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Peripheral venous cannulation is a common invasive procedure. Fracture of an intravenous cannula is rare and an under-reported complication of peripheral venous cannulation. Embolization of the intravenous fragment into the central venous system is potentially fatal. Urgent surgical retrieval, which is performed through a transverse or longitudinal incision, is the treatment of choice. We herein present the use of Z-plasty incision for the retrieval of a retained fractured peripheral intravenous cannula in a 61-year-old Nigerian man on hemodialysis for chronic kidney disease. The major benefits of this innovation are facilitation of access for exploration and prevention of joint contracture.

Fluvial aggradation and incision are often linked to Quaternary climate cycles, but it usually remains unclear whether variations in runoff or sediment supply or both drive channel response to climate variability. Here we quantify sediment supply with paleo-denudation rates and provide geochronological constraints on aggradation and incision from the Sfakia and Elafonisi alluvial-fan sequences in Crete, Greece. We report seven optically stimulated luminescence and ten radiocarbon ages, eight Be-10 and eight Cl-36 denudation rates from modern channel and terrace sediments. For five samples, Be-10 and Cl-36 were measured on the same sample by measuring Be-10 on chert and Cl-36 on calcite. Results indicate relatively steady denudation rates throughout the past 80 kyr, but the aggradation and incision history indicates a link with climate shifts. At the Elafonisi fan, we identify four periods of aggradation coinciding with Marine Isotope Stages (MIS) 2, 4, 5a/b, and likely 6, and three periods of incision coinciding with MIS 1, 3, and likely 5e. At the Sfakia fan, rapid aggradation occurred during MIS 2 and 4, followed by incision during MIS 1. Nearby climate and vegetation records show that MIS 2, 4, and 6 stadials were characterized by cold and dry climates with sparse vegetation, whereas forest cover and more humid conditions prevailed during MIS 1, 3, and 5. Our data thus suggest that past changes in climate had little effect on landscape-wide denudation rates but exerted a strong control on the aggradation-incision behaviour of alluvial channels on Crete. During glacial stages, we attribute aggradation to hillslope sediment release promoted by reduced vegetation cover and decreased runoff; conversely, incision occurred during relatively warm and wet stages due to increased runoff. In this landscape, past hydroclimate variations outcompeted changes in sediment supply as the primary driver of alluvial deposition and incision., Earth Surface Processes and Landforms, 48 (2), ISSN:0197-9337, ISSN:1096-9837

Supplemental Digital Content is Available in the Text. An integrated workflow combining behavioral testing, mass-spectrometry–based proteomics, and network activity predictions revealed a hitherto unknown dorsal root ganglia protein signature relevant for incisional pain in mice., After surgery, acute pain is still managed insufficiently and may lead to short-term and long-term complications including chronic postsurgical pain and an increased prescription of opioids. Thus, identifying new targets specifically implicated in postoperative pain is of utmost importance to develop effective and nonaddictive analgesics. Here, we used an integrated and multimethod workflow to reveal unprecedented insights into proteome dynamics in dorsal root ganglia (DRG) of mice after plantar incision (INC). Based on a detailed characterization of INC-associated pain-related behavior profiles, including a novel paradigm for nonevoked pain, we performed quantitative mass-spectrometry–based proteomics in DRG 1 day after INC. Our data revealed a hitherto unknown INC-regulated protein signature in DRG with changes in distinct proteins and cellular signaling pathways. In particular, we show the differential regulation of 44 protein candidates, many of which are annotated with pathways related to immune and inflammatory responses such as MAPK/extracellular signal-regulated kinases signaling. Subsequent orthogonal assays comprised multiplex Western blotting, bioinformatic protein network analysis, and immunolabeling in independent mouse cohorts to validate (1) the INC-induced regulation of immune/inflammatory pathways and (2) the high priority candidate Annexin A1. Taken together, our results propose novel potential targets in the context of incision and, therefore, represent a highly valuable resource for further mechanistic and translational studies of postoperative pain.

The lower Gállego River has been strongly degraded since the 1960s due to human activity (gravel mining, dump accumulation, channeling works), which has produced a deep channel incision. Although these human-driven processes are usually reported in fluvial bibliography, in this case, more complex results are observable. For instance, regarding the depth and incision rates, we observed no relationship between the most anthropically impacted areas and the sections with the deepest incisions; moreover, the deepening process continues 40 years after the human interventions ceased. The reason for this maladjustment is the role played by the exhumation of the underlying Pleistocene substrate, affected by the synsedimentary processes of karstification. The appearance of paleodolines filled with fine sediments on the incision bottom and sides is the main factor conditioning the continuity and magnitude of the process. Besides, these paleodepressions direct the river dynamics and course, thus favoring its widening when they appear and causing the development of a new riverbed (Qt13) while the 1960s floodplain (Qt12) is becoming an old terrace located between 5 and 11 m above the new alluvial bottom. There are no previous records about this kind of consequences in the regional fluvial dynamics. El curso bajo del río Gállego ha sido fuertemente degradado desde los años 1960 por la actividad antrópica (extracción de áridos, acumulaciones de escombros, obras de encauzamiento) que ha conducido a una fuerte incisión. Aunque este tipo de procesos inducidos por el hombre son habituales en la bibliografía fluvial, en este caso se aprecian efectos más complejos. Son, por ejemplo, la profundidad y velocidad de la incisión, la falta de relación entre puntos de máxima intervención y los de mayor incisión o la continuidad del proceso cuarenta años después de cesar ese tipo de acciones. La respuesta a estos desajustes está en el papel que está jugando la exhumación del sustrato pleistoceno infrayacente, afectado por procesos sin sedimentarios de karstificación. La aparición de paleodolinas rellenas de sedimentos finos en el fondo y laterales de la incisión es actualmente el principal determinante de su importancia y continuidad. Además, estas paleodepresiones dirigen la dinámica y trazado del río y puntualmente fa- vorecen ensanchamientos laterales. Esto propicia la aparición de un nuevo lecho (Qt13) a medida que el lecho de los años 1960 (Qt12) va quedando como una terraza colgada entre 5 y 11 m sobre el nuevo fondo aluvial. No hay antecedentes de este tipo de consecuencias en la dinámica fluvial regional. Fil: Peña Monné, Jose Luis. Universidad de Zaragoza. Facultad de Filosofía y Letras; España Fil: Longares Aladrén, Luis Alberto. Universidad de Zaragoza. Facultad de Filosofía y Letras; España Fil: Rubio Fernández, V.. Universidad Autónoma de Madrid; España Fil: Sampietro Vattuone, Maria Marta. Universidad Nacional de Tucumán. Facultad de Ciencias Naturales e Instituto Miguel Lillo. Laboratorio de Geoarqueología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán; Argentina Fil: Sánchez-Fabre, Miguel. Universidad de Zaragoza. Facultad de Filosofía y Letras; España

ObjectivesEmergency caesarean sections (ECS) are time-sensitive procedures. Multiple factors may affect team efficiency but their relative importance remains unknown. This study aimed to identify the most important predictors contributing to quality of care during ECS in terms of the arrival-to-delivery interval.DesignA retrospective cohort study. ECS were classified by urgency using emergency categories one/two and three (delivery within 30 and 60 min). In total, 92 predictor variables were included in the analysis and grouped as follows: ‘Maternal objective’, ‘Maternal psychological’, ‘Fetal factors’, ‘ECS Indication’, ‘Emergency category’, ‘Type of anaesthesia’, ‘Team member qualifications and experience’ and ‘Procedural’. Data was analysed with a linear regression model using elastic net regularisation and jackknife technique to improve generalisability. The relative influence of the predictors, percentage significant predictor weight (PSPW) was calculated for each predictor to visualise the main determinants of arrival-to-delivery interval.Setting and participantsPatient records for mothers undergoing ECS between 2010 and 2017, Nordsjællands Hospital, Capital Region of Denmark.Primary outcome measuresArrival-to-delivery interval during ECS.ResultsData was obtained from 2409 patient records for women undergoing ECS. The group of predictors representing ‘Team member qualifications and experience’ was the most important predictor of arrival-to-delivery interval in all ECS emergency categories (PSPW 25.9% for ECS category one/two; PSPW 35.5% for ECS category three). In ECS category one/two the ‘Indication for ECS’ was the second most important predictor group (PSPW 24.9%). In ECS category three, the second most important predictor group was ‘Maternal objective predictors’ (PSPW 24.2%).ConclusionThis study provides empirical evidence for the importance of team member qualifications and experience relative to other predictors of arrival-to-delivery during ECS. Machine learning provides a promising method for expanding our current knowledge about the relative importance of different factors in predicting outcomes of complex obstetric events.

The role of spinal glia in the development and maintenance of chronic pain has become over the last years a subject of increasing interest. In this regard, toll-like receptor 4 (TLR4) signaling has been proposed as a major trigger mechanism. Hence, in this study we explored the implications of TLR4 inhibition in the periphery and primarily in the CNS, focusing on the impact this inhibition renders in pain development and glia activation in the dorsal horn in two models of pain. Making use of a synthetic cluster of differentiation 14 (CD14)/TLR4 antagonist, the effect of TLR4 blockade on tactile allodynia and heat hyperalgesia was evaluated in osteoarthritic and postoperative rat models. An in vitro parallel artificial membrane permeation assay was performed to determine the proneness of the drug to permeate the blood-brain barrier prior to systemic and central admin- istration. Findings suggest a dominant role of peripheral TLR4 in the model of incisional pain, whilst both pe- ripheral and central TLR4 seem to be responsible for osteoarthritic pain. That is, central and peripheral TLR4 may be differently involved in the etiopathology of diverse types of pain what potentially seems a promising approach in the management of pain

AU-eJIR, 7, 2, 62-80

In recent years, preclinical pain research has failed to develop genuinely new analgesics for clinical use. This fact is reflected by a high number of patients, limited drug efficacy accompanied by side effects, and a long-term opioid intake. Two main aspects have been addressed, which hinder translation: the use of non-relevant pain models and a mismatch between pain-related outcomes in preclinical and clinical studies. Conversely, disease-specific pain models that mirror more closely the clinical situation and multidimensional behavioral outcome measures that objectively and reproducibly assess relevant pain-related symptoms in a preclinical setting could improve translation. Mechanistically, a matter of debate is the role of Ly6G+neutrophil granulocytes (NGs) for pain. NGs are essential to eliminate pathogens and promote the wound healing process. For this purpose, there is a need to release various pro- and anti-inflammatory mediators, some of which could ameliorate or enhance pain. However, the contribution of NGs to different pain entities is contradictory for reflex-based tests, and completely unknown in the context of non-evoked pain (NEP) and movement-evoked pain (MEP). First, we combined withdrawal reflex-based assays with novel video-based assessments for NEP- and MEP-related behavior in two mouse pain models. The pain models utilized in this study were incision (INC) and pathogen/adjuvant-induced inflammation (CFA), translating well to postsurgical and inflammatory pain entities. Second, we depleted NGs and applied a set of behavioral assessments to investigate the role of NG migration in different pain modalities. Our comprehensive behavioral approach identified pain-related behaviors in mice that resemble (NEP) or differentiate (MEP) behavioral trajectories in comparison to mechanical and heat hypersensitivity, thereby indicating modality-dependent mechanisms. Further, we show that injury-induced accumulation of NGs minimally affects pain-related behaviors in both pain models. In conclusion, we report a novel assessment to detect NEP in mice after unilateral injuries using a more unbiased approach. Additionally, we are capable of detecting an antalgic gait for both pain entities with unique trajectories. The different trajectories between MEP and other pain modalities suggest that the underlying mechanisms differ. We further conclude that NGs play a subordinate role in pain-related behaviors in incisional and inflammatory pain.

BACKGROUND A lactational breast abscess is a localized accumulation of infected fluid in breast tissue, due to which many women stop breastfeeding. Lack of adequate anaesthesia is the most common factor limiting incision and drainage (I & D) in the Emergency Department (ED). The present study was planned to compare the efficacy of dexmedetomidine and propofol among patients undergoing incision and drainage (I & D) for lactational breast abscess. METHODS A total of 50 consenting patients in the age group of 18-40 years, American Society of Anaesthesiologists (ASA) I and II undergoing incision and drainage (I & D) of lactational breast abscess were included in the study. The patients were divided into two groups of 25 patients each. Group D received dexmedetomidine and Group P received Propofol. Sedation score, heart rate (HR), systolic blood pressure (SBP), requirement of rescue injection fentanyl, patient satisfaction, surgeon satisfaction and complications were recorded. RESULTS Baseline values of the mean heart rate and mean systolic blood pressure were comparable between the groups, but intraoperatively, there was a statistically significant reduction in the mean heart rate and mean systolic blood pressure. There was statistically significant fall in systolic blood pressure in group P [8 (32%) vs 2 (8%)]. There was statistically significant difference in requirement of injection fentanyl in group D [3 (6%) vs 12 (24)]. Both, patient satisfaction and surgeon satisfaction were significantly better in D group when compared to P group. Sedation score and time to achieve adequate RSS was comparable between both the groups. CONCLUSIONS Dexmedetomidine seems to be a better drug with minimal haemodynamic instability when compared to propofol.

Se describe una instalación de laboratorio que permite realizar ensayos en canal con alimentación separada de arena y grava, como es caracterísitico de los lechos de muchos ríos. Se hacen ensayos de gran duración, en que el transporte como carga de fondo llega a valer 1 kg/s. El material sólido que sale del canal se envía hacia la cabecera en donde se separa la grava de la arena. La alimentación se hace con dos tolvas, una para cada material, cuyos pesos se miden continuamente para conocer los caudales de alimentación. Los ensayos persiguen alcanzar el equilibrio, es decir la permanencia del lecho sin erosión ni crecimiento a largo plazo. Se ofrecen ejemplos reales de varios tipos de ensayo: recirculación con erosión del lecho y con crecimiento del lecho, recirculación pura y alimentación pura. Los cuatro son ejemplos de transporte sólido con movilidad igualada. Se hace una discusión del significado de los ensayos.

Early life surgery produces peripheral nociceptive activation, inflammation, and stress. Early life nociceptive input and inflammation have been shown to produce long-term processing changes that are not restricted to the dermatome of injury. Additionally stress has shown long-term effects on anxiety, depression, learning, and maladaptive behaviors including substance abuse disorder and we hypothesized that early life surgery would have long-term effects on theses complex behaviors in later life. In this study surgery in the rat hindpaw was performed to determine if there are long-term effects on anxiety, depression, audiovisual attention, and opioid reward behaviors. Male animals received paw incision surgery and anesthesia or anesthesia alone (sham) at postnatal day 6. At 10 weeks after surgery, open field center zone entries were decreased, a measure of anxiety (n = 20) (P = 0.03) (effect size, Cohen’s d = 0.80). No difference was found in the tail suspension test as a measure of depression. At 16–20 weeks, attentional performance in an operant task was similar between groups at baseline and decreased with audiovisual distraction in both groups (P < 0.001) (effect size, η2 = 0.25), but distraction revealed a persistent impairment in performance in the surgery group (n = 8) (P = 0.04) (effect size, η2 = 0.13). Opioid reward was measured using heroin self-administration at 16–24 weeks. Heroin intake increased over time in both groups during 24-h free access (P < 0.001), but was greater in the surgery group (P = 0.045), with a significant interaction between time and treatment (P < 0.001) (effect size, Cohen f2 = 0.36). These results demonstrate long-term disruptions in complex behaviors from surgical incision under anesthesia. Future studies to explore sex differences in early life surgery and the attendant peripheral neuronal input, stress, and inflammation will be valuable to understand emerging learning deficits, anxiety, attentional dysfunction, and opioid reward and their mechanisms. This will be valuable to develop optimal approaches to mitigate the long-term effects of surgery in early life.

BACKGROUND: Global studies indicate that surgical site infections (SSIs) are a major healthcare challenge within hospitals and can have a profound impact on patient quality of life and healthcare costs. Closed-incision negative-pressure therapy (ciNPT) has been reported to provide positive clinical benefits for patients with various incisions, including those following colorectal surgeries. METHODS: Investigators performed a prospective, randomized, multicenter trial to evaluate complications of surgical incisions in patients who received a ciNPT dressing versus a conventional surgical dressing (control) over their closed incision following colorectal surgery. The incidence of SSI was determined at 7, 15, and 30 days postsurgery. RESULTS: A total of 148 patients participated in the study. Results showed that the SSI rate on day 7 was lower in the ciNPT group versus the control group (10/ 75 [13.3%] vs 17/73 [23.3%]), but this difference was not statistically significant. On day 15, the SSI rate was 12/75 (16.0%) in the ciNPT group versus 21/73 (28.8%) in the control group; however, this difference was only marginally statistically significant (P = .0621). At 1 month, the SSI rate remained lower in the ciNPT group (13/75 [17.3%] vs 21/73 [28.8%], P = .0983) compared with the control group. CONCLUSIONS: Future studies with larger population sizes are necessary to determine the impact of ciNPT on patients' incisions after colorectal surgery.

Geologists often look at the Earth’s surface to understand the underlying processes that cause mountain formation. As tectonic forces drive uplift of Earth’s surface, processes of erosion transport sediment to lower elevations. Climate can play a large role in landscape formation as well as increased precipitation, accelerating rates of erosion. Rivers leave markers of landscape evolution through terrace landforms, former river floodplains that are left behind when rivers incise into a valley. To better understand landscape response to uplift, this research investigated the initial linkages between uplift, hillslope erosion (mass wasting) and river incision. At some point, it is thought that these three will be in equilibrium. Taiwan is a young mountain range making it the ideal setting to capture landscape development in the initial stages of uplift. I compare rates of river incision to rates of hillslope erosion and timing of terrace deposition to understand the links between erosion, tectonics and climate in the beginning stages of mountain building. This thesis uses luminescence to provide age control for the last time sediment was exposed to light to determine when river terraces formed. Field mapping and observations allowed us to measure the height between terraces to quantify the rate at which streams incised. The results from this study show that the rivers of southern Taiwan are incising on average at a rate of 2.4 ± 1.2 meters per thousand years (m/kyr) with rates ranging from 6 ± 2.6to 0.2 ± 0.1 m/kyr. River incision rates and hillslope erosion (denudation) rates increase northward with drainage development suggesting that rates of erosion are primarily linked to tectonic forces on medium to longer-term scales (1,000-1,000,000 years) . Regional periods of terrace development occurred at 1, 11, 18, 28, and 40 ka. Periods of terrace development align with periods of increased East Asian Summer Monsoon (EASM) intensity chronicled in paleoclimate records. The EASM is the dominate weather pattern that delivers moisture to East Asia affecting 1/3 of global populations. Terrace deposits recording EASM intensity extends the record of landscape response to climate in Taiwan and reveals that climate signals can obscure tectonic forces on short-time scales (100 – 103 yrs).

We analysed the interplay between coastal uplift, sea level change in the Black Sea, and incision of the Kizilirmak River in northern Turkey. These processes have created multiple co-genetic fluvial and marine terrace sequences that serve as excellent strain markers to assess the ongoing evolution of the Pontide orogenic wedge and the growth of the northern margin of the Central Anatolian Plateau. We used high-resolution topographic data, OSL ages, and published information on past sea levels to analyse the spatiotemporal evolution of these terraces; we derived a regional uplift model for the northward advancing orogenic wedge that supports the notion of laterally variable uplift rates along the flanks of the Pontides. The best-fit uplift model defines a constant long-term uplift rate of 0.28 +/- 0.07 m/ka for the last 545 ka. This model explains the evolution of the terrace sequence in light of active tectonic processes and superposed cycles of climate-controlled sea-level change. Our new data reveal regional uplift characteristics that are comparable to the inner sectors of the Central Pontides; accordingly, the rate of uplift diminishes with increasing distance from the main strand of the restraining bend of the North Anatolian Fault Zone (NAFZ). This spatial relationship between the regional impact of the restraining bend of the NAFZ and uplift of the Pontide wedge thus suggests a strong link between the activity of the NAFZ, deformation and uplift in the Pontide orogenic wedge, and the sustained lateral growth of the Central Anatolian Plateau flank. Publisher's Version

The incision is the beginning of every surgical intervention, where separation of the tissues occurs. The uses of thermal mechanisms in skin incisions have been controversial due to higher repair time, necrosis of surrounding tissue, postoperative infection, and poor cosmetic results. The purpose of this study was to determine the evolution of the various types cutting systems and compare the tissue’s response on the use of conventional instrumentation versus diathermy

The headwaters of fluvial systems on the East European Plain between the boundaries of the Marine Isotope Stage 2 (MIS 2) and MIS 6 glaciations evolved during the last 150,000 years. At least three main events of high surface runoff caused intensive erosion: at the end of MIS 6, at the end of MIS 2 and in the Middle Holocene. Erosion developed in the territory with variable resistance of geological substrate, from hard-to-erode tills to weak sandy deposits. All erosional features in moraines formed in the pre-Holocene time. Even relatively large forms, such as balkas (small dry valleys), have not yet reached concave longitudinal profiles. A general tendency of their development was deepening. Short episodes of incision occurring during climatic events with increased water flow alternated with long periods of stabilization. Sand-covered areas are most favorable for linear erosion. The gullies formed in the Middle Holocene developed concave longitudinal profiles. The diversity of catchment areas, initial slope inclinations and sediment properties causing their resistance to erosion led to greater differences in the relief features and evolution of the upper reaches of the fluvial systems within the MIS 6 glaciation area compared to the more uniform landscape conditions in the extraglacial regions.

In diabetes mellitus, the wound healing process is impaired and delayed. Plants are actively investigated for safe, effective, and well-tolerated treatment options for wound. The plant Buddleja polystachya has a traditional claim for the treatment of wound. Fresh leaves are crushed and given for topical application. The objective of this study was to evaluate the wound healing activity of hydro-alcoholic extract and solvent fractions of leaves of B. polystachya fresen (Buddlejaceae) in normal and diabetic mice. Method: B. polystachya leaves were extracted using 80% methanol and further fractionated using chloroform, ethyl acetate, and water. The wound healing activity was tested using excision, incision, and diabetic wound models. Area of wound contraction, time of epithelialization, and wound breaking strength were determined. Result: Treatment with 5% w/w (P

Çalışmada 21 yazar bulunmaktadır. Bu yazarlardan sadece Bursa Uludağ Üniversitesi mensuplarının girişleri yapılmıştır. Live surgery (LS) is considered a useful teaching opportunity. The benefits must be balanced with patient safety concerns. To evaluate the rate of complications of a series of urologic LS performed by experts during the Congress Challenge in Laparoscopy and Robotics (CILR). We present a large, multi-institution, multi-surgeon database that derives from 12 CILR events, from 2004 to 2015 with a total of 224 cases. Radical prostatectomy (RP) was the most common procedure and a selection of complex cases was noted. The primary measure was postoperative complications and use of a Postoperative Morbidity Index (PMI) to allow quantitative weighing of postoperative complications. From 12 events, the number of cases increased from 11 in 2004 to 27 in 2015 and a total of 27 surgeons. Of 224 cases (164 laparoscopic and 60 robotic), there were 26 (11.6%) complications: 5 grade I, 5 grade II, 3 grade IIIa, 12 grade IIIb and 1 grade V, the latter from laparoscopic cystectomy. Analysis of PMI was 23 times higher from cystectomy compared to RP. In the setting of live surgery, the overall rate of complications is low considering the complexity of surgeries. The PMI is not higher in more complex procedures, whereas RP seems very safe.

This paper presents a new geomorphological map for the lower Hushe Valley (below 3400 m asl), located to the SE of the Central Karakoram in Baltistan (North Pakistan). Fieldwork and remote sensing were combined to improve understanding of the most recent surface landforms to produce a 1:50,000 scale map. Thirteen landform types associated with glacial, fluvial, gravitational and mass wasting processes were identified and mapped. Particular emphasis was made on currently dynamic processes that could pose a threat to the population. The distribution of the landforms on the valley (reworked tills, alluvial fans, rockfalls, among others) differs between the eastern and the western hillslopes, and from north to south, mainly due to bedrock types, location of geological structures and distribution of lateral tributaries. This map is the first and necessary step towards a deep assessment on geological risk related to external processes in the area. This research was funded by the Basque Government (Eusko Jaurlaritza) through the Humanitarian Action 2018 fund (PRE2018EH/0004) and the Consolidated Research Group IT1029-16. We also thank the University of the Basque Country UPV/EHU for the support

Background Endoscopic ultrasound-guided fine-needle aspiration and biopsy (EUS-FNA/FNB) has been traditionally used for making a tissue diagnosis. Several newer techniques are emerging as a viable alternative to EUS-FNA/FNB, including mucosal incision-assisted biopsy (MIAB), with a view to increasing the diagnostic yield for upper gastrointestinal (GI) subepithelial tumors (SETs). We conducted a systematic review and meta-analysis to describe the overall diagnostic yield of MIAB for upper GI SETs. Methods Multiple electronic databases (MEDLINE, EMBASE and Google Scholar) and conference abstracts were comprehensively searched. The primary outcome of our meta-analysis was the overall diagnostic yield of the MIAB. The secondary outcome was to study complications in terms of perforation and clinically significant bleeding. The meta-analysis was performed using a DerSimonian and Laird random-effect model. Results Seven studies were included in the final meta-analysis, reporting a total of 159 patients (male 86, female 73) with a mean age of 58 years. The overall pooled diagnostic yield of MIAB was 89% (95% confidence interval [CI] 82.65-93.51, I 2=0.00). Histologically, GI stromal tumor was the reported diagnosis in 38.62% (95%CI 22.29-56.24, I 2=77.51%) of tumors, followed by leiomyoma 25% (95%CI 18.02-32.62, I 2=4.42%). The overall rate of clinically significant bleeding following the procedure was 5.03% (95%CI 0.36-12.86, I 2=57.43%) and no perforations were reported. Conclusions MIAB is a safe and effective technique for the diagnosis of upper GI SETs and can be considered as a viable alternative to EUS-FNA/FNB. MIAB can be performed during routine endoscopy and no advanced equipment is required.

Remote preconditioning of trauma (RPCT) by surgical incision is an effective cardioprotective strategy via the transient receptor potential vanilloid 1 (TRPV1) channel as a form of remote ischemic preconditioning (RIPC). However, cardioprotection by RIPC has been shown to be completely blocked by propofol. We thus hypothesized that propofol may interfere with RPCT induced cardioprotection, and that RPCT induces cardioprotection via the cardiac TRPV1 channel. Male Sprague-Dawley rats were subjected to 30 min of myocardial ischemia followed by 2 h of reperfusion. RPCT was achieved by a transverse abdominal incision. Additionally, propofol or the TRPV1 receptor inhibitor capsazepine (CPZ) was given before RPCT. Infarct size was assessed by triphenyltetrazolium staining. Heart TRPV1 expression was detected by Western blot and immunofluorescence. RPCT significantly reduced infarct size compared to control treatment (45.6 ± 4% versus 65.4 ± 2%, P

International audience; A combined geological–geomorphological analysis of the Païolive area, Ardèche, southern France, allows to discuss the extension, origin and chronology of the karst that affects late Jurassic limestone. Results point to paleo-surface abandonment, river incision and karst formation resulting from a late Miocene and pre-Messinian uplift of the area. The epigene karst does not extend below the present-day base level.

In this study, we aimed to investigate the influence of N-acetylcysteine (NAC) on the gene expression profile, neoangiogenesis, neutrophils and macrophages in a rat model of incisional wounds. Before creating wounds on the backs of 24 Sprague–Dawley rats, intradermal injections were made. Lidocaine–epinephrin solutions were supplemented with 0.015%, 0.03% or 0.045% solutions of NAC, or nothing (control group). Scars were harvested on the 3rd, 7th, 14th and 60th day post-surgery. We performed immunohistochemical staining in order to visualize macrophages (anti-CD68), neutrophils (anti-MPO) and newly formed blood vessels (anti-CD31). Additionally, RT-qPCR was used to measure the relative expression of 88 genes involved in the wound healing process. On the 14th day, the number of cells stained with anti-CD68 and anti-CD31 antibodies was significantly larger in the tissues treated with 0.03% NAC compared with the control. Among the selected genes, 52 were upregulated and six were downregulated at different time points. Interestingly, NAC exerted a significant effect on the expression of 45 genes 60 days after its administration. In summation, a 0.03% NAC addition to the pre-incisional anesthetic solution improves neovasculature and increases the macrophages’ concentration at the wound site on the 14th day, as well as altering the expression of numerous genes that are responsible for the regenerative processes.

The nature of Holocene Asian summer monsoon (ASM) evolution documented by diverse natural archives remains controversial, with a contentious issue being whether or not a strong Asian summer monsoon prevailed during the early Holocene. Here we present sequences of multiple proxies measured in sediment cores from Genggahai Lake in the NE Tibetan Plateau (NETP). The results suggest that a higher lake level and relatively lower terrestrial vegetation cover occurred synchronously during the early Holocene (11.3–8.6 kyr cal BP), compared with the period from 8.6 to 6.9 kyr cal BP. This finding clearly reflects the existence of different hydroclimatic conditions between the lake and its catchment due to diverse driving mechanisms. The early Holocene high stand of the lake, as demonstrated by the stratigraphic variability of the remains of aquatic biota, may have responded to the strengthened ASM and increased monsoonal precipitation; the relatively low vegetation cover in the marginal region of the Asian monsoon during the early Holocene, and the coeval widespread active sand dune mobility in both the NE Tibetan Plateau and NE China, most likely resulted from a low level of effective moisture due to high evaporation, and hence they cannot be interpreted as evidence of a weak ASM. Our results potentially reconcile the current divergent interpretations of various proxy climate records from the region. Our findings suggest that the ASM evolution was characterized by a consistent pattern across the monsoonal regions, as indicated by the oxygen isotope record of Chinese speleothems.

Purpose. To study results of the ReLEx® SMILE operation to correct myopia and myopic astigmatism at a two-year follow-up. Material and methods. The SMILE surgery was performed in the patients of the main group for a correction of myopia with the sphere up to 10.0D and myopic astigmatism up to 4.0D (390 eyes – 200 patients), of them 80 male (40% ) and 120 female (60%). The study had two control groups: LASIK (166 eyes, 86 patients) and PRK (122 eyes, 62 patients). In the main group, the age of patients ranged from 18 to 54 years (29.7±5.9 years). The follow-up was up to 2 years. BCVA was from 0.7 to 1.2 (0.97±0.12). The central corneal thickness (according to US-keratopachymetry) was from 468 to 654 microns. The horizontal diameter of the cornea was from 11.2 to 12.9mm (12.0±0.5mm). The preoperative characteristics of the eyes in the control groups were similar. Results. Already 1 month after the SMILE and LASIK operations, UCVA was 1.0 and higher and remained stably high during the entire two-year follow-up. After PRK, the recovery rate of UCVA was statistically significantly lower in the first 3 months after surgery (p< 0.001), and then significantly increased and approached that after SMILE and LASIK operations. The UCVA in the distance 2 years after the SMILE and LASIK technologies was higher than after the PRK operation (statistically significant difference: p< 0.005). In this period a slightly higher UCVA at distance was noted after the LASIK operation (1.06±0.26) than after the SMILE surgery (1.04±0.28), but this difference was statistically unreliable (p=0.142). In 2.3% of all SMILE operations, insignificant complications were noted that were completely curable and was not affect the recovery and restoration of visual acuity of patients. The SMILE operation was repeated next day in 1 eye with the loss of vacuum. Most complications were revealed during the phase of surgical development and mastering the SMILE surgery in the first 20 patients. Conclusion. The SMILE technology is a safe and effective keratorefractive operation for the correction of myopia with spherical equivalent from 1.0D to 12.0D. The SMILE technology is characterized by a rapid restoration of UCVA and minimal postoperative corneal syndrome, as in LASIK, and at the same time there is no superficial flap of the cornea, as in the PRK operation. The highest UCVA in the distance is noted after the SMILE technology in long-term two-year follow-up period in comparison with the standard operations of LASIK and PRK.

La dynamique fluviale de la Loire est influencée par deux principaux facteurs : les changements hydro-climatiques et les pressions anthropiques. Ces derniers sont à l’origine de l’incision du lit et de la rétraction de la bande active. La question fondamentale portant sur la réponse géomorphologique locale du plancher alluvial suite à ces perturbations est abordée à travers l’étude de trois sites en Loire moyenne. Le degré d’influence anthropique varie d’un site à un autre. L’objectif de cet article est d’étudier les interactions entre la dynamique hydro-sédimentaire et les aménagements fluviaux. Les événements hydrologiques étudiés sont les crues de récurrence annuelle et quinquennale. Les résultats obtenus soulignent l’influence des seuils durs artificiels (fondations de pont, anciens quais et chevrettes) sur l’évolution morpho-sédimentaire du plancher alluvial. La réponse géomorphologique constatée suite au passage d'une crue quinquennale (2260 m³.s-¹) sur les trois sites est différente. Cette crue, survenue en novembre 2008, a engendré sur les sites fortement anthropisés un rehaussement temporaire du fond du lit. Une érosion post crue s’est produite au sein des trois sites mais à des rythmes différents. The Loire River dynamics is influenced by two main factors: hydro-climate change and anthropogenic pressures. These have caused incision of the river bed and narrowing of the active channel. The fundamental question on the local geomorphological response of the riverbed to the disturbances is addressed through the study of three sites in the middle part of the Loire. Study sites are subjected to different degrees by human activities. The objective of this paper is to determine the interactions between sediment dynamic with annual and five-year flood and the impact of human activities. The results highlight the influence of fluvial engineering works (bridges, old docks, weirs and dikes) on the morpho-sedimentary evolution of the river bed. The flood occurred in November 2008 had a different geomorphic impact in the three study sites. This flood resulted in a temporary accumulation of sediment at sites influenced by human activities. Post flood erosion occurred in the three sites, but at different rates.

Schumann et al. (2016) presented a field assessment of late Pleistocene to Holocene fluvial sediments preserved in the valleys of Santa Rosa Island, California. This is a rigorous study, based on stratigraphic descriptions of 54 sections and numerous radiocarbon ages. The paper makes important contributions that we would like to highlight, but other parts of the paper rely upon overly simplistic interpretations that lead to misleading conclusions. In one case, a conclusion of the Schumann et al. paper has important management implications for Santa Rosa Island and similar locations, compelling us to discuss and qualify this conclusion.

Background Lingual abscesses have become extremely rare since the discovery of antibiotics, despite the relatively frequent exposure of tongue to bite trauma during mastication and seizures. It is a potentially life-threatening clinical entity. Even though there were some case reports on tongue abscess from overseas, none of them were reported from Africa, particularly from Ethiopia. Case presentation A 36-year-old male patient with severe, continuous pain and swelling of tongue for 6 weeks was presented to Goba Referral Hospital. The swelling was 2 cm by 1 cm, located on posterior central tongue, and frank pus oozed from the center of the swelling. He had associated dysphagia, odynophagia, and speech difficulty. He had no previous personal and family history of similar illness and tonsillitis. Gram staining revealed the presence of Gram-positive cocci in clusters. Pyogenic lingual abscess was the diagnosis. Treatment included incision and drainage with the administration of systemic antibiotics, which covered both aerobic and anaerobic organisms, and anti-pain drugs. The condition did not relapse in 6 months of follow-up. Conclusion Lingual abscess should be considered in patients presenting with tongue swelling, dysphagia, odynophagia, and speech difficulty. Since lingual abscess that occurs on the posterior part of the tongue has diagnostic difficulty, professionals in rural setup where diagnostic resources (such as ultrasound and magnetic resonance imaging) are scarce should be careful not to misdiagnose it. Incision and drainage with the administration of systemic antibiotics and anti-pain drugs is an effective treatment option for lingual abscess.

El yacimiento rupestre al aire libre del Arroyo de las Almas, en las inmediaciones del encuentro entre los ríos Águeda y Duero, presenta un conjunto de 600 motivos grabados, con una larga diacronía desde el Paleolítico Superior hasta la Edad Contemporánea. Presentamos una visión detallada de su arte Paleolítico, con 21 figuras documentadas en 5 rocas, grabadas por incisión, y que corresponden a 13 zoomorfos, 7 signos y 1 motivo indeterminable, además de grupos de líneas no figurativas. Los análisis formales y técnicos llevados a cabo y sus paralelos, nos permiten afirmar que son integrables, desde la óptica cronocultural, entre el inicio del Magdaleniense y el final del ciclo artístico Paleolítico. Este conjunto, formaría parte de la vasta red de yacimientos artísticos en la cuenca del Duero, en su mayoría con arte al aire libre, cuyas principales características de implantación sugieren una inicial función como lugar privilegiado de paso, entorno a la desembocadura de Águeda.AbstractThe open-air rock art site Arroyo de las Almas, close to the meeting point of the rivers Águeda and Douro, displays approximately 600 engraved motifs, with a chronology ranging from the Upper Palaeolithic to Contemporary Age. We present a detailed analysis of the Upper Palaeolithic art of the site, corresponding to 21 registered figures in 5 rocks, all engraved by incision and corresponding to 13 zoomorphic figures, 7 signs and 1 undetermined motif, as well as groups of non-figurative lines. The typological and stylistic analyses carried out and their parallels allow us to affirm that all of them are chronologically integrable between the beginning of the Magdalenian and the end of the Palaeolithic artistic cycle. This set was part of the vast network of artistic sites in the Douro basin, for the most part with open-air art. The main implantation characteristics of the site suggest its function as a privileged passage site, around the mouth of the Águeda.

Introduction: Scalpel incisions produce nominal harm to neighboring and adjacent tissues. Diathermy is considered to be an efficient mode of incision and its use is widespread, but due to scarring potential, advanced wound contamination rate and poor wound healing, the extensive use of surgical diathermy for incisions. Aim: To compare the use of electrosurgery and conventional scalpel in making an abdominal incision with respect to blood loss, operating time, wound infection rate and post-operative pain. Materials and Methods: This was a prospective study in which patients above 16 years of age were included and all patients undergoing abdominal surgery were randomly allocated to two arms of the study. In Group A, incision by conventional scalpel and in group B, incision by diathermy were made. Incisions were of three types i.e., Kocher’s incision were 4, Midline were 22 and Pfannestiel were 44. Data was collected and entered in the Microsoft excel sheet and analysed for blood loss, operating time, wound infection rate and post-operative pain. Results: Total number of patients included in this study was 70. Age of the participants were in range of second to seventh decade, youngest being 19 years and the oldest being 73 Years of age. Male and female ratio was 1:6. Time taken for incision and blood loss in group B is less than group A respectively. (p=0.009, p=0.001) in all types of incision. Rate of complications following electrocautery incision were also low and no haematoma or seroma were noted in those wounds. Conclusion: Diathermy technique is compatible with conventional scalpel being safe, effective and simple. Less blood loss was noted with clearer field of dissection, as compared to one created by conventional steel scalpel. Because of the faster haemostasis, the mean time of making an incision was also less in case of diathermy.

Purpose: The purpose of the study is to compare the surgical access and post-operative outcome of two intra-oral incisions used for approaching a mandibular body fracture. Methods: This clinical trial involved 60 patients with mandibular body fractures who were randomly allocated to control and study groups. The fractures were approached using the routine vestibular incision in the control group and crevicular incision with vertical release in the study group. The effects of incision design on the post-surgical outcome variables like swelling, trismus, paresthesia, wound healing and gingival recession were statistically analysed with non-parametric tests by using SPSS 22.0 software. Comparison of continuous variables between the groups and time points was done using Mann Whitney test and Friedman test respectively. Chi-square test was used to compare proportions between groups. Dunn's test with Bonferroni correction was used for pair wise comparisons. Results: The study group demonstrated favourable surgical outcome in the immediate postoperative phase as compared to the control group. The difference in mouth opening, swelling and neurosensory impairment between the two groups was found to be statistically significant (p < 0.05). Conclusion: Crevicular incision was found to be an ideal alternative to vestibular incision in achieving surgical access and fixation of mandibular body fractures with reduction in postoperative patient discomfort and better surgical outcome. Key words: Mandibular fractures; Incision; Nerve injury

According to Ayurveda, individual herbs are insufficient to achieve a desired therapeutic effect. When it is optimized as multiple herbs composition in a particular ratio it will give a therapeutic effect in a better way with reduced toxicity. In order to develop such an intervention, the present study was intended to develop a polyherbal drug from methanolic extracts of Plumbago zeylanica Linn, Datura stramonium Linn and Argemone mexicana Linn. The study also aimed to evaluate the impact of polyherbalism on antimicrobial and antioxidant effect, thereafter the ratio of individual plant extracts was optimized accordingly to treat the wound. The poyherbal drug was put on preclinical trial to access the anti-inflammatory and wound healing activity as 2% and 5% polyherbal carbopol-940 gels. The antimicrobial activity was assessed by agar well diffusion and broth dilution method while wound healing activity was evaluated by excision and incision wound models. Topical anti-inflammatory activity was assessed by carrageenan induced paw oedema. The findings of the study revealed the synergistic antimicrobial potential of Polyherbal drug against gram-positive and negative strains. Polyherbal carbopol- 940 gels (2% and 5%w/w) promoted the wound healing and anti-inflammatory effect. The high rate of wound contraction (

Objectives The aim of this systematic review was to provide an overview of time to return to work (RTW) after carpal tunnel release (CTR), including return to different occupations and working patterns.Methods A systematic search from inception to 2016 was conducted using nine electronic databases, trial registries and grey literature repositories. Randomized controlled trials and observational studies reporting RTW times after CTR were included. Study risk of bias was assessed using Cochrane risk of bias assessment tools. Time to RTW was summarized using median and range.Results A total of 56 relevant studies were identified: 18 randomized controlled trials and 38 observational studies. Only 4 studies were rated as having a low risk of bias. Reported RTW times ranged from 4–168 days. Few studies reported occupational information. Among 6 studies, median time to return to non-manual work was 21 days (range 7–41), compared with 39 days for manual work (range 18–101). Median time to return to modified or full duties was 23 days (ranges 12–50 and 17–64, respectively), as reported by 3 studies. There was no common method of defining, collecting or reporting RTW data.Conclusions This review highlights wide variation in reported RTW times after CTR. Whilst occupational factors may play a role, these were poorly reported, and there is currently limited evidence to inform individual patients of their expected duration of work absence after CTR. A standardized definition of RTW is needed, as well as an agreed method of collecting and reporting related data.

Purpose. The purpose of the work is provided by the system experimental study of the effect of strengthening the level of the ratio of complex mechanical properties of the finished bolts and peeled samples and analysis of the data on the basis of geometric and structural reinforcement. Methodology . A uniaxial tensile test was carried out on full-size bolts and the peeled samples to diameters of 10 mm and 8 mm at a testing machine FP - 100/1 recording full diagram of deformation and fracture. Findings. The level of strength of qualitatively and quantitatively has different effects on the characteristics of the ratio of resistance to plastic deformation and ductility characteristics ductile fracture resistance, determined on the finished bolts and peeled samples. At the same time, the analysis suggests that the combination of mechanical properties determined on finished bolts, the most adequate to their mechanical behavior during operation. This conclusion is particularly important for acceptance testing of bolts of strength class 8.8 or higher. Originality. For the first time experimentally shown that the system is functional cuts on specific metal products can have both hardening and softening effect on the characteristics of resistance to plastic deformation in terms of normal stress depending on the level of hardening and given an interpretation of the observed phenomena on the basis of changes in the ratio of the concentration of eg-tions and the degree of rigidity of the stress state in the cuts. Practical value. Limitation of mechanical tests are only willing bolts, other than greater consistency determines the properties of their structural strength bolts in the operation, reduce the overall time-consuming tests.

WOS: 000360993700019 PubMed ID: 26231993 Introduction: Current study aims to analyze the impact of previous vertical laparotomy on safety and feasibility of laparoscopic sigmoid colon and rectal cancer operations. Methods: All consecutive patients who underwent a laparoscopic resection for sigmoid colon or rectal cancer were included. These aspects were abstracted and compared within no laparotomy and previous vertical laparotomy groups: demographics, perioperative aspects, pathological features and survival. Results: There were 252 patients in no laparotomy group, and 25 cases with previous vertical incisions including lower (n = 12,48%), upper (n = 7, 28%), and lower&upper (n = 2, 8%) midline and paramedian (n = 4, 16%) laparotomies. Veress insufflation and open technique were used in 19 (76%) and 6 (24%) cases, respectively, during the insertion of the first trocar in previous laparotomy group. Patients in previous laparotomy group were significantly older (59.2 +/- 13.4 vs. 66.2 +/- 0.1, p = 0.01), but gender, ASA scores, tumor and technique related factors were similar within the groups, including operation time (200 [70-600] vs. 200 [130-390] min, p = 0.353), blood loss (250 [100-1500] vs. 250 [0-2200] ml, p = 0.46), additional trocar insertion (10 [4%] vs. 3 [12%], p = 0.101), conversion (20 [7.9%] vs. 4 [16%], p = 0.25), postoperative complication (59 [23.4%] vs. 4 [16%], p = 0.06) and 30-day mortality (7 [2.8%] vs. 1 [4%], p = 0.536) rates. Oncological outcomes regarding pathological features and 5-year survival rates (65% vs. 73.2%, p = 0.678) were not different. Conclusion: The presence of a previous laparotomy does not worsen the outcomes in patients undergoing laparoscopic removal of sigmoid or rectal cancer, thus laparoscopy may be considered to be safe and feasible in these cases.

This paper proposes the novel technique for analysis of dynamic stress state of multi-connected infinite plates under the action of oscillating forces. Calculation of dynamic stresses at the incisions of plates is held using the boundary-integral equation method and the theory of complex variable functions. The numerical implementation of the developed algorithmis based on the method of mechanical quadratures and collocation technique. The algorithm is effective in the analysis of the stress state caused by steady-state vibrations of plates.

Rivers change through time in response to upstream and downstream controls and may change over very short time periods (i.e., few years), in particular when human impact affects fluvial systems. In the Lighvan River catchment, a semi-arid mountainous area in northwestern Iran, remarkable changes in the fluvial environment and channel morphology have taken place over the last few years. The aim of this paper is to explain driving factors of channel changes along the Lighvan River, in a 16-km-long reach, over the period 2000–2012. Data and methods used include maps and field survey to quantify channel changes; analysis of hydrological data (precipitation and discharges); Landsat images for land-use classification and then evaluation of possible changes in flood peak discharge by SCS method; and calculation of unit stream power changes. In general, the channel underwent incision (up to 1 m) and narrowing (up to 18 m), although aggradation occurred in few cross sections in the upstream part of the study reach and widening in few cross sections in the downstream part. Investigation of causes of these changes showed that magnitude of annual peak discharges increased over the period 1991–2012, and it can be suggested that such increase is related to natural causes (i.e., increase of precipitation) and human impact so that both human and natural factors had a role in the recent evolution of the Lighvan River. Channelization and increase of peak discharges (due to an increase of precipitation and land-use changes) have been the main drivers of channel evolution.

As witnesses of the dynamic and increased extension and densification of the development of our urban spaces, we need a re-qualification of the values that we as members and professionals create in the urban environment in which we live in. Skopje is a fragmented city, consisted of a diverse morphological and social context and the permanence and transformation of the urban structure is in a constant conflict. Defining new tactics for transformation of the housing structure and presenting new models for housing is the new challenge that the city will be facing in order to create a homogeneous morphological and ideological identity. The research of the possible transformation offers a method which can be applied and adapted on versatile urban contexts and provide upgrade and integration of the program and volume of the city. In this research, the linear structure is chosen as a basic morphological element. Towards a better understanding of this formal act of positioning an axis, we first have to understand the political and social events from historical, social and cultural aspect. In the first part, the research is based on examples of the historical genesis of linear structures and examples regarding the research of linear structures or cities and in the second part, closing in on the study area of the city of Skopje and the east-west axis of development and growth of the city (the master plan of the architect Ludek Kubes in 1948). The method of incision is presented in the third part, incision or cutting through, from a theoretical aspect and superposing a linear structure as a tactic for transforming the urban morphology. The urban fragments are a distinctive phenomenon of the city of Skopje; the principals of informal transformation may offer a strategy that will succeed to unify and connect the contradictory condition, which is a consequence of different ideas, implementations and non-realization of plans and also of political, economic and other social factors.

The aim of the present study is to evaluate the anti-inflammatory and wound healing activities of the extracts prepared from the aerial parts of Campanula lyrata Lam. subsp. lyrata (Campanulaceae) by using in vivo methods in order to confirm the traditional utilization. n-Hexane, diethyl ether, ethyl acetate (EtOAc), methanol (MeOH) and aqueous extracts were separately prepared from the air-dried and powdered plant materials. Carrageenan-, and serotonin- induced hind paw edema, 12-Otetradecanoylphorbol- 13-acetate (TPA)-induced mouse ear edema and acetic acid-induced increase in capillary permeability models were employed in mice for the anti-inflammatory activity assessment. Wound-healing activity was investigated by using incision and excision wound models along with hydroxyproline determination and histopathological analyses. MeOH extract displayed significant antiinflammatory effect in the carrageenan- and serotonin- induced hind paw edema model and in acetic acidinduced increase in capillary permeability model with the values of 25.3, 27.8 and 31.8%, respectively. MeOH extract was also found to have significant wound healing potential in the incision and excision wound models with the values of 26.9 and 39.6%, respectively. MeOH extract ointment treated group tissues also showed enhaced hydroxyproline content. The present study confirms the anti-inflammatory and wound healing activities of C. lyrata subsp. lyrata

Introduction Pseudocyst of the pinna is a rare condition that occurs when fluid accumulates in the intercartilagenous space of the auricle. The main goal when treating this condition is to keep acceptable cosmetic results with no recurrence rate. Objective To demonstrate the superior impact of incision and drainage of auricular pseudocysts with the insertion of a catheter drain and daily irrigation as the treatment of this condition. Methods A total of 42 patients with auricular pseudocysts were enrolled in the present study in the period between May 2011 and May 2017. All of the patients were treated with incision and drainage with compression. The average follow-up time reached ∼ 6 months in all of the cases. Results All of the patients had satisfactory cosmetic results with no recurrence and no complications. Conclusion Among the different methods of surgical treatment of pseudocyst of the pinna, incision and drainage with daily irrigation is a significantly efficient method both for the eradication of auricular pseudocysts and for good cosmetic results.

Background To evaluate visual acuity, corneal astigmatism and corneal higher-order aberrations (HOAs) after implantation of trifocal diffractive IOLs operated with either a corneal steep-axis incision or 135° incision. Method This prospective study enrolled patients randomly assigned to different groups. According to preoperative corneal astigmatism, 101 eyes of 77 patients were assigned into group A1 (0 ~ 0.50 D) or A2 (0.51 ~ 1.00 D) with a corneal steep-axis incision or group B1 (0 ~ 0.50 D) or B2 (0.51 ~ 1.00 D) with a 135° incision. Visual acuity, corneal astigmatism and corneal higher-order aberrations (HOAs) were followed-up for 3 months. Results Corneal astigmatism in group A2 significantly decreased 3 months after surgery (P

Objective The aim of this article is to introduce a new skin and fascia opening for intrathecal baclofen pump implantation in the abdomen, with the purpose of reducing complications related to wound breakdown. Methods We introduce a novel way of cutaneous and fascial opening that leads two opposed “L shaped” incisions. Results This method entails numerous advantages. The first advantage is avoiding the direct alignment of overlapped sutures, which creates a locus minoris resistentiae that can weaken and break under the push of the pump. Another advantage consists of an increased obstruction against deep extension of infective processes from cutaneous origin. The wide opening of the subfascial pocket permits the implantation of any type of pump available, and it reduces complexities in reopening the pouch for pump replacement. It also permits the fastening of all anchoring systems usually present in pumps. Another advantage is the improved possibility of careful muscle cauterization thanks to the wide fascia opening, with reduced risk of postsurgical hematoma. Our results showed a reduction of wound complications with this method. Conclusions This method could contribute to reducing the rate of wound complications and patient discomfort.

Les ajustements morphologiques de la moyenne Garonne toulousaine durant les 200 dernières années sont analysés à partir de données topographiques et cartographiques anciennes. L’objectif principal est de quantifier ces changements, d’estimer leur amplitude, d’identifier les périodes d’évolution et les facteurs de contrôle associés. Malgré la faible résolution chronologique des données disponibles, les résultats mettent en évidence l’existence de trois grandes phases d’ajustements : (i) entre 1830 et les années 1860, le chenal s’exhausse et la bande active s’élargit ; (ii) entre 1860 et 1920, l’aggradation du chenal se poursuit alors que la bande active entame une phase de contraction ; (iii) enfin depuis 1920 jusqu’à ce jour, le chenal s’incise et la contraction de la bande active se poursuit. La mise en relation des ajustements latéraux et verticaux avec les facteurs de contrôle anthropiques et naturels suggère un rôle dominant des activités humaines dans le lit mineur de la Garonne notamment au cours du XXe siècle. En effet, les extractions massives de granulats conjuguées aux travaux de fixation du cours d’eau entre les années 1960 et 1980, semblent clairement impliquées dans l’accélération des phénomènes de contraction et d’incision du chenal qui ont lieu en grande partie durant cette période. Néanmoins, la contraction et l’enfoncement du chenal initiés dès la fin du XIXe - début XXe siècles pourraient avoir pour origine principale une réduction de l’activité hydro-sédimentaire de la Garonne en lien avec la sortie du Petit Age Glaciaire (PAG), les activités humaines ne venant que renforcer une dynamique déjà amorcée. The morphological adjustments of the Toulouse middle Garonne over the last 200 years are analyzed based on topographic and cartographic data. The main goal of this study is to quantify the evolution of the channel morphological changes; estimate their amplitude, periodize the evolution and finally identify associated controlling factors. The results clearly show the existence of three major phases of adjustments: (i) between 1830 and 1860s, the channel is characterized by aggradation and widening; (ii) between 1860s and 1920, the channel is still in aggradation while beginning a phase of narrowing; and (iii) from 1920 until today, the channel incision starts and the narrowing continues.By linking lateral and vertical adjustments with anthropogenic and natural controlling factors our findings suggest a dominant role of human activities in the channel of the Garonne River especially during the 20th century. Indeed, the massive in-stream mining and channel works (bank protections) along the channel took place from the 60s to 80s, and seem to be clearly involved in the acceleration of narrowing and incision, which largely occurred during this period. Nevertheless, the narrowing and incision of the channel initiated at the end of the 19th - early 20th century could have mainly originated from a decrease of the hydro-sedimentary activity of the Garonne River in connection with the end of the Little Ice Age, while human activities would only be reinforcing the already initiated dynamics.

Background To compare the clinical outcomes after implantation of AcrySof Toric IOLs with different clear corneal incisions. Methods Sixty cataract patients with regular corneal astigmatism who underwent phacoemulsification combined with implantation of an AcrySof Toric IOL were enrolled. They were divided into two groups according to the position of the clear corneal incision: steep-axis and non-steep-axis. Main outcome measurements included visual acuity, residual astigmatism and changes of corneal astigmatism 3 months postoperatively. Deviation of IOL axis according to the re-calculation using the actual surgically induced astigmatism (SIA) and visual function 3 months after surgery were also evaluated. Results The corneal astigmatism decreased significantly in steep-axis group 3 months postoperatively (P

Purpose We hypothesized that the elastic nature of the choroid leads to tissue contraction following a full-thickness, sharp incision. Furthermore, we sought to quantify, measure, and compare tissue contraction in ex vivo porcine globes and human globes of various ages using predetermined variables. Method A full-thickness, ex vivo choroidal incision was performed in either pig (n = 97) or human (n = 30) specimens. Variables included trephine diameter (1.5, 2.0, or 2.5 mm) versus a straight surgical blade, and temperature (1.7 °-4.4° vs. 36.6°F). Central centripetal and surround centrifugal tissue contractions were measured. Mean percentage tissue contraction was assessed as a ratio of trephine diameter to final tissue contraction measured immediately following each incision using a standardized device. Results For trephination in pig specimens, centripetal contraction ranged from 38% to 50% with a mean of 44%. Centrifugal contraction was approximately 15%. Human choroidal contraction was 39% and 15%, respectively, with a statistically significant inverse relationship to age (R2 = 0.35, P ≤ 0.01). Asymmetric contraction was noted when incisions were closer to choroidal attachment sites to the sclera, such as near vortex ampullae. Linear incisions resulted in contraction that correlated with incision length (R2 = 0.35, P ≤ 0.001). Conclusions A full-thickness choroidal incision results in significant tissue contraction. For circular incisions, the centripetal contraction approaches 50% of the original incision size. For linear incisions, the contraction corresponds directly with incision length. In human specimens, there is less contraction with advancing age. Translational Relevance Our findings have clinical relevance for choroidal biopsy, traumatic injury, and choroidal translocation surgery.

Streams commonly respond to base-level fall by localizing erosion within steepened, convex knickzone reaches. Localized incision causes knickzone reaches to migrate upstream. Such migrating knickzones dictate the pace of landscape response to changes in tectonics or erosional efficiency and can help quantify the timing and source of base-level fall. Identification of knickzones typically requires individual selection of steepened reaches: a process that is tedious and subjective and has no efficient means to measure knickzone size. We construct an algorithm to automate this procedure by selecting the bounds of knickzone reaches in a -space (drainage-area normalized) framework. An automated feature calibrates algorithm parameters to a subset of knickzones handpicked by the user. The algorithm uses these parameters as consistent criteria to identify knickzones objectively, and then the algorithm measures the height, length, and slope of each knickzone reach. We test the algorithm on 1, 10, and 30m resolution digital elevation models (DEMs) of six catchments (trunk-stream lengths: 2.1-5.4km) on Santa Cruz Island, southern California. On the 1m DEM, algorithm-selected knickzones confirm 93% of handpicked knickzone positions (n=178) to a spatial accuracy of 100m, 88% to an accuracy within 50m, and 46% to an accuracy within 10m. Using 10 and 30m DEMs, accuracy is similar: 88-86% to 100m and 82% to 50m (n=38 and 36, respectively). The algorithm enables efficient regional comparison of the size and location of knickzones with geologic structures, mapped landforms, and hillslope morphology, thereby facilitating approaches to characterize the dynamics of transient landscapes. Plain Language Summary The shape of rivers reflects the environments that they flow through and the environments that they link together: mountains and oceans. Anywhere along the length of a river, changes in environmental conditions are propagated upstream and downstream as the river changes its morphology to match the new environmental conditions. Commonly, rivers steepen as land uplifts faster in regions of high tectonic convergence. The steepening of river gradients is propagated upstream and can be mapped to trace zones of high tectonic activity across landscapes and estimate the source and timing of environmental change. Such insights may indicate regions where earthquakes have become more frequent in the recent past and how rivers respond to these changes. In this submission, we detail an algorithm that can use digital topographic data (similar to google earth), to automatically map and measure anomalously steep river reaches across continental scales. This technology can highlight areas that have experienced recent sustained changes in environmental conditions, evident by changes in the morphology of rivers. Such environmental conditions could be changes in tectonic uplift and earthquake activity, changes in sea level, changes in land-use, or changes in climate, all factors that can produce measurable differences in river morphology over time.

Ventral hernia is a common complication of abdominal surgeries, with the incidence of up to 20% in some series. Giant ventral hernia is that with a neck more than 10 cm wide. The loss of abdominal domain due to the shift of viscera into the hernia sac could lead to the complication after surgery. A 54-year-old female presented with a giant pedunculated ventral hernia. She had low tension mesh repair through a transverse suprapubic incision. The surgical repair of giant hernia with mesh has led to reduced complications. The sublay mesh repair method has further reduced the rate of underlay mesh recurrence.

Channel incision isolates flood plains, disrupts sediment transport, and degrades riparian ecology. Reactivation and periodicity of incision may affect the water table and hydrological conditions far beyond the stream margin. Long-term incision and its recent acceleration along Iron Springs Creek, North Dakota, USA, has affected adjacent ecosystems. An agricultural surface drain empties directly into the original spring-fed source of the creek, which triggered channel erosion both up- and downstream. Historical maps, recent LiDAR, and field surveying were used to characterize incision since ditch excavation in 1911. Although the soils are sandy, small hydrological gradients impede natural drainage in the surrounding stabilized dunes. Incision resulting from expanded drainage and increased precipitation has been as much as 5 m. Numerical models of lateral groundwater profiles corroborated with field measurements show that the nearby water table responds quickly, becoming deeper and less variable. With 1 m of recent incision, model evapotranspiration rates are decreased 50% to 15% from the channel margin to 1 km, respectively, and the hydropattern disrupted &gt, 1 km. Species diversity is reduced and floristic quality is 25% less near the drain. A near-channel solution to erosion&mdash, fencing out cattle&mdash, failed to mitigate the problem because a broader watershed approach was necessary.

The catchments in the western Rift Valley escarpment of northern Ethiopia are highly responsive in terms of hydro-geomorphic changes. With deforestation, dense gully and scar networks had developed by the 1980s on the escarpment between the towns of Alamata and Korem, transporting huge amounts of runoff and sediment down to the fertile and densely populated Raya Valley. To reverse this problem, catchment-scale rehabilitation activities were initiated in the mid-1980s. In this study, we examine the major hydro-geomorphic response of streams after catchment rehabilitation. Scar networks in 20 adjacent catchments were mapped on Google Earth imagery of 2005, and their density was explained in terms of its corresponding Normalized Difference Vegetation Index and slope gradient. Soil and water conservation measures and vegetation recovery have reduced discharge and sediment flow which in turn resulted in various hydro-geomorphic changes. In a multiple regression analysis, scar density was negatively related with Normalized Difference Vegetation Index and positively with average gradient of very steep slopes (r2 = 0·53, p