Silicone breast implants: the role of immune system on capsular contracture formation

Cyclic methylsiloxanes in wastewater treatment plants: Occurrence, emissions, environmental distributions, and occupational exposure

Cyclic methylsiloxanes (CMSs), widely found in wastewater treatment plants (WWTPs), are potentially hazardous to the environment and human health. In this study, the environmental behavior and human exposure risks of three CMSs (D4-D6) were evaluated in WWTPs located in Beijing and Kunming, Yunnan province. D5 had the highest concentrations in air, water, and sludge, with seasonal variation that consisted of a high concentration in summer and low concentration in winter. The CMS concentrations in air were 3-4-fold higher in the A2/O (Anaerobic-Anoxic-Oxic) treatment units than in the other units. CMS emissions to air, soil, and water from the Beijing WWTP were in the ranges of 3.4 × 104-5.0 × 104 kg·a-1, 4.5 × 102-7.5 × 102 kg·a-1, and 2.5 × 102-2.9 × 102 kg·a-1, constituting 98 %, 1.3 %, and 0.7 % of the total emissions, respectively. Total daily inhalation exposure doses of CMSs (ADDinh,CMSs) associated with four different jobs in WWTPs showed that wastewater treatment technicians had the highest ADDinh,CMSs (51 μg/kg/day), indicating that these people had the highest occupational exposure risk in WWTPs. Therefore, this study identified that atmospheric emission was the main environmental fate of CMSs in WWTPs, and provide a basis for the improvement of WWTP process and risk management decisions. ENVIRONMENTAL IMPLICATION: Assessing the environmental fate and occupational exposure risk of cyclic methylsiloxanes (CMSs) found in wastewater treatment plants (WWTPs) is crucial. This is the first study to identify that atmospheric emission was the main environmental fate of CMSs in WWTPs, especially D5; the inhalation exposure doses of CMSs were all significantly higher in the occupational population working in WWTPs. The results described in our study will help enhance the understanding of current knowledge base of environmental fate and exposure risk of CMSs in WWTPs, and provide a basis for the improvement of WWTP process and risk management decisions.

Assessing the impact of mining on cyclic and linear methylsiloxane distribution in Tibetan soils: Source contribution and transport pattern

The pervasive presence of methylsiloxanes (MSs), comprising linear and cyclic congeners, in the environment poses significant ecological risks, yet the understanding of their transport mechanisms and deposition patterns remains limited. This study analyzed the concentrations of 12 linear-MSs (L3-L14) and 7 cyclic-MSs (D3-D9) in 29 surface soil samples collected across varying altitudes (3726 to 4863 m) near the Jiama mining sector in Tibet, aiming to investigate the distribution and transport dynamics of MSs from the emission source. The distribution of total MS concentration (ranging from 50.1 to 593 ng/g) showed a remarkable correlation with proximity to the mining site, suggesting the emergent source of mining activities for the MSs in the remote environment of the Tibetan Plateau. Employing the innovative model of robust absolute principal component scores-robust geographically weighted regression (RAPCS-RGWR), the analysis predicted that the mining operations contributing 57.1 % of the total soil MSs, would significantly surpass contributions from traffic emissions (14.7 %), residential activities (13.2 %), and the environmental factor of total organic matter content (14.9 %). The Boltzmann equation effectively modeled the distribution pattern of soil MSs, highlighting atmospheric transport and gravitational settling as key distribution mechanisms. However, linear-MSs exhibited longer transport distances than cyclic-MSs and were more profoundly affected by prevailing wind directions, suggesting their differential environmental behaviors and risks. Our study underscored that the mining sector possibly emerged as a significant source of Tibetan MSs, and provided insights into the transport and fate of MSs in remote, high-altitude environments. The findings emphasize the need for targeted pollution control strategies to mitigate the environmental footprint of mining activities in Tibet and similar regions.

Interference of the gas chromatography- mass spectrometry instrumental background on the determination of trace cyclic volatile methylsiloxanes and exclusion of it by delayed injection

Cyclic volatile methylsiloxanes (cVMS) have been widely found in various types of environmental media and attracted increasing attention as new pollutants. However, there is still a great challenge in the accurate quantification of trace cVMS, due to their volatility, and the high background originating from GC/MS accessories and surroundings. In this work, the main sources of the high background were investigated in detail for octamethylcyclotetrasiloxane (D4), decmethylcyclopentasiloxane (D5) and dodecmethylcyclohexosiloxane (D6). Several effective measures were employed to minimize these backgrounds, including the delayed injection method to minimize the interference from the injection septum. Then, a GC-MS method was developed for the accurate determination of D4, D5 and D6, with a linear range of 2 - 200 μg/L. The coefficient of determination was 0.9982-0.9986, the limit of detection (LOD) was 0.40-0.52 μg/L, and the quantitative range was 1.88-190 μg/L. Good reproducibility and recovery were obtained, indicating the reliability of the established analytical method.

Assessment of the internal and external exposure risks to methylsiloxanes in communities near a petroleum refinery

Methylsiloxanes (MSs) are widely used in industrial production and have attracted much attention due to their potential health risks to humans. MSs are present in emissions from petroleum refining, and it is therefore important to assess the health risks to residents living near refineries. In this study, we evaluated the pollution characteristics and human exposure risks of three cyclic MS (CMS) oligomers (D4-D6) in areas upwind and downwind of a petroleum refinery. The concentrations of total CMSs were 4-33 times higher in the downwind than upwind areas. At the same sampling site, the concentrations of CMSs were higher indoors than outdoors. The maximum concentration of CMSs was found in the indoor environment 200 m downwind of the petroleum refinery (75 μg/m3 in air and 2.3 μg/g in dust). The concentrations and detection rates of CMSs in plasma samples were higher in the downwind than upwind residents. Although residents living downwind of the petroleum refinery were a non-occupationally exposed population, they should be considered a highly CMS-exposed population because of their extremely high internal exposure doses. Inhalation exposure was the main source of CMSs in the plasma of these residents. When different exposure pathways were investigated, inhalation exposure was the major contributor to the average daily dose in residents of locations near the petroleum refinery, whereas the dermal absorption of personal care products was the major contributor at other sites. Although the overall risks of exposure to total CMSs were below the chronic reference dose for all exposure pathways, the combined joint toxic effects of various CMSs remain unclear. Further studies are therefore required to determine the exposure risks and subsequent health effects of CMSs for the residents of these areas.

Occurrence and fate of chlorinated methylsiloxanes in surrounding aqueous systems of Shengli oilfield, China

Mono-chlorinated products of cyclic volatile methylsiloxanes (cVMS), i.e., Monochlormet-hylheptamethylcyclotetrasiloxane [D3D(CH₂Cl)], monochlormethylnonamethylcyclopenta-siloxane [D4D(CH₂Cl)], and monochlormethylundemethylcyclohexasiloxane [D5D(CH₂Cl)], were detected in water [<LOQ (Limit of quantitation) -86.3 ng/L, df (detection frequency) = 23%-38%, n=112] and sediment samples [<LOQ-504 ng/g dw (dry weight), df = 33%-38%, n=112] from 16 lakes located in Shengli oilfield of China, and had apparent increasing trends (31%-34% per annum) in sediments during Year 2014-2020. Simulated experiments showed that chloro-cVMS in sediment-water system had approximately 1.7-2.0 times slower elimination rates than parent cVMS. More specifically, compared with those of parent cVMS, volatilization (86-2558 days) and hydrolysis (135-549 days) half-lives of chloro-cVMS were respectively 1.3-2.0 and 1.8-2.1 times longer. In two species of freshwater mussels (n=1050) collected from six lakes, concentrations of chloro-cVMS ranged from 9.8-998 ng/g dw in Anodonta woodiana and 8.4-970 ng/g dw in Corbicula fluminea. Compared with parent cVMS, chloro-cVMS had 1.1-1.5 times larger biota-sediment accumulation factors (2.1-3.0) and 1.1-1.7 times longer half-lives (13-42 days). Their stronger persistence in sediment and bioaccumulation in freshwater mussels suggested that environmental emission, distribution and risks of chloro-cVMS deserve further attention.

Methylsiloxanes risk assessment combining external and internal exposure for college students

Methylsiloxanes (MSs) are widely used as solvents or emollients in various personal care products (PCPs) and may pose a health risk. In this study, we assessed external and internal exposure to MSs among students at two universities in southwestern China. Samples of air, dust, and PCPs were collected to evaluate indoor non-dietary exposure to MSs via multiple pathways among the students. Indoor MS levels were approximately 1-3 orders of magnitude higher in the dormitories of female students than in either classrooms or the dormitories of male students. Lipstick contained the highest MS levels. Cyclic MS (CMS: D4-D6) levels were 1 order of magnitude higher in female students than in male students. Among the three CMSs, D5 levels were highest in the plasma of all students (1.3-15 ng/mL). In dormitories, dermal contact with PCPs was the major route of exposure to CMSs for all students. Among linear MSs (LMSs: L5-L16), dermal PCP absorption and dust ingestion were the predominant exposure routes for male and female students, respectively. Although the overall risk of exposure to D4 and D5 was below the chronic reference dose for all exposure routes and all students, the total daily doses of exposure to D4 and D5 via dermal PCP absorption approached the chronic reference dose in four female students. Therefore, the effects of MSs on female students should be further investigated in future studies.

Occurrence and Behavior of Methylsiloxanes in Urban Environment in Four Cities of China

Methylsiloxanes (MSs), used in industrial production and personal care products, are released in various environmental media. In this study, we combined monitoring and modeling to investigate the occurrence and behavior of MSs in the urban environment in China. MSs were widely found in the air, water, soil and sediment of four cities in China. The concentrations of MSs in all four environmental media of Zhangjiagang were higher than those in the other three cities (Beijing, Kunming and Lijiang), indicating that the siloxane production plant had a significant impact on the pollution level of MSs in the surrounding environment. The samples with high MS concentrations were all from the sample sites near the outlet of the WWTPs, which showed that the effluent of the WWTPs was the main source of MS pollution in the surrounding environment. The modeling results of the EQC level III model showed that D4 discharged into the environment was mainly distributed in the air, while D5 and D6 were mainly distributed in the sediment. CMSs (D4-D6) discharged into various environmental media could exist in the urban environment for a long time with low temperatures in cities. When the temperature was 0 °C, the residence time of D5 and D6 could be 68.1 days and 243 days in the whole environmental system in Beijing. This study illustrates the importance of CMSs (D4-D6) in low-temperature environments and the potential environmental risks that they may pose.

3D printed miniature atomic emission detector coupling with gas chromatography: A sensitive and cost-effective strategy for the determination of volatile methylsiloxanes in municipal sewage

The determination of volatile methylsiloxanes (VMSs) in municipal sewage has attracted great attention. Gas chromatography-mass spectrometry (GC-MS) is the most mature detection technique for VMSs, however, its instrumentation and operation cost are unfavorable in low- and middle-income countries. Herein, a novel and cost-effective strategy by using a 3D printed miniature microplasma optical emission detector (μAED) as an alternative to MS detector, was developed to detect VMSs in municipal sewage by GC after preconcentration by a laboratory-built automatic purge and trap (P&T) system. Two types of μAEDs have been fabricated and their analytical performances were compared. The one using two tungsten rods as electrodes shows better performance and was thus selected as the detecting system for real sample analysis. Under the optimized conditions, the P&T-GC-μAED system provided limits of detection of 3.6 ng L^-1 to 15.5 ng L^-1 of Si for tested VMSs. Relative standard deviations were better than 3.0% and good recoveries ranging from 82.4% to 102.8% were obtained for all analytes. The applicability of this system was demonstrated via the measurement of VMSs in the influents and effluents from 10 wastewater treatment plants (WWTPs) in Chengdu, China.

Methylsiloxanes in street dust from Hefei, China: Distribution, sources, and human exposure

Methylsiloxanes are widely found in the environment and have been of increasing concern because of their strong resistance to degradation and potential toxicity to organisms. However, little is known about the distributions of these chemicals in street dust and the associated human health risks. This study investigated three cyclic (D₄-D₆) and nine linear methylsiloxanes (L₅-L₁₃) in street dust from Hefei, China and found total concentrations in the range of 183-1030 (median, 527) ng/g dry weight. The linear congeners were dominant and represented a median of 85.3% of the total methylsiloxanes. D₅ contributed 90.0% of the total concentrations of cyclic methylsiloxanes. In this study, higher concentrations of dust methylsiloxanes were found in the industrial area relative to the other functional areas. A source assessment indicated that the linear and cyclic methylsiloxanes in the street dust were mainly from the industrial and traffic activities, respectively, in addition to important sources of the use of siloxanes-containing products. The estimated median daily intakes of total methylsiloxanes through street dust were 0.037 and 0.476 ng/kg-bw/d for adults and children, respectively, under high-exposure scenarios. More research is needed to characterize the occurrence of methylsiloxane in various exposure sources and the associated adverse effects on human health.

Assessment of internal exposure to methylsiloxanes in children and associated non-dietary exposure risk

Methylsiloxanes (MSs) are a significant source of indoor environmental pollution due to their high production level and widespread application, and pose a potential health risk. Given the special vulnerability of children to environmental contaminants, assessment of indoor MSs exposure in children is quite essential. In this study, we assessed internal exposure doses and external exposure levels of MSs in children from industrial and residential areas in southwestern China. Indoor air, indoor dust, and personal care product (PCP) samples were collected to evaluate indoor non-dietary MSs exposure in children through various pathways. The concentrations of MSs in indoor environments of industrial areas were approximately one to four orders of magnitude higher than those of residential areas. Sun protection products contained the highest concentrations of MSs. Relatively high levels of cyclic methylsiloxanes (CMSs) were found in plasma of children from industrial areas, which were one to two orders of magnitude higher than those in children from residential areas. The highest MSs levels in plasma were detected in infants (0-1 year), with values of 1.4 × 10² ng/mL and 1.3 × 10² ng/mL for CMSs (D4-D6) and linear methylsiloxanes (LMSs) (L5-L16), respectively. The internal exposure dose of infants in residential areas is driven by major unknown sources of MSs. The average daily doses via inhalation and dust ingestion in children from industrial areas were one to three orders of magnitude higher than in those from residential areas, indicating that these children should be considered a highly exposed population. Inhalation and dust ingestion were both major exposure pathways to MSs for children of all age groups in industrial areas, whereas dermal absorption from PCPs was the predominant exposure pathway for children of all age groups in residential areas (except for infants). Although the exposure risk to D4 and D5 was at an acceptable level for all children studied, the total daily exposure doses of these two cyclic compounds via inhalation for infants in the industrial areas was near the chronic reference dose. Meanwhile, MSs may accumulate in infant plasma within a short period of time (<6 months). Therefore, infants should be the focus of greater attention in future research. As indoor environments may pose high risks for infants in industrial areas, they should be the focus of future research.

The Effect of Size of Materials Formed or Implanted In Vivo on the Macrophage Response and the Resultant Influence on Clinical Outcome

Both the chemistry and size of a material formed in vivo, or an implanted biomaterial, can alter the in vivo host response. Within the size range covered within this review, over 1 μm, chemistry is only important if the solid material is unstable and leeching small molecules. The macrophage activity and the resultant inflammatory response, however, are related to the size of the solid material. The premise of this review is that differences in size of the solid material, in different cases, can be the reason why there is some individual-to-individual variation in response. Specifically, the inflammatory response is enhanced when the size is between 1-50 μm. This will be looked at for three configurations: spherical particulate (silicone oil or gel from breast implants), elongated particulate (monosodium urate [MSU] crystals in gout or in kidney stones), and fibers (e.g., polyester used in fabric implants). These specific examples were selected because many still believe that the clinical outcome for each is controlled by the surface chemistry, when in fact it is the size. In each case, specific studies will be highlighted to either show a mechanism for creating different sizes and therefore a differential biological response (first three) or how changing the size and shape (diameter and spacing of fibers, in this example) can affect the response and can help explain the different responses to fabric implants found in vivo within the 1-50 μm size range. It was found that polyester fibers under 70 μm had a significant increase in macrophage response. Further, it was found that compounds found in synovial fluid could limit MSU crystal size. In addition, it was shown that plasma with low triglyceride levels emulsifies silicone oils to a greater extent than plasma with higher triglyceride levels. Therefore, in three cases it appears that differences in the inflammatory response between individuals and between different implants could be explained just by the size of the material formed or implanted.

Methylsiloxane occurrence and distribution in free-range poultry eggs near a rural industrial park: Indicators of potential risks to birds

The ecological harm from methylsiloxanes has drawn worldwide attention. This study investigated three cyclic (D₄-D₆) and four linear siloxanes (L₇-L₁₀) in the eggs of free-range poultry collected near a rural industrial park in China and found total concentrations in the range of 19.2-1204 (median, 268) ng/g dry weight. Higher concentrations of methylsiloxanes were observed in chicken eggs than duck eggs. Cyclic siloxanes represented a median of 62.2% of the total methylsiloxane concentrations. A source assessment indicated that local soils and outdoor dust were more important sources of egg methylsiloxanes than poultry food. The partitioning of methylsiloxanes between egg yolk and egg albumen was investigated, and preferential distributions of the chemicals in the yolk were observed. This study confirmed that methylsiloxanes were highly prevalent in the study poultry eggs. The results suggested that the potential risks to some wild birds inhabiting this area should be of concern, as their physiologies and feeding ecologies are similar to those of the studied poultry, although available ecotoxicological data of the chemicals to birds remains scarce. Additional research is needed to characterize the accumulation of methylsiloxanes in different bird species and its associated adverse effects on their offspring.

Hyperactivation of RAP1 and JAK/STAT Signaling Pathways Contributes to Fibrosis during the Formation of Nasal Capsular Contraction

Silicone implant-based augmentation rhinoplasty or mammoplasty induces capsular contracture, which has been acknowledged as a process that develops an abnormal fibrotic capsule associated with the immune response to allogeneic materials. However, the signaling pathways leading to the nasal fibrosis remain poorly investigated. We aimed to explore the molecular mechanism underlying the pathogenesis of nasal capsular contracture, with a specific research interest in the signaling pathways involved in fibrotic development at the advanced stage of contracture. By examining our recently obtained RNA sequencing data and global gene expression profiling between grade II and grade IV nasal capsular tissues, we found that both the RAP1 and JAK/STAT signaling pathways were hyperactive in the contracted capsules. This was verified on quantitative real-time PCR which demonstrated upregulation of most of the representative component signatures in these pathways. Loss-of-function assays through siRNA-mediated Rap1 silencing and/or small molecule-directed inhibition of JAK/STAT pathway in ex vivo primary nasal fibroblasts caused a series of dramatic behavioral and functional changes, including decreased cell viability, increased apoptosis, reduced secretion of proinflammatory cytokines, and synthesis of type I collagen, compared to control cells, and indicating the essential role of the RAP1 and JAK/STAT signaling pathways in nasal capsular fibrosis. Our results sheds light on targeting downstream signaling pathways for the prevention and therapy of silicone implant-induced nasal capsular contracture.

Capsular Contracture in Breast Implant Surgery: Where Are We Now and Where Are We Going?

Capsular contracture is the leading complication after surgery with breast implants. A lot of progress has been made investigating this complication over the years, and knowledge has been gained on this complication. Currently, the exact cause for capsular contracture is still unclear. It has been hypothesized that immunobiological factors (i.e., immunological and bacterial factors) and several risk factors play a central role in its development. In this paper, we give an overview of the known immunological factors that have been investigated in contracted and non-contracted capsules, as well as the role of bacterial formation around breast implants. We also report on risk factors that might increase the risk of capsular development. Lastly, it provides the latest research on this matter and discusses future perspectives as follow-up research is needed to unravel the pathogenic process leading to capsular contracture. This knowledge is of interest to establish medical therapies in order to prevent such side effects. Overall, capsular contracture seems to be a multifactorial condition consisting of several risk factors. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The State of the Art about Etiopathogenetic Models on Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL): A Narrative Review

BACKGROUND

Breast-implant-associated anaplastic large cell lymphoma is a rare malignancy linked to texturized breast implants. Although many researchers focus on its etiopathogenesis, this topic is affected by a lack of evidence.

MATERIALS AND METHODS

A literature review about BIA-ALCL was made.

RESULTS AND CONCLUSIONS

Although the incidence is reported between 1:355-1:30,000, there is great attention to BIA-ALCL. The incidence is uncertain due to many reasons. It may well be lower, due to inclusion in multiple databases as pointed out by the FDA and undiagnosed cases. The role of chronic inflammation, bacterial contamination, and mechanical forces was discussed. Clarification is needed to understand the mechanisms underlying the progression of alterations and mutations for BIA-ALCL; new molecular analysis and pathogenetic models should be investigated.

Immediate Breast Reconstruction after mastectomy with polyurethane implants versus textured implants: A retrospective study with focus on capsular contracture

BACKGROUND

Capsular contracture (CC) is the most common complication following Immediate Breast Reconstruction (IBR) with breast implants. Different implant surfaces were developed aiming to reduce the incidence of CC. We evaluated the incidence and degree of CC after Direct-to-Implant (DTI) IBR with insertion of textured (TE) or polyurethane (PU) covered implants.

METHODS

A retrospective review of consecutive patients treated at our Institution with mastectomy and one-stage IBR and implant reconstruction between 2013 and 2018, with or without post mastectomy radiation therapy (PMRT), was conducted. Immediate breast reconstruction was performed by implanting 186 PU covered implants and 172 TE implants.

RESULTS

Three-hundred-twelve women underwent 358 DTI IBR with PU or TE implants, were analyzed with a median follow-up time of 2.3 years (range 1.0-3.0). The overall rate of CC Baker grade III and IV was 11.8% (95%CI: 8.4-16.3), while, after PU and TE implant placement it was 8.1% (95% CI: 4.1-15.7) and 15.8% (95% CI: 4.1-15.7) [p = 0.009]), respectively. Irradiated breasts developed CC more frequently rather than non-irradiated breasts (HR = 12.5, p < 0.001), and the relative risk was higher in the TE group compared with the PU group (HR = 0.3, p = 0.003).

CONCLUSIONS

After mastectomy and one-stage IBR, the use of PU covered implants is associated with a lower incidence of CC compared to TE implants. This advantage is amplified several folds for patients who necessitate PMRT. Footnote: Capsular contracture (CC); Immediate Breast Reconstruction (IBR); Directto- Implant (DTI); Textured (TE); Polyurethane (PU); Post mastectomy radiation therapy (PMRT); Nipple Sparing mastectomy (NSM).

Methylsiloxanes in plasma from potentially exposed populations and an assessment of the associated inhalation exposure risk

Methylsiloxanes (MSs) are ubiquitous in indoor air and pose an important health risk. Thus, assessments of indoor inhalation exposure by measuring MSs levels in plasma are needed. In this study, we measured plasma MSs concentrations and evaluated daily indoor inhalation exposure in potentially exposed populations, including residents of industrial areas, university campus, and residential areas, all located in southwestern China. The concentrations of MSs in indoor air (gas-phase and PM_2.5) collected from factory housing and from girls' dormitories on university campus were approximately one to three orders of magnitude higher than in parallel samples from other areas. The consequences of MSs exposure were investigated by measuring MSs levels in the plasma samples of the exposed populations. Relatively high levels of cyclic MSs (CMSs: D4-D6) were found in the plasma of the co-resident family members of factory workers and in female college students living in campus dormitories. The highest levels of CMSs (D4-D6) and linear MSs (L5-L16), 2.3 × 10² and 2.0 × 10² ng/mL, respectively, were detected in the very young (0-3 years old) co-resident children of factory workers. The average daily dose via inhalation (ADD_inh) in different groups showed that the ADD_inh values of all MSs (D4-D6, L5-L16) were one to two orders of magnitude higher in the co-resident family members of factory workers and in female college students than in other groups, indicating that both populations should be considered as potentially highly exposed to MSs. A further assessment showed that inhalation exposure is the main source of CMSs (D4-D6) in plasma for people exposed to high indoor air levels of these compounds. Although the health risk assessment showed that the health risk from inhalation exposure to D4 and D5 was acceptable for all of the studied groups based on the current chronic reference dose (cRfD), the maximum ADD_inh,CMSs value in 0- to 3-year-old children was only 7.9-fold below the cRfD. Because the toxicity of other MSs is unknown, the potential health risk of MSs to very young children via inhalation exposure should be further analysed.

Can low-temperature point discharge Be used as atomic emission source for sensitive determination of cyclic volatile methylsiloxanes?

Despite of increased interest in the application of miniature microplasma atomic spectrometry for environmental analytical chemistry, the amenable element detection range is limited to some metal elements and carbon due to it low power consumption. In this work, the generation of silicon atomic emission (251.6 nm and 288.2 nm) from the organosiloxanes was found possible in a low-temperature, low-power, and compact point discharge. Consequence, a tiny point discharge silicon optical emission spectrometer (μPD-OES) was exploited, and used as a novel GC detector for the determination of various cyclic volatile methyl siloxanes (cVMSs). Under the optimized conditions, the developed system provided limits of detection (LODs) of 0.2 mg L^-1, 0.04 mg L^-1, 0.03 mg L^-1 and 0.02 mg L^-1 of Si for hexamethylcyclotrisiloxane, octamethylcyclotetrasiloxane, decamethylcyclopentasiloxane and dodecamethylcyclohexasiloxane, respectively. Meanwhile, relative standard deviations (RSDs) of better than 2.3% were obtained. In contrast to gas chromatography mass spectrometer, GC-μPD-OES significantly simplifies the experimental setup with low power consumption and a miniature configuration. As far as we know, this work reports for the first time that silicon atomic emission can be generated in such low temperature microplasma. The accuracy of this system was validated by determining cVMSs in five daily-used shampoo samples collected from retail store, providing satisfactory recoveries (84%-114%) and excellent agreement with values determined by GC-MS at the 95% confidence level.

Typical indoor concentrations and mass flow of cyclic volatile methylsiloxanes (cVMSs) in Dalian, China

Cyclic volatile methylsiloxaes (cVMSs), namely hexamethylcyclotrisiloxane (D3), octamethylcyclotetrasiloxane (D4), decamethylcyclopentasiloxane (D5) and dodecamethylcyclohexasiloxane (D6), were studied for a typical indoor environment of male and female dormitories in the campus of Dalian Maritime University (DMU) in China. An empty, frit-fitted SPE cartridge was placed on top of an Isolute ENV + cartridge, sampling cVMSs in particulate and gas phases, respectively. The highest concentration of D3, D4, D5, and D6 was 190, 460, 37,000, and 670 ng m^-3, respectively. All cVMSs, especially D5, were higher in female dormitories than that in male dormitories. Emission rate from different sources of cVMSs in dormitories was calculated from a survey of the use of personal care products (PCPs) by students living in the dormitory during the sampling period. The mean emission rate (ER, mg·d^-1) of D4 and D5 in male dormitories was 0.12 ± 0.01 and 0.49 ± 0.03 mg d^-1, respectively, and that in female dormitories was 0.21 ± 0.05 and 46 ± 17 mg d^-1, respectively. Then, we modified an existing mass balance model to predict the indoor air levels of D4 and D5 in both male and female dormitories based on the usage of PCPs. There was a good agreement for D4 and D5 concentrations in female dormitories between modeled and measured concentrations with the ratio of predicted to measured values to be 1.5 and 1.2, respectively, which indicated that use of PCPs was the main source of cVMSs in university dormitories.

Tube-type passive sampling of cyclic volatile methyl siloxanes (cVMSs) and benzene series simultaneously in indoor air: uptake rate determination and field application

Cyclic volatile methyl siloxanes (cVMSs) and benzene series compounds have attracted increasing attention because they are associated with various adverse health effects. In this study, we developed and validated a novel passive air sampling method (PAS), using Tenax-TA as the sorbent, to measure the concentrations of cVMSs (D4, D5, and D6) and benzene series compounds simultaneously in indoor air. The uptake rates (R), which were calibrated side-by-side by an active air sampling method (Tenax-TA-AAS), ranged from 0.10 to 0.56 mL min-1 depending on chemicals, and the R of the TD tube with Tenax-TA was controlled by the sampler material-side and not the air-side. The passive sampling efficiency (PSE) of styrene and m,p-xylene was close to 1. Based on Pearson correlation analysis, a negative correlation was found between the molecular weight of compounds and their uptake rates. Furthermore, the calibrated Tenax-TA-PAS method was used to quantify cVMSs and benzene series compounds in a living room and an office environment in the urban area of Dalian, China. The concentrations of toluene were the highest in both the living room (10.4 μg m-3) and office (7.02 μg m-3) among the target compounds.

Removal of Nasal Silicone Implant and the Impact of Subsequent Capsulectomy

BACKGROUND

Little is known about contributory factors of unremoved periimplant capsule causing nasal deformities after postrhinoplasty silicone implant extraction. This study investigated the impact of retained capsule causing contracture deformity and effect of subsequent capsulectomy in preventing and correcting the deformity.

METHODS

A total of 103 patients underwent secondary surgery for silicone implant removal and grafted cartilage between May of 2015 and June of 2017. Among them, 67 patients without septal extension graft or open wound and with 8-week or more follow-up were analyzed retrospectively. All operations were approached with an intranasal incision. Three procedures were performed: (1) removal of implant plus tip graft only (n = 12), (2) removal of implant plus tip graft plus subtotal capsulectomy (n = 47), and (3) removal of implant plus tip graft plus subtotal capsulectomy in patients with contraction and thick capsule (n = 8). Preremoval/postremoval of nasal bridge length index and nasolabial angle were measured with the lateral view.

RESULTS

In group 1, nasal bridge length index decreased by 6.2 percent and nasolabial angle increased by 5.7 percent. In group 2, nasal bridge length index increased by 2.5 percent and nasolabial angle decreased by 2.2 percent. In group 3, nasal bridge length index increased by 8.6 percent and nasolabial angle decreased by 7.9 percent.

CONCLUSIONS

For patients undergoing surgical removal of a nasal silicone implant with or without cartilage, a concomitant capsulectomy is required to prevent potential contractures and to minimize tip deformity. Capsulectomy can release and lengthen the contracted nose without septal extension or derotation grafting. Dorsal skin irregularity did not occur regardless of whether capsulectomy was performed.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

PCR Characterization of Microbiota on Contracted and Non-Contracted Breast Capsules

BACKGROUND

The aetiology of capsular contracture around breast implants remains unclear. The leading theory is that a subclinical infection around the implant plays a role in the development of capsular contractions. Several studies found associations between the presence of bacteria and the occurrence of capsular contraction. However, it is unclear whether detected bacteria originate from the breast capsule, breast glandular tissue or skin contamination. Moreover, this has never been investigated with molecular techniques. The aim of this study was to assess the bacterial microbiota on breast capsules, glandular tissue and skin using a highly sensitive PCR assay.

MATERIALS AND METHODS

Fifty breast capsules were collected during implant removal or replacement. Ten specimens of glandular breast tissue and breast skin were collected in females who were undergoing reduction mammoplasty. A sample specimen (4 mm) was sterilely obtained from all tissues. All specimens were analysed by IS-pro, a 16S-23S interspace region-based PCR assay.

RESULTS

Low numbers of Staphylococcus spp. (four species in four capsules) were found on breast capsules. There was no difference in bacterial presence between normal and contracted capsules. The skin of the breast-harboured Streptococcus spp. and Staphylococcus spp. while the glandular tissue was sterile.

CONCLUSION

The low numbers of bacteria found on the capsules are most likely caused by contamination during capsule removal. More and larger studies are needed to investigate the bacterial presence on breast capsules using a PCR assay. This is the first study in which breast capsules have been studied using a highly sensitive PCR assay.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Toll-Like Receptors (TLRs) Expression in Contracted Capsules Compared to Uncontracted Capsules

INTRODUCTION

The etiology of capsular contracture after surgical implantation of breast implants remains unclear, but an important role is seen for the immune system. Toll-like receptors are immune receptors recognizing both pathogen-associated molecular patterns and damage-associated molecular patterns. The former are present on bacteria such as Staphylococcus epidermidis (bacteria earlier associated with capsular contracture), and the latter are released after (mechanical) stress. The aim of this study was to investigate the expression of TLRs 1-10 in relation to capsular contracture.

MATERIALS AND METHODS

Fifty consecutive breast capsules were collected during implant removal or replacement. The extent of capsular contracture was scored according to the Baker score. A sample specimen (0.5 cm3) was obtained from all tissues. cDNA was synthesized from isolated mRNA from the collected specimens. PCR analyses were conducted to test for cDNA presence and to quantify concentration. TLR1-10 expression was measured for each of the Baker scores separately and compared to all Baker scores.

RESULTS

Expression of all TLRs in all Baker scores was seen. TLR2 and TLR6 were more often present in contracted samples (Baker 3 or 4) compared to uncontracted samples (Baker 1 or 2) [Baker 2 vs. 3 (p = 0.034) and Baker 2 vs. 3 (p = 0.003), respectively]. None of the TLRs displayed a significantly higher expression in contracted capsules compared to uncontracted capsules.

CONCLUSION

This study shows that TLR2 and TLR6 are more often expressed in contracted capsules compared to non-contracted capsules however not in higher concentrations.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Classification pattern and step-by-step procedure for cartilage grafts with silicone implants for nasal tip plasty in Asians

Dorsal augmentation using silicone and tip plasty with autogenous cartilage is commonly performed in Asians. No study has investigated the classification pattern and step-by-step procedure for tip plasty using silicone implants. Therefore, this study classified cartilage grafts using silicone implants in Asians and developed a step-by-step procedure for their implementation. The study included 39 patients who had undergone augmentation rhinoplasty with a silicone implant combined with a conchal cartilage graft as a shield, an onlay graft, or both. We classified the implant-conchal cartilage complex into two main types (edge and no-edge types). In the edge type, the shield graft tip was located 1-2 mm above the silicone implant or onlay graft. In the no-edge type, it was located at the same level as the silicone implant or onlay graft. Each type was classified into three groups depending on the number of onlay grafts: group I, 0; group II, 1; and group III, ≥2. The cartilage complex was placed on the dorsum. The conchal cartilages were harvested through a post-auricular incision while preserving the radix helicis as cartilage bars. The donor site was closed primarily without a tie-over dressing. Of the 39 patients, 35 were satisfied with the outcome. Three revision operations for implant displacement and one revision for a patient who changed her dorsal height preference were performed. No donor site morbidity occurred. This method may be safe and reliable, with minimal morbidity associated with graft harvesting for tip plasty in Asians.

Low-Level Laser Treatment Is Ineffective for Capsular Contracture: Results of the LaTCon Randomized Controlled Trial

BACKGROUND

Breast reconstruction with implants can be complicated by symptomatic capsular contracture, especially after radiotherapy. A phase I, nonrandomized clinical trial demonstrated improvement in capsular contracture and avoidance of revision surgery with low-level laser therapy. This phase II, double-blind, randomized controlled trial assessed the efficacy of low-level laser for treating capsular contracture in women with breast reconstruction following mastectomy for breast cancer.

METHODS

Participants had completed their definitive implant-based reconstruction a minimum of 6 months previously and were randomized to weekly treatments over 6 weeks with either an active or inactive low-level laser handpiece (Riancorp LTU-904). Pain, tightness, arm movement, and appearance were assessed by patient questionnaires. Breast symmetry, shape, naturalness, softness, and grade of contracture were assessed by clinician reports. Participants were assessed at 1 and 6 months after completion of the treatments.

RESULTS

A total of 42 patients (intervention arm, n = 20; placebo, n = 22) were assessed in the trial. Thirty-two had postmastectomy radiotherapy. There was no significant difference in the change in any patient-reported outcomes or clinician-reported outcomes of breast symmetry, shape, or naturalness for the two groups. There was a significantly greater improvement in clinician-reported breast softness (p < 0.05) and degree of contracture (p < 0.05) in the placebo group at both 1- and 6-month follow-up.

CONCLUSION

Low-level laser is not an effective therapy for breast implant capsular contracture in reconstruction patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, I.

Predicting Indoor Emissions of Cyclic Volatile Methylsiloxanes from the Use of Personal Care Products by University Students

Characterization of indoor emissions of cyclic volatile methylsiloxanes (cVMS) due to the use of personal care products is important for elucidating indoor air composition and associated health risks. This manuscript describes a mass transfer model to characterize the emission behaviors of decamethylcyclopentasiloxane (D5, the most abundant indoor cVMS) from skin lipids. A C-history method is introduced to determine the key parameters in the model, i.e., the initial concentration and diffusion coefficient of D5 inside the skin lipids. Experiments were conducted in a university classroom to examine the D5 emission behaviors by using a proton-transfer-reaction time-of-flight mass spectrometer (PTR-TOF-MS). Data from the first class session of two typical days was applied to obtain the key parameters, which were subsequently used for predicting D5 concentrations in other class sessions. Good agreement between model predictions and experiments demonstrates the effectiveness of the model and parameter determination method. With the model, we found that the reuse of personal care products has a significant impact on the D5 emissions. In addition, the time-dependent emission rate and remaining amount of D5 inside the skin can also be calculated. These results indicate a fast decay pattern during the initial emission period, which is consistent with prior experimental studies.

The aetiopathogenesis of capsular contracture: A systematic review of the literature

BACKGROUND

Capsular contracture is the most frequent complication after breast augmentation or reconstruction with breast implants. The immune system plays a prominent role in capsular contracture formation, albeit to an unknown extent. Bacterial contamination in situ has been hypothesized to be causative for capsular contracture. How this relates to the immunological processes involved is unknown. This article aims to provide an overview of immunological and bacterial factors involved in development of capsular contracture.

MATERIALS AND METHODS

We undertook a systematic literature review focused on immunological factors and microbiota in relation to capsular contraction around implants. This systematic review was performed in accordance with the PRISMA guidelines. PubMed, EMBASE, and the Cochrane databases were searched from inception up to October 2016. Included studies were assessed for the following variables: subject characteristics, number of capsules, primary indication for surgery, surgical procedure, follow-up or implant duration, study methods, type of antibiotics or medical therapies and outcomes related to microbiota and immunological factors.

RESULTS

Data on immunological factors and bacterial contamination were retrieved from 64 included studies. Notably the presence of macrophages and Staphylococcus epidermidis within capsules was often associated with capsular contracture.

CONCLUSION

This review provides a clear overview of the immunological factors associated with capsular contracture and provides a hypothetical immunological model for development of the disease. Furthermore, an overview of bacterial contamination and associations with capsular contracture has been provided. Follow-up research may result in clinical recommendations to prevent capsular contracture.

Evaluation of Antibiotic Irrigation Versus Saline Irrigation in Reducing the Long-Term Incidence and Severity of Capsular Contraction After Primary Augmentation Mammoplasty

BACKGROUND

Capsular contracture is the most frequent complication after primary augmentation mammoplasty. The practice of irrigating implant pockets with a triple antibiotic solution has been widely adopted in an attempt to prevent capsular contracture, despite a limited understanding of the inciting pathophysiology. Capsular contracture is commonly attributed to subclinical infection, immunologic response to breast implants, and chronic inflammatory changes caused by the presence of the implants. The purpose of this study was to evaluate if antibiotic irrigation was superior to saline in reducing the long-term incidence and severity of capsular contracture after primary augmentation mammoplasty.

METHODS

A retrospective cohort study enrolling patients having undergone primary augmentation mammoplasty by the authors between 2011 and 2012 for all women satisfying inclusion and exclusion criteria was conducted using prospectively collected quality assurance data. Surgical technique between surgeons was controlled such that the only difference was the use of antibiotic irrigation in the treatment group. Analysis with predetermined 95% confidence intervals was performed using χ test and analysis of variance.

RESULTS

Fifty-five patients underwent surgery. Twenty-eight patients treated with saline (control) were included, ranging in age from 22 to 50 years with a mean follow-up time of 2.8 years. Twenty-seven patients were treated with triple antibiotic solution (treatment) ranging in age from 22 to 56 years with a mean follow-up time of 2.6 years. Rates of capsular contracture were 3.6% (control group) and 3.7% (treatment group). χ statistic was found to be 0.0014 (P = 0.97) and analysis of variance F value was 1 (P = 0.39).

CONCLUSIONS

There was no difference between triple antibiotic and saline irrigation in the incidence or severity of capsular contracture at 2.8 years follow-up when high-quality surgical technique is used.

Contracted Nose after Silicone Implantation: A New Classification System and Treatment Algorithm

Background

Silicone implants are frequently used in augmentation rhinoplasty in Asians. A common complication of silicone augmentation rhinoplasty is capsular contracture. This is similar to the capsular contracture after augmentation mammoplasty, but a classification for secondary contracture after augmentation rhinoplasty with silicone implants has not yet been established, and treatment algorithms by grade or severity have yet to be developed.

Methods

Photographs of 695 patients who underwent augmentation rhinoplasty with a silicone implant from May 2001 to May 2015 were analyzed. The mean observation period was 11.4 months. Of the patients, 81 were male and 614 were female, with a mean age of 35.9 years. Grades were assigned according to postoperative appearance. Grade I was a natural appearance, as if an implant had not been inserted. Grade II was an unnatural lateral margin of the implant. Clearly identifiable implant deviation was classified as grade III, and short nose deformation was grade IV.

Results

Grade I outcomes were found in 498 patients (71.7%), grade II outcomes in 101 (14.5%), grade III outcomes in 75 (10.8%), and grade IV outcomes in 21 patients (3.0%). Revision surgery was indicated for the 13.8% of all patients who had grade III or IV outcomes.

Conclusions

It is important to clinically classify the deformations due to secondary contracture after surgery and to establish treatment algorithms to improve scientific communication among rhinoplasty surgeons. In this study, we suggest guidelines for the clinical classification of secondary capsular contracture after augmentation rhinoplasty, and also propose a treatment algorithm.

Distribution, source, fate and bioaccumulation of methyl siloxanes in marine environment

Studies have shown that some cyclic methyl siloxanes were identified as characterized of persistent, bioaccumulated, toxic, and potential to ecological harm. In this study, we determined methyl siloxanes in seawater, sediment and bottom fish samples collected from marine environment in Northeast China. The mean concentrations of total methyl siloxanes were 46.1 ± 27.2 ng/L, 12.4 ± 5.39 ng/g dry weight (dw) and 5.10 ± 1.34 wet weight (ww) in seawater, sediment and fish, respectively. Very strong and significant correlations (r = 0.94, p < 0.0001) were found in compositions of methyl siloxanes between seawater and sewage, indicating that sewage was the main source of methyl siloxanes in the marine area studied. It was found that the mean value of biota-sediment accumulation factor (BSAF) was.0.716 ± 0.456 for D4, 0.103 ± 0.0771 for D5, 1.06 ± 0.528 for D6 and 0.877 ± 0.530 for D7.

A multiphase analysis of partitioning and hazard index characteristics of siloxanes in biosolids

Siloxanes are widely used in personal care and industrial products due to their soft texture, low surface tension, thermal stability, antimicrobial and hydrophobic properties, among other characteristics. As a result, they are released to gas phase during waste decompositions and found in biogas at landfills and digester gas at wastewater treatment facilities. The objectives of this study were to investigate the release of siloxanes in aqueous and gaseous phase as well as in biosolids in a local wastewater treatment facility. The formation reactions were estimated using first order kinetics for commonly found siloxanes (L3, D3, D4, D5 and D6) during waste decomposition. Expected concentrations and the risk factors of exposure to siloxanes were evaluated based on the initial concentrations, partitioning characteristics and persistence parameter. D4 and D5 presented the highest initial gaseous phase concentrations of 5000 and 1800 μg/m(3) respectively. Based on first order kinetics, partition coefficients and initial concentrations, the hazards potentials were largest for D4 in both liquid phase and biosolids while D6 poses the highest risk in gaseous phase.

Orthosis reduces breast pain and mechanical forces through natural and augmented breast tissue in women lying prone

Background

Breast implant displacement or rupture can cause aesthetic problems and serious medical complications. Activities with prone positioning and loading of the anterior chest wall, such as massage, chiropractic or osteopathic therapies may increase the risk of implant failure and can also cause discomfort in women with natural breast tissue. Here we test the effectiveness of a newly developed orthosis on pain, mechanical pressure and displacement of breast tissue in women with cosmetic augmentation, post-mastectomy reconstruction, lactating or natural breast tissue.

Methods

Thirty-two females volunteers, aged 25–56 years with augmented, reconstructed, natural or lactating breast tissue and cup sizes B-F, participated in this open-label clinical trial. We measured pain perception, peak pressure, maximum force, and breast tissue displacement using different sizes of the orthosis compared to no orthosis. Different densities of the orthosis were also tested in a subgroup of women (n = 7). Pain perception was rated using a validated 11-point visual-analogue scale. Peak pressure and maximum force were assessed using a bilateral set of capacitance-pliance® sensor strips whilst participants were load bearing in a prone position, and breast displacement was measured by magnetic-resonance-imaging.

Results

The orthosis significantly reduced pain, breast displacement and mechanical pressures in women with natural and augmented breast tissue in prone position. Greater relief of pain and greater reduction in mechanical forces were found with increased size and density of the orthosis. Use of the orthosis improved overall comfort by 64-100%, lowered peak pressure by up to 85% and maximum force by up to 96%. Medio-lateral displacement of breast tissue was reduced by 16%, resulting in a 51% desirable increase of breast tissue height.

Conclusion

Our study demonstrated that the newly developed orthosis significantly reduced pain, mechanical pressure and breast tissue displacement in women with augmented and natural breast tissue when lying prone. Our findings are of clinical significance, potentially reducing the risk of complication from prone activities in women with breast augmentation or reconstruction, as well as improving comfort whilst undergoing prone procedures.

Trial registration

Australia and New Zealand Clinical Trials Register, ACTRN12613000541707.

Foreign body response induced by tissue expander implantation

The foreign body response (FBR) is described as the host's response to implanted biomaterials, which involves a complex cascade of immune modulators. The dynamic changes of immune cells, inflammatory cytokines and the formation of a fibrous capsule remain to be elucidated. In the present study, a model of subcutaneous implantation of a tissue expander was used. The results revealed that macrophages, the main immune cells in FBR, infiltrated into the expanded tissue and located at the tissue‑material interface from day 1‑90. Following the decrease of the number of macrophages, collagen deposited and fibroblasts transformed into myofibroblasts at the tissue‑material interface, leading to the formation of a fibrous capsule from day 14. The persistent existing macrophages led to a high expression of proinflammatory cytokines, including tumor necrosis factor‑α and interleukin‑1β, both of which initiated the NK-κB and JNK inflammatory pathways, mediating the FBR to tissue expander implantation.

Revisiting Triple Antibiotic Irrigation of Breast Implant Pockets: A Placebo-controlled Single Practice Cohort Study

Background:

Capsular contracture is the most common complication following primary augmentation mammoplasty. It remains poorly understood but is attributed to subclinical infection, immunologic response to breast implants, and chronic inflammatory changes caused by the presence of the implants. The infectious theory of contracture has lead to the practice of irrigating implant pockets with a triple antibiotic solution. The purpose of this study was to determine if antibiotic irrigation reduced the incidence and severity of capsular contracture compared with saline irrigation.

Methods:

A cohort study enrolling all patients having undergone primary augmentation mammoplasty performed by surgeon A and surgeon B between 2011 and 2012 for all women satisfying inclusion and exclusion criteria was conducted. The only difference in surgical technique was the use of antibiotic irrigation by surgeon B. A chi-square test and analysis of variance with predetermined 95% confidence intervals were performed.

Results:

Fifty-five patients were operated on. Twenty-eight of surgeon A’s patients were included, ranging in age from 22 to 50 with a mean follow-up time of 1.8 years. Twenty-seven of surgeon B’s patients were included, ranging in age from 22 to 56 with a mean follow-up time of 1.6 years. Rate of capsular contracture was 3.6% (surgeon A) and 3.7% (surgeon B). Chi-square statistic was found to be 0.0014 (P = 0.97) and analysis of variance F value was 1 (P = 0.39).

Conclusions:

Triple antibiotic breast irrigation is not associated with a significant reduction in the incidence or severity of capsular contracture compared with sterile saline when high-quality surgical technique is used.

Occurrence of linear and cyclic volatile methyl siloxanes in indoor air samples (UK and Italy) and their isotopic characterization

The occurrence of linear- and cyclic-volatile methyl siloxanes (lVMSs and cVMSs, respectively) in various indoor environments, occupational and domestic, in Italy and in the United Kingdom was studied. The results show that the cVMSs are the most abundant, detected in average concentrations that in some cases were as high as 170μgm(-3). Our study highlights the differences that can be observed between various indoor environments (e.g. domestic like bathrooms, bedrooms, or occupational) and between two countries. In most cases, the concentrations found in the UK are higher than in the respective indoor environments in Italy. The assessment of exposure to these two countries for adults and children revealed significant differences both not only in the levels of exposure, but also in the patterns. In Italy, the biggest part of the exposure to VMSs takes place domestically, whereas in the UK, it is observed for occupational environments. Additionally, the compound specific isotopic analysis was employed as a source identification technique. The results are promising mainly for D5 that occurs in higher concentrations, but not for the less abundant lVMSs and cVMSs.

Spatiotemporal effects of a controlled-release anti-inflammatory drug on the cellular dynamics of host response

In general, biomaterials induce a non-specific host response when implanted in the body. This reaction has the potential to interfere with the function of the implanted materials. One method for controlling the host response is through local, controlled-release of anti-inflammatory agents. Herein, we investigate the spatial and temporal effects of an anti-inflammatory drug on the cellular dynamics of the innate immune response to subcutaneously implanted poly(lactic-co-glycolic) microparticles. Noninvasive fluorescence imaging was used to investigate the influence of dexamethasone drug loading and release kinetics on the local and systemic inhibition of inflammatory cellular activities. Temporal monitoring of host response showed that inhibition of inflammatory proteases in the early phase was correlated with decreased cellular infiltration in the later phase of the foreign body response. We believe that using controlled-release anti-inflammatory platforms to modulate early cellular dynamics will be useful in reducing the foreign body response to implanted biomaterials and medical devices.

Survey of cyclic and linear siloxanes in sediment from the Songhua River and in sewage sludge from wastewater treatment plants, Northeastern China

Siloxanes are used in a wide range of industrial applications, such as fuel additives, automotive polishes and waxes, and antifoaming agents, as well as in personal care products and biomedical devices. Despite the potential for environmental occurrence, few studies have reported sources and pathways of siloxanes in the environment. In this study, we determined concentrations of four cyclic siloxanes, namely, octamethylcyclotetrasiloxane (D₄), decamethylcyclopentasiloxane (D₅), dodecamethylcyclohexasiloxane (D₆), and tetradecamethylcycloheptasiloxane (D₇) as well as 13 linear siloxanes (L₄ to L₁₆), in sediments sampled from the Songhua River and in sewage sludge sampled from treatment plants that discharge wastewater into the Songhua River in northeastern China. Siloxanes were found in all of the sediment samples at total concentrations (sum of all cyclic and linear siloxanes) as high as 2050 ng/g dry weight (dw). The respective total concentration ranges for cyclic (D₄, D₅, D₆, and D₇) and linear (L₄ to L₁₆) siloxanes in sewage sludge were 602 to 2360 and 98 to 3310 ng/g dw. Cyclic siloxanes were found at greater concentrations than linear siloxanes in sediment samples. However, the summed concentrations of linear siloxanes were higher than the summed concentrations of cyclic siloxanes in sludge samples. Among cyclic siloxanes, D₇ and D₅ were the dominant compounds in both sediment and sludge. Among linear siloxanes, L₁₀ and L₁₁ together accounted for 55% of the total concentrations in sludge samples, and L₆ accounted for 30% of the total concentration in sediment samples. To our knowledge, this is the first report to document concentrations and compositions of organosiloxanes in sediments and sewage sludge from China.

Role of immune cells and inflammatory cytokines in regulation of fibrosis around silicone expander implants

This study aimed to investigate the progress of wound healing around silicone expander with particular emphasis on fibroblasts, myofibroblasts and collagen in the repair phase. Semi-quantitative evaluation of inflammatory cells and their cytokines, fibroblasts and myofibroblasts at the tissue-material interface was carried out. Commercially available silicone expander was implanted in gluteus muscle of young female Wistar rats for 3, 7, 14, 30, 90 and 180 days. Ultra high molecular weight polyethylene served as control. The cellular response was studied by immunohistochemistry and Transmission Electron Microscopy. A thick collagenous fibrous capsule was observed around the silicone expander at 180 days, with persistent myofibroblasts, lymphocytes and macrophages as compared to the thin fibrous encapsulation around the UHMWPE implants. The regulatory role of cytokines and immune cells in myofibroblast persistence in tissue-implant interface around silicone expander has been extensively studied. Results of this study indicate the need to elucidate the signaling molecules in the transition of fibroblast to myofibroblast around silicone expander implants.

Survey of organosilicone compounds, including cyclic and linear siloxanes, in personal-care and household products

The determination of organosiloxanes in consumer products is important for the evaluation and characterization of sources of human and environmental exposures. In this study, we determined concentrations of cyclic siloxanes [octamethylcyclotetrasiloxane (D(4)), decamethylcyclopentasiloxane (D(5)), dodecamethylcyclohexasiloxane (D(6))], tetradecamethylcycloheptasiloxane (D(7))] and linear siloxanes (L(4) to L(14)) in a variety of consumer products (n = 76), including hair-care products, skin lotions, body washes, cosmetics, nursing nipples (i.e., pacifiers), cookware, and household sanitation products such as cleansers and furniture polishes, using gas chromatography-mass spectrometry with selected ion monitoring. Prior to the analysis of samples, a method was developed to reduce the contamination arising from organosiloxanes present in certain gas chromatograph (GC) parts, such as the inlet septum; use of a Restek BTO septum at an inlet temperature of 200 degrees C gave the lowest background level (D(4): 0.8 pg; D(5): 0.3 pg; D(6): 0.2 pg). Concentrations of cyclic siloxanes in consumer products analyzed ranged from <0.35 to 9380 microg/g, from <0.39 to 81,800 microg/g, from <0.33 to 43,100 microg/g, and from <0.42 to 846 microg/g for D(4), D(5), D(6), and D(7), respectively. Concentrations of linear siloxanes varied from <0.059 to 73,000 microg/g. More than 50% of the samples analyzed contained D(4), D(5), or D(6). Cyclic siloxanes were predominant in most of the sample categories; D(5) was predominant in hair-care products, skin lotions, and cosmetics; D(6) or D(7) was predominant in rubber products, including nipples, cookware, and sealants. Potential daily exposure to total organosiloxanes (sum of cyclic and linear siloxanes) from the use of personal-care products by adult women in the United States has been estimated to be 307 mg. Significant positive correlations (p < 0.01) existed in our study between D(4) and D(7), D(4) and linear siloxanes, D(5) and D(6), and D(5) and linear siloxanes. The correlations can be related to the composition of organosiloxanes used in consumer products. The results of our study suggest that a wide variety of consumer products that are used on a daily basis contain cyclic and linear siloxanes and these products can contribute considerably to human exposures.

Flector tissugel used to treat capsular contracture after breast augmentation surgery

Capsular contracture constitutes the main postoperative complication after breast augmentation by implant placement. To date, no systemic treatment known allows for improvement that does not simultaneously put the patient at risk for secondary complications of a more general nature. Flector Tissugel is the sole locally active antiinflammatory patch. Its durable local antiinflammatory effect is associated only with a risk for rare and highly limited side effects. After approximately 3 weeks of treatment, a high frequency of change from capsular contracture Baker 2 or 3 to Baker 1 occurs, provided the application was started no later than 3 months after the onset of capsular contracture.

Clinical and Morphological Conditions in Capsular Contracture Formed around Silicone Breast Implants

BACKGROUND

A study was performed to investigate histological changes in capsules formed around silicone breast implants and their correlation with the clinical classification of capsular contracture defined by the Baker score. For histological classification, the authors used the classification introduced by Wilflingseder, which identifies four grades of contracture.

METHODS

The study included 24 female patients (average age, 40 +/- 12 years) with capsular contracture after bilateral cosmetic breast augmentation with smooth silicone gel implants (Mentor, Santa Barbara, Calif.). The Baker score was determined preoperatively for each patient. Samples of capsular tissue were obtained from all patients for histologic and immunohistochemical analyses. Capsular thickness, age of the collagen fibers, presence of synovia-like metaplasia on the inner surface of the capsule, number of histiocytes, giant cells, and other inflammatory cells, amount of silicone, foreign body granulomas, and capsule calcification were evaluated.

RESULTS

There was a positive correlation between capsular thickness (p < 0.05) and Baker score. Silicone-containing deposits were found in all four histological capsule types. A trend toward greater capsular thickness was documented in patients with severe inflammatory reaction. These patients also had more clinical symptoms. Greater capsular thickness was associated with a higher number of silicone particles and silicone-loaded macrophages in the peri-implant capsule.

CONCLUSIONS

The authors demonstrated a positive correlation (p < 0.05) between the clinical classification (Baker score I to IV) and the histological classification introduced by Wilflingseder (Wilflingseder score I to IV). An exact histological classification is needed to describe precisely the morphological changes in capsular contracture.

Breast Implant Capsules Are Partially Composed of Bone Marrow–Derived Cells

Capsular contracture is the most common complication following breast augmentation or reconstruction with implants. We recently demonstrated that bone marrow-derived cells provide fibroblasts to murine skin during wound healing. To determine if bone marrow-derived cells were the cellular source of periprosthetic capsules, we created chimeric C57BL mice containing bone marrow cells from isogeneic enhanced green fluorescent protein (EGFP) mice and implanted with a textured silicone shell implant. We found that none of the mice developed infection or capsular contracture, but day 30 capsules were composed of 26.4 +/- 6.1% EGFP cells, and day 60 capsules had 21.8 +/- 10.3% EGFP cells. Immunohistochemistry revealed a small population of EGFP cells in the capsules that were myofibroblasts. Thus, breast implant capsules are partially composed of bone marrow-derived cells and, given the potential of these cells to become myofibroblasts, may explain the cellular source of capsular contracture when it develops.

The use of biomedical sensors to monitor capsule formation around soft tissue implants

Piezoelectric sensors have been shown to respond reproducibly to changes in tissue mechanical properties surrounding an implant over a 4-month period. The vibrational amplitude at a frequency corresponding to the radial resonance shows a statistically significant change over time. The initial period of inflammation is marked by a significant reduction in amplitude, which is indicative of an increase in viscous dissipation of the tissue. As collagen displaces the cellular response, the amplitude continues to decrease. Finally, as the tissue matures, the capsule becomes stiffer, and the viscous dissipation lessens. These results are consistent with qualitative assessments of explanted capsules. Strain gauges encased in a monolithic block of silicone exhibited a greater degree of variability, yet show similar trends over time. The strain increases in the initial 4-week period and remains relatively steady over the following 4 weeks. Beyond 8 weeks, the gauges begin to extrude from the animal or suffer a loss of electrical continuity. Steps are being taken to improve the strain sensor longevity in the animals.

Kinetics of T lymphocyte responses to persistent antigens

Long term sequential study of immune responses in the same individuals is difficult from the time commitment required and the problem of maintaining enough subjects to provide for comparative analysis. We closely studied one hundred women with silicone mammary devices through cross sectional analysis up to 26 years post implantation and a similar sample of women to 6 years post explantation. The T cell index, calculated from tritiated thymidine incorporation during lymphoblast transformation, rose to a post implant peak at 10.5-12.0 years, falling progressively over the next 14.0-15.5 years to values indicative of probable immune quiescence. Post explantation, the index rose over the first 3 years and then sharply declined to within the range for unexposed controls. The shape of these time curves contains considerable information referent cell dynamics for both stimulatory and inhibitory factors and for demonstrating net group effects, appropriate to analysis in the cross sectional perspective. When a subset of four women was studied frequently and sequentially up to 8 years, an internal oscillatory pattern emerged, focusing attention on both the stimulatory and the inhibitory aspects of long term clonal expansion. IL-2 has stimulatory and inhibitory properties at different levels of production and is considered a prime candidate as the essential cytokine. The equations have details, however, which require exploration beyond any such provisional conclusion. The analytic process was aided by normalization of oscillatory data to eliminate subject variability and by Pareto optimization to assess the trend shown by normalization. Pareto analysis revealed two minimally coordinated oscillations, one over time and the other along net clonal expansion or decline of the siloxane specific T lymphocyte clone. The segments of the time related oscillation greatly exceeded the reaction times of cytokines currently known to be active in T cell regulation. Although the ultimate controlling factor(s) may be cytokine or chemokine combinations, the data are compatible with some more basic regulatory factor(s) of cell integrity, including limits on the number of cell divisions which can be sustained in long term immunopathic lesions, among other processes.