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Work-related musculoskeletal disorders (WMSDs) are an array of conditions affecting the human locomotor system, such as muscles, tendons, nerves, bones, and joints. It is related to physiological, kinesiological and biomechanical changes which result in pain, paresthesia, inflammation, weakness, tiredness, heaviness in limbs, fatigue, reduced range of motion and/or compression of peripheral nerves. The aim of this study was to investigate the therapeutic effects of positive (massage gum) or negative pressure (vacuum therapy) combined with laser on the health of workers with back pain, investigating pain intensity, shoulder mobility, spinal flexibility, life quality, and well-being. Twenty-one workers (female and male) aged between 20 and 60 years and who had medical referral for pain complaint in low back, neck and shoulders due to WMSDs participated in this study and were randomized into 3 groups: (1) Positive Pressure plus Laser Group (PPL): positive pressure using a massage gun was applied after the laser; (2) Negative Pressure plus Laser Group (NPL): negative pressure by vacuum was applied together with the laser and; (3) Control group (CG): without positive and negative pressure treatments or laser therapy. All workers received an educational booklet with postural orientation and suggestions focused on stretching exercises. Anamnesis, visual analogue scale (VAS) to assess pain intensity, and functional tests to assess spine flexibility and shoulders mobility were performed. Quality of life and well-being also were evaluated. The regions of lumbar, thoracic and cervical spine were treated once a week, totaling seven sessions. The main result was a reduced pain and an increased spinal flexibility, shoulders mobility, and quality of life in the PPL and NPL groups compared to the CG (p < 0.05). Furthermore, NPL showed better results compared to PPL (p < 0.05) for lumbar and cervical pain, as well as for right shoulder mobility. Therefore, laser combined with negative pressure massage was more effective in reducing lumbar and cervical pain and increasing shoulder mobility compared to positive pressure massage in workers. • The most workers remain sitting for long periods, indicating a factor which may lead to complaints of back pain. • The positive or negative pressure massage plus laser reduce pain, increase function and improve quality of life. • Negative pressure massage combined with laser showed better results for pain relief and shoulder mobility. [ABSTRACT FROM AUTHOR]

Lateral Epicondylalgia (LE) represents one of the most common injuries of the upper limb. It is necessary to find effective treatments that reduce pain and increase functionality. To determine the effects of an integrated intervention of Pulsed Negative Pressure Myofascial Vacuum Therapy (VT), Percutaneous Electrolysis (PE) and eccentric exercise (EE) in the treatment of LE compared versus Manual Therapy soft tissue mobilization (MT) and Ultrasound therapy (US) and EE. Single-blind randomized controlled trial. Forty participants, with unilateral LE, were randomly divided into two groups: VT + PE + EE group (n = 20) and MT + US + EE group (n = 20). The VT + PE + EE group received one weekly session for four weeks and a regimen of EE daily at-home, and the MT + US + EE group received 10 sessions over a period of two weeks and a regimen of EE daily at-home. Numerical pain rating scale (NPRS), range of motion (ROM) pressure pain threshold (PPT) and function (PRTEE questionnaire) were measured before treatment, at the end of treatment, and at one- and three-month follow-ups. The statistically significant improvements were found post-treatment, favoring the VT + PE group in pain intensity (p < 0.001; ES = 0.408), PRTEE-S Pain (p = 0.001; ES = 0.377), PRTEE-S Specific function (p = 0.004; ES = 0.306) and PRTEE-S Total (p = 0.001; ES = 0.355). The VT + PE + EE treatment showed greater effectiveness than the MT + US + EE treatment at immediate post-treatment, as well as at the one-month and three-months follow-up. VT and PE added to an EE program could be an effective treatment for pain, ROM, PPT, and function in patients with LE. • Electrolysis and Myofascial Vacuum Therapy in epicondylalgia. • Electrolysis, negative pressure & eccentric exercises: effective in epicondylalgia. • Electrolysis+negative pressure+exercise more effective than manual therapy+ultrasound. [ABSTRACT FROM AUTHOR]

Introduction Chronic low back pain is a common musculoskeletal healthcare presentation with an expense of over $100 billion annually. The clinical effect of myofascial cupping on pain and function is not clear, especially when different cupping techniques are combined. The purpose of this case series was to explore changes in pain and function following local static and distal dynamic myofascial dry cupping treatments in patients with chronic low back pain. Case Descriptions Three adults from the general population received three ten-minute treatment sessions, 48 hours between each session, of static dry cupping to the low back followed by dynamic myofascial cupping of the quadriceps and hamstring musculature. Outcome measures were taken at two different time points within one-week per participant. Subjective measures included the numeric pain rating scale and the Oswestry Disability Index, objective measures included passive straight leg raise measurements, and pressure pain threshold. Results and Discussion Local static combined with distal dynamic myofascial cupping reduced pain, pain sensitivity and perceived disability, and improved hamstring muscle extensibility in all three participants. These encouraging results support the initiation of a larger controlled trial aimed at investigating the efficacy of combined dry cupping interventions to treat musculoskeletal dysfunction and pain. Level of Evidence 4 (case series) [ABSTRACT FROM AUTHOR]

A proportional valve is one of the important parts used by the hydraulic control system to make precise operations. Flow control and direction are functions of proportional directional control valves. Despite this being important there are some problems, such as in flow control. This operation may cause the deficient performance of the actuator and the system. This paper presents the improvement of the performance hydraulic proportional directional control valve. The work suggests that the proportional valve would only be able to control flow in one direction, either metering in or out. Accordingly, the proposed work arrangement suggests many types of setups, by adding two-way directional control valves. Firstly, to know how the performance is deficient, some case is studied analytically. To demonstrate that, the prepared proposal has been made. The setup of the proposed arrangement is achieved. The arrangement is subject to simulation and tested practically to study the performance. The work included the electronic setup. As a result, the work leads to the improvement of the operation of proportional valves to control flow in one direction. The result of this investigation is to think about a new sort of valve that might be created to function better. As well as can also be made more flexible operations, depending on the type of load effect and flow control needed. In conclusion, the valve operation can be used as meter-in or meter-out flow controlling. [ABSTRACT FROM AUTHOR]

Gastric (anastomotic or staple-line) leaks after bariatric surgery are rare but potentially life-threatening complications. Endoscopic vacuum therapy (EVT) has evolved as the most promising treatment strategy for leaks associated with upper gastrointestinal surgery. The aim of this study was to evaluate the efficiency of our gastric leak management protocol in all bariatric patients over a 10-year period. Special emphasis was placed on EVT treatment and its outcome as a primary treatment or as a secondary treatment when other approaches failed. This study was performed at a tertiary clinic and certified center of reference for bariatric surgery. In this retrospective single-center cohort study, clinical outcomes of all consecutive patients after bariatric surgery from 2012 to 2021 are reported, with special emphasis placed on gastric leak treatment. The primary endpoint was successful leak closure. Secondary endpoints were overall complications (Clavien-Dindo classification) and length of stay. A total of 1046 patients underwent primary or revisional bariatric surgery, of whom 10 (1.0%) developed a postoperative gastric leak. Additionally, 7 patients were transferred for leak management after external bariatric surgery. Of these, 9 patients underwent primary and 8 patients underwent secondary EVT after futile surgical or endoscopic leak management. The efficacy of EVT was 100%, and there were no deaths. Complications did not differ between primary EVT and secondary treatment of leaks. Length of treatment was 17 days for primary EVT versus 61 days for secondary EVT (P =.015). EVT for gastric leaks after bariatric surgery led to rapid source control with a 100% success rate both as primary and secondary treatment. Early detection and primary EVT shortened treatment time and length of stay. This study underlines the potential of EVT as a first-line treatment strategy for gastric leaks after bariatric surgery. [ABSTRACT FROM AUTHOR]

Deep inferior epigastric perforator (DIEP) flaps are considered the gold standard for autologous breast reconstruction but create large abdominal incisions that risk donor-site morbidity during harvest. Closed incision negative pressure therapy (ciNPT) is emerging as an effective alternative to standard postoperative dressings, but there is a paucity of data in DIEP flap donor sites. We conducted a retrospective case-control study investigating the use of ciNPT in DIEP flap donor sites at a single institution between March 2017 and September 2021. Patients who underwent microsurgical autologous breast reconstruction with DIEP flaps were included. Patients were divided into those with donor incision sites managed with ciNPT (n = 24) and those with conventional postoperative wound dressings (n = 20). We compared patient demographics, wound drainage volumes and postoperative outcomes between the two groups. A cost-benefit analysis was employed to compare the overall costs associated with each complication and differences in length of stay between the two groups. There was no statistically significant difference in age, body mass index (BMI), comorbidity burden or smoking status between the two groups. Both groups had similar lengths of stay and wound drainage volumes with no readmissions or reoperations in either group. There was a statistically significant reduction in donor-site complications (p = 0.018), surgical site infections (p = 0.014) and seroma formation (p = 0.016) in those with ciNPT. Upon cost-benefit analysis, the ciNPT group had a mean reduction in cost-per-patient associated with postoperative complications of £420.77 (p = 0.031) and £446.47 (p = 0.049) when also accounting for postoperative length of stay ciNPT appears to be an effective alternative incision management system with the potential to improve complication rates and postoperative morbidity in DIEP flap donor sites. Our analysis demonstrates improved cost-benefit outweighing the increase in costs associated with ciNPT. We recommend a multicentre prospective trial with formal cost-utility analysis to strengthen these findings. [ABSTRACT FROM AUTHOR]

• Pectus excavatum treatment with vacuum bell conveys risk of skin lesions. • Protocols of gradual increase in negative pressure are used to decrease this risk. • A vacuometer for the measurement of negative pressure by the patients is reported. • It has a high patient satisfaction rate. • No patients presented skin lesions in this series when using the vacuometer. To report the implementation of a specially designed vacuometer for the ambulatory measurement of the exact negative pressure self-applied by the patient when using the vacuum bell for the treatment of pectus excavatum and to analyze patient satisfaction with the device, by conducting a survey. Between October 2018 and June 2020, all patients with pectus excavatum who received a vacuum bell at our Pectus Clinic were provided with a specially designed pectus vacuometer for their personal use. We described the vacuometer, the fundamentals of its development, and the utilization protocol. A survey was conducted evaluating comfort, clarity of instructions, usefulness, simplicity of connection, and likeability. The level of satisfaction was assessed using a Likert scale ranging from 1 (very negative experience) to 5 (very positive experience). The occurrence of skin lesions provoked by the application of the vacuum bell was registered. From 72 submitted surveys, 54 patients answered. Patient demographics comprised 44 (81.5%) males and a mean age of 12.6 ± 6.0 years. The mean initial external pectus depth was 2.0 ± 0.7 cm and the mean duration of treatment was 13.2 ± 8.6 months. No skin lesions were detected while using the vacuum bell and the vacuometer. The mean general satisfaction score was 4.4 ± 0.7 and 83.3% of the respondents did not have any inconvenience with the vacuometer. A patient who considered himself cured was the only dropout during the study. In this study, we described the feasibility and fundamentals of the application of a specifically designed vacuometer for ambulatory use as an adjunct to the treatment of pectus excavatum with a vacuum bell, and demonstrated a high satisfaction level with the device. In addition, the vacuometer might help avoid skin lesions secondary to the vacuum bell and foster adhesion to treatment. Treatment study. IV [ABSTRACT FROM AUTHOR]

Cupping therapy (CT) represents a cornerstone of traditional Chinese and Persian medicine, but it has its roots in the history of therapy. Although its exact mechanisms of action have been not fully understood, it is widely used as an alternative or complementary treatment of a broad spectrum of diseases, mainly musculoskeletal pain and muscular tension. Some practitioners use CT to cure dermatoses, but the most common adverse events occur at the skin level. We describe a case and briefly review the related literature. [ABSTRACT FROM AUTHOR]

Foot ulcers are one of the major causes of morbidity and mortality among diabetics in India. Early diagnosis and timely management is vital in preventing the progression of the disease which may require amputation. Conventional methods take a long time for healing. This study aims to compare negative pressure wound therapy (NPWT) and conventional saline dressings in diabetic foot ulcer (DFU) healing. This prospective randomized study was conducted in 45 patients with grade 1 and 2 DFUs. 22 patients in group A received NPWT and 23 patients in group B received saline dressings. The formation of granulation tissue, reduction in ulcer size, duration of hospital stay and time for complete healing of wounds were assessed. The formation of granulation tissue (91.14 vs 52.61%, p < 0.001) and reduction in ulcer size (40.78 vs 21.18%, p = 0.008) at 14 days was significantly more in group A. The duration of hospital stay (15.68 vs 29.00 days, p < 0.001) and time for 100% coverage of the wound with granulation tissue (14.82 ± 7.30 vs 44.57 ± 7.11 days, p < 0.001) was significantly less in group A. Complete healing of wounds at 3 months was observed in 20 patients (90.9%) in group A and 6 patients (26.1%) in group B (p = 0.006). In our study NPWT led to early reduction in ulcer size, more granulation tissue formation, shorter hospital stay and complete wound healing. In lower and middle income countries like India with high prevalence of DFUs, early recovery is a boon to the patients to resume their daily activities. • Diabetic foot ulcers are one of the major causes of mortality and morbidity among the 62 million diabetics in India. • Patients were prospectively randomized to receive either 14 days of NPWT or saline dressings and followed up for 3 months. • Our study highlights that the formation of granulation tissue and reduction in ulcer size is significantly more with NPWT. • The duration of stay and complete healing of wound was significantly more with NPWT and may prevent progression of disease. [ABSTRACT FROM AUTHOR]

Background and objective After general thoracic surgery, a chest tube is usually placed for closed drainage to expel gas accumulation in the thoracic cavity and fluid accumulation to promote lung re-expansion. It can also be observed whether there is active bleeding after the operation and whether there is a pulmonary leak. The conventional drainage of the chest cavity is connected with a water-sealed drainage bottle, and the patient condition is judged by observing the drainage situation and the fluctuation of the water column, which is a very classic method. However, the water-sealed bottle has the disadvantages of being easy to overturn and inconvenient to carry, which is not conducive to the early activities of patients. Under the concept of accelerated rehabilitation, our center applied a new type of anhydrous thorax negative pressure drainage device and achieved good results. The purpose of this study was to observe the effect of a new type of anhydrous thoracic negative pressure drainage device in patients after thoracic surgery. Methods Retrospective analysis of patients who underwent lung surgery in the First Affiliated Hospital of Zhejiang University Medical College from January 2018 to December 2019, patients were divided into two groups. One group of patients used a traditional closed-chest drainage water-sealed bottle as a control group, and the other group used a new type of anhydrous negative-pressure drainage bottle as an experimental group. Patients' gender, age, hypertension, diabetes, smoking history, surgical incisions and surgical methods, and the length of hospital stay and postoperative hospital stay were calculated. Results There were no statistical differences in age, gender, comorbidities (hypertension, diabetes, smoking history), scope of surgery, and duration of surgery between the two groups of patients, but there were statistical differences in surgical incisions between the two groups of patients (P=0.01). We found that patients using the new waterless negative pressure drainage device were shorter than patients with water negative pressure drainage device in terms of postoperative hospital stay and total hospitalization time, and the difference was statistically significant (P=0.02, P=0.04). Conclusion The new type of anhydrous thoracic negative pressure drainage device has a good effect on the rapid recovery and advancement after thoracic surgery [ABSTRACT FROM AUTHOR]

• The first reported case of urgent exploratory colorectal surgery and sigmoid mass resection in a COVID-19 positive patient. • Discussion of surgical techniques to minimize theoretical viral transmission pre, peri and postoperatively. • Discussion or risks of fecal transmission of COVID-19 transmission intraoperatively. • Discussion of personal protective equipment utilization and post-surgical COVID-19 screening among surgical healthcare staff. The COVID-19 pandemic presents a unique global health challenge further complicating surgical management of COVID-19 positive patients due to a lack of published literature. Within we discuss a 48-year-old Chinese man, presenting with acute gastrointestinal obstruction due to sigmoid colonic mass. The patient was screened and tested positive for COVID 19 due to his employment in Wuhan, China at the COVID-19 pandemic epicenter. The patient was subsequently taken for open sigmoid colonic resection, however the case presented multiple challenges due to the patient's COVID-19 positive status. The challenges of surgical management of COVID-19 positive patients exist are four-fold. First the unknown efficacy of pre-surgical risk stratification in COVID-19 positive patients, second the risk of aerosolized COVID-19 transmission during intubation for surgery, third the risk of fecal COVID-19 transmission to surgical staff during large bowel resection, and fourth the post-operative challenges of caring for COVID-19 positive patients. Further research is needed into these topics, as well as the medical management of COVID-19 surgical patients. [ABSTRACT FROM AUTHOR]

The energy-volume curve of a crystalline solid is critically examined in terms of the mechanical contributions of its constituent atoms. In addition to the usual analysis in the positive compression regime, our computational approach covers the tensile behavior in the negative pressure region up to the spinodal stability limit. Using the rich polymorphism of ZnO as a test-bed example, we propose two atomic decomposition schemes that are able to recover the bulk moduli and the critical strengths of four ZnO phases providing an intriguing interpretation of the chemical bonding network as a parallel circuit of mechanical resistors. Our scheme also allows the identification of the role played by the cation and anion in the densification of the high-pressure polymorphs and up to the material rupture points. This approach may help in the quest for tailored materials with outstanding mechanical performance. • First-principles calculated E-V curve of a crystalline solid (ZnO) provides valuable information of its mechanical properties at positive and negative pressures. • Zn and O Atomic Equations of State allows to understand how the density of ZnO polymorphs increases as pressure is applied and how the energy stored is distributed among the atomic constituents. • The crystalline bonding network of ZnO polymorphs behaves as a parallel circuit of mechanical resistors in analogy with a parallel circuit of electrical resistors. • Critical parameters defining the instability limit of ZnO polymorphs under "hydrostatic" tensile conditions can be anticipated using analytical EOS describing the calculated E-V curve. [ABSTRACT FROM AUTHOR]

Resumo Justificativa e objetivos O edema pulmonar por pressão negativa ocorre por aumento da pressão negativa intratorácica após inspiração contra via aérea superior obstruída. A pressão gerada é transmitida aos capilares pulmonares e supera a pressão de equilíbrio hidrostático, o que causa extravasamento de líquido para o parênquima pulmonar e alvéolos. Em anestesiologia, situações comuns como laringoespasmo e obstrução de via aérea superior podem desencadear essa complicação, que apresenta considerável morbidade e exige diagnóstico e propedêutica imediatos. A desobstrução das vias aéreas superiores, ventilação não invasiva com pressão positiva, oxigênio suplementar e, se necessário reintubação com ventilação mecânica são a base da terapia. Relato de caso Caso 1: Masculino, 52 anos, submetido a apendicectomia sob anestesia geral com intubação orotraqueal, uso de bloqueador neuromuscular adespolarizante, revertido com anticolinesterásico; apresentou laringoespasmo após extubação, seguido de edema pulmonar. Caso 2: Feminino, 23 anos, submetida a mamoplastia redutora sob anestesia geral com intubação orotraqueal, bloqueador neuromuscular adespolarizante revertido com anticolinesterásico, apresentou inspiração contra glote fechada após extubação, tratada com ventilação não invasiva com pressão positiva; após uma hora apresentou edema pulmonar. Caso 3: Masculino, 44 anos, submetido a ureterolitotripsia sob anestesia geral, sem bloqueador neuromuscular, apresentou laringoespasmo após retirada de máscara laríngea e evoluiu com edema pulmonar. Caso 4: Masculino, sete anos, submetido a redução cruenta de fratura sob anestesia geral com intubação orotraqueal, uso de bloqueador neuromuscular adespolarizante; apresentou laringoespasmo revertido com ventilação não invasiva com pressão positiva após extubação, seguido de edema pulmonar. Conclusões O anestesiologista deve evitar que o paciente faça inspiração forçada contra glote fechada, além de ser capaz de reconhecer e tratar os casos de edema pulmonar por pressão negativa. Abstract Background and objectives Negative pressure pulmonary edema occurs by increased intrathoracic negative pressure following inspiration against obstructed upper airway. The pressure generated is transmitted to the pulmonary capillaries and exceeds the pressure of hydrostatic equilibrium, causing fluid extravasation into the pulmonary parenchyma and alveoli. In anesthesiology, common situations such as laryngospasm and upper airway obstruction can trigger this complication, which presents considerable morbidity and requires immediate diagnosis and propaedeutics. Upper airway patency, noninvasive ventilation with positive pressure, supplemental oxygen and, if necessary, reintubation with mechanical ventilation are the basis of therapy. Case report Case 1: Male, 52 years old, undergoing appendectomy under general anesthesia with orotracheal intubation, non‐depolarizing neuromuscular blocker, reversed with anticholinesterase, presented with laryngospasm after extubation, followed by pulmonary edema. Case 2: Female, 23 years old, undergoing breast reduction under general anesthesia with orotracheal intubation, non‐depolarizing neuromuscular blocker, reversed with anticholinesterase, presented with inspiration against closed glottis after extubation, was treated with non‐invasive ventilation with positive pressure; after 1 hour, she had pulmonary edema. Case 3: Male, 44 years old, undergoing ureterolithotripsy under general anesthesia, without neuromuscular blocker, presented with laryngospasm after laryngeal mask removal evolving with pulmonary edema. Case 4: Male, 7 years old, undergoing crude fracture reduction under general anesthesia with orotracheal intubation, non‐depolarizing neuromuscular blocker, presented with laryngospasm reversed with non‐invasive ventilation with positive pressure after extubation, followed by pulmonary edema. Conclusions The anesthesiologists should prevent the patient from perform a forced inspiration against closed glottis, in addition to being able to recognize and treat cases of negative pressure pulmonary edema. [ABSTRACT FROM AUTHOR]

Despite scientific evidence that root canal debridement is the cornerstone for successful treatment, the effectiveness of a combination of delivery and activation systems in cleaning root canals remains unknown. This study is the first to demonstrate the remaining pulp tissue in root canals after irrigation with various techniques such as positive pressure syringe-and-needle irrigation, ultrasonic activation, negative pressure irrigation and ultrasonic activation after negative pressure irrigation. The results showed that negative pressure irrigation alone and its combination with ultrasonic activation resulted in significantly superior effectiveness than positive pressure irrigation and ultrasonic activation alone in the apical-third of root canals. [ABSTRACT FROM AUTHOR]

Regulated negative pressure-assisted wound therapy (RNPT) is one of the most important wound treatment technologies developed and applied over the last two decades. To-date RNPT has been proven to be clinically effective in treating chronic wounds, however, the effects of different specific pressure delivery protocols on the progress and quality of tissue repair are not adequately understood yet. Here, we suggest a viscoelastic, three-dimensional finite element modeling framework of RNPT, with several realistic features such as a non-symmetrically configured multi-layered tissue structure. The effects of the RNPT system on the wound-bed were simulated by applying time varying pressure boundary conditions. Three commonly-used operation modes were simulated: continuous, non-continuous intermittent and dynamic, and each mode was applied at four different pressure levels. Outcome measures of strain and stress magnitudes and distributions were acquired from the dermis and subcutaneous fat. Taken together, the strain and stress data from the different simulated RNPT modes and intensities demonstrated that tissue loads which are actually applied in and around the wound, and at the different tissue components of the wound, can differ substantially from the pressure levels that are set in the device during therapy sessions. This is critical information for understanding the potential effects of RNPT, for setting the device prior to therapy and for designing the next generation of these systems. [ABSTRACT FROM AUTHOR]

The large numbers of research are carried out in the field of wall climbing robots. These wall-climbing robots are utilized for variety of applications including hazardous operations. The wall-climbing robots must be capable of manoeuvring in different wall surfaces without sacrificing its mobility. For such capabilities, wall-climbing robots should be enabled with proper adhesion mechanism such as suction based absorption technology. In this paper, the modeling and experimental analysis of suction pressure generated inside the suction chamber with different suction chamber contours is analyzed. In this study, a novel bottom restrictor is included at the bottom of the designed suction chamber. The suction motor, suction chamber with different contours and bottom restrictor is modelled using 3D Solidworks software and performance analysis were done using FLU-EFD computational fluid dynamics (CFD) package. The impact on the adhesion efficiency of the climbing robot with the designed bottom restrictor is experimentally evaluated and tested on non-plastered brick walls. [ABSTRACT FROM AUTHOR]

Background Cupping therapy is a traditional therapy that has been employed worldwide for thousands of years. Despite a lack of quality clinical studies evaluating the efficacy of cupping therapy, its long history and widespread use throughout the world suggests the commonly claimed health benefits should not be completely discounted as without merit. Purpose The goal of this paper is to present the research detailing what is known concerning the effects of suction on skin and underlying tissue, and the reaction of the body to that stimulus. Understanding the literature on the physiological effects of this mechanical force may help elaborate an explanation for the advertised local and systemic effects of cupping therapy. Findings Negative pressure causes stretching of the skin and underlying tissue and dilation of the capillaries. This stimulates an increase in tissue blood flow, eventually leading to capillary rupture and ecchymosis. Macrophages phagocytize the erythrocytes in the extravascular space which stimulates the production of Heme Oxygenase-1 (HO-1) to metabolize the heme. Heme catalysis results in the production of carbon monoxide (CO), biliverdin(BV)/bilirubin(BR) and iron. HO-1, BV, BR, and CO has been shown to have antioxidant, anti-inflammatory, antiproliferative, and neuromodulatory effects in animal and human systems. These substances also stimulate a shift of macrophages to the anti-inflammatory M2 phenotype. There is evidence that the effects are both local and systemic. Conclusion Besides the mechanical effect of cupping increasing the local blood flow and stretching underlying tissue, activation of the HO-1 system could account for many of cupping therapy's claimed local and systemic health benefits. [ABSTRACT FROM AUTHOR]

Objective: A randomized controlled trial was undertaken to investigate the effect of prophylactic negative pressure dressings on postoperative surgical site infection (SSI) rates in closed laparotomy wounds. Summary of Background Data: Laparotomy wounds are associated with high rates of SSI. The effect of prophylactic negative pressure dressing of closed incisional wounds on SSI rate is unknown. Methods: A randomized, controlled, open-label trial was conducted (clinicaltrials.gov registration number NCT02780453). Fifty patients undergoing open abdominal surgery were included, with 25 patients randomized to the negative pressure dressing group and 25 to the standard dressing group. The primary endpoint was SSI incidence at 30 days postoperatively. Secondary endpoints included SSI incidence at 4 days, length of stay, cosmetic outcome, and patient satisfaction. Statistical analysis was performed on a per-protocol basis using SPSS version 23.0. Results: The incidence of SSI at 30 days postoperatively was significantly reduced in the treatment group compared with the control group [8.3% vs 32.0%, P = 0.043 (1-sided), P = 0.074 (2-sided)]. There was no difference in SSIs at 4 days postoperatively [4.1%vs 8.0%, P=0.516 (1-sided), P=1.0 (2-sided)]. Analysis of predictors of wound infection identified standard wound dressings as the only significant predictor of SSI development. Length of stay was significantly reduced in the negative pressure dressing group [6.1 vs 14.7 days, P = 0.019 (2-sided)]. Cosmetic outcome and patient satisfaction did not show any difference between the 2 groups. Conclusions: Prophylactic use of negative pressure dressings for closed laparotomy wounds significantly reduces the incidence of SSI at 30 days postoperatively. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe for the first time in literature the specific methodology of use of negative pressure wound therapy (NPWT) for duodenal fistula through clinical cases. The constant increase of use of NPWT for complex surgical situations imposes tailored previously undescribed solutions for the technique. PATIENTS AND METHODS: Herein, three cases of high output duodenal fistula successfully treated with Negative Pressure Wound Therapy (NPWT) are reported. The technical details for the application of NPWT to these fistulas are discussed and described. RESULTS: A ll t hree p atients r ecovered w ithout the necessity of further surgical operations. CONCLUSIONS: When using NPWT, management of high-output duodenal fistulas must rely on some degree of customization of the aspiration systems. The aim of the procedure is to put under depression the duodenal hole and surrounding tissues "all in one" and not to separate the complex wound in sectors as usually indicated. We suggest calling this technique Negative Pressure Fistula Therapy. [ABSTRACT FROM AUTHOR]

To better understand the transport of airborne particulate matter (PM) in hospital environments when surge control strategies are implemented, tests were conducted in a recently decommissioned hospital during a one-week period. An aerosol was released within a patient room and concentrations measured in the room and hallway with and without surge control ventilation system modifications. The average hallway protection efficiencies were high (>98%) both for the baseline ventilation configuration and when the ventilation system was modified for whole floor negative pressure, indicating very little PM reached the hallway. During entry/exit events through the patient room door into the hallway, the average minimum hallway protection efficiencies were lower during the modified ventilation operation (93–94%) than for the baseline operation (98–99%). These lower hallway protection efficiencies may be explained by the 52% reduction in the outdoor air ventilation being supplied to the hallway during the modified operation mode. This suggests that patient room doors should remain closed to control PM movement into the hallway. In addition, if there is concern about airborne infection transmission, an anteroom may be used to further reduce the transport of particles from the patient rooms to the hallways of the ward. [ABSTRACT FROM AUTHOR]

• Two quick solutions for isolating patient beds during the COVID-19 pandemic. • The neural network is used in the presented paper as a type of artificial intelligence technique. • The hospital was able to make the best possible choice with the aid of the analyzed neural network model. • The prefabricate method is the most cost-effective and time-efficient option based on the research model and execution. Decreasing the COVID spread of infection among patients at physical isolation hospitals during the coronavirus pandemic was the main aim of all governments in the world. It was required to increase isolation places in the hospital's rules to prevent the spread of infection. To deal with influxes of infected COVID-19 patients' quick solutions must be explored. The presented paper studies converting natural rooms in hospitals into isolation sections and constructing new isolation cabinets using prefabricated components as alternative and quick solutions. Artificial Intelligence (AI) helps in the selection and making of a decision on which type of solution will be used. A Multi-Layer Perceptron Neural Network (MLPNN) model is a type of artificial intelligence technique used to design and implement on time, cost, available facilities, area, and spaces as input parameters. The MLPNN result decided to select a prefabricated approach since it saves 43% of the time while the cost was the same for the two approaches. Forty-five hospitals have implemented a prefabricated solution which gave excellent results in a short period of time at reduced costs based on found facilities and spaces. Prefabricated solutions provide a shorter time and lower cost by 43% and 78% in average values respectively as compared to retrofitting existing natural ventilation rooms. [ABSTRACT FROM AUTHOR]

The aim of our prospective study was to investigate the clinical results and advantages of a minimally invasive sinus tarsi approach with cannulated screw fixation combined with vacuum-assisted closure for the treatment of severe open calcaneal fractures with medial wounds. A total of 31 patients (32 feet) with open calcaneal fractures who were admitted to our hospital from January 2008 to May 2013 were selected for the study and randomly divided into 2 groups: the cannulated screw group (n = 16 patients, 16 feet) and the plate group (n = 15 patients, 16 feet). The Böhler and Gissane angles were compared before and after surgery. The clinical results were evaluated using according to the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale and the rate of infection. The follow-up duration for all patients ranged from 10 to 36 (mean 24) months. No statistically significant differences were found in the radiologic indicators, incidence of early postoperative complications, or American Orthopaedic Foot and Ankle Society ankle-hindfoot scores ( p > .05) between the 2 groups. However, a statistically significant difference was seen in the duration of hospitalization ( p < .05) between the 2 groups. A minimally invasive sinus tarsi approach with cannulated screw fixation combined with vacuum-assisted closure is an effective method for the treatment of severe open calcaneal fractures with medial wounds. It provides good reduction and requires fewer days of hospitalization. [ABSTRACT FROM AUTHOR]

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Abstract: INTRODUCTION: We aimed to present the management of a patient with fistula of ileal conduit in open abdomen by intra-condoid negative pressure in conjunction with VAC Therapy and dynamic wound closure system (ABRA). PRESENTATION OF CASE: 65-Year old man with bladder cancer underwent radical cystectomy and ileal conduit operation. Fistula from uretero-ileostomy anastomosis and ileus occurred. The APACHE II score was 23, Mannheim peritoneal index score was 38 and Björck score was 3. The patient was referred to our clinic with ileus, open abdomen and fistula of ileal conduit. Patient was treated with intra-conduid negative pressure, abdominal VAC therapy and ABRA. DISCUSSION: Management of urine fistula like EAF in the OA may be extremely challenging. Especially three different treatment modalities of EAF are established in recent literature. They are isolation of the enteric effluent from OA, sealing of EAF with fibrin glue or skin flep and resection of intestine including EAF and re-anastomosis. None of these systems were convenient to our case, since urinary fistula was deeply situated in this patient with generalized peritonitis and ileus. CONCLUSION: Application of intra-conduid negative pressure in conjunction with VAC therapy and ABRA is life saving strategies to manage open abdomen with fistula of ileal conduit. [Copyright &y& Elsevier]

Copyright of Fibres & Textiles in Eastern Europe is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article mainly focuses on structural material anti-cracking property under negative pressure for the tunnel secondary lining of Wu-Guang passenger dedicated line during service period in China and points out that dynamic crack of the tunnel secondary lining is the key influential factor for structural material under negative pressure. In view of that no standard method has been proposed to test and characterise the anti-cracking performance of tunnel secondary lining, a new method for evaluating the cracking performance of tunnel secondary lining in service is presented in this paper. When load level reached 30% of the maximum, anti-air permeability of cellulose fibre concrete was evidently improved by 40% than that of plain concrete. This result shows that novel structural material cellulose fibre concrete can improve the anti-cracking performance of tunnel secondary lining in service. [ABSTRACT FROM AUTHOR]

Abstract: INTRODUCTION: To present the management of open abdomen with colorectal fistula by application of intrarectal negative pressure system (NPS) in addition to abdominal NPS. PRESENTATION OF CASE: Twenty-year old man had a history of injuries by a close-range gunshot to the abdomen eight days ago and he had been treated by bowel repairs, resections, jejunal anastomosis and Hartman's procedure. He was referred to our center after deterioration, evisceration with open abdomen and enteric fistula in septic shock. There were edematous, fibrinous bowels and large multiple fistulas from the edematous rectal stump. APACHE II, Mannheim Peritoneal Index and Björck scores were 18, 33 and 3, respectively (expected mortality 100%). After intensive care for 5 days, he was treated by abdominal and intrarectal NPS. NPS repeated for 5 times and the fistula was recovered on day 18 completely. Fascial closure was facilitated with a dynamic abdominal closure system (ABRA) and he was discharged on day 33 uneventfully. There was no herniation and any other problem after 12 months follow-up. DISCUSSION: Management of fistula in OA can be extremely challenging. Floating stoma, fistula VAC, nipple VAC, ring and silo VAC, fistula intubation systems are used for isolation of the enteric effluent from OA. Several biologic dressings such as acellular dermal matrix, pedicled flaps have been used to seal the fistula opening with various success. Resection of the involved enteric loop and a new anastomosis of the intestine is very hard and rarely possible. In all of these reports, usually patients are left to heal with a giant hernia. In contrast to this, there is no hernia in our case during one year follow up period. CONCLUSION: Combination of intra and extra luminal negative pressure systems and ABRA is a safe and successful method to manage open abdomen with colorectal fistula. [Copyright &y& Elsevier]

Copyright of Cirugía Plástica Ibero-Latinoamericana is the property of Cirugia Plastica Ibero-Latinoamericana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: In this paper, the geometric model, combustion model and the initial and boundary conditions were determined by the actual long narrow confined space. The variation of the temperature field at different time were studied, the temperature distribution law of long narrow confined space were simulated by detection points, which including the dome temperature variation at different time, and the temperature distribution law in the horizontal and vertical direction, the law of temperature distribution in the three directions were studied when the simulation was 120s. The study provided reference for evacuation and rescuing of long narrow confined space fire under the negative pressure ventilation condition. [Copyright &y& Elsevier]

The purpose of the current investigation was to explore how intra-oral negative pressure and submental muscle activity vary across sips from straws varying in internal diameter and across conditions of low versus high effort. Healthy adults took discrete sips from four straws varying in internal diameter. Sips were performed under normal and high effort conditions. Submental surface electromyography (sEMG) and negative intra-oral pressure were recorded during sips. Significant main effects of straw condition were observed for negative intra-oral pressure. A non-significant trend for increased muscle activity associated with smaller straw diameter was also observed. Significant main effects of effort condition were observed for both submental sEMG and negative intra-oral pressure. The findings are interpreted as supporting the clinical hypothesis that high resistance drinking straws varying in diameter may offer systematic overload to the oral musculature. The findings also support encouraging maximum effort to achieve even further overload. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: This study compared canal and isthmus debridement efficacies between side-vented needle irrigation (SNI) and the VPro EndoSafe (VPro) negative-pressure device (Vista Dental, Racine, WI) in mesial roots of mandibular first molars with narrow isthmuses in a closed-canal design. Methods: Twenty teeth with narrow isthmuses were selected using micro–computed tomography scanning. Collagen solution was reconstituted with 1% NH4OH to simulate debris and injected into canals via vacuum. Canals were instrumented to size 40/.04. Final irrigation was performed with 17% EDTA and 6% NaOCl using SNI with a 30-G needle or the VPro system. Roots were demineralized, and Masson trichrome–stained sections were prepared at 1.2 to 3.2 mm from the anatomic apex for a total of 6 canal levels. Debris-filled areas within the canals and isthmuses were measured using ImageJ software (National Institutes of Health, Bethesda, MD) and statistically analyzed using repeated-measures analysis. Results: There was no significant difference between techniques and debridement efficacy among the 6 levels within the canal (P = .108). The debridement efficacy at 1.6 mm differed significantly from that at 3.2 mm. VPro had significantly more debris at isthmus levels 2.0 and 2.4 mm than SNI (P = .009). A significant difference was observed between the canal and the isthmus (P < .001). Neither VPro nor SNI removed debris completely from the apical third or isthmus. Conclusions: VPro EndoSafe did not differ significantly from SNI in the overall debridement efficacy in the apical third of mesial roots of mandibular first molars. [Copyright &y& Elsevier]

A nylon (PA) alloy (NOVA) prepared by reactive blending PA with poly(ethylene-co-glycidylmethacrylate) (EGMA) at a 7/3 wt. ratio is a super-ductile material. It did not break when subjected to a high speed impact test. To understand the super-ductile nature, NOVA and neat PA were subjected to a series of analyses. We did not find any essential difference in crystal unit cell and crystal lamellar structure between PA and NOVA. Homogeneous ductile deformation (without necking) seems to originate from the negative pressure effect of EGMA particles that dilate the PA ligament matrix to enhance local segment motions. Microscopic EGMA particles that contain 20 nm PA domains seems to prevent spherulite formation, leading to rod-like lamella aggregates. Those rod-like structures were easily broke down to fragmented lamellae by bulk deformation. This implies that the structure change does not yield a harmful defect even for highly deformed states. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Many microvascular anastomoses have been performed with Unilink devices, and their advantages have been discussed in the literature over the past few decades. However, there are two drawbacks that have not been addressed and that have limited the development of next-generation microvascular anastomotic devices. First, the Unilink device has metallic pins for fixing vessel walls that remain permanently in the body. Second, the surgeon must manually attach vessel walls to the device. A novel microvascular anastomotic ring device, which uses negative pressure as an atraumatic force to semiautomatically fix the vessel walls, was built and tested in rats. Methods: The device was designed with three-dimensional computer-aided design (3D-CAD) software, constructed with laser lithography, and tested in the femoral veins of eight rats. At 2 weeks’ post implantation, the vein was exposed again, and the patency was examined subjectively. The specimens were examined with light and scanning electron microscopy. Results: Of the eight devices, one broke during the implantation procedure and was omitted from the study. The other seven veins were successfully anastomosed by the devices. Two weeks later, six of the seven veins remained patent, and one had separated. In the patent specimens, endothelialisation was complete, and no thrombus formation was found. Conclusions: A novel microvascular anastomotic ring device that uses negative pressure to semiautomatically fix the vessel walls without requiring metallic pins was successfully designed. [ABSTRACT FROM AUTHOR]

Summary: In microtia reconstruction, maintaining a healthy contact between the skin and the fabricated cartilage framework is essential to attaining a smooth and accentuated contour of the reconstructed auricle. Conventional means to achieve this include bolster sutures and continuous suction drains, both of which have associated shortcomings. A new dressing method was developed and applied in 10 consecutive patients who underwent the first of a two-stage microtia reconstruction using the Nagata technique. A small catheter was introduced into the space between the skin and the cartilage framework. Negative pressure was applied through the catheter, drawing the skin onto the cartilage framework. This evens out the skin, accentuates the contour of the framework and concurrently eliminates potential dead space. Skin contact on the framework is maintained whilst the catheter is removed and an occlusive transparent dressing is applied to the ear. Of the 10 cases in which this manoeuvre was performed, one had to be converted to the bolster suture technique due to a persistent air leak from the wound. Overall results of the nine cases in which this technique was carried out successfully demonstrate smooth skin contour and excellent definition of the fabricated framework. This negative pressure manoeuvre provides a simple, safe and consistent approach to achieving a smooth and accentuated contour in auricular reconstruction. [Copyright &y& Elsevier]

High- and low-pressure vacuum drains are commonly used after surgical procedures. High-pressure vacuum drains (ie, sealed, closed-circuit systems) are efficient and allow for easy monitoring and safe disposal of the drainage. Low-pressure vacuum drains use gentle pressure to evacuate excess fluid and air, and are easy for patients to manage at home because it is easy to reinstate the vacuum pressure. Perioperative nurses should be able to identify the various types of commonly used drains and their surgical applications. Nurses should know how to care for drains, how to reinstate the vacuum pressure when necessary, and the potential complications that could result from surgical drain use. [ABSTRACT FROM AUTHOR]

Abstract: Background: Integra artificial skin (Integra) (Integra Life Sciences Corporation, Plainsboro, NJ) is increasingly used as a skin substitute in reconstructive surgery. However, reliable fixation to the wound bed, a factor of paramount importance for successful application, is often hard to achieve. The vacuum-assisted closure system (VAC; KCI, Switzerland), a well-established subatmospheric pressure device, might be of interest to overcome these problems because of its ability to conform to almost any surface. The goal of this study was to test whether negative pressure application yields reliable fixation of Integra in children undergoing reconstructive surgery. Methods: Between 2001 and 2004, VAC was applied in 18 children (n = 18) aged 7 months to 16.5 years. All required reconstructive surgery with implantation of Integra covering 1% to 12% of the total body surface area. After Integra implantation, VAC was installed for 13 to 30 days. Results: The VAC fixation of Integra was successful in 17 patients (94.5%). The only failure (5.5%) occurred in a patient in whom negative pressure could not be maintained because of a lesion site susceptible to both dislodgement and infection (perianal region). Consequently, infection occurred, and Integra had to be removed. Conclusions: These results demonstrate that VAC is a valid tool for reliable fixation of Integra in children undergoing even demanding reconstructive surgery. [Copyright &y& Elsevier]

This was a multicenter, quasiexperimental, 140-month, acute care study comparing central line-associated bloodstream infection rates associated with positive or negative intravenous connectors to a zero fluid displacement connector. A decrease in central line-associated bloodstream infections was found after changing from either negative or positive intravenous connectors to the zero fluid displacement connector (P = .004) with total cost savings of over $3 million. [Copyright &y& Elsevier]

Objectives: This study aimed to investigate the efficacy of a vacuum myofascial therapy device (VT) for improving pressure pain thresholds (PPTs), range of motion (ROM), neck pain-related disability, pain, and quality of life in patients with non-specific neck pain.Methods: A randomized controlled trial in which thirty-eight participants with non-specific neck pain (NP) were randomly assigned to either an experimental (VT) or a comparison physical therapy program (PTP) group. The VT group (n = 19) received five sessions of treatment with a vacuum myofascial therapy device while the PTP group (n = 19) received five sessions of massage, ultrasound therapy (US), and transcutaneous electric nerve stimulation (TENS) over two weeks. The outcome measures were the numerical pain rating scale (NPRS), range of motion, quality of life (SF-12), neck disability Index (NDI), and PPTs at the end of treatment and at one-month follow-up.Results: Although both groups experienced improvements in pain, neck disability, range of motion, and pressure pain, these only were statistically significant in the VT group. At one-month follow-up, the VT group still showed improvements in pain, neck disability, and range of motion.Discussion: Vacuum myofascial therapy applied with a device offers similar results to other vacuum-based techniques such as cupping therapy. Moreover, in this device the parameters are digitally controlled, which allows for the precise reproduction of treatment. [ABSTRACT FROM AUTHOR]

Soft-tissue expansion in the upper extremities is a valuable technique with increasing indications, which means that using of tissue expansion in reconstruction of upper limb increases day after day. Tissue expansion with implantable balloons is a fairly standard method in reconstructive surgery. This article describes the use of external tissue expansion by using negative pressure in soft-tissue reconstruction of the upper extremities in 40 patients. Valved cups (external expanders) were applied to the skin on one or both sides of the lesion. With the subsequent application of a negative pressure source to the valves, gradual tissue expansion occurred inside the external expanders. When there was enough surface area of the expanded skin to cover the exposed area after lesion excision, the expansion process was stopped and surgery was performed. The upper limit of negative pressure must not exceed −200 mbar. The complications were mild and mainly involved skin blistering. External tissue expansion using a negative pressure technique is simple, safe, cost effective, and associated with good results in the reconstruction of soft-tissue injuries. [Copyright &y& Elsevier]

The growth and enlargement of jaw cysts are associated with raised intracystic pressure and bone resorption surrounding the cysts. The major bone-resorbing cells are the osteoclasts. They are acting under the influence of local bone-resorbing factors: prostaglandins, proteinases and cytokines. It was found that positive pressure enhanced the expression of IL-1αmRNA and protein in epithelial cells of odontogenic keratocyst, and increased the secretion of matrix metalloproteinase and PGE2 in a co-culture of odontogenic keratocyst fibroblasts and epithelial cells. However, the signal intensities for IL-1α mRNA and protein in the epithelium were significantly decreased after marsupialization which relived intracystic pressure. Experimental study indicated that intermittent negative pressure could promote osteogenesis in human bone marrow-derived stroma cells (BMSCs) in vitro. We propose a hypothesis that bone formation around the cyst of the jaws would be stimulated by intracystic negative pressure. [ABSTRACT FROM AUTHOR]

An answer is presented to a question which asks what a negative pressure room in an operating room is.

Abstract: Negative pressure wound therapy (NPWT) is described as it is used in the treatment of an infant burn victim. This case highlights the ability and techniques used to maintain an airtight dressing seal in the perirectal region. Use of this dressing type post–skin grafting allowed for 100% graft adhesion and no bacterial contamination despite close proximity to the rectum. Favorable experience and outcome with this patient are strong indicators that NPWT should be considered as a viable treatment in pediatric populations and that situations where body contour or fluids may make NPWT difficult to administer should not be a deterrent to therapy. [Copyright &y& Elsevier]