Search

OBJECTIVE Surgical evacuation of chronic subdural hematoma (SDH) in cancer patients is often contraindicated owing to refractory thrombocytopenia. Middle meningeal artery embolization (MMAE) recently emerged as a potential alternative to surgical evacuation for patients with chronic SDH. The goal of this study was to evaluate the safety and efficacy of MMAE for chronic SDH in cancer patients with refractory thrombocytopenia. METHODS A multiinstitutional registry was reviewed for clinical and radiographic outcomes of cancer patients with transfusion-refractory thrombocytopenia and baseline platelet count < 75 K/µl, who underwent MMAE for chronic SDH. RESULTS MMAE was performed on a total of 31 SDHs in 22 patients, with a mean ± SD (range) platelet count of 42.1 ± 18.3 (9–74) K/µl. At the longest follow-up, 24 SDHs (77%) had reduced in size, with 15 (48%) showing > 50% reduction. Two patients required surgical evacuation after MMAE. There was only 1 procedural complication; however, 16 patients (73%) ultimately died of cancer-related complications. Median survival was significantly longer in the 16 patients with improved SDH than the 6 patients with worsened SDH after MMAE (185 vs 24 days, p = 0.029). Length of procedure, technical success rate, SDH size reduction, and complication rate were not significantly differ between patients who underwent transfemoral and transradial approaches. CONCLUSIONS Transfemoral or transradial MMAE is a potential therapeutic option for thrombocytopenic cancer patients with SDH. However, treatment benefit may be marginal for patients with high disease burden and limited life expectancy. A prospective trial is warranted to address these questions.

Until now, influences of different grinding mechanisms on specific energy consumption have been subject of many researches. In this regard, the technologies of impact and attrition milling have been compared by several studies. Although energy consumption is of major concern, the product properties or the behaviour of the components within the mixture may vary depending on the mechanism chosen. Such investigation is still missing for the dry stirred media milling. Moreover, its comparison with the conventional techniques regarding to this phenomenon is also lacking within the literature. This paper initially aims to provide an insight on components' interaction within ball milling and stirred milling and then comparison of the two outcomes. Within the scope, the first phase of grinding tests consisted of ball milling and stirred milling of calcite within a single and multi-component environment. For the mixtures, each component was separated via chemical analyses hence comparisons were made regarding to size reduction of the individuals. Further tests were performed with a copper ore to investigate the behaviours of the minerals by benefitting from MLA analyses. As a result, the two technologies were compared on the basis of energy consumption, components' interaction and their contributions to the liberation characteristics of the minerals. (c) 2021 The Society of Powder Technology Japan. Published by Elsevier B.V. and The Society of Powder Technology Japan. All rights reserved.

To measure the lesion size reduction in eyes with active toxoplasma retinochoroiditis during the disease course with swept-source optical coherence tomography angiography (SS-OCTA). We retrospectively analysed the chorioretinal lesion size in a group of 14 eyes with a single active toxoplasma retinochoroiditis lesion. SS-OCTA was performed at the baseline and follow-up in all eyes. The 6 × 6 mm choriocapillaris slab images were evaluated with image analysis (MATLAB). The number of black and white pixels in a 1500-µm-diameter circle centred on each active lesion was counted at the time of baseline examination and at the first follow-up visit when the chorioretinal scar formation was noticed. Fourteen eyes with a single active toxoplasmosis retinochoroiditis lesion were included. Ten patients were female and three were male. The mean age was 29.1 ± 14.9 years. Active lesions were at the macula in five eyes, at the periphery in six eyes and juxtapapillary in three eyes. At the initial examination, the lesion area was observed as an area with a decreased flow signal on SS-OCTA. There was the perilesional capillary disruption in superficial and deep capillary plexi together with a diffuse capillary network attenuation and non-detectable flow signal zones in the choriocapillaris slabs. In addition to sulfamethoxazole-trimethoprim and azithromycin combination, oral corticosteroids were only co-administered in five (35%) eyes with macular involvement. The chorioretinal scar formation was observed in 4 to 16 weeks. At the time of inactivity, the original lesion was diminished in size when compared to its baseline in all study eyes (p = 0.001) with a mean black pixel reduction percentage of 21.8%. The reduction was 15.4% in eyes with macular lesion, 31.6% with peripheral lesions and 18.1% with juxtapapillary lesions (p = 0.001, p = 0.032, p = 0.028, p = 0.043, respectively). Visual acuity was correlated with black pixel reduction percentage in eyes with macular lesion (r = 0.56, p

Third molar agenesis is a dental anomaly that occurs in approximately 25% of people worldwide and results in the complete absence of one or more of the third molars in the dentition. A rise in the prevalence of congenitally absent third molars has been noted in modern populations, and it has been proposed as the final evolutionary step in the dental reduction of the human dentition. Whilst much research has been conducted in modern cohorts, relatively little has been published on third molar agenesis in archaeological assemblages. A post-medieval assemblage from Chichester was visually and radiographically analysed to determine the prevalence of this anomaly. Third molars were measured to determine if there was an association between agenesis and size reduction. Prevalence of agenesis was found to be relatively high at 42.7% and 2 of 8 measurements were found to produce significant differences. Consequently, it can be said that high rates of third molar agenesis are not solely a modern phenomenon, as many prevalence rates in recent populations are lower. However, if we are to assess the significance of size differences in third molars of those with agenesis and those without, and to detect patterns within and between these groups, assemblages with larger sample sizes are needed. In order to better understand the trajectory and evolution of this anomaly, more archaeological assemblages must be examined.

This article analyses the effect of the size reduced Silver (Ag) loaded hydrogel by (a) lyophilisation (S1) (b) ball milling (S2) techniques and its effect on anti‐bacterial activity. The g loaded hydrogel, S1 and S2 shows an increase in swelling with an increase in pH. The swelling is more for Ag loaded hydrogel in low pH. For pH above 7, the swelling ratio of Ag loaded hydrogel and S1 are almost the same while S2 shows very less swelling. The anti‐bacterial studies reveal that S1 and Ag loaded hydrogel reacted well in S. aureus (Staphylococcus aureus) but no zone formation was seen in S2 .whereas no zone was formed in S1 and S2 for E‐coli (Escherichia coli). As the next step, the anti‐bacterial activity of Ag loaded hydrogel with the addition of curcumin (CS1―size reduced by lyophilisation, CS2―size reduced by ball milling) and turmeric (TS1―size reduced by lyophilisation, TS2―size reduced by ball milling) were investigated. In case of E.coli, a zonal formation of 1.2 cm for TS1 and 1.1 cm for TS2 and 1 cm for CS1 and 0.2 cm for CS2 was observed. For S.aureus, 1.1 and 1 cm were seen for TS1 and CS1. TS2 and CS2 did not show any zone formation. These studies clearly show that size reduction by lyophilisation (S1, TS1 and CS1) is more efficient in all the cases when compared to the ball milling technique (S2, TS2 and CS2). Comparing TS1 with S1 and CS1, TS1 has highly efficient/effective anti‐bacterial properties than S1 and CS1. Therefore, lyophilised hydrogel incorporating turmeric and silver (TS1) is an excellent choice compared to using curcumin for wound dressing applications.

Thyroid nodules (TNs) are a frequently seen clinical problem which increased in incidence with the usage of high-resolution ultrasound (US). Most of these nodules are benign and do not need any further management unless they start to be symptomatic, cosmetically unacceptable, or proven to be malignant. Surgery has been the only treatment option. Since scientists and clinicians became more conservative and toward minimally invasive techniques, TNs’ management was not exceptional. Minimally invasive US-guided techniques were introduced in the last two decades as a management of TNs. Radiofrequency ablation (RFA) is considered relatively the newest of all and showed a significant reduction in the size and improvement of clinical symptoms.. The aim of this article is to review basic principles and technical details of RFA. RFA showed promising results in TNs size reduction as well as cure of hyperthyroidism due to toxic nodules. Data also reported improvement of compressive symptoms after the procedure. As RFA is a relatively new novel technique in management of thyroid disease, with further studies focusing more on indications, and outcomes, we predict that RFA will be widely applied in the management of thyroid disease. It plays a major role in reducing the number of patients undergoing surgeries and avoiding all the risk related to it.

Introduction: Treatment with ulipristal acetate effectively controls excessive bleeding due to uterine fibroids and reduces their size. Uterine fibroid size reduction is expected to improve the results of the myomectomy and the reproductive prospects of the patient. Methods: Retrospective and descriptive analysis of a series of 53 patients who achieved pregnancy after being treated for symptomatic uterine fibroids. The primary endpoints were pregnancy and birth outcomes in women with symptomatic uterine fibroids that conceived following at least one course of therapy with ulipristal acetate 5 mg/day. The secondary endpoints were time until pregnancy, reasons for ulipristal acetate treatment, number of treatment courses completed, hemorrhagic control achievement, hemoglobin levels, fibroid FIGO classification, largest fibroid diameter, and type of myomectomy (if any). Results: Fifty-five pregnancies were registered in 53 patients following ulipristal acetate therapy (43 live births, 9 miscarriages, and 3 ongoing pregnancies). Half of the patients became pregnant without interval surgery. Bleeding control was achieved in 96% of the cases. A significant increase (p Conclusion: So far, this is the largest case series reporting both pregnancy and birth outcomes following ulipristal acetate therapy for uterine fibroids. Our data support favorable outcomes after therapy for this population subset.

Context Chronic nonhealing ulcer is a troublesome condition in patients especially with diabetes. Autologous PRP therapy can safely and effectively heal a chronic nonhealing ulcer in such patients. Aims To study the effectiveness of autologous PRP therapy in a chronic nonhealing ulcer. Settings and design A retrospective descriptive study from previous case records of chronic nonhealing ulcer patients who were treated with autologous PRP therapy at a specialty orthopedic hospital from September 2017 to August 2019. Methods and materials Data on patients who presented with chronic nonhealing ulcers of >4 weeks duration who were treated with autologous PRP therapy and followed up for 20 weeks. Statistical analysis used Statistical Package for the Social Sciences (SPSS) version 20 was used to calculate mean. Microsoft Excel was used for preparing the chart. Results The mean age of patients treated with autologous PRP therapy was 61.24 years, and the follow-up period was 20 weeks. The mean duration of ulcer healing following PRP therapy was 11.25 weeks, 80% of the patient showed ulcer size reduction of >75% following therapy. Conclusions In this retrospective descriptive study, it has demonstrated the effectiveness and safety of autologous PRP therapy in the healing of chronic nonhealing ulcers.

Loss of fixation and seal represent a key problem when undertaking endovascular repair of abdominal aortic aneurysms (AAA) with hyperangulated necks (HAN). This study assesses the outcomes following the use of adjunct endostapling to supplement proximal aorto-prosthetic fixation in patients who have AAAs with HAN. A retrospective review of a prospective database of 42 patients with HAN (> 60°) who underwent endovascular aneurysm repair (EVAR) with supplementary endostapling was undertaken. Primary outcomes assessed were: change in post-EVAR neck angulation at first post-procedure scan, freedom from type 1 endoleaks, migration and reintervention for proximal seal complications. Secondary parameters included assessment for neck dilatation, sac size changes and EndoAnchor distribution patterns. In total, 42 patients underwent EVAR between 2013 and 2019. There was one 30-day mortality resulting in 41 patients (34 male, 7 females aged 76.8 ± 8.9 years)) being analysed; 251 EndoAnchors were deployed in total, averaging 6 ± 2 per patient; 38 such cases were primary deployments. Neck angulation was 76.9 ± 14 degrees pre-EVAR and 50.2 ± 14.5 degrees post-procedure (p

Size reduction of oil shale is an essential process that allows the liberation of organic-rich constituents from inorganic portions to prepare the oil shale for further beneficiation processes. Gri...

Objective To investigate the correlations and feasibility of diffusion kurtosis imaging (DKI) parameters and tumour histopathology after radiotherapy in human nasopharyngeal carcinoma (NPC) xenografts on nude mice. Materials and Methods Seventy-two nude mice were used for the construction of CNE-1 (radio-insensitive) and CNE-2 (radio-sensitive) NPC xenograft models, followed by fraction irradiation at different doses of X-ray. The nude mice were randomly divided into six groups in each cell line models according to the dose of X-ray they have received and with six mice in each group. DKI scan was performed after radiation. DKI parameters, tumour histopathology and AQP-1 biomarkers were detected. One-way ANOVA and Pearson’s correlation analysis were used in statistical analysis. Results In CNE-1 and CNE-2 NPC xenografts, D values were increased (P Conclusion Changes in D and K parameters after fractional irradiation are closely related with NPC cellular and pathological characteristics, especially size reduction and necrosis induction. These parameters exhibit potential abilities of monitoring the response to fractional irradiation in radio-sensitive NPC xenografts.

Background Intimal injury in microvessels due to common risk factors such as atherosclerosis or inadequate manipulation are known to have a major impact on developing thrombosis and eventually vascular obstruction. Understanding of these injuries is therefore of great significance to prevent far-reaching consequences such as flap loss in free tissue transfer. It was the aim of this study to evaluate artificially induced intimal lesions with focus on alteration in size and configuration. Methods Intimal defects were created surgically in the abdominal aorta of 30 male Wistar rats. After planimetric measurement of the defect sizes, configuration of defects were classified as round, horizontal, or vertical. Seven days postoperatively, the rats underwent a second-look surgery. Finally, the abdominal aorta was harvested, and the endothelial defects were reevaluated concerning size and configuration using a defined pattern. Results The mean defect size created intraoperatively was 1.68 ± 0.6 mm2. The classification of the defects configurations resulted in 43.3% round, 20% horizontal, and 36.7% vertical defects. Reevaluation at 7 days after surgery showed defect shrinkage in 96.7% in total and 42.8% averaging due to reendothelialization. A shift in defect configuration was detected in 56.7%, the strongest being in vertical defect configurations (100%). Vascular occlusion did not occur in any of the specimen. Conclusion Intimal injuries undergo a fast repair process in terms of size reduction and configuration modification due to reendothelialization. Especially vertical defects, representing a great risk for thrombus formation, convert into lower risk horizontal defect configurations. In high-flow vessels such as the rat aortas, small endothelial damage seems to have no significant impact to produce complete vascular occlusion. Still, all efforts should be made to avoid any kind of intimal injury.

Detection of metastasis spread at an early stage of disease in lymph nodes can be achieved by imaging techniques, such as PET and fluoride-marked tumor cells. Intraoperative detection of small metastasis can be problematic especially in minimally invasive surgical settings. A γ-radiation sensor can be inserted in the situs to facilitate intraoperative localization of the lymph nodes. In the minimally invasive setting, the sensor must fit through the trocar and for robot-aided interventions, a small, capsule-like device is favorable. Size reduction could be achieved by using only a few simple electronic parts packed in a single-use sensor-head also leading to a low-cost device. This paper first describes the selection of an appropriate low-cost diode, which is placed in a sensor head (Ø 12 mm) and characterized in a validation experiment. Finally, the sensor and its performance during a detection experiment with nine subjects is evaluated. The subjects had to locate a 137Cs source (138 kBq activity, 612 keV) below a wooden plate seven times. Time to accomplish this task and error rate were recorded and evaluated. The time needed by the subjects to complete each run was 95 ± 68.1 s for the first trial down to 40 ± 23.9 s for the last. All subjects managed to locate the 137Cs source precisely. Further reduction in size and a sterilizable housing are prerequisites for in vitro tests on explanted human lymph nodes and finally in vivo testing.

Background Rathke cleft cysts (RCCs) are known sellar/suprasellar lesions that can grow and become symptomatic. For most asymptomatic lesions, stability is a typical outcome of surveillance; however, random relapse or cyst size fluctuation may also be observed. The conventional treatment for growing cysts is transsphenoidal removal. Methods A literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. For significance, all journals were screened. Only records of tissue diagnosed RCCs with changes in size were included. Age and sex at diagnosis, size of the lesion, symptoms (if any), pituitary dysfunction, follow-up period, and size reduction were included in the data items. Results A total of 4 articles where selected after the second exclusion method. Three articles where case series and one was a case report. Eight total patients where histologically proven to have Rathke cleft cysts which fluctuated in size without intervention. Conclusion This review shows that RCCs can decrease or fluctuate in size following a dynamic process that is not fully understood. In the absence of symptoms, a larger cyst or an absolute increase in a cyst size, which may traditionally provoke an early surgical intervention, should be assessed and managed carefully to avoid potentially unneeded surgical morbidity.

Introduction and importance A wandering spleen is characterized by excessive splenic mobility due to the laxity of its ligaments, which leads to spleen migration and its long mobile vascular pedicle is liable to torsion. The purpose of this paper was to present a wandering splenomegaly reduction after splenic detorsion and splenopexy. Case presentation A 14-year-old boy presented a symptomatic visible pelvic wandering splenomegaly with torsion of the splenic pedicle. He was submitted to laparotomy, detorsion of the spleen, and splenopexy to the left diaphragm and surrounded peritoneum. The patient had an uneventful follow-up and was discharged from the hospital on the second postoperative day. All laboratory exams went to normal. The size of the spleen reduced from the 22 × 16 × 13 cm before the treatment to 14 × 12 × 10 cm after the surgical procedure. Clinical discussion The most relevant aspect of this communication is the reduction of the huge splenomegaly to a normal size spleen after detorsion of the splenic vessels and splenopexy to the left diaphragm. Reduction of the splenic size is well-known after distal splenorenal shunt, but this is the first publication of a spontaneous splenic size reduction after treating a congestive wandering splenomegaly by detorsion of the spleen pedicle. Conclusion Ectopic congestive splenomegaly due to the splenic pedicle rotation is adequately treated by splenic detorsion and splenopexy in its proper subdiaphragmatic site, which reduces the splenic size to normal., Highlights • Wandering spleen is a rare splenic disorder due to the absence of splenic ligaments. • Wandering spleen in the pelvis is responsible for urinary and digestive complaints. • Wandering splenomegaly occurs due to torsion of splenic pedicle. • Wandering spleen should be treated with splenopexy in the left subphrenic splenic proper site. • Detorsion of splenic pedicle and splenopexy may reduce the splenomegaly.

Summary:. Both internal and external tissue expanders take advantage of the innate adaptive mechanisms the skin exerts in response to mechanical tension, known as the stress-relaxation phenomenon. Internal tissue expander use is time-consuming and can be complicated by infection and extrusion. In this case series, continuous external tissue expanders used to manage large pediatric wounds were assessed. Fourteen patients (ages: 4 days to 17 years) with large wounds underwent continuous external tissue expansion intraoperatively. The success of wound closure was assessed. In addition, the size of the patient’s wounds, duration of device application, and postoperative complications were evaluated. The continuous external tissue expander was applied to wound sizes ranging from 14.7 to 560 cm2 for 5 to 10 days until the wound was amenable for direct closure. In 11 of the 14 patients, delayed primary closure was achieved. The device significantly reduced the wound sizes of the remaining three cases (average 80% size reduction). There was no incidence of wound dehiscence or infection. This case series demonstrates the benefit of the continuous external tissue expansion in managing pediatric wounds that would not otherwise be amenable to primary closure. The method allows for timely closure with limited risk of infection or extrusion, and should be in the armamentarium of reconstructive plastic surgeons.

Cryotherapy is a standard treatment for warts. Tuberculin immunotherapy is a novel therapeutic option. We compared the efficacy and safety of cryotherapy versus tuberculin immunotherapy in a randomized, assessor-blinded study. 15 patients were treated with intralesional tuberculin and 15 patients received cryotherapy every 2 weeks until complete wart resolution or a maximum of six sessions. Wart diameter, total number of warts and adverse effects were documented. Complete clearance of treated warts was achieved in 13(86.7%) and 11(73.3%) of patients with immunotherapy and cryotherapy respectively. Immunotherapy showed greater wart size reduction (51.88 ± 89.36 mm) than cryotherapy (32.99 ± 36.19 mm), (p = 0.46). Immunotherapy resulted in 64% reduction in total number of warts compared to 23.2% with cryotherapy, p < 0.01. More blisters developed with cryotherapy (46.7%) than immunotherapy (6.7%), (p = 0.01). Compartment syndrome-like features complicate immunotherapy in 1 patient. Tuberculin immunotherapy and cryotherapy are equally effective in treating warts. Immunotherapy has added benefit with resolution of distant warts. Safety profiles were similar except for blisters which were more common with cryotherapy.

Ball milling is used for size reduction of biomass for isolating lignin. However, it is known that it can lead to some structural alteration of lignin. Fibrillation using ultrafriction grinding is a newer size reduction technology which was applied to poplar for isolating cellulolytic enzyme lignin. Compositional analysis of poplar, enzymatic hydrolysis yield, water retention value, lignin yield, lignin structural characterization, and lignin molecular weight analysis were carried out to compare lignin isolated from fibrillated and ball milled poplar. By using fibrillation instead of planetary ball milling for size reduction of poplar, higher β-O-4′ linkage content, lignin yield, and molecular weight were obtained. Replacing ball milling with fibrillation for size reduction allows recovery of lignin whose structure is closer to that of lignin in biomass.

This study aims to investigate the effect of combined mechanical and ultrasonic milling on the size reduction of talc. Firstly, the talc sample was wet ground in a stirred media mill for five different times (30, 60, 90, 120, and 150 min), and the optimum result was subsequently achieved with treatment by ultrasonication. The effects of amplitude (20, 35, and 50 μm), solid content (2.5, 5, 7.5, and 10%), and sonication time (60, 120, and 240 min) on the sizes of the final product were investigated. The pre-milling by wet grinding caused a decrease in the grinding resistance of talc. Sequential ultrasonic treatment, which was applied to the talc sample, generated smaller particles in comparison to those acquired by stirred media milling alone. Experimental results were assessed based on the product particle size (d10, d50), reduction ratio, and specific energy consumption. Submicron particles prepared by ultrasonic treatment were perfectly stable compared to stirred media milling alone as investigated in terms of particle size. In addition, the effects of mechanical and ultrasonic milling on structural properties of talc particles were characterized by XRD analysis.

Oat starch granules were subjected to ultrasound treatment using either a 20 kHz horn sonicator at intensities of 39, 48, 63 W/cm2 or an ultrasound bath operating at an intensity of 5 W/cm2 for 10 and 20 min. Morphological, structural and functional properties of native and sonicated samples were investigated. SEM micrographs revealed the presence of fissures and pores on the surface of starch granules treated with the horn sonicator. An obvious size reduction was also observed at the highest sonication intensity. Ultrasound treatment increased the amylose content, swelling power, solubility, Transmittance, water, and lipid holding capacity; while the gel hardness diminished after sonication. The syneresis results revealed that higher amounts of water were expelled from the sonicated starch gels during 5 days of storage as compared to the native counterpart. The onset, peak and conclusion temperatures of gelatinization increased; while, the gelatinization temperature range decreased due to sonication. A decrease in the degree of crystallinity as well as the enthalpy of gelatinization demonstrated that the crystalline structures of oat starch granules were destroyed to some extent upon sonication, while the A-type crystalline pattern remained unchanged.

Twin-screw melt granulation (TSMG) was applied to process a powder blend consisting of 80% gabapentin (GABA) and 20% hydroxypropyl cellulose. The effect of screw profile and processing conditions on the process-induced transformation and chemical degradation of gabapentin was studied. When a neutral kneading block was used, gabapentin underwent polymorphic transformation. A forward kneading block in combination with processing under torque conditions was required to minimize chemical degradation and to inhibit polymorphic transformation of gabapentin. Both the size of the extruded granules and gabapentin degradant level correlated positively with the specific rate, the ratio between feed rate and screw speed. At higher specific rate, the barrel was filled to a greater extent. The material packing and compressive forces were enhanced, as proven by the increased rupturing of CAMES® sensor beads and GABA crystal size reduction. This resulted in more interaction between the powder particles and facilitated granule growth. Simultaneously, this also resulted in higher degradant level. To attain adequate tabletability, the specific rate must reach a threshold value. The development of an optimum TSMG process requires balancing processing parameters based on the physical and chemical stability of GABA as well as its tabletability.

Introduction Chest ultrasound is increasingly used for the diagnosis of pediatric lung disease but there are limited data for its use in pediatric pulmonary tuberculosis (PTB). Aim To describe chest ultrasound findings in children with suspected PTB. Methods Consecutive children, presenting with suspected PTB to a tertiary children's hospital in Cape Town between July 2014 and March 2016, were enrolled in this cohort study. Children were categorized into three groups based on microbiological and clinical features; confirmed PTB (microbiologically confirmed), unconfirmed PTB (clinical diagnosis only), and unlikely PTB (respiratory disease not due to PTB). A clinician, blinded to categorization, performed chest and mediastinal ultrasound for consolidation, pleural gaps, pleural effusions, B-lines or enlarged mediastinal lymph nodes at enrolment and 1, 3, and 6 months thereafter. Two readers interpreted the ultrasounds independently. Results One hundred seventy children (median age 26.6 months) were enrolled; 40 (24%) confirmed PTB, 85 (50%) unconfirmed PTB, and 45 (26%) unlikely PTB. In children with confirmed PTB, pleural effusion was more common (30% vs 9% in unlikely PTB, P = 0.024), mediastinal lymph nodes were larger (median size 1.5 cm vs 1.0 cm in unlikely PTB, P = 0.027), resolution of consolidation occurred less commonly at 1-month follow-up (24% vs 67% unlikely TB, P = 0.014) and the proportional size reduction of a consolidation was lower (44% vs 80% in unlikely PTB, P = 0.009). Inter-reader agreement was perfect to moderate. Conclusion Chest ultrasound identified abnormalities suggestive of PTB with a high inter-reader agreement. Consolidation showed slower resolution in children with confirmed PTB.

Background and Aim: Different processing treatments affect the functional properties of milk. This study aimed to evaluate the effects of boiling and ultrasonication on radical scavenging activity, micellar casein particle size, and the whiteness of milk. Materials and Methods: Milk was subjected to boiling and ultrasonication treatments. Then, the micellar casein size and the whiteness of the milk were evaluated using L-Value- intensity of whiteness and the radical scavenging capacity of the milk was evaluated using 1,1-diphenyl-2-picrylhydrazyl method. Results: The radical scavenging activity of the milk was found to be reduced during the different processing treatments, but this decrease was non-significant for the ultrasonication treatment (p>0.05). However, a significant reduction in radical scavenging activity (p

We present the case of a 53-year-old woman who presented with left-sided atypical facial pain in the V1-V2 distribution of the trigeminal nerve. Further imaging workup revealed a left-sided cavernous aneurysm compressing the V1 and V2 roots of the trigeminal nerve. She was treated with endovascular flow diversion to reduce aneurysmal mass effect, and at six-month follow-up she had near-complete resolution of her pain with significant size reduction of the aneurysm. Accurate localization of a lesion along the course of the trigeminal nerve is important to elucidate the underlying cause of facial pain and therefore guide appropriate management. Cavernous sinus aneurysms resulting in trigeminal nerve compression with resulting facial pain are amenable to treatment with flow diversion with the Pipeline Embolization Device.

Vascular complications (VCs) are difficult to predict and remain an important issue after transfemoral (TF) transcatheter aortic valve implantation (TAVI) although their incidence has decreased with size reduction of introducers. We aimed to evaluate a standardized measurement of femoral artery depth (FAD) using computed tomography (CT) to predict VCs after TAVI. We performed a retrospective study of 679 TF TAVI patients. We evaluated a standardized CT method to measure FAD immediately above the bifurcation. Sheath-to-femoral-artery ratio (SFAR), calcification, and tortuosity were also evaluated. VCs were defined by the Valve Academic Research Consortium (VARC)-2. Receiver operating characteristic (ROC) curves were used to predict major VCs and the need for a stent-graft. The median values of FAD and SFAR were 49.0 (36.2 to 66.7) mm and 0.95 (0.81 to 1.18), respectively. Major VCs occurred in 37 (5.4%) patients and a stent-graft was required in 49 (7.1%) patients. FAD predicted the need for a stent-graft [0.61 (0.51 to 0.70), p = 0.04] but not major VCs [0.52 (0.40 to 0.63), p = 0.76]. In contrast, SFAR did not predict the need for a stent-graft [0.53 (0.43 to 0.62), p = 0.61] but predicted major VCs [0.70 (0.58 to 0.81), p = 0.001]. Calcification and tortuosity predicted neither major VCs nor the need for a stent-graft. In conclusion, the results of our study suggest that CT measurements of FAD and SFAR provide additional information to predict major VCs and the need for a femoral stent-graft after TF TAVI.

In the design of a microstrip power divider, there are some important factors, including harmonic suppression, insertion loss, and size reduction, which affect the quality of the final product. Thus improving each of these factors contributes to a more efficient design. In this respect, a hybrid technique to reduce the size and improve the performance of a Wilkinson power divider (WPD) is introduced in this paper. The proposed method includes a typical series LC circuit, a miniaturizing inductor, and two transmission lines, which make an LC branch. Accordingly, two quarter-wavelength branches of the conventional WPD are replaced by two proposed LC branches. Not only does this modification lead to a 100% size reduction, an infinite number of harmonics suppression, and high-frequency selectivity theoretically, but it also results in a noticeable performance improvement practically compared to using quarter-wavelength branches in the conventional microstrip power dividers. The main important contributions of this technique are extreme size reduction and harmonic suppression for the implementation of a filtering power divider (FPD). Furthermore, by tuning the LC circuit, the arbitrary numbers of unwanted harmonics are blocked while the operating frequency, the stopband bandwidth, and the operating bandwidth are chosen optionally. The experimental result verifies the theoretical and simulated results of the proposed technique and demonstrates its potential for improving the performance and reducing the size of other similar microstrip components.

Background Follicular unit extraction (FUE) grafting is a surgical procedure which provides the vitiliginous patches with undifferentiated stem cells of the hair follicles. It has been postulated that adjuvant therapy enhances the results. This is the first study to assess two different adjuvant therapies vs FUE alone. Aims To study the efficiency of FUE alone or combined with either topical calcipotriol betamethasone dipropionate (CBD) or NB-UVB phototherapy in cases of nonsegmental stable vitiligo. To assess the role of dermoscopy in monitoring the pattern and degree of repigmentation. Patients/ methods 53 patients with 94 lesions with stable nonsegmental vitiligo were divided into three groups. Group 1 (n = 16) with 30 lesions received FUE alone. Group 2 (n = 18) with 32 lesions received FUE plus topical CBD. Group 3 (n = 19) with 32 lesions received FUE plus NB-UVB phototherapy. Assessment was done by grades of repigmentation, color match, percent of size reduction, and immunohistochemical evaluation of perilesional CD8+T lymphocytes. Results The fastest onset of repigmentation was observed in both groups 2 and 3 in the second week (16.7%, 10.5%, respectively).Group 2 achieved the best response by all methods of assessment. Perifollicular diffuse repigmentation was the commonest dermoscopic pattern in 60 lesions (63.8%). There was a statistically significant decrease in perilesional CD8+T lymphocytes after 4 months. Conclusion FUE is an effective method of surgical treatment of stable vitiligo, and topical CBD as a new adjuvant therapy is successful in targeting the immunological background of vitiligo. Dermoscopy has an essential role in monitoring the repigmentation response.

Highlights • Proposed a mechanism of virus spread in various climates & built indoor conditions. • Fast drying and size reduction of respiratory droplets makes the virus more active. • Dry and low humidity has a higher spread potential even in the outdoor environment. • Drying of indoor condition is very fast due to sensible heating of the indoor space. • Recommended humidity control check as a mandatory measure in Air Conditioning usage., Coronavirus spread is more serious in urban metropolitan cities compared to rural areas. It is observed from the data on the infection rate available in the various sources that the cold and dry conditions accelerate the spread of coronavirus. In the present work, the existing theory of respiratory droplet drying is used to propose the mechanism of virus spread under various climates and the indoor environment conditions which plays a greater role in the virus spread. This concept is assessed using four major parameters such as population density, climate severity, the volume of indoor spaces, and air-conditioning usage which affect the infection spread and mortality using the data available for various states of India. Further, it is analysed using the data from various states in India along with the respective climatic conditions. It is found that under some indoor scenarios, the coronaviruses present in the respiratory droplets become active due to size reduction that occurs both in sessile and airborne droplet nuclei causing an increase in the spread. Understanding this mechanism will be very useful to take the necessary steps to reduce the rate of transmission by initiating corrective measures and maintaining the required conditions in the indoor built environment.

Reservoir computing (RC) is a machine learning algorithm that can learn complex time series from data very rapidly based on the use of high-dimensional dynamical systems, such as random networks of neurons, called "reservoirs." To implement RC in edge computing, it is highly important to reduce the amount of computational resources that RC requires. In this study, we propose methods that reduce the size of the reservoir by inputting the past or drifting states of the reservoir to the output layer at the current time step. These proposed methods are analyzed based on information processing capacity, which is a performance measure of RC proposed by Dambre et al. (2012). In addition, we evaluate the effectiveness of the proposed methods on time-series prediction tasks: the generalized Henon-map and NARMA. On these tasks, we found that the proposed methods were able to reduce the size of the reservoir up to one tenth without a substantial increase in regression error. Because the applications of the proposed methods are not limited to a specific network structure of the reservoir, the proposed methods could further improve the energy efficiency of RC-based systems, such as FPGAs and photonic systems.

Mother-pup interactions are extremely important to offspring survival and growth. The goal of this study was to evaluate the influence of prenatal and neonatal interventions on maternal care, analyzing the effect of maternal exercise, as a healthy intervention, and also the litter size reduction, a model that has been widely used to study early overfeeding in rats. Female Wistar rats were divided into 1) sedentary, and 2) swimming exercise for four weeks, starting one week before mating (5 days/week, 30 min/session). One day after birth, the litter was culled to 8 pups (normal) or 3 pups (small) per dam, yielding control and overfed subgroups for each maternal group, respectively. From postnatal days 2-9 the litter was observed 5 periods a day, to evaluate maternal behavior. Litter reduction caused important alterations in maternal behavior, reducing the total time out of the nest and increasing the frequency of maternal care and lactation in several observation periods, justifying the increased pup's weight gain already demonstrated by this animal model. The practice of maternal exercise did not prevent, but cause the less intensive frequency of non-maternal behavior and lactation in arched-back position, induced by the reduction of litter size. These data demonstrated that small litter size altered maternal behavior, and gestational exercise does not influence significantly these changes.

Highlights • Bdelloids are adaptive models for studying aggregate-metabolism interactions. • Starvation causes reversible organ shrinkage in bdelloids. • The organ shrinkage is in connection with autocatabolic processes. • Beta-amyloid attenuates the starvation-induced germovitellaria shrinkage. • Human-type amyloid-aggregates are metabolism-regulators in two bdelloid species., Investigation of human neurodegeneration-related aggregates of beta-amyloid 1–42 (Aβ42) on bdelloid rotifers is a novel interdisciplinary approach in life sciences. We reapplied an organ size-based in vivo monitoring system, exploring the autocatabolism-related alterations evoked by Aβ42, in a glucose-supplemented starvation model. The experientially easy-to-follow size reduction of the bilateral reproductive organ (germovitellaria) in fasted rotifers was rescued by Aβ42, serving as a nutrient source- and peptide sequence-specific attenuator of the organ shrinkage phase and enhancer of the regenerative one including egg reproduction. Recovery of the germovitellaria was significant in comparison with the greatly shrunken form. In contrast to the well-known neurotoxic Aβ42 (except the bdelloids) with specific regulatory roles, the artificially designed scrambled version (random order of amino acids) was inefficient in autocatabolism attenuation, behaving as negative control. This native Aβ42-related modulation of the ‘functionally reversible organ shrinkage’ can be a potential experiential and supramolecular marker of autocatabolism in vivo.

Objective: While myriads of studies have suggested that a survey of wound pH environment could indicate wound healing activities, it is not clear whether wound alkalinity can be used as a prognostic indicator of nonhealing wounds. Currently available systems cannot reliably assess the pH environment across wounds, which is the objective of this study. Approach: A disposable device, DETEC® pH, was developed and characterized on its ability to map wound alkalinity by pressing a freshly recovered wound dressing against its test surface. By comparing the wound's alkalinity and size reduction rates (∼7 days) following pH measurement, we assessed the capability of wound alkalinity to prognosticate subsequent short-term wound size reduction rates. Results: The device had high accuracy and specificity in determining the alkalinity of simulated wound fluids soaked onto wound dressing. The type of wound dressing type had an insignificant effect on its detection sensitivity. Upon testing discarded wound dressings from human patients, the device quickly determined alkaline and acidic wounds. Finally, statistical analyses of wound size reduction rates in wounds with various alkalinities confirmed that wound alkalinity has a strong influence on, at least, short-term wound healing activity. Innovation: Without directly contacting the patient, this device provides a quick assessment of wound alkalinity to prognosticate immediate and short-term wound healing activities. Conclusion: DETEC® pH may serve as a prognosis device for wound care specialists during routine wound assessment to predict wound healing progress. This information can assist the decision-making process in a clinical setting and augur well for chronic wound treatment. DETEC® pH can also be used as an aid for home health care nurses or health care providers to screen nonhealing wounds outside clinics.

Background Management of erosive Oral Lichen Planus (eOLP) is challenging. Currently, topical corticosteroids are widely used as first-line therapy, but they might be associated with side-effects and incomplete clinical response. Among non-pharmacological strategies, ozone at low medical concentration has proven to induce a mild activation of protective anti-oxidant pathways, thus exerting therapeutic effects in many inflammatory diseases. The aim of this randomized controlled study was to investigate the effectiveness of ozonized water in association with conventional topical corticosteroids for the treatment of eOLP. Material and Methods Fifty-one patients were included in the study and randomized into 2 groups: study group (n=26) included patients receiving ozonized water treatment; control group (n=25) included patients receiving placebo treatment (i.e. double-distilled water). Treatment protocol consisted of 1-minute oral rinses, repeated for 4 times, twice a week for 4 weeks. All patients received conventional corticosteroid topical therapy (betamethasone soluble tablets, 2 rinses/day for 4 weeks). Assessment of size of lesions, sign and pain scores was performed before treatment, after 2 weeks of treatment (T1) and at the end of 4-week treatment (T2). Efficacy Index (EI) of treatment, candidiasis and relapse rates were also recorded. Results All patients experienced significant improvement of sign and pain scores with a higher rate of improvement in ozone-treated group (T1 improvement rates: Thongprasom 92.2% vs 28%; VAS pain 76.9% vs 32%; p

To investigate the safety and efficacy of Self-Assembling Peptide P11-4 (SAP P11-4) compared to placebo or fluoride varnish (FV), a randomized, controlled, blinded, split-mouth study with sequential design was conducted. Subjects presenting two teeth with White-Spot-Lesions (WSLs) were included and teeth were randomly assigned to test or control. Control received placebo at baseline (D0) and test SAP P11-4, all received FV at Day 90 (D90). Standardized photographs were taken at each visit, and WSL size changes were morphometrically assessed. Hierarchical Linear Modelling, considering paired and sequential design, was used to test four hypotheses. SAP P11-4 lesions (test, D90–D0) showed significant WSL size reduction compared to placebo (control, D90–D0; p = 0.008) or FV (control, D180–D90; p = 0.001). Combination of SAP P11-4 and delayed FV after 90 days (test, D180–D0), showed a significant difference compared to FV alone (control D270–D90; p = 0.003). No significant difference on FV efficacy was found when SAP P11-4 was applied 3 months before FV (test D270–D90; control D270–D90, p = 0.70). SAP P11-4 treatment resulted in superior caries regression compared to either placebo or FV, and FV efficacy seems not to be affected by SAP P11-4. SAP P11-4 was found to be a safe and effective WSL treatment.

In these days, more focus is made in improving the immune system and curing diseases by using food and food-related products. In these contexts, fruits are being extensively used to treat and prevent diseases. After utilization of fruits and vegetable, huge amount of waste is generated during pre- and post-harvesting process. This produced waste is generally discarded as waste in the dump yards which is hazardous to the environment. However, recent studies have confirmed that fruit and vegetable peel (FVP) waste can be a valuable source of bioactive compounds, due to the presence of steroids, phenolics, tannins, flavonoids, triterpenoids, glycosides, carotenoids, ellagitannins, anthocyanins, vitamin C and essential oil. These compounds can add value to the FVP if extracted efficiently. Several economically valuable products having superior medicinal, nutritional and antioxidant properties can be obtained from FVPs by various processes like drying, size reduction, fermentation, solvent extraction and many more. The bioactive compounds in the FVP show its various uses in the treatment of wounds, acne, diarrhoea, gastroenteritis and rotavirus enteritis, allergies, malaria, coughs, degenerative muscular diseases, bacterial/fungal infections, cancer, cardiovascular disorder, diabetes, liver diseases, dental plaque, inflammatory ailments including rheumatism, menstrual pain, etc. This chapter reviews the antioxidant, antiatherogenic, antimicrobial, antiallergenic, anti-inflammatory, antithrombotic, cardioprotective and vasodilatory properties of some commonly used FVP. This will help to obtain the maximum health benefits and maximize the industrial profits.

IntroductionIntracardiac rhabdomyomas can cause severe ventricular dysfunction and outflow tract obstruction.Case reportA term newborn infant with antenatal diagnosis of giant left ventricle rhabdomyoma presented with cardiac failure and duct-dependent systemic circulation after birth. She was treated successfully with everolimus, showing decrease in tumour size and improvement in left ventricular ejection fraction.DiscussionTumour regression rate was 0.32 cm2/day and improved to 0.80 cm2/day with the use of everolimus. Herein we report a newborn with inoperable giant left ventricular cardiac rhabdomyoma and significant regression of the tumour. To our knowledge, this is the largest left ventricular rhabdomyoma reported. A review of the literature was undertaken for comparison.ConclusionEverolimus has proven to be efficacious in size reduction of cardiac rhabdomyomas in cases when surgical resection is not possible.

In our previous study, media milling was found to significantly increase the content of diosgenin in aqueous yam suspensions via size reduction. This study is a continuation to understand the estrogenic activity of the media-milled yam using diosgenin as a reference material. We have examined the effects of the media-milled yam on estrogen level in a yeast strain expressing hERβ and the proliferation of two cancer cell lines (MCF-7 and Ishikawa). As a common form of estrogen, 17β-estradiol exhibited high estrogenic activity, and enhanced the growth of both cancer cell lines. Diosgenin also exhibited estrogenic activity, but inhibited the growth of both cancer cell lines. The media-milled yam yielded an estrogen equivalent of 1.65 × 10−4 g/g with a moderate inhibition on the growth of both cancer cell lines. The data indicated that diosgenin was the major compound for the estrogenic activity and inhibition on cancer cells exerted by the media-milled yam.

Purpose Due to donor/recipient size matching challenges, lung transplant candidates height may pose a significant disadvantage for receiving a transplant, resulting in longer wait times and increased waitlist mortality. We hypothesize that a proactive approach focused on donor lung size reduction improves access to transplantation with equivalent post-operative outcomes. Methods We retrospectively reviewed our experience with transplant candidates listed from Jan 2010 to May 2019. Since January 2016, our program considers surgical downsizing of donor lungs via non-anatomical reduction or lobar transplantation whenever LAS prioritization recommends matching to a shorter stature candidate and downsizing is anatomically feasible. We compared this cohort of patients (recent era) to those from our early era in which size reduction was not proactively performed (Jan 2010- Dec 2015). We excluded pediatric, redo and multiorgan transplants. Our primary endpoint was waitlist mortality or removal due to clinical deterioration. Secondary endpoints were time to transplant and post-operative outcomes. Results We included 410 patients with 226 in the early era and 184 in the recent era. Age (mean 54.46 vs 57.87) and LAS (mean 44.73 vs 44.18) were comparable between both groups. Donor characteristics were similar between periods. The number of patients with surgically downsized grafts was significantly higher in the current period compared to the early period (n=62; 34.4% vs n=20; 8.9%; p Conclusion Removal of size restrictions through proactive surgical downsizing improved access to transplantation. Despite more technically demanding, this change in practice has not impacted postoperative outcomes. The significant decreases in waitlist mortality and wait times suggest that this approach is able to address a significant disparity in our field.

Objective Some authors have hypothesized that caloric restriction (CR) could determine a reduction in the onset of some types of cancer and in their progression. The aim of the study is to compare the efficacy of CR combined with neoadjuvant chemotherapy versus a standard diet combined with neo-CT in women with breast cancer (BC). Methods and procedures 81 patients were enrolled, 22 in the CR group and 59 in the control group. CR scheme was designed as follow: caloric intake reduced by 50% of total energy expenditure in the 48h before and in the neo-CT day; by 30% the following days until T2 (6 months). Results The analysis at T2 are showing that in the CR group 72,2% had a complete response to the treatment while in the control group the 28,8% had a complete response. The results highlight a positive effect of the CR on the response to the therapy (OR=4.12 95%CI from 1.29 to 13.11). Conclusion The results obtained show that CR, monitored by a nutritionist and a trained dietitian, could represent an effective and inexpensive method in strengthening the cytotoxicity of standard neo-CT, both in terms of size reduction and malignancy reduction in BC, leading to a better clinical outcome.

Glioblastoma resists chemoradiotherapy, then, recurs to be a fatal space-occupying lesion. The recurrence is caused by re-growing cell populations such as glioma stem cells (GSCs), suggesting that GSC populations should be targeted. This study addressed whether a novel anti-cancer drug, OTS964, an inhibitor for T-LAK cell originated protein kinase (TOPK), is effective in reducing the size of the heterogeneous GSC populations, a power-law coded heterogeneous GSC populations consisting of glioma sphere (GS) clones, by detailing quantitative growth properties. We found that OTS964 killed GS clones while suppressing the growth of surviving GS clones, thus identifying clone-eliminating and growth-disturbing efficacies of OTS964. The efficacies led to a significant size reduction in GS populations in a dose-dependent manner. The surviving GS clones reconstructed GS populations in the following generations; the recovery of GS populations fits a recurrence after the chemotherapy. The recovering GS clones resisted the clone-eliminating effect of OTS964 in sequential exposure during the growth recovery. However, surprisingly, the resistant properties of the recovered-GS clones had been plastically canceled during self-renewal, and then the GS clones had become re-sensitive to OTS964. Thus, OTS964 targets GSCs to eliminate them or suppress their growth, resulting in shrinkage of the power-law coded GSC populations. We propose a therapy focusing on long-term control in recurrence of glioblastoma via reducing the size of the GSC populations by OTS964.

Three types of fish bones including fish skull, rib, and backbone were cooked at 120 °C for 20 min to remove tissues and impurities. The fish bones were minced and ground into microscaled particles before treated in a high-energy wet ball mill to obtain nanoparticles. The effects of bone structure on size reduction of fish bone particles during nanomilling and the calcium release properties were investigated. The results showed that fish rib has higher elasticity modulus than fish skull and fish backbone due to its highly ordered structure. Prior to nanomilling of ground fish bones, the particle size of the skull was the greatest followed by backbone and rib. The mean particle size and calcium release were not significantly different after 8-h nanomilling. However, the size reduction and calcium release rates of the nanoparticles were similar between fish skull and backbone while the fish rib had the lowest values in both categories. The kinetics of size reduction during nanomilling and the calcium release properties of the nanoparticles were well described with the first-order exponential decay function and first-order kinetic function, respectively. Correlation analysis indicated that among all mechanical properties, elasticity modulus of fish bone, to the highest degree, determined their size reduction rate and calcium release rate during nanomilling.

Lipografting is emerging as a “rescue” treatment for postoperative sequelae, soft tissue volume defects and refractory fistulas. After complicated laparotomies or colostomies, also peristomal soft tissue volume deficiencies and scarring can occur and lead to severe care problems. Currently, no satisfactory treatment is available for these sequelae resulting in general surgery. In this case report, we applied the operative approach by means of a minimal-invasive scar release combined to waterjet-assisted lipotransfer and sculpturing on the abdominal wall as a treatment of peristomal irregularities. We applied one procedure on a patient with insufficient stoma sealing on large enteroatmospheric fistulas in “frozen” open abdomen (Bjork 4 classification). Clinical and aesthetic outcome were measured and evaluated via digital photographs and CT scan pre- and postoperatively. Size reduction, complete sealing of the stoma appliance and total healing of the peristomal skin damage were accomplished within 5 weeks. Level of Evidence: Level V, therapeutic study.

The effect of simulated mastication (size reduction and α-amylase addition) on lipid digestion and β-carotene bioaccessibility of starch-based filled hydrogels was examined. The mechanical aspects of mastication were simulated by pureeing the hydrogel samples (semi-solid pieces) for 2 min using a mortar and pestle to mimic the chewing process. The microstructure, lipid digestion, and β-carotene bioaccessibility of the filled hydrogels were then measured as the samples were passed through simulated oral, gastric, and small intestinal phases. A filled hydrogel that was not subjected to simulated mastication in the oral phase had small and evenly distributed lipid droplets in the oral and gastric phases, regardless of the presence or absence of α-amylase. However, the lipid droplets in filled hydrogels that were subjected to simulated mastication became aggregated, especially after exposure to α-amylase. There were also appreciable differences in the initial rate of lipid digestion and in carotenoid bioaccessibility depending on whether or not simulated mastication was employed. These results suggest that the mechanical processing of the hydrogels in the simulated oral phase plays an important role in determining their subsequent gastrointestinal fate.

Objective: To evaluate the effectiveness of steroid and 5-fluorouracil (5-FU) injection combination for keloid management. Methods: A 22-year-old female patient was presented with recurrent skin lesions. The skin lesions first appeared 10 years prior to consultation, had been surgically excised, and were given triamcinolone acetonide injection. However, no improvement was observed. A decision was made to use and evaluate treatment using an intralesional 4 mg (0.1 ml of 40 mg/ml) triamcinolone acetonide and 45 mg (0.9 ml of 50 mg/ml ) 5-FU injection combination for 5 weeks. Results: Clinical improvements were observed in the third week as the lesions softened and pruritic sensation dinimished. At the end of the fifth week, improvements in the form of keloid lesion flattening and size reduction were observed. Conclusions: Intralesional injection using a combination of triamcinolone acetonide and 5-fluorouracil is effective for keloid lesion treatment. Keywords: 5-fluorouracil, intralesional injection, keloid, triamcinolone acetonide DOI: 10.15850/ijihs.v5n1.959

The large brain and small postcanine teeth of modern humans are among our most distinctive features, and trends in their evolution are well studied within the hominin clade. Classic accounts hypothesize that larger brains and smaller teeth coevolved because behavioral changes associated with increased brain size allowed a subsequent dental reduction. However, recent studies have found mismatches between trends in brain enlargement and posterior tooth size reduction in some hominin species. We use a multiple-variance Brownian motion approach in association with evolutionary simulations to measure the tempo and mode of the evolution of endocranial and dental size and shape within the hominin clade. We show that hominin postcanine teeth have evolved at a relatively consistent neutral rate, whereas brain size evolved at comparatively more heterogeneous rates that cannot be explained by a neutral model, with rapid pulses in the branches leading to later Homo species. Brain reorganization shows evidence of elevated rates only much later in hominin evolution, suggesting that fast-evolving traits such as the acquisition of a globular shape may be the result of direct or indirect selection for functional or structural traits typical of modern humans.

Techniques for inferior turbinate reduction vary with various surgical methods, which differ in the approach of preservation of tissue from total turbinectomy to limited submucosal cauterization. Our preferred method to address hypertrophic inferior turbinate by mini turbinoplasty-tunneling technique are presented. Critical steps include creation of window in the inferior turbinate with a 4 mm microdebrider blade and removal of both inferior turbinate mucosal hypertrophy and bony component to convert a convex looking inferior turbinate to concave shape. This allows proper debulking of the entire medial aspect of the inferior turbinate and widening of the nasal valve area. Mini turbinoplasty-tunneling technique for hypertrophic inferior turbinates, is a safe method in achieving turbinate size reduction with minimal morbidity and long-term relief of nasal obstructive symptoms without added risk of complications. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12070-018-1292-9) contains supplementary material, which is available to authorized users.