, photonic devices, pnictogen-decorated microfibers, high-speed transistors, and flexible 2D electronics. Previous studies have mainly been dedicated to study the synthesis, properties, and applications of the heavy pnictogens nanosheets; however, the toxicological behaviour of these nanosheets has yet to be established. Herein, the cytotoxicity study of pnictogen nanosheets (As, Sb, and Bi) was conducted over 24 h of incubation with various concentrations of test materials and adenocarcinoma human lung epithelial A549 cells. After the treatment period, the remaining cell viabilities were obtained through absorbance measurements with WST-8 and MTT assays. These findings demonstrate that the toxicity of pnictogen nanosheets decreases down Group 15, whereby arsenic nanosheets are considered to be the most toxic, whereas bismuth nanosheets induce low cytotoxicity. The findings of this study constitute an important initial step towards enhancing our understanding of the toxicological effects of pnictogen nanosheets in light of their prospective commercial applications., (© 2019 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Uterine leiomyomas are the most common tumours arising from the female reproductive tract. However, giant myomas, which are greater than 11.4 kg in weight, are exceedingly rare. They may cause a pressure effect on surrounding organs, heart and lungs, which can be potentially life threatening. We present a case of a 53-year-old woman with a massive uterine mass complicated by restrictive lung disease. She underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy with frozen section and reconstruction of the abdominal wall by the gynaecologists and plastic surgeons. The excised specimen weighed 27.8 kg, which included a benign subserosal leiomyoma measuring 64 by 50.5 by 15 cm. Intraoperative blood loss was 7 L and her postoperative recovery was complicated by coagulopathy and haemorrhagic shock. This case illustrates the pivotal role of multidisciplinary care in the management of complicated surgical patients and the need for careful perioperative care., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Much research effort has been put in to study layered compounds with transition metal dichalcogenides (TMDs) being one of the most studied compounds. Due to their extraordinary properties such as excellent electrochemical properties, tuneable band gaps, and low shear resistance due to weak van der Waals interactions between layers, TMDs have been found to have wide applications such as electrocatalysts for hydrogen evolution reactions, supercapacitors, biosensors, field-effect transistors (FETs), photovoltaics, and lubricant additives. In very recent years, Group 5 transition metal ditellurides have received an immense amount of research attention. However to date, little has been known of the potential toxicities posed by these materials. As such, we conducted the cytotoxicity study by incubating various concentrations of the Group 5 transition metal ditellurides (MTe 2 ; M=V, Nb, Ta) with human lung carcinoma epithelial A549 cells for 24 hours and the remaining cell viabilities after treatment was measured. Our findings indicate that VTe 2 is highly toxic whereas NbTe 2 and TaTe 2 are deemed to exhibit mild toxicities. This study constitutes an exemplary first step towards the understanding of the Group 5 transition metal ditellurides' toxicity effects in preparation for their possible future commercialisation., (© 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Background: Loss of nipple projection is a common problem following nipple reconstruction. The aim of this study was to demonstrate that the use of a tightly rolled dermal graft is effective in the long-term maintenance of nipple projection., Methods: Nipple reconstruction was performed using the C-V flap technique. A dermal graft was harvested from the dog-ear portion of previous scars. The graft was rolled tightly into a compact cylinder and used to augment the nipple reconstruction. Postoperatively, stacked Allevyn dressing was used for protecting the nipple from compression for a minimum of two months. Nipple projection was measured at the time of surgery and at 12 months postoperatively., Results: Forty nipple reconstructions were performed using this technique. There were 19 transverse rectus abdominis musculocutaneous (TRAM) flaps, 10 latissimus dorsi (LD) flaps, and 11 tissue-expanded breast mounds. At one year, the mean projection was 0.80 cm (range, 0.62-1.22 cm). The twelve-month average maintenance of nipple projection was 70.2% for the TRAM flap group, 76.3% for the LD flap group, and 61.8% for the tissue-expanded group. In two patients with previous irradiation of the reconstructed breasts, relatively poor maintenance of nipple projection was noted (45.7%). No complications were noted, and all of the donor sites healed well primarily., Conclusions: Our results demonstrated that the use of a C-V flap with a tightly rolled dermal graft for nipple reconstruction improves the long-term maintenance of nipple projection. Its advantages include reproducibility, technical simplicity, cost-effectiveness, and minimal donor site morbidity.

We report a case of sternal reconstruction using bilateral sternal bar turnover flaps in a 4-year-old boy with an inferior sternal cleft, as part of Cantrell's pentad. When the patient was 10 months old, he underwent sternal reconstruction using a resorbable poly-L-lactic-polyglycolic acid plate in the first stage when there was insufficient autogenous tissue to provide a reliable reconstruction. Bilateral sternal bar turnover was performed in the second stage at 4 years of age. This operative technique is described in this report. This novel technique provides a robust, dynamic, and reliable reconstruction for inferior sternal defects.

We present a case of a 10-month-old male infant with thoracoabdominal ectopia cordis, as part of Cantrell pentad, repaired using a poly-L-lactic-polyglycolic acid plate, a resorbable plating system widely used in craniomaxillofacial reconstruction. This is the first reported case of sternal reconstruction using a poly-L-lactic-polyglycolic acid plate. The repair was successfully carried out without cardiopulmonary compromise and good aesthetic outcome was achieved., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: The surgical risk of unruptured aneurysms is well quantified. Although the outcomes for ruptured aneurysms are also well described, due to the concurrent morbidity from the natural history of the haemorrhage, the relative contributions of surgery and natural history to outcome following aneurysmal subarachnoid haemorrhage (SAH) is not. Our aim was to quantify these risks., Methods: This was a retrospective case note and radiological review of 200 patients with aneurysmal World Federation of Neurological Surgeons grade 1 or 2 SAH, treated with surgical clipping over a period of 3 years. Cases were reviewed to establish the incidence of surgical complications. Outcome was assessed at 3-month follow-up on Glasgow outcome score and the influence of surgical complications on this was assessed., Results: Thirty-seven patients suffered a surgical complication (19%). Over one half (19/37) were due to a vascular injury and 13 of those resulted in an unfavourable outcome (7% of all operations). The remainder of the patients who suffered a surgical complication (18/37) included those with direct brain injury, cranial nerve injury, post-operative haematoma and bone flap infection. Of those, only two cases resulted in poor outcome (1% of operations). In total, 22 patients had an unfavourable outcome (11%). In 15 (8%), surgical complications were deemed the major contributory factor., Conclusions: Overall, surgically treated good-grade SAH has a good outcome. The majority of poor outcomes are due to surgical complications and most of these are vascular. Careful preservation of perforators and accurate clip placement remain the key factors in determining outcome in surgically treated good-grade SAH.

This article details an algorithm we used for selection of recipient vessels in free tissue transfer to the head and neck. Eighty-eight consecutive free flaps to the head and neck were performed in 85 patients. The superior thyroid was the commonest recipient artery used (61%). The facial artery, used in 14% of our cases, is the choice vessel in instances where neck dissection is not performed. In these cases, we have to access the neck separately for recipient vessels and it can be exposed easily via a short (3-cm) incision. The superficial temporal artery (11%) is our choice vessel for patients with previous neck dissection or radiotherapy as it is well outside the previous operative or irradiated field. Other vessels such as the transverse cervical and end-to-side anastomosis to the carotid artery were also used when appropriate. Recipient vein selection depends primarily on the selected artery. Corresponding veins and large branches of the internal jugular vein (IJV) in the vicinity of the selected artery are preferred. When these are exhausted, the external jugular vein and end-to-side anastomosis to the IJV are considered. We found this algorithm to be reliable in identifying the appropriate vessels in all cases., (© Thieme Medical Publishers.)

Background: Chronic subdural haematoma causes serious morbidity and mortality. It recurs after surgical evacuation in 5-30% of patients. Drains might reduce recurrence but are not used routinely. Our aim was to investigate the effect of drains on recurrence rates and clinical outcomes., Methods: We did a randomised controlled trial at one UK centre between November, 2004, and November, 2007. 269 patients aged 18 years and older with a chronic subdural haematoma for burr-hole drainage were assessed for eligibility. 108 were randomly assigned by block randomisation to receive a drain inserted into the subdural space and 107 to no drain after evacuation. The primary endpoint was recurrence needing redrainage. The trial was stopped early because of a significant benefit in reduction of recurrence. Analyses were done on an intention-to-treat basis. This study is registered with the International Standard Randomised Controlled Trial Register (ISRCTN 97314294)., Findings: Recurrence occurred in ten of 108 (9.3%) people with a drain, and 26 of 107 (24%) without (p=0.003; 95% CI 0.14-0.70). At 6 months mortality was nine of 105 (8.6%) and 19 of 105 (18.1%), respectively (p=0.042; 95% CI 0.1-0.99). Medical and surgical complications were much the same between the study groups., Interpretation: Use of a drain after burr-hole drainage of chronic subdural haematoma is safe and associated with reduced recurrence and mortality at 6 months., Funding: Academy of Medical Sciences, Health Foundation, and NIHR Biomedical Research Centre (Neurosciences Theme).

Malignant peripheral nerve sheath tumours (MPNST) are exceedingly rare in an intracranial location. In this report clinical and pathological evidence for the diagnosis of a MPNST arising from of the oclumotor nerve is presented. To our knowledge this is the first such case reported in the medical literature.

Lymphatic drainage from the peritoneal cavity to mediastinal lymph nodes has been reported, indicating that abdominal fluid is not immobile. We studied this movement in rats receiving Tc-99m albumin nanocolloid which has smaller particle sizes than does Tc-99m microaggregated albumin colloid used for liver/spleen imaging. The Tc-99m albumin nanocolloid had a radiochemical purity of 99.33%-99.77% with free pertechnetate of 0.23%-0.67%. During pentobarbital anesthesia, thoracoabdominal images were obtained 4-6 hr after intraperitoneal injection of 350 mCi Tc-99m albumin nanocolloid with 5 ml of normal saline. The images showed symmetrical radiotracer localization in the mediastinal lymph nodes. Scintigraphic demonstration of drainage to the mediastinal region from the peritoneal cavity may be explained by flow directly into mediastinum through the lymphatic system, indicating lymphatic patency between the peritoneal cavity and mediastinum. Absence of visualization may indicate lymphatic block. This type of information concerning lymphatic drainage may have clinical impact for a patient with malignant or intractable ascites. The radionuclide technique is easily performed for this assessment.

At irregular intervals, a 99mTc-labelled microcolloid for liver and spleen scintigraphy was reported to accumulate in the lungs, in the absence of any pathophysiological condition usually associated with this phenomenon. These findings were in direct contrast to the results obtained during quality control assays performed on the production batches of the kit. The authors tested the hypothesis that the presence of Al3+ ions in the generators eluate used to label the kit caused the formation of larger size aggregates. The experimental results suggest that the 99mTc-pertechnetate solution used for labelling contained far more than 40 micrograms Al3+ per ml, hence a many-fold increase of the maximum level tolerated by the pharmacopoeia. The authors advise caution when interpreting findings of pulmonary activity in the absence of clear evidence of pathological conditions that are sometimes associated with this biodistribution pattern.