Augmentation Options Research Articles

Common Effluent Treatment Plants Monitoring and Process Augmentation Options to Conform Non-potable Reuse

The stringency in effluent discharge and reuse standards has made it extremely expensive to discharge the effluents safely or reuse them. Therefore, existing wastewater treatment plants should be evaluated and improved or augmented. With this aim, five existing common effluent treatment plants (CETPs) in North India were evaluated, including: the State infrastructure Development Corporation Uttrakhand Limited (SIDCUL) Haridwar, which processes 4.5 Million Liters per day (MLD); the Industrial Model Township (IMT) Manesar Gurgaon, 55 MLD (comprising two streams of 25 and 30 MLD each); the Lawrence Road Industrial Area (LRIA), Delhi, 12MLD (12MLD LRIA); Mayapuri Industrial Area (MIA), Delhi, 12MLD; and the Integrated Industrial Estate (IIE) SIDCUL Pantnagar, 4.0 MLD. These plants were designed to produce treated effluent for non-potable reuse. Results showed that the integrated efficiency (IEa) of all CETPs was 10–20% larger than standard integrated efficiency (IEs), indicating the suitability of the technology, except for 12MLD at MIA CETP where the IEa was 20% lower than IEs, due to the absence of any biological unit in the process. Combined post-treatment of secondary effluent by coagulation, Ultrafiltration (UF), followed by ozonation for CETP SIDCUL Haridwar, was also conducted for its non-potable water reuse. This process was able to reduce Biochemical Oxygen Demand (BOD) by 77%, Chemical Oxygen Demand (COD) by 76%, turbidity by 96%, and Total Suspended Solids (TSS) by 100%. All these parameters confirmed the effluent standards for non-potable reuse. The color was reduced to 4.0 from 42.0 Pt-Co units by the exposure ozone concentration of 8.3 mg/L for up to 4.0 min on the treated water from SIDCUL CETP, which reduced the color by 90% and complied with reuse standards. Hence Combined post treatment by coagulation, UF followed Ozonation of secondary treated effluent could be a better option for the potable reuse of treated water in various domestic and industrial applications.

Sidebar: Community-driven Approaches to Preventing Overdoses Among American Indians.

### BACKGROUND AND PURPOSE: Spinal instrumentation plays a key role in the treatment of spinal instability in patients with metastatic tumors. Poor bone quality, radiation, and diffuse osseous tumor involvement present significant challenges to spinal stabilization with instrumentation and occasionally result in postinstrumentation compression fractures. Vertebral cement augmentation has been effective in the treatment of painful tumor-related compression fractures. Our objective was to describe cement augmentation options in the treatment of vertebral compression fractures associated with spinal instrumentation in patients with metastatic tumors. ### MATERIALS AND METHODS: Patients who underwent percutaneous vertebral cement augmentation in the treatment of instrumentation-associated vertebral compression fractures between 2005 and 2011 were included in the analysis. Only fractures that occurred within the construct or at an adjacent level were included. The change in Visual Analog Scale and need for further surgery were analyzed. ### RESULTS: Eleven patients met the inclusion criteria, with 8 tumors located in the thoracic spine and 3 tumors in the lumbar spine. The median time between instrumented surgery and vertebral augmentation was 5 months (1--48 months) and the median follow-up after cement augmentation was 24 months (4--59 months). A total of 22 vertebrae that were either within or immediately adjacent to the surgical instrumentation underwent vertebral augmentation. All patients reported a decrease in their pain scores (mean decrease: 6 Visual Analog Scale points; *P* \< .003). One patient required reoperation after cement augmentation. None of the patients experienced vertebral cement augmentation--related complications. ### CONCLUSIONS: Vertebral cement augmentation represents a safe and effective treatment option in patients with recurrent or progressive back pain and instrumentation-associated vertebral compression fractures.

Outpatient Cosmetic Breast Augmentation with DIEP Flaps

BACKGROUND: Breast augmentation ranks as one of the most commonly performed cosmetic procedures. It is a relatively inexpensive and straightforward procedure that yields good results with low risk. However, potential problems with implants exist such as deflation, leaks, malposition, pain, and capsular contraction. Breast Implant Illness (BII) or Breast Implant Associated Lymphoma (BIA-ALCL) remains a high concern for many patients. As a reliable alternative or treatment for these issues and concerns, the authors describe the use the deep inferior epigastric perforator (DIEP) flap in outpatient cosmetic breast augmentation and mastopexy. METHODS: We reviewed patients who had undergone cosmetic breast augmentation with DIEP flaps over a 12-month period. Any patient who desired breast augmentation, implant exchange, or augmentation mastopexy with concomitant abdominoplasty was considered a candidate for the procedure. Charts were reviewed for all patients who elected to proceed with cosmetic DIEP flaps. All patients underwent our early recovery protocol, including microfascial incisions to harvest the DIEP flaps, and rib preservation in addition to ERAS protocols with intraoperative anesthetic blocks. RESULTS: Eleven consecutive patients underwent bilateral cosmetic breast augmentation with DIEP flaps and mastopexy. Overall, all patients referred dissatisfaction with their abdomen and breasts. Three patients presented with ptotic breasts following recent pregnancies. Four patients were displeased with their breasts following augmentation with prosthetic implants. Three patients were experiencing pain and discomfort due to bilateral capsular contractures, with two of them being consistent with Breast Implant Illness. Lastly, one patient decided to undergo breast augmentation following bariatric surgery. Microfascial incisions for single perforator abdominal flaps (n = 17) averaged 1.7 cm (range 1.3–2.4), while flaps with multiple perforators (n = 5) averaged 2.4 cm (range 2-–2.5). Dissection of recipient IMA vessels was performed without disruption of the rib. No fascia or muscle tissue was taken during flap dissection. All patients had strong Doppler signals before discharge within 23 hours. No partial or total flap losses were reported, without major complications or take-backs. Average follow-up was 15 weeks. One patient required in-office debridement and closure due to suture granuloma at the abdominal incision. One patient developed minimal T-zone necrosis of the mastopexy site, which healed secondarily. Another patient, who had undergone prior mini-abdominoplasty, had limited flap edge necrosis that also healed secondarily. DISCUSSION: Combined breast augmentation or augmentation mastopexy with abdominoplasty is a commonly performed surgical procedure. Patients who desire abdominoplasty and augmentations are ideal candidates for this procedure. Breast augmentation with autologous tissue, particularly the DIEP flap, is an attractive option inherent to the additional abdominal tissue available to harvest. Likewise, women with implant complications like severe capsular contractures, or patients who have concerns for BIA-ALCL or have Breast Implant Illness, yet would like to maintain breast volumes, are excellent candidates. These conditions and the fear of these problems required other reliable options for breast augmentation or removal of implants secondary to refractory illness. Our early recovery protocol allows us to perform microsurgical breast reconstructions and augmentations in an outpatient setting, with outstanding results and no total or partial flap losses, thus offsetting the high costs associated with the DIEP flap.

Biomechanical Principles of Breast Implants and Current State of Research in Soft Tissue Engineering for Cosmetic Breast Augmentation.

Currently there are limited implant-based options for cosmetic breast augmentation, and problems associated with those have been increasingly appreciated, most commonly capsular contracture, which occurs due to a chronic foreign body reaction against non-degradable implant materials such as silicone and polyurethane leading to scar tissue formation, pain, and deformity. The underlying biomechanical concepts with implants create a reciprocal stress-strain relationship with local tissue, whilst acting as a deforming force. This means that with time, as the implant continues to have an effect on surrounding tissue the implant and host's biomechanical properties diverge, making malposition, asymmetry, and other complications more likely. Research directed towards development of alternative therapies based on tissue engineering and regenerative medicine seeks to optimize new tissue formation through modulation of tissue progenitors and facilitating tissue regeneration. Scaffolds can guide the process of new tissue formation by providing both an implant surface and a three-dimensional space that promotes the development of a microenvironment that guides attachment, migration, proliferation, and differentiation of connective tissue progenitors. Important to scaffold design are the architecture, surface chemistry, mechanical properties, and biomaterial used. Scaffolds provide a void in which vascularization, new tissue formation, and remodelling can sequentially occur. They provide a conduit for delivery of the different cell types required for tissue regeneration into a graft site, facilitating their retention and distribution. Whilst recent research from a small number of groups is promising, there are still ongoing challenges to achieving clinical translation. This article summarizes the biomechanical principles of breast implants, how these impact outcomes, and progress in scaffold-guided tissue engineering approaches to cosmetic breast augmentation. 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 .

Bilateral Simultaneous Sinus and Nasal Floor Augmentation in Severe Atrophic Maxilla: a Case Report

Introduction: One of the most challenging cases in implantology is severely atrophic alveolar ridges which do not have adequate bone for implant placement. One common treatment option for dealing with this challenge is LeFort I osteotomy with inlay bone graft which allows implant insertion and correction of the maxillomandibular relationship simultaneously. Although this method has a high success rate, it is somewhat invasive and has potential complications in some cases. In recent decades, implant surgeons have focused on less invasive and more predictable treatment options for bone augmentation and implant rehabilitation. Now a question comes into mind when there are not much discrepancies in maxillomandibular skeletal relationship and inter arch distance, do we really need LeFort I down-grafting and take its risks? Methods: In this study, we present a case who did not need any change in the skeletal relationship of the jaws and inter arch space based on examination and prosthetic consultation, so we implemented bilateral simultaneous sinus and nasal floor augmentation instead of LeFort 1 interpositional inlay bone graft. Results: Six months after the surgery, new radiography showed adequate height and width of augmented bones gained in and under sinuses and nose floor. So there is no limitation on choosing suitable implant lengths and diameters. Conclusion: This study indicated successful augmentation of severely resorbed maxillary alveolar ridge with bilateral sinus and nose floor grafting technique instead of LeFort I interpositional bone graft in a case who didn’t have more discrepancies in skeletal and inter arch space.

Facial Masculinization from Procedures to Payment: A Review.

As the demand for gender-affirming procedures continues to increase, patients and providers have a greater imperative to understand the current state of facial masculinization. Facial reconstruction for transgender women has been shown to treat gender dysphoria effectively and reduce rates of discrimination and victimization. Although facial masculinization surgery for transgender men is less common, there are multiple surgical and nonsurgical options to supplement the effect of hormone therapy on facial appearance, including but not limited to: receding the hair line, flattening the forehead, expanding the supraorbital ridge, increasing the dorsal nasal projection, squaring the jaw, and augmenting the chin. This review aims to summarize these techniques for providers who wish to inform transgender male patients about their options and discuss them in the context of patient satisfaction and availability of insurance coverage.

Prevalence of Pre-existing Conditions Relevant for Adverse Events and Potential Drug-Drug Interactions Associated with Augmentation Therapies Among Patients with Treatment-Resistant Depression.

IntroductionPre-existing conditions relevant for adverse events (AE) and the potential for drug–drug interactions (DDIs) may limit safe pharmacotherapeutic augmentation options for patients with major depressive disorder (MDD). This concern may be heightened among patients with treatment-resistant depression (TRD), who often have comorbid medical disorders.MethodsAdults with MDD and ≥ 1 antidepressant claim within the first observed major depressive episode were identified in the MarketScan® Databases. Those initiating a new regimen after two regimens at adequate dose and duration were considered to have TRD. The index date was defined at TRD onset or on a random antidepressant claim among patients with non-TRD MDD. Pre-existing conditions 12 months pre-index and potential DDIs 3 months pre/post-index associated with specific non-antidepressant augmentation therapies, including atypical antipsychotics (APs), buspirone, psychostimulants, anticonvulsants, thyroid hormone, and lithium were compared between 1:1 matched TRD and non-TRD MDD cohorts.ResultsOverall, 3414 patients with TRD and non-TRD MDD (mean age 39.7 years, 69% female) were matched. Relative to non-TRD MDD, patients with TRD had 33% higher likelihood of ≥ 1 pre-existing condition relevant for AEs listed in product labels of non-antidepressant augmentation therapies (p < 0.001). Patients with TRD vs. non-TRD MDD had 12.9 and 6.4 times higher likelihood of ≥ 2 and ≥ 3 DDIs, respectively, based on their medication regimen (all p < 0.001).ConclusionPre-existing conditions relevant for listed AEs and potential DDIs limit safe augmentation options in MDD, particularly among patients with TRD. Payer prior authorization policies requiring several augmentation therapy trials to access novel treatments may complicate clinical management of this population.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-021-01862-z.

Breast augmentation in the transgender patient: narrative review of current techniques and complications.

Gender-affirming surgery (GAS) is often a crucial step during the journey to identity actualization for transgender patients. Surgical breast augmentation, or "top surgery", is frequently cited as the most important and sometimes only gender-affirming procedure sought by transfeminine patients. The breast augmentation process is remarkably similar in transgender and cisgender patients. However, there are unique guidelines, anatomic considerations, and contextual issues for the transgender patient population that must be taken into account by providers to achieve optimal outcomes. The aim of this review is to outline the current state of breast augmentation for transfeminine patients. We walk through our suggested pre-surgical evaluation, breast augmentation options, and post-surgical care. In the preoperative period, providers must establish a positive provider-patient relationship that allows for thorough history taking, physical examination, and goal setting. Providers must be able to select an appropriate implant, incision location, and operative plane to balance patient desires and pre-existing anatomic characteristics in transfeminine patients. Postoperatively, the provider must address acute and chronic needs to allow for continued satisfaction and safety. After reading this review, we aim for providers to be well-equipped to provide the highest quality breast augmentation care for their transfeminine patients. As research into best practices for breast augmentation in transfeminine patients continues to develop, we expect that surgical practice will continue to evolve.

Improved accuracy of pest detection using augmentation approach with Faster R-CNN

In agriculture, Pests are decreasing agricultural productivity. Identifying a pest is a challenging process and subject to expert opinion. Nowadays, lots of work carried out for automatic pest detection. It becomes possible because of emerging Deep Learning’s object detection architectures. This paper shows the multi-class pest detection using Faster R-CNN architecture and compared the performance results of image augmentation with focused on the accuracy performance along with small dataset. We have used Horizontal Flip and 90 Degree Rotation augmentation parameters for solving class imbalance problem. We found that trained pest detection model with augmentation options can perform better with an accuracy of 91.02% using Faster R-CNN architecture.

Cement augmentation of calcar screws may provide the greatest reduction in predicted screw cut-out risk for proximal humerus plating based on validated parametric computational modelling: Augmenting proximal humerus fracture plating.

AimsFixation of osteoporotic proximal humerus fractures remains challenging even with state-of-the-art locking plates. Despite the demonstrated biomechanical benefit of screw tip augmentation with bone cement, the clinical findings have remained unclear, potentially as the optimal augmentation combinations are unknown. The aim of this study was to systematically evaluate the biomechanical benefits of the augmentation options in a humeral locking plate using finite element analysis (FEA).MethodsA total of 64 cement augmentation configurations were analyzed using six screws of a locking plate to virtually fix unstable three-part fractures in 24 low-density proximal humerus models under three physiological loading cases (4,608 simulations). The biomechanical benefit of augmentation was evaluated through an established FEA methodology using the average peri-screw bone strain as a validated predictor of cyclic cut-out failure.ResultsThe biomechanical benefit was already significant with a single cemented screw and increased with the number of augmented screws, but the configuration was highly influential. The best two-screw (mean 23%, SD 3% reduction) and the worst four-screw (mean 22%, SD 5%) combinations performed similarly. The largest benefits were achieved with augmenting screws purchasing into the calcar and having posteriorly located tips. Local bone mineral density was not directly related to the improvement.ConclusionThe number and configuration of cemented screws strongly determined how augmentation can alleviate the predicted risk of cut-out failure. Screws purchasing in the calcar and posterior humeral head regions may be prioritized. Although requiring clinical corroborations, these findings may explain the controversial results of previous clinical studies not controlling the choices of screw augmentation.

Breast augmentation for transfeminine patients: methods, complications, and outcomes.

Gender-affirming procedures are critical steps in helping transgender patients reach identity actualization and maximal quality of life. Although there are many techniques for gender-affirming care, surgical breast augmentation, or "top surgery," is often cited as the most important-and sometimes only-procedure sought by transfeminine patients. Unfortunately, years of individual and systemic prejudice placed barriers between transgender patients and the healthcare providers needed to affirm gender identity. Policy has recently begun to change as research proving the safety, need, and outcomes of breast augmentation in transfeminine patients dismantles long-established systemic inequalities. With this change, more patients are seeking knowledgeable and respectful providers who can address their unique gender-affirming needs. Overall, breast augmentation in transfeminine patients is technically similar to procedures performed in cisgender peers, but with significant considerations. The most common method of augmentation relies on breast implants, since removable prostheses, exogenous hormones, and fat grafting alone often produce unsatisfactory results. Special attention needs to be directed towards anatomic differences in transgender versus cisgender patients in order to achieve optimal size and position of the breast and nipple-areolar complex. Complications for transfeminine patients undergoing breast augmentation are rare, and complication rates are equivalent with cisgender peers who pursue similar procedures. Short- and long-term benefits to quality of life have been well-documented. The aim of this review is to give providers the technical knowledge concerning breast augmentation options, pre-surgical evaluation, post-surgical care, and special considerations in transfeminine patients so that provider and patient can have a successful, respectful partnership in reaching gender-affirming goals.

Autologous Plasma Filler in Treatment of Nasolabial Folds

Abstract Background There is an increasing demand for aesthetic correction of deep NLFs. Dermal fillers are one of the nonsurgical options for soft tissue augmentation, plasma filler is a recent technique tried in soft tissue augmentation. This procedure could be performed on an outpatient basis at a moderate cost, without any rejection reactions. Objective The presented study aimed to confirm the efficacy and safety of autologous plasma filler in treating nasolabial fold wrinkles. Subjects and Methods The present study included 40 females attended the Dermatology outpatient clinic of Ain Shams University Hospitals from March 2017 to November 2017. The age of patients ranged from 20 to 60 years old, with the mean age of 38.60 years old ± 11.48 SD. Results The overall success of our study was defined according to clinical improvement of NLFs subjectively by patients' satisfaction score which showed that 42.5% of patients rated their improvement as excellent, 35% as good and 22.5% as poor. The mean of WSRS decreased significantly from (3.20 ± 0.96) before treatment to (1.50 ±0.630) after 4 weeks of the treatment session. Furthermore, the mean value of GAIS scores 2 weeks after treatment session was (4.47 + 0.730) then become (4.03±0.964) 4 weeks after the treatment session. Conclusion In conclusion, Treatment with plasma filler injection resulted in significant improvement of NLFs with minimal complications.

Osteoporotic Bone: When and How to Use Augmentation?

The number of fragility fractures is rising, and treatment is a challenge for orthopaedic trauma surgeons. Various augmentation options have been developed to prevent mechanical failure. Different composites can be used based on the fracture type, patient needs, and biomechanical needs. Indications for augmentation are not limited to osteoporotic fractures but can also be performed as a salvage procedure or in pathologic fractures. Biomechanical studies have shown advantages for augmented implants in the spine, proximal femur, and humerus. Clinical studies are preliminary but promising, showing good clinical results after augmentation with reduced mechanical failure and minimal complications.

Urban water management challenges and achievements in Windhoek, Namibia

Abstract This paper gives an overview of the main challenges and achievements faced by Windhoek's water management sector. The paper highlights pertinent issues arising from increased water demand, and also explores current and future water supply augmentation options. Water planners experience management challenges as a result of a combination of factors, mainly, lack of funds and staff, limited expertise, poor communication between stakeholders, and weak regulation and enforcement. In order to meet these challenges water managers need to develop more robust and resilient strategies, including greater focus on water demand management.

A Proposal of Pseudo-periosteum Classification After GBR by Means of Titanium-Reinforced d-PTFE Membranes or Titanium Meshes Plus Cross-Linked Collagen Membranes.

After guided bone regeneration (GBR) with different devices, a layer of connective tissue called pseudo-periosteum can be observed above the newly formed bone. The aim of this study is to evaluate the clinical and histologic features and to suggest a classification of this connective tissue after GBR with nonresorbable membranes or titanium (Ti)-mesh plus resorbable membranes. Forty patients with partial edentulism in the posterior mandible were randomized into two groups: 20 patients were treated by means of Ti-reinforced dense polytetrafluoroethylene (d-PTFE) membrane (group A), while the other 20 patients were treated with Ti-mesh and a cross-linked collagen membrane (group B). After 9 months and during re-opening surgery, bone density and pseudo-periosteum type were recorded. Pseudo-periosteum was classified into Type 1 (no tissue or tissue < 1 mm); Type 2 (regular tissue between 1 and 2 mm); and Type 3 (irregular tissue or tissue > 2 mm). Histologic analyses were performed to identify the features of pseudo-periosteum. Out of 40 patients, 36 (n = 19 in Group A; n = 17 in Group B) with 99 implants were analyzed after GBR and according to the study protocol. The vertical bone gain was 4.2 ± 1.0 mm in Group A and 4.1 ± 1.0 mm in Group B. Group A had a higher bone density and greater amounts of type 1 periosteum than Group B (P = .01 for both). The preliminary results of this study show that both d-PTFE membranes and Ti-mesh plus collagen membranes are two valid options for bone augmentation in the mandible. However, nonresorbable membranes achieve higher bone density and a thinner pseudo-periosteum layer above the newly formed bone.

Impact of a novel pharmacist-delivered behavioral intervention for patients with poorly-controlled diabetes: The ENhancing outcomes through Goal Assessment and Generating Engagement in Diabetes Mellitus (ENGAGE-DM) pragmatic randomized trial.

BackgroundMany factors contribute to suboptimal diabetes control including insufficiently-intensive treatment and non-adherence to medication and lifestyle. Determining which of these is most relevant for individual patients is challenging. Patient engagement techniques may help identify contributors to suboptimal adherence and address barriers (using motivational interviewing) and help facilitate choices among treatment augmentation options (using shared decision-making). These methods have not been used in combination to improve diabetes outcomes.ObjectiveTo evaluate the impact of a telephone-based patient-centered intervention on glycosylated hemoglobin (HbA1c) control for individuals with poorly-controlled diabetes.DesignTwo-arm pragmatic randomized control trial within an explanatory sequential mixed-methods design.Subjects1,400 participants 18–64 years old with poorly-controlled type 2 diabetes.InterventionThe intervention was delivered over the telephone by a clinical pharmacist and consisted of a 2-step process that integrated brief negotiated interviewing and shared decision-making to identify patient goals and options for enhancing diabetes management.Main measuresThe primary outcome was change in HbA1c. Secondary outcomes were medication adherence measures. Outcomes were evaluated using intention-to-treat principles; multiple imputation was used for missing values in the 12-month follow-up. We used information from pharmacist notes to elicit factors to potentially explain the intervention’s effectiveness.Key resultsParticipants had a mean age of 54.7 years (SD:8.3) and baseline HbA1c of 9.4 (SD:1.6). Change in HbA1c from baseline was -0.79 (SD:2.01) in the control arm and -0.75 (SD:1.76) in the intervention arm (difference:+0.04, 95%CI: -0.22, 0.30). There were no significant differences in adherence. In as-treated analyses, the intervention significantly improved diabetes control (-0.48, 95%CI: -0.91, -0.05). Qualitative findings provided several potential explanations for the findings, including insufficiently addressing patient barriers.ConclusionsA novel telephone-based patient-centered intervention did not improve HbA1c among individuals with poorly-controlled diabetes, though as-treated analyses suggest that the intervention was effective for those who received it.Trial registrationClinicalTrials.gov NCT02910089

Meniscus Repair Enhancement Options

Meniscal tears are one of the most common pathologies of the knee. They can be managed with observation, partial meniscectomy, or repair. The limited vascularity of the meniscus central to the periphery limits the healing potential of meniscal tissue; however, recent development of biologic augments and surgical techniques have expanded the capability for meniscus repair; potentially avoiding partial meniscectomy in selected cases. The procedures and adjuncts include mechanical stimulation of the healing response, fibrin augmentation, bone marrow aspirate concentrate, mesenchymal stem cells, platelet-rich plasma, scaffolds, and others in development used either in isolation or combination. It is important for surgeons to become familiar with evolving biologic augmentation options to improve meniscal repair healing in an attempt to optimize the long-term health of the knee joint.

Bilateral breast reconstruction and pectus excavatum correction: a case and review of the literature

Pectus excavatum is a chest wall malformation characterized by anterior chest wall depression. It is often associated with hypoplastic breasts, sternal rotation, and consequent breast asymmetry. We present here the case of a 52-year-old female with pectus excavatum, a bilateral nipple-sparing mastectomy for breast cancer, and immediate autologous breast reconstruction using bilateral deep inferior epigastric perforator flaps. To correct reconstructed breast deformities and pectus excavatum depression and to enhance breast volume to treat hypoplastic breasts, three sessions of Brava-assisted fat grafting were performed. These postoperative courses were uneventful and without any complications. The patient was satisfied with the final esthetic results. There are only two case reports to perform bilateral breast reconstruction and surgical correction of pectus excavatum, which were used with both pedicle musculocutaneous flap and breast implant, with or without a sternal implant. In this study, we discuss indications and surgical options for bilateral breast reconstruction, pectus excavatum, and breast augmentation. Level of Evidence: Level V, therapeutic study.

The All Towns Reconciliation Strategies a partnership between water resource management and water services

Abstract In 2012, the South African Department of Water and Sanitation (DWS) initiated a study: Continuation of the Northern Planning Region's All Towns Reconciliation Strategies: Phase 1. This study reviewed, prioritised and updated the rudimentary All Towns strategies initially developed by DWS in 2011. The purpose of the strategies was to reconcile water requirements with available resources for the 2011–2035 planning horizon by estimating the projected water requirements, determining available water resources (surface and groundwater) and developing a water balance. Recommendations were made to conserve, manage and administer local water sources as well as to augment water supplies from other sources if required. The recommendations provided actions and options for implementation by the relevant Water Services Authorities and the DWS at a local and regional level, providing the opportunity for integrated and coordinated planning. Bulk and reticulation metering, the implementation of water conservation and demand management programmes and recommendations on the updating of water use allocations were prioritised. Detailed studies required to determine the most feasible water resource augmentation options to ensure a positive water balance were identified. The study coordinated efforts by officials and stakeholders representing both the water resources and water services sectors. The prioritised strategies defined the deficit or surplus of the water resources per water source on a technical level, but also highlighted the need for planning and coordination between the water resources and water services sectors. The strategies are not legally mandated documents, but represent some of the best efforts spanning across various sectors to realise coordinated water infrastructure planning in DWS’ Northern Planning Region. The use of the documents in the local, district and national planning environments should be promoted for integrated planning, and it may be fitting to incorporate the All Towns Reconciliation Strategy documents as a valuable resource to inform the water legislation currently being reviewed.

Bony Bankart lesions and glenoid defects : From refixation techniques to bony augmentation

Rim defects of the anterior glenoid cavity are amain reason for residual shoulder instability after traumatic dislocation of the shoulder. These defects can be the result of aglenoid rim fracture or chronic glenoid erosion after repeated shoulder dislocations. Treatment concepts for these entities are entirely different. While in the acute fracture situation glenoid rim fractures can be treated operatively or non-operatively, augmentation of the anterior glenoid for stabilization of the shoulder should be considered if the defect exceeds 15-25% of the anterior glenoid. The purpose of this article is to summarize the diagnostics and indications for treatment of glenoid rim fractures. Radiological assessment and options for augmentation are reviewed for both acute fractures as well as chronic instability following an anterior glenoid rim defect.