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Objective: To reveal the use of a material called endoprotector designed to prevent contamination in minimally invasive abdominopelvic surgery. Methods: Endoprotector is formed by giving a circular shape to the transparent polyurethane material and passing around it in the form of a pürse-string with a surgical suture. This material, which is used in minimally invasive surgeries by inserting it into the abdomen through a trocar hole and laying it on the floor of the operating area, has been in the patent process. Results: It is characteristic that it is a new product, called endoprotector, and the use of a laparoscopic protective drape is a new technique. At the end of the procedure, the extension of the suture shrinks by pulling from the trocar, and the formed pouch is taken out of the abdomen together with the trocar. Difficulty in removing the trocar from within is the only known shortcoming of the technique. Conclusion: Endoprotector is designed to prevent contamination in minimally invasive surgery. It reduces peritonitis and intra-abdominal infections, the need for irrigation, and the use of drains, thus shortening postoperative ileus and hospital stay; and predicted to reduce outcomes such as tumor implantation.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing COVID-19 has been a dynamically changing virus, requiring the development of adapted vaccines. This study estimated the potential public health impact alternative vaccination strategies for COVID-19 in Singapore.Research Design and Methods The outcomes of alternative vaccination strategies with a future adapted vaccine were estimated using a combined Markov decision tree model. The population was stratified by high- and standard-risk. Using age-specific inputs informed by local surveillance data and published sources, the model estimated health (case numbers, hospitalizations, and deaths) and economic (medical costs and productivity losses) outcomes in different age and risk subpopulations.Results Booster vaccination in only the elderly and high-risk subpopulation was estimated to avert 278,614 cases 21,558 hospitalizations, 239 deaths, Singapore dollars (SGD) 277 million in direct medical costs, and SGD 684 million in indirect medical costs. These benefits increased as vaccination was expanded to other subpopulations. Increasing the booster vaccination coverage to 75% of the standard-risk population averted more deaths (3%), hospitalizations (29%), infections (145%), direct costs (90%), and indirect costs (192%) compared to the base case.Conclusions Broader vaccination strategies using an adapted booster vaccine could have substantial public health and economic impact in Singapore.

This study addresses the need to evaluate the social sustainability of pavement management decisions, particularly during the use and maintenance stages. While Life Cycle Assessment (LCA) and Life Cycle Cost Analysis (LCCA) are well-established for assessing environmental and economic impacts, Social Life Cycle Assessment (S-LCA) remains understudied for pavements, especially within the context of pavement management. This research introduces a methodology using the Capability Approach to quantify social impacts, emphasizing their importance, relevance, and influenceability. The resulting framework provides a working list of key social impacts such as fatalities, bodily health, mobility, comfort, environmental emissions, financial impact, and equity. These impacts are particularly relevant during the use and maintenance stages of pavement life cycle, where management decisions directly affect road users and surrounding communities. A case study illustrates the application of this framework, analyzing pavement conditions and their social impacts on communities. This study offers a structured approach for integrating social sustainability into pavement management decisions.

This narrative review describes pneumococcal serotype prevalence for invasive disease and carriage and antibiotic resistance among specimens collected from children in countries across South and Southeast Asia from 2012 to 2024. Literature search retrieved 326 articles; 96 were included. The prevalence of pneumococcal serotypes varied geographically and over time after introduction of pneumococcal conjugate vaccine. Serotypes common in both pneumococcal carriage and disease were 6A, 6B, 14, 15B/15C, 19F, and 23F; serotypes 1, 3, 5, 19A, 15A, 10A, and 35B were also common in disease. Most of these serotypes are included in the 13-valent and 10-valent PCV. Carriage and disease isolates remained generally highly susceptible to vancomycin (mostly 100%) and levofloxacin (mostly >97%). These findings indicate that vaccine-preventable serotypes contribute significantly to pneumococcal disease burden in children in South and Southeast Asia. Consistency of national immunization programs with World Health Organization recommendations may reduce rates of pneumococcal disease in this region.

Two new mechanisms for downstream ice growth (i.e., downstream of the primary ice shape) in aircraft icing scenarios were investigated. The first mechanism is local variation of relative humidity with its potential for water deposition due to supersaturation. The second mechanism is induced-vortex effects due to their potential impact on droplet paths. It was shown that for rough surfaces with an extended period of exposure, relative humidity effects can lead to additional growth. The resultant frost is a sandpaperlike roughness that can severely degrade the aerodynamic performance of the wings. It was also shown that the vortices induced by the existing ice-shape features are capable of altering the droplet paths. As a result, impingements occur beyond the limits predicted by the methods in other icing prediction codes. DOI: 10.2514/1.28794

Abstract The social pillar of pavement sustainability is understudied compared to economic and environmental pillars, making it difficult to integrate into life-cycle methodologies. While methods such as social life cycle assessment (S-LCA) exist, they usually focus on social governance rather than quantifying the impact of pavement investment decisions on communities. This study introduces a methodology to quantify the impact of road condition on vulnerable communities, specifically Environmental Justice (EJ) communities. The methodology calculates the impact of road condition on residents and analyzes fuel consumption (as an example impact) for road users during recurrent home-work trips as a function of pavement condition for EJ and non-EJ communities. It was found that EJ communities in Massachusetts are twice as likely to live near poor condition roads and consume twice as much excessive fuel during recurrent home-work trips. The proposed method is designed to integrate into existing life-cycle methods and represents a significant step towards integrating equity into pavement management decisions.

Background Coronavirus disease 2019 (COVID-19) case numbers have increased following the emergence of the Omicron variant. This study estimated the impact of introducing and increasing the coverage of an Omicron-adapted bivalent booster vaccine in Malaysia. Research Design and Methods A combined cohort Markov decision tree model was used to compare booster vaccination with an Omicron-adapted bivalent COVID-19 vaccine versus no booster vaccination in Malaysia. The model utilized age-specific data from January 2021 to March 2022 derived from published sources. The outcomes of interest included case numbers, hospitalizations, deaths, medical costs, and productivity losses. The population was stratified into high-risk and standard-risk subpopulations, and the study evaluated the benefits of increased coverage in different age and risk groups. Results Vaccinating only high-risk individuals and those aged ≥ 65 years was estimated to avert 274,313 cases, 33229 hospitalizations, 2,434 deaths, Malaysian ringgit (MYR) 576 million in direct medical costs, and MYR 579 million in indirect costs. Expanding vaccination coverage in the standard-risk population to 75% was estimated to avert more deaths (31%), hospitalizations (155%), infections (206%), direct costs (206%), and indirect costs (281%). Conclusions These findings support broader population Omicron-adapted bivalent booster vaccination in Malaysia with potential for significant health and economic gains.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing COVID-19 has continuously evolved, requiring the development of adapted vaccines. This study estimated the impact of the introduction and increased coverage of an Omicron-adapted bivalent booster vaccine in Thailand. Research Design and Methods The outcomes of booster vaccination with an Omicron-adapted bivalent vaccine versus no booster vaccination were estimated using a combined cohort Markov decision tree model. The population was stratified into high- and standard-risk subpopulations. Using age-specific inputs informed by published sources, the model estimated health (case numbers, hospitalizations, and deaths) and economic (medical costs and productivity losses) outcomes in different age and risk subpopulations. Results Booster vaccination in only the elderly and high-risk subpopulation was estimated to avert 97,596 cases 36,578 hospitalizations, 903 deaths, THB 3,119 million in direct medical costs, and THB 10,589 million in indirect medical costs. These benefits increased as vaccination was expanded to other subpopulations. Increasing the booster vaccination coverage to 75% of the standard-risk population averted more deaths (95%), hospitalizations (512%), infections (782%), direct costs (550%), and indirect costs (687%) compared to the base case. Conclusions Broader vaccination with an Omicron-adapted bivalent booster vaccine could have significant public health and economic benefits in Thailand.

Abstract Periosteal or osteoperiosteal medial femoral condyle (MFC) flaps may be good options for atrophic nonunion. The aim of this study was to evaluate the effectiveness and safety of pedicled MFC flap in the treatment of recalcitrant femur nonunion without bone defect. Thirteen patients (11 male and 2 female), who suffered recalcitrant femur nonunion and were treated with pedicled osteoperiosteal MFC flap between January 2014 and April 2018, were included in this study. Patient files were reviewed retrospectively. Atrophic or recalcitrant 2/3 distal femoral nonunion were the indications for this clinical procedure. Demographics and operative data, flap size, visual analog scale (VAS) score, time to union, and complications were evaluated. A total of 13 patients underwent femur nonunion treatment with MFC flap after an average of 3.4 previous surgical procedures. The median age was 34 (Q1: 32.5, Q3:43) years old. The mean flap size was 4.3 × 6.4 cm, all nonunions healed in a median 5 months (Q1: 4.5, Q3: 6). There were an intraoperative knee medial collateral ligament injury in a patient, hematoma in a patient, and seroma in two patients. The median length of the follow-up was 40 months (Q1: 30, Q3: 47). There wasn’t any additional complication in long-term follow-up. Functional outcomes were satisfactory. The median preoperative VAS score was 7 (Q1: 6, Q3: 9.5), decreasing to 1 (Q1: 0, Q3: 1) at the 6-month follow-up, and further reducing to 0 (Q1: 0, Q3: 1) at the 24-month follow-up. The nonunion period ranged from 6 to 18 months. The pedicled MFC flap is a good option for recalcitrant femur nonunion where larger vascularized flaps are not warranted. It is easy to harvest, does not require microvascular anastomosis, is effective, and offers minimal donor site morbidity.

IntroductionEpidemiological modeling is widely used to offer insights into the COVID-19 pandemic situation in Asia. We reviewed published computational (mathematical/simulation) models conducted in Asia that assessed impacts of pharmacological and non-pharmacological interventions against COVID-19 and their implications for vaccination strategy.MethodsA search of the PubMed database for peer-reviewed, published, and accessible articles in English was performed up to November 2022 to capture studies in Asian populations based on computational modeling of outcomes in the COVID-19 pandemic. Extracted data included model type (mechanistic compartmental/agent-based, statistical, both), intervention type (pharmacological, non-pharmacological), and procedures for parameterizing age. Findings are summarized with descriptive statistics and discussed in terms of the evolving COVID-19 situation.ResultsThe literature search identified 378 results, of which 59 met criteria for data extraction. China, Japan, and South Korea accounted for approximately half of studies, with fewer from South and South-East Asia. Mechanistic models were most common, either compartmental (61.0%), agent-based (1.7%), or combination (18.6%) models. Statistical modeling was applied less frequently (11.9%). Pharmacological interventions were examined in 59.3% of studies, and most considered vaccination, except one study of an antiviral treatment. Non-pharmacological interventions were also considered in 84.7% of studies. Infection, hospitalization, and mortality were outcomes in 91.5%, 30.5%, and 30.5% of studies, respectively. Approximately a third of studies accounted for age, including 10 that also examined mortality. Four of these studies emphasized benefits in terms of mortality from prioritizing older adults for vaccination under conditions of a limited supply; however, one study noted potential benefits to infection rates from early vaccination of younger adults. Few studies (5.1%) considered the impact of vaccination among children.ConclusionEarly in the COVID-19 pandemic, non-pharmacological interventions helped to mitigate the health burden of COVID-19; however, modeling indicates that high population coverage of effective vaccines will complement and reduce reliance on such interventions. Thus, increasing and maintaining immunity levels in populations through regular booster shots, particularly among at-risk and vulnerable groups, including older adults, might help to protect public health. Future modeling efforts should consider new vaccines and alternative therapies alongside an evolving virus in populations with varied vaccination histories.

In this study, we propose a generalized Marshall-Olkin exponentiated exponential distribution as a submodel of the family of generalized Marshall-Olkin distribution. Some statistical properties of the proposed distribution are examined such as moments, the moment-generating function, incomplete moment, and Lorenz and Bonferroni curves. We give five estimators for the unknown parameters of the proposed distribution based on maximum likelihood, least squares, weighted least squares, and the Anderson-Darling and Cramer-von Mises methods of estimation. To investigate the finite sample properties of the estimators, a comprehensive Monte Carlo simulation study is conducted for the models with three sets of randomly selected parameter values. Finally, four different real data applications are presented to demonstrate the usefulness of the proposed distribution in real life.

Viabilities of three different probiotic starters (LGG, LA-5, and ABT-2) inoculated to the formulations (F1-9) based on blends of apple juice and some vegetable extracts containing fructooligosaccharide and lactitol were monitored during fermentation and cold storage. Storage quality and stability of formulations in terms of physicochemical and antioxidant properties and sensory evaluation were investigated. F7 (Apple Juice + Cucumber extract + Carrot extract; 1 : 1 : 1, v/v/v) was the most successful among the formulations in terms of probiotic growth with more than 7 logs CFU‧mL-1 for all starters after fermentation at 37 °C for 24 h. F8 (Apple Juice + Cucumber extract (1 : 1, v/v) + 2 % FOS + 4 % Lactitol) come second for only LGG starter. Among the starters, LGG strain maintained its required viability with more than 6 logs CFU‧mL-1 in the formulations (F7-9) during cold storage. The viabilities of LA-5 and ABT-2 with more than 7 logs at the beginning of the storage periods constantly decreased below 1 log and 3 logs, respectively. Antioxidant properties of the probiotic beverages did not change significantly during the fermentation and storage period. F9 (Apple juice + Cucumber extract + Carrot extract (1 : 1 : 1, v/v/v) + 2 % FOS + 4 % Lactitol) was the most preferred formulation compared to all other formulations.

PURPOSEIn this study, we aimed to assess the effectiveness of malignancy stratification algorithms of the American College of Radiology (ACR) and European Thyroid Association (ETA) in the delineation of thyroid nodules using a database of nodules that were unequivocally diagnosed by means of histopathological examination and meticulously matched with the imaged nodules.METHODSA total of 165 patients having 251 thyroid nodules with histopathologically proven definitive diagnoses during a 5-year period were included in this study. All patients had preoperatively undergone ultrasonography (US) examination, and US characteristics of the thyroid nodules were retrospectively analyzed and assigned in compliance with the thyroid imaging reporting and data system categories recommended by the ACR (ACR-TIRADS) and ETA (EU-TIRADS). The diagnostic effectiveness in the delineation of thyroid nodules and unnecessary fine-needle aspiration (FNAB) rates were evaluated.RESULTSOverall, 189 nodules (75.30%) were diagnosed as benign, while 62 nodules (24.70%) were reported to be malignant based on histopathological assessment. Sensitivity and specificity rates were 71% and 75% for ACR-TIRADS and 73% and 80% for EU-TIRADS. The area under the curve values were 0.78 and 0.80 for ACR-TIRADS and EU-TIRADS, respectively. The unnecessary FNAB rates were 61% for ACR-TIRADS and 64% for EU-TIRADS as per the recommended criteria of each algorithm.CONCLUSIONThe diagnostic performance of both malignancy stratification systems was signified to be moderate and sufficient in a cohort of nodules with definite histopathological diagnosis. In light of our results, we demonstrated the strengths and weaknesses of the ACR- and EU-TIRADS for physicians who should be familiar with them for optimal management of thyroid nodules.

In this study, we describe the synthesis, characterization and antiproliferative activity of three organo-ruthenium(II) half-sandwich complexes [RuCl(η6-p-cym)(N,S-L)]Cl (I, II, and III). To form these complexes, three thiosemicarbazone ligands (TSCs) were synthesized; L = 5-nitro-2-carboxyaldehyde-thiophen-N-methyl-thiosemicarbazone, (L1); 2-acetyl-5-bromo-thiophen-N-methyl-thiosemicarbazone, (L2) and 2-acetyl-5-bromo-thiophen-N,N-dimethyl-thiosemicarbazone, (L3). The isolated compounds were analyzed using spectroscopic techniques such as elemental analysis, conductance measurements, FT-IR, 1H NMR spectroscopy, MALDI-TOF mass spectrometry, and single-crystal XRD. Our results demonstrated that the synthesized thiosemicarbazone ligands (TSCs) are bound to the metal ion as a bidentate ligand that coordinates through the thiocarbonyl sulfur and azomethine nitrogen atoms in all complexes (I, II, and III). The X-ray crystal structures of L1 and L2 revealed that both compounds are crystallized in the triclinic crystal system with space group P-1. The biological potency of newly synthesized TSC ligands (L1, L2, and L3) and their corresponding ruthenium complexes (I, II, and III) were investigated on human primary ovarian (A2780) and human metastatic ovarian (OVCAR-3) cell lines. To get detailed information respecting antitumor properties, cytotoxicity, DNA/BSA binding affinity, cellular uptake, DNA binding competition, and trans-epithelial resistance measurement assays were performed. Our results demonstrate that newly synthesized ruthenium(II) complexes possess potential biological activity. Moreover, we observe that the ruthenium complexes reported here show anticancer activity on primary (A2780) and metastatic (OVCAR-3) ovarian cancer cells.

Objective: To compare the differences in the clinical course of acute appendicitis between early elderly (60-79 years) and late elderly patients (≥80 years). Method: The sample consisted of 177 patients aged over 60 that underwent surgery at the emergency service with the diagnosis of acute appendicitis between January 2010 and May 2018. Patients’ data were retrospectively obtained from electronic records. Patients that had undergone appendectomy or negative appendectomy or had an appendix tumor were excluded from the study. The patients were divided into two groups by age; early elderly (60-79 years) and late elderly (≥80 years). Results: Of the 177 patients included in the study, 162(91%) were 60-79 years old and 15 (9%) were over 80. A statistically significant difference was found between the early and late elderly groups in terms of perforation, requirement for intensive care (p =0.001), red cell distribution width (p =0.025), the Clavien-Dindo classification (p =0.020), and the Charlson comorbidity index (p =0.005). The mean hospital stay was four and 11 days for early and late elderly groups, respectively. Multivariate analysis revealed that age alone was an independent factor with a statistically significant effect on mortality (OR=Odds Ratio: 53, 95% CI: 16.91-166.08; (p

A Bayesian belief network (BBN) methodology is developed for integrating CO2 leak detection inferences from multiple monitoring technologies at a geologic sequestration site. The methodology is demonstrated using two monitoring methods: near-surface soil CO2 flux measurement and near-surface perfluoromethylcyclohexane (PMCH) tracer monitoring, from the Zero Emission Research and Technology (ZERT) release test in 2007. Statistical models are fitted to natural background soil CO2 flux and background PMCH tracer concentrations to determine critical levels for leak inference. Leakageinduced increments of soil CO2 flux and PMCH tracer concentrations are computed through TOUGH2 simulations for different leakage rates and subsurface permeabilities. The background characterizations and the simulation results are subsequently used to determine the conditional probabilities of leak detection in the BBN model. The BBN model is illustrated for use in evaluating the performance of alternative monitoring networks in a network design phase, and for combining inferences from multiple observations in the operational phase of a site. The detection capabilities of combined networks with different monitoring densities for soil CO2 flux and PMCH tracer concentration are compared. Given the test condition, the greater sensitivity of the PMCH tracer allows it to detect smaller leaks, while detection by the soil CO2 flux monitors implies that a larger leak is most likely present. [ABSTRACT FROM AUTHOR]

The present study aimed to determine the cost of childhood pneumococcal infections under 5 years of age and to provide further data for future health economy studies. Electronic medical records of children diagnosed with meningitis caused by S. pneumoniae and all-cause pneumonia, and acute otitis media (AOM) between January 2013-April 2014 were retrospectively evaluated. Direct costs for the treatments of hospitalized patients (pneumonia and pneumococcal meningitis) including costs of healthcare services consisted of costs of hospital bed, examination, laboratory analyses, scanning methods, consultation, vascular access procedures, and infusion and intravenous treatments. Direct costs for patients (AOM) treated in outpatient setting included constant price paid for the examination and cost of prescribed antibiotics. Indirect costs included cost of work loss of parents and their transportation expenses. Data of 130 children with pneumococcal meningitis (n = 10), pneumonia (n = 53), and AOM (n = 67) were analyzed. The total median cost was €4,060.38 (direct cost: €3,346.38 and indirect cost: €829.18) for meningitis, €835.91 (direct cost: €480.66 and indirect cost: €330.09) for pneumonia, and €117.32 (direct cost: €17.59 and indirect cost: €99.73) for AOM. The medication cost (p = 0.047), indirect cost (p = 0.032), and total cost (p = 0.011) were significantly higher in pneumonia patients aged ≥36 months than those aged

Background: Although laser depilation has been performed for removal or reduction of unwanted and dark-colored hair in recent years, techniques including the appropriate approaches for different skin types and body areas have not yet been optimized.Objective: We review the principles of laser hair removal and report a retrospective study of 322 patients who received long-pulse alexandrite laser hair removal for 3 or more sessions between January 2000 and December 2002.Methods: Prior to treatment, patients were evaluated by a physician and informed of the mechanism, efficacy, and possible side effects of treatment. Patients were classified by skin type according to the Fitzpatrick classification. Those patients with systemic disease, a history of sun sensitivity, or who had used drugs known to cause photosensitivity were excluded from laser treatment. All treatments were performed with a long-pulse alexandrite laser with a constant spot size (18 mm) and 3-ms pulse width that applied energy of 755 nm. Sessions were repeated at different intervals depending on the body parts to be treated.Results: The overall hair reduction rate for all patients, independent of skin type, was estimated as 80.8%. There were 2 cases of hypopigmentation and 8 cases of hyperpigmentation post-treatment. No other complications were reported.Conclusions: Treatment with the long-pulse alexandrite laser can meet the expectations of patients who desire permanent hair removal. Careful examination of patients prior to therapy, as well as thorough patient education, are essential to patient compliance and success with this technique. [ABSTRACT FROM AUTHOR]

Purpose: For reconstruction of intraoral and lower face defects, it is important to use flaps that prevent reliable and pliable soft tissue and it is possible to use aesthetically most compatible with recipient site. In this study, the authors aimed to present their clinical experiences and results of lower face and intraoral defects reconstructions with submental artery island perforator flap without including the digastric muscle to have a thinner and useful flap., Methods: Six patients with lower face and intraoral defects that were reconstructed using the submental artery island flap between November 2013 and February 2015 were retrospectively analyzed. Patient demographics, age, sex, defect etiologies, and complications were assessed., Surgical Technique: Hand Doppler examination was performed and submental artery marked preoperatively. The superior border of the flap was designed at least 1 cm away from the mandibular border to avoid injury to the marginal mandibular nerve and prevent lip eversion. After the identification of the submental artery via the retrograde dissection, the anterior belly of the digastric muscle was not included the flap to prevent a thinner flap. After the dissection, the island flap was transferred to the defect site through a subcutaneous tunnel. The donor sites were closed primarily., Results: A partially flap necrosis was occurred in 1 patient due to hematome in the tunnel around the pedicle. The wound healed uneventfully with conservative management. In the remaining patients there were no complications., Conclusion: The submental artery perforator island flap without including the digastric muscle is a reliable and suitable option for the medium-sized defects in the lower face and intraoral defects.

Purpose: The aim of this study was to perform a retrospective analysis of patients who underwent periorbital area reconstructions, determine their sociodemographic characteristics, analyze the effects of defect etiologies and locations classified according to periorbital subunits on our reconstruction options, and to present our treatment outcomes and clinical experience., Methods: A retrospective chart review of 23 patients operated in our department between January 2010 and March 2013 and underwent periorbital area reconstructions, was performed. In addition to the demographic characteristics of the patients; defect etiologies, locations according to Spinelli aesthetic subunits, and the degrees of involvement were determined., Result: Analysis of the reconstructive methods showed that primary closure with lateral cantholysis was performed in 1 patient with a defect involving less than 50% of zone 1 along with a partial defect involving less than 50% of zone 2. In another patient with a full-thickness defect involving 75% of zone 1, reconstruction was made with a temporally based monopedicle forehead transposition (Fricke) flap prepared from the lower eyelid, and a conchal cartilage graft. In 2 other patients with partial defects involving more than 50% of zone 2; reconstruction was made with full-thickness skin grafts taken from the retroauricular area. Four patients had full-thickness defects that involved 50% to 75% of zone 2; 3 of them were reconstructed with a Tenzel lateral semicircular rotation flap and 1 with a Tripier flap. In 3 patients who had full-thickness defects involving 75% of zone 2; reconstruction was made with a paramedian forehead flap and conchal cartilage graft. In 3 patients with full-thickness defects involving more than 75% of zone 2, a Mustarde cheek rotation flap was used for reconstruction. Six patients had defects in zone 3, 3 of them were reconstructed with a glabellar flap, 2 with a paramedian forehead flap, and 1 with a bilobed flap. One patient with a defect that involved 50% of zone 4 was reconstructed with a McGregor flap., Conclusions: Construction of a reconstructive algorithm by separation of the eyelid into aesthetic units and use of local healthy tissues provide functionally and aesthetically acceptable results.

Unlabelled: Impaired wound healing in humans under psychological stress and the positive effects of antidepressant drugs on wound healing were also shown in the literature. However, there are currently no studies regarding the effects of antidepressant drugs on tendon healing. The aim of this study was to compare tendon healing under normal conditions versus social stress. We also aimed to perform a histological and biomechanical analysis of the effects of the antidepressant drug fluoxetine on tendon healing. Sixty Sprague Dawley rats were divided into six groups. A social stress regimen was used to stress the rats. The use of fluoxetine in the social stress group yielded significantly better biomechanical results and the collagen organizations of the fluoxetine group were more similar to the normal tendon collagen organization. Fluoxetine seems to inhibit the negative effects of stress on tendon healing and seems to improve tendon healing., Levels of Evidence: Level 5.

Abdominal wall hernias are often diagnosed on clinical examination or encountered intraoperatively during an abdominoplasty. The aim of this study is to evaluate the long-term results of the use of dermal automesh for the repair of incidental hernias during abdominoplasty operations, and to perform a comparative analysis of the biomechanical strengths of dermal automesh vs biological tissue graft. Between 2008-2012, dermal automesh was used in 12 patients for hernia repair. After repair of hernia, dermal automesh was applied over the repaired area in an onlay fashion. Postoperative follow-up was performed by physical examination and magnetic resonance imaging (MRI) of the abdominal wall. Biomechanical test was performed with prepared samples from excised abdominal panniculus for tensile strength and yield power. Mean age was 45 years (range = 36-54 years). Total follow-up was 26 (14-52) months. MRI studies showed that there were no hernias or defects of the anterior abdominal wall. The tensile strength of the dermal mesh was measured as 15.9 ± 6.0 Mpa (6.4-24.5), maximum load before yield measured 680 ± 175.2 N (336.0-856.0). In conclusion, dermal automesh is a useful option for surgeons who encounter undiagnosed hernias during abdominoplasties.

Conventional anastomosis with interrupted sutures can be time-consuming, can cause vessel narrowing, and can lead to thrombosis at the site of repair. The amount of suture material inside the lumen can impair the endothelium of the vessel, triggering thrombosis. In microsurgery, fibrin sealants have the potential beneficial effects of reducing anastomosis time and promoting accurate haemostasis at the anastomotic site. However, there has been a general reluctance to use fibrin glue for microvascular anastomoses because the fibrin polymer is highly thrombogenic and may not provide adequate strength. To overcome these problems, a novel technique was defined for microvascular anastomosis with fibrin glue and a venous cuff. Sixty-four rats in two groups are included in the study. In the experimental group (n = 32), end-to-end arterial anastomosis was performed with two stay sutures, fibrin glue, and a venous cuff. In the control group (n = 32), conventional end-to-end arterial anastomosis was performed. Fibrin glue assisted anastomosis with a venous cuff took less time, caused less bleeding at the anastomotic site, and achieved a patency rate comparable to that provided by the conventional technique. Fibrin sealant assisted microvascular anastomosis with venous cuff is a rapid, easy, and reliable technique compared to the end-to-end arterial anastomosis.

Lip carcinoma is one of the most common cancers of the head and neck region. Lower lips are more frequently affected. Squamous cell carcinoma accounts for more than 95% of the cases. The aim of treatment is to achieve the highest cure rates with adequate excision with clear surgical margins while leaving the smallest defect sizes behind for reconstruction. Excised tissue is known to shrink when removed, in relation with its retractile properties. In this study, the evaluation of the amount of shrinkage in excised lip cancer specimens and determination of the relation between surgical and histopathologic margins were aimed. The study included 21 consecutive excised lip specimens for the treatment of squamous cell carcinoma of the lip. The volume of the specimen, tumor length, and margin distance measurements were measured and recorded step by step from before surgical excision to histopathologic evaluation. Specimens were evaluated in a standardized fashion by the same pathologist after 48 hours of fixation. For data analysis, Number Cruncher Statistical System 2007 and Power Analysis and Sample Size 2008 Statistical Software (Kaysville, UT) were used. The surgical margins of the excised lip specimen shrink up to 41% to 47.5% from before excision to histopathologic evaluation. The most significant step was the excision step, followed by the formalin fixation step. The histopathologic process itself and the duration of formalin fixation did not result a significant change in surgical margins. The tumor tissue itself did not show a significant shrinkage.

Aim. The classic inguinal lymph node dissection is the main step for the regional control of the lower extremity melanoma, but this surgical procedure is associated with significant postoperative morbidity. The permanent lymphedema is the most devastating long-term complication leading to a significant decrease in the patient's quality of life. In this study we present our experience with modified, saphenous vein sparing, inguinal lymph node dissections for patients with melanoma of the lower extremity. Methods. Twenty one patients (10 women, 11 men) who underwent saphenous vein sparing superficial inguinal lymph node dissection for the melanoma of lower extremity were included in this study. The effects of saphenous vein sparing on postoperative complications were evaluated. Results. We have observed the decreased rate of long-term lymphedema in patients undergoing inguinal lymphadenectomy for the lower extremity melanoma. Conclusion. The inguinal lymphadenectomy with saphenous vein preservation in lower extremity melanoma patients seems to be an oncologically safe procedure and it may offer reduced long-term morbidity.

Autologous fat grafts have been used successfully for structural fat grafting in facial, lip, and hand rejuvenation, body contour improvement, and traumatic defect restoration. The purposes of this study were to define a new fat graft harvesting and processing technique, which is named the "Lopasce technique" (low-pressure aspiration and slow centrifugation technique), and to evaluate the late clinical outcomes of fat grafting by this technique for different indications. A retrospective study was performed using the medical records of 21 patients (17 women and four men). The mean injected fat volume was 33.2 ± 34 cc (range 6-125 cc). The mean follow-up period was 13.2 ± 5.6 months (range 6-26 months). Postoperative results were evaluated by subjective and objective methods. In the subjective evaluation, 19 patients stated that there had been little resorption and that it was not necessary to repeat the fat grafting, one patient reported that the fat was resorbed in part, and one patient reported that the fat was resorbed completely. In the objective evaluation, the amount of fat graft taken in the recipient sites was between 60%-80% (average 70%) when compared with preoperative and late postoperative photographs of the patients at the 6- and 26-month follow-ups. Fat grafting is a simple, effective, and reproducible technique with a high satisfaction rate and few disadvantages or complications. We consider that structural fat grafting with the lopasce technique is an easy, effective, and long-lasting treatment for correction of congenital or acquired defects associated with various medical conditions.

Frontal sinus fractures constitute 5% to 15% of maxillofacial fractures, and isolated anterior table injuries account for 33% of frontal sinus fractures. The treatment strategy of frontal sinus fractures should be individualized according to the extent of the injury. Endoscope-assisted repair without any fixation method for the treatment of mildly and moderately displaced (1-5 mm) and closed isolated anterior table frontal sinus fractures is a good alternative technique for treatment.Between April 2010 and December 2011, 5 patients with mildly and moderately displaced isolated anterior table fractures were treated. There were no lacerations in forehead skin of the patients. Preoperatively, the patients showed forehead depression at the fracture site, and computed tomography scan was taken to determine the extent of the frontal sinus fracture. Endoscope-assisted closed reduction treatment was applied to all patients.All fractures were reduced successfully. None of the patients needed to undergo conversion to traditional incision techniques. No patients required fixation materials. Cosmetic deformity was corrected in all patients perfectly.In the standard treatment modality of frontal sinus fractures, repair is best performed by a coronal approach. However, bicoronal incision has many disadvantages. Several authors have recently described some endoscopic and closed approaches to these injuries. The main disadvantages of these methods are poor visualization or fixation requirement with exogenous materials.Endoscopic reduction of mildly and moderately displaced closed isolated anterior table frontal sinus fractures without fixation is feasible. It results in a good clinical outcome in selected cases.

Hidradenitis suppurativa is a recurrent, chronic, and suppurative cutaneous disease of unknown etiology. Radical excision of all affected skin followed by flap coverage of the defect is the treatment method of choice in severe and recurrent cases. This study discusses the use of local islanded perforator flaps in the reconstruction of defects following excision of hidradenitis suppurativa lesions in axillary, gluteal, and inguinal regions. Eleven male patients (mean age of 39.3 years) underwent reconstruction of hidradenitis suppurativa defects with 13 local islanded perforator flaps. Three patients (one being bilateral) had gluteal, two patients (one being bilateral) had inguinal, and six patients had axillary involvement. The defects in the gluteal region were repaired with superior gluteal artery perforator flaps, inguinal defects were repaired with medial circumflex femoral artery perforator flaps, and the axillary defects were repaired with thoracodorsal artery perforator flaps. There was no total flap loss in the postoperative period, but one marginal necrosis and two wound infections occurred. There was no recurrence of hidradenitis suppurativa or revision requirement during the mean follow-up period of 11.5 months., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Objective: Random-pattern skin flaps are used widely in plastic surgery, but necrosis resulting from ischaemia in the distal sections of the flap is a serious problem. Free oxygen radicals and the accumulation of increased neutrophil granulocytes play important roles in tissue injury and may lead to partial or complete necrosis of the flap. Amniotic membrane is a biomaterial used widely in clinical settings to prevent the infiltration and activation of leucocytes. The aim of this study was to test the effects of amniotic membrane on the survival of ischaemic skin flaps in rats., Methods: A total of 32 male rats were divided randomly into four groups of eight, according to the procedure to be tested: flap-only (F), flap-amniotic membrane (FA), flap-Tegaderm(®) (FT) and flap-amniotic membrane-Tegaderm(®) (FAT). Rectangular, random-pattern, caudally based modified McFarlane skin flaps were elevated at the dorsum of the rats in all four groups. The flap-only group was also the control group; in this group, the flaps were elevated and sutured to their native position. In the FA group, after the flaps were elevated, the amniotic membrane was inserted underneath the undersurface of the flap. In the FT group, after the flaps were elevated, a piece of Tegaderm was inserted underneath the undersurface of the flap. In the FAT group, the amniotic membrane was inserted underneath the undersurface of the flap and the Tegaderm(®) was inserted in the flap donor area. The survival rate of the skin flaps was measured on day 7, and histologic assessments were performed., Results: The survival rate of the skin flaps was significantly improved in the FA and FAT groups (67-69%, p < 0.05) compared with the F and FT groups (46-48%, p < 0.05). Histologic analysis showed many more blood vessels and fewer neutrophils in the FA and FAT groups than in the F and FT groups., Conclusion: This study showed that amniotic membrane could improve the survival rate of ischaemic skin flaps., (Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

The aim of this study was to investigate the biomechanical and histological perspectives of healing of Achilles tendon in diabetic rats and compare the results with non-diabetic subjects. Fifty four adult Wistar Albino rats weighing 300-350 g were used throughout the study. Six animals were excluded from the study and replaced. Rats were randomly assigned to either the experimental or the control group comprised of 24 rats in each. Diabetes was induced in experimental group with streptozotocin. 3 days after the induction of diabetes, both Achilles tendons were transected 5 mm proximal to their insertions to the calcaneal bone and repaired by using 6/0 polypropylene sutures with modified Kessler method. At weeks 2, 4 and 6, eight rats from each group were euthanized. Left Achilles tendons including the repair site were prepared for histological evaluation and right legs were prepared for mechanical testing. When compared to control group, diabetic animals displayed a lower peak force for failure in each of the second, fourth and sixth week. The differences between the groups in each week were found to be significant in statistical assessments (p < 0.05). Histologic assessment revealed that the diabetic animals had significantly less amount of fibroblast proliferation and lymphocyte infiltration compared to the control group. There is significant delay in tendon strength at the end of week 2, 4 and 6 postoperatively in the diabetic rats. Therefore diabetic individuals require specific postoperative follow up and rehabilitation procedures.

We report a case of young patient with a postoncologic right buccomandibular defect in which the deepithelialized medial sural artery perforator flap was used to obtain a symmetric contour of the defective side. The aim of this study was to compare treatment strategies of facial contour deformities and to give detailed information about medial sural artery flap dissection with a clinical presentation.

Temporomandibular joint ankylosis is a devastating condition for the patient associated with both functional disability and aesthetic deformities. Various techniques have been described in the literature to overcome this problem; however, there is still a high risk of reankylosis in patients undergoing multiple temporomandibular joint operations, severe heterotopic ossification, and fibrosis of the soft tissues. This study includes 5 patients with severe and recurrent ankylosis. Two-stage reconstruction with excision of the bony mass and placement of a distraction device in the first stage, followed by gradual distraction of soft tissues, and placement of a total joint prosthesis in the second stage were performed in all patients. The 2-step approach helps to overcome the fibrosis and adhesions in the soft tissues and allows placing an implant with a higher ramus component. This approach seems to be a useful and effective technique for the management of such patients with high risk of reankylosis.

Objective: The tarsal plate is the skeleton support system of the eyelids; therefore, repair during eyelid reconstruction is crucial. Many autogenous graft materials have been proposed for the tarsal reconstruction, such as nasal cartilage, palatal mucosa, upper eyelid tarsus, and auricular cartilage. Nail thickness and shape are similar to the tarsal plate with enough support for the eyelid. It also easily integrates with host tissues. The aim of this experimental study was to macroscopically and histopathologically compare nail xenografts with cartilage autografts when used in eyelid reconstruction in rabbits., Methods: In total, 12 New Zealand rabbits were used in the experiment. Full-thickness defect with a 1-cm diameter was created in both upper eyelids. The right upper eyelids were used for cartilage autograft reconstruction, and the left upper eyelids were used for nail xenograft reconstruction. All animals were killed on week 12 after eyelid reconstruction. After the animals were killed, the upper eyelids of the rabbits were resected for macroscopic and histologic analysis., Results: In histologic evaluation, moderate foreign body giant cell formation and moderate histiocytic, neutrophilic, basophilic, and lymphocytic infiltration were observed in both experimental group and control group. In addition, this marked fibrous capsule formation was observed around the nail xenograft, which was absent in the cartilage autograft group., Conclusions: Nail has some advantages such as being cost-effective, being easy to obtain, and having less rejection risk for being composed of dead cells. Nail xenografts can be taken into account instead of cartilage grafts in eyelid reconstruction.

The most decisive step during free tissue transfers and replantation surgery may be respected as microvascular anastomosis. The conventional end-to-side anastomosis technique with simple interrupted sutures is well established and proven to be successful. On the other hand, conventional technique can be time consuming and can cause vascular thrombosis, vessel narrowing, and foreign-body reactions. Search for a more rapid and secure alternative to conventional technique is carried on. In this study, we defined a new technique for end-to-side anastomosis with fish-mouth incisions and application of fibrin glue and compared our results with those we obtained with conventional end-to-side anastomosis. We evaluated end-to-side anastomosis of carotid arteries of a total number of 64 Wistar-Albino rats. In control group (n = 32), conventional anastomoses with 8 to 10 sutures were performed. In experimental group (n = 32), fish-mouth incisions were applied first on the recipient artery, followed by performing anastomosis with only 2 corner sutures and applying commercially available fibrin glue. Time taken to perform the anastomosis was significantly shorter with the experimental group (P = 0.001), whereas early and late patency and aneurysm rates were comparable to those achieved with control group. Histological evaluation did not point out any significant differences between the groups. We have defined a rapid and safe alternative technique of end-to-side anastomosis with the use of fibrin glue. This method may be an alternative especially where multiple anastomoses are required or where it is difficult to approach anastomotic line, as it is easily performed, rapid, safe, and not involving any complex equipments.

Loading the eyelid with a gold weight is a popular technique for improving closure of the eyelid in patients with facial palsy. Despite it being both safe and simple, placement of the weight into a submuscular pocket is not always successful. Ulceration of the skin, and extrusion and visibility of the implant, are quite common short or long-term complications. We have developed a technical refinement of lid-loading. After the implant has been sutured in the appropriate place, we cover the implant with a fascia lata graft. We have used this technique in 8 patients who had had excision of an acoustic neuroma. No implant ulcerated or migrated, and none of the patients complained that the implant was visible during follow up of between 3 months and 4 years. Tendinous grafts act as a strong barrier to the gold weight because they are durable and thick. Fascia lata is easily harvested and leaves an inconspicuous scar at the donor site. We therefore recommend the technique to avoid complications., (Copyright © 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Constricted ear deformity was first described by Tanzer and classified it into 3 groups according to the degree of constriction. The group IIB deformity involves the helix, scapha, and antihelical fold. The height of the ear is sharply reduced, and the soft tissue envelope is not sufficient to close the cartilage framework after expansion and reshaping.This study describes expanding the cartilage and increasing the height by advancing the helical root superiorly and repairing the skin-cartilage defect with a superior auricular artery chondrocutaneous flap in Tanzer group IIB constricted ear deformity.Six ears of 6 patients were treated with this technique during the past 3 years. All patients were satisfied with the appearance of their corrected ears, and the increase in height was maintained through the follow-up period.The described technique does not have the disadvantages and possible complications of harvesting a costal cartilage graft. Moving and fixing the root of helix to a more superior position provide the auricle with additional length. The superior auricular artery chondrocutaneous flap not only provides adequate soft tissue for primary closure of the anterior portion of the auricle but also aids in repairing the cartilage defect resulting from the superior advancement of the helix as well.

Ecthyma gangrenosum is a rare invasive cutaneous infection mostly caused by Pseudomonas aeruginosa in immunosuppressed patients, especially during neutropenic states. Embolic lesions usually accompanying with septicemia of P. aeruginosa are typically painless, round, and centrally necrotic with a surrounding erythematous halo. Facial involvement occurred only in 6% of the patients, which may result to complicated defects for reconstruction. In this article, we aimed to present a case with relapse of acute lymphoblastic leukemia presented to our clinic with 50% defect of the lower lip due to ecthyma gangrenosum and its late-term reconstruction.

Venous ulcers are characterised by longstanding and recurrent loss of skin integrity. Once occurred, healing is slow and recurrence is high because of inappropriate conditions of the wound bed. This study involves 20 patients with chronic venous ulcers at least 6 weeks of duration treated with negative pressure wound therapy (NPWT). Patients underwent a radical debridement of all devitalised tissues in the first operation. After adequate haemostasis, silver-impregnated polyurethane foam was applied. Once the wounds were determined to be clean and adequate granulation tissue formation was achieved, split-thickness skin grafts were applied. Black polyurethane foam was applied over them. All wounds completely healed without the need for further debridement or regrafting. The mean number of silver-impregnated foam dressing changes prior to grafting was 2·9 (one to eight changes). The mean number of NPWT foam changes was 2·6 after skin grafting (two to five changes). Two patients who did not use conservative treatments for chronic venous insufficiency (CVI) after discharge from the hospital had recurrence of venous ulcers in the follow-up period. Application of NPWT provides quick wound-bed preparation and complete graft take in venous ulcer treatment., (© 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.)

Aim: Large defects of the scalp, head and neck region are often encountered by plastic surgeons. The repair of such defects is dependent upon their location, size and depth. This study describes the use of large scalp flaps as a salvage procedure in the reconstruction of large scalp, head and neck region defects in elderly patients with poor general condition or advanced malignancy., Material and Methods: The presented study includes 22 patients operated between 2007 and 2011 for the reconstruction of large defects of the hair-bearing skin and head/neck region with large scalp flaps. A defect exceeding 25 cm² area was classified as "large" as defined in the previous studies. The patients' medical records were analyzed., Results: Scalp flaps provided a satisfactory and durable reconstruction in the late follow-up term. All flaps were completely survived except in one case in which a partial necrosis in the distal margin occurred. Major complications were recorded in 4.5% of patients while minor complications were recorded in 13.5% of them., Conclusion: In conclusion, large scalp flaps should be considered as a salvage procedure for reconstruction of large scalp, head and neck defects especially for palliative situations in elderly patients with significant comorbidities and advanced malignancies.