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The relevance of the present article is explained by the need for a detailed study of the influence of medium and small business representatives on the economic indicators of the Republic of Kazakhstan. In this regard, this study is aimed at identifying or covering the development of entrepreneurship theory and establishing methodological approaches that allow assessing the impact of entrepreneurship on the socio‐economic development of regions. The leading method for the researched subject is a systems analysis, which allows comprehensively considering the regional economy as a complex multi‐component structure, performing in unstable global conditions. In addition, the following methods were used: logical analysis, comparative, economic, synthesis and deduction, classification, and mathematical statistics. The research results are presented in the format of figures and tables showing the contribution and influence of small and medium businesses on the economy of the Republic of Kazakhstan; in the course of the study, the authors covered the components that influence the successful development of the entrepreneurship macro‐environment; identified the factors that influence the socio‐economic development of the region. The study materials are of practical value for economists, teachers, and students in the field of economics, representatives of small and medium businesses. [ABSTRACT FROM AUTHOR]

This study aims to identify ways to adapt religious practices and beliefs to meet the contemporary dynamics of society. For this purpose, the following methods of scientific cognition were used: analysis, comparison, synthesis, deduction, classification, as well as interdisciplinary and systemic approaches. In the course of the research, a comprehensive review of the contemporary religious situation was conducted. The following global trends were revealed and identified: secularism, non-traditional religious movements, demographic, political and economic changes. Through the literature review, the concept of religious variability was formulated, revealing the normativity of change and transformation of religious beliefs and traditions, and a detailed study of traditional and non-traditional movements revealed the relationship between the rise of non-traditional religious beliefs and crises. The study also explored the role and place of digital technologies in the context of religion. This made it possible to determine that traditional religious movements often do not fully utilize the full potential of social networks and the Internet, thus depriving themselves of the opportunity to communicate quickly and effectively with believers, as well as to engage in discussion with representatives of other religions and atheists. The interrelationships between religion, politics, and economics in modern society were identified and a number of problems that follow from these interrelationships were presented: the interference of religion in political processes, which can create divisions in society and undermine the secular principles of the state, while economic crises can cause upheavals in religious communities. Solutions to all the problems identified were proposed, which included educational programmes, digitalization of traditional religious organizations, and the development of effective interreligious dialogue.

The environment significantly impacts the lives of bees and their feeding. This study aimed to investigate bee foraging using melissopalynological analysis and DNA metabarcoding in intensive farming, reserved, and urbanized areas. The highest alpha diversity was observed in the reserved and intensive farming areas. The urbanized area had less diversity. In the intensive farming area, Sinapis , Helianthus , and Fagopyrum predominated; in the reserved area, Melilotus , Helianthus , and Brassica predominated. In the urbanized area, garden plants, namely radish ( Raphanus sativus ) and cucumber ( Cucumis hystrix ), and agricultural plants, namely soybean ( Glycine max ) and melon ( Cucumis melo ), were often found. The most significant agreement was between the rbcL and the melissopalynological analysis. The ITS2 revealed equal matches with both rbcL and melissopalynology, but this marker missed or underestimated some genera. Trifolium pretense and Brassica nigra were identified simultaneously by the melissopalinology method and two genetic markers in DNA metabarcoding. The species Convolvulus arvensis , Melilotus officinalis , Echium vulgare , Brassica rapa , Helianthus divaricatus , and Onobrychis viciifolia were found in all ecological areas. Imperfect databases impose some limits in the identification of some taxa using metabarcoding. The further research and expansion of plant databases is needed. Studying the food preferences of bees in different environmental conditions and landscapes is necessary to develop measures to preserve their populations., Competing Interests: The authors declare no conflicts of interest.

When handling large wounds, zone of injury is a key concept in reconstructive microsurgery, as it pertains to the selection of recipient vessels. Historically, surgeons have avoided placing microvascular anastomosis within widely traumatized, inflamed, or radiated fields. The harvest of vein grafts facilitates reconstruction in complex cases by extending arterial and/or venous pedicle length. To illustrate the utility and fidelity of these techniques, this paper reviews the indications and outcomes for vein grafting in ten consecutive patients at a single tertiary referral center hospital. The case series presented is unique in three aspects. First, there are two cases of successful coaptation of the flap artery to the side of the arterial limb of an arteriovenous loop. Second, there is a large proportion of cases where vein grafts were used to elongate the venous pedicle. In these 10 cases, the mean vein graft length was 37 cm. We observed zero flap failures and zero amputations. Although limited in sample size, these case data support the efficacy and reliability of long segment vein grafting in complex cases in referral centers.

The combination of hemophilia and sickle cell disease poses unique challenges in the perioperative management of patients requiring free tissue transfer (FTT). Extremity FTT requires mitigation of risk factors related to perioperative bleeding and microvascular thrombosis. This case report highlights the nuances of managing an open ankle fracture in a patient with both sickle cell trait and severe hemophilia A. The narrative and discussion highlights the importance of a multidisciplinary team with regard to executing a limb salvage plan in the setting of complex medical decision-making., (© 2023 HMP Global. All Rights Reserved. Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of ePlasty or HMP Global, their employees, and affiliates.)

Competing Interests: The authors have no financial interest to declare in relation to the content of the article.Disclosure statements are at the end of this article, following the correspondence information.

As perfusion assessment technologies and microsurgical techniques have evolved, plastic surgeons have become increasingly aggressive and creative in offering reconstructive solutions to limb salvage problems. In the distal lower extremity, pedicled perforator flap transfer has grown in popularity as compared to the historically reliable option of free tissue transfer. Pedicled perforator flaps typically avoid muscle harvest and restore the thin, supple soft tissue in the distal extremity, where there is a relative lack of redundancy of soft tissues. They also allow for a shorter operative time and recovery in otherwise complex wounds of the foot and ankle. This case report highlights the indications, nuance, and post-operative course of a patient who underwent peroneal perforator flap for coverage of a complex ankle wound in the setting of a calcaneal fracture., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Aukerman et al.)

Objective: Failure rates of microvascular autologous breast reconstruction are reportedly low. When failure of the microvascular anastomoses does occur, it is most likely to be salvaged if detected early. Flap compromise or venous congestion occurring several weeks later is uncommon and with significantly lower salvage rates. Methods: We present a unique case of delayed venous congestion of a single-perforator deep inferior epigastric perforator flap breast reconstruction in which the usual pedicle thrombosis was not identified. Presentation of the flap compromise occurred 72 hours postoperatively and again in the delayed setting 5 weeks after surgery, from suspected compression at the perforator level. Results: The deep inferior epigastric perforator flap was successfully salvaged with conservative measures, and the flap healed without fat necrosis or further complication. Conclusion: This case highlights the higher risk of flap compromise with reconstructions in a radiated field and potentially with single-perforator flaps., (Copyright © 2019 The Author(s).)

Background: Super-high superficial musculoaponeurotic system (SMAS) suspension and tailor tack plication are powerful facelift tools used in cases of primary facial rhytidectomy., Technique: Thorough pre-operative patient screening and counseling are completed in an outpatient cosmetic surgery center. A super-high SMAS flap is developed by undermining and incising along a line extending from the tragus to lateral canthus and dissecting the SMAS sufficiently to induce movement of the lateral nose and the oral commissure with traction on the SMAS. The SMAS is suspended from the deep temporal fascia using 4-0 Mersilene sutures. Tailor tack sutures are placed strategically in the SMAS caudal to the malar bone to eliminate any residual laxity in the SMAS close to the oral commissures and the cheek area. This is repeated until the laxity of the SMAS is completely eliminated. The orbicularis muscle is conservatively suspended laterally from the deep temporal fascia, facial volume is restored with fat grafting, the neck is contoured, if necessary, and the vest-over-pants platysma overlap technique is commonly utilized. Concomitant forehead rejuvenation, blepharoplasty, and laser resurfacing are extremely common., Results: Of the 72 cases of primary rhytidectomy performed by the senior author on consecutive patients included in the study, there were 64 (89%) female and 8 (11%) male patients. The average age of the patient at the time of primary facelift was 58 years old. Fifteen out of 72 (21%) patients received one dose of desmopressin (DDAVP) injection during the surgery, and one patient received DDAVP the day after surgery to maintain hemostasis. There was no incidence of facial nerve injury. Of those 72 cases, 3 (4%) developed minor hematomas that were resolved by aspiration. There were no expanding hematomas that required surgery. Of the 26 patients whose satisfaction was documented, 24 were very satisfied. Two patients expressed their dissatisfaction with the results, and one of these patients underwent a revision operation by the senior author. The other patient was mainly not pleased with the recovery duration., Conclusion: An alteration in the SMAS elevation and suspension is described with strategic submalar plication, providing a powerful technique for primary facial rhytidectomy that offers reliable and significant malar lift, orbicularis suspension, improvement in jowls, and repositioning of the oral commissure. The technical details are demonstrated through complete video segments along with many nuances that make delivery of optimal and natural outcomes possible, while maintaining the normal anatomy., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background: Patients with severe neck skin laxity due to excess submental adipose tissue have required either standard rhytidectomy or direct excision of neck skin with Z-plasty and submental lipectomy. Our recent experiences with four patients who declined cervicofacial rhytidectomy demonstrate that submental lipectomy and platysmarrhaphy appear to obtain sufficient improvement., Methods: The submental area, submandibular area, and lateral neck are injected with local anesthetic. An incision is made in the submental area anterior to the existing crease, and the incision is taken through the subcutaneous tissue to the underlying fat. The skin is undermined in the deep subcutaneous plane. The lateral fat that cannot be visualized directly is suctioned using a number 2 cannula. Supra-platysmal and subplatysmal excess fat are excised under direct vision. The anterior bellies of the digastric muscle are excised partially or completely to obtain a flat contour if necessary. The submaxillary gland is partially or totally removed as indicated. The platysmarrhaphy is performed, and a TLS drain is placed in position and brought out through the left post-auricular sulcus using the attached trocar. The submental incision is then closed without skin excision., Result: Non-excisional surgical neck rejuvenation was performed on four patients with significant skin laxity. There was adequate improvement in the cervicomental angle and neck profile contour in all patients, indicating that significant improvement may be achieved without skin excision., Conclusion: Patients with excess skin can achieve acceptable results with submental lipectomy and platysmarrhaphy without rhytidectomy or direct excision of neck skin., Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A 4-year-old-boy required emergent craniectomy and drainage of a large right-sided acute subdural hematoma after head trauma, during which massive sinus hemorrhage with brain swelling occurred. Acute intraoperative management entailed dural cover using synthetic dural membrane substitute and scalp coverage over the herniated brain using acellular dermal matrix. After intensive monitoring and control of raised intracranial pressure over the next few days, the exposed brain was then covered by scalp and forehead flaps with cadaveric skin grafting to the donor site. This temporary coverage continued until adequate resolution of the intracranial swelling and control of the hydrocephalus using a ventriculoperitoneal shunt. Ultimately, the flaps were derotated and the craniectomy site was reconstructed with autologous banked bone. The child had a significant functional recovery with some residual left-sided weakness. This case is the first report of local tissue flaps used for temporary coverage of malignant brain herniation in a pediatric head trauma patient and highlights their effective use. Through serial surgical procedures the brain was successfully covered without significant blood loss and the patient's local tissues returned to their original donor sites with good cosmetic outcome, without sacrifice of the patient's own skin or free flap options.

The short nose deformity is a complex entity with diverse causes and variable characteristics. This article divides shortening into anterior and pan-nose shortening as well as mild, moderate, or severe. Mild anterior shortening can be corrected with shield grafting, whereas moderate to severe shortening can be corrected using septal extension grafts, composite grafts, or the tongue-and-groove technique. Ancillary technical considerations are reviewed. General principles of patient assessment and rhinoplasty execution are discussed. Surgical cases are presented, and pertinent aspects of preoperative planning, surgical technique, and perioperative care are discussed.

Objective: Numerical implication of sulcal and gyral topography for surgical approaches has not been studied., Methods: Percentage gain of distance using sulci as compared to that of gyri was calculated by measuring distances toward the ventricles in 15 hemispheres., Results: Superior frontal sulcus was closest proving greater than 50% gain in distance compared to superior frontal gyrus; inferior temporal sulcus provided greater gain in the temporal lobe., Conclusion: Sulci provide upto 58% distance gain. For trans-gyral approaches, MFG and ITG were found closer to the respective ventricular area.

Objective: To find a safe operative corridor to the ventricular trigone avoiding injury to the optic radiations (ORs)., Methods: In 24 adult hemispheres, dimensions of the atrium, height of the OR, and the cortex-to-atrium distance were measured. Superior parietal lobule (SPL), parieto-occipital sulcus (POS), and middle temporal gyrus (MTG) traced approaches were used to measure maximum safe angles to enter the atrium without traversing the OR. A statistical algorithm was generated using these measurements to predict the height of the OR and safe angles from measurements from MR imaging of five test hemispheres. Statistically calculated angles were compared with measured angles from dissection., Results: Mean length and height of atrium, height of OR, and cortico-atrium distances were 2.07 cm, 3.36 cm, 2.53 cm, and 4.11 cm, respectively. The height of the atrium influenced the height of the OR significantly (p < 0.0001). The height of the dilated and small atrium was > 4.5 cm (> 95th percentile) and < 2 cm (< 5th percentile), respectively. For the SPL approach, the mean sagittal angle was 15.75 to 41.04 degrees; the mean coronal angle was - 17.08 to 14.92 degrees. For the POS approach, the mean sagittal angle was 51.29 to 70.1 degrees; the mean coronal angle was -8.63 to 17.22 degrees. Mean calculated height (statistically) of the OR was 0.29 mm above the mean observed height (dissection). The calculated angles and observed angles were very similar when tested for a variability of ± 2 degrees., Conclusion: The height of the normal atrium was 2.58 cm (height of atrium to height of OR ratio was 1:0.76). An operative corridor to the atrium without damaging the OR can be calculated from MR imaging of the brain., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Failure to recognize asymmetrically positioned eyebrows, often altered by the patient to camouflage nasal asymmetry, can lead the surgeon to design the rhinoplasty using a faulty midline landmark. The purpose of this study was to investigate the frequency of eyebrow asymmetry and to test whether there is an association between eyebrow position and the direction of nasal deviation., Methods: Life-size photographs of 100 rhinoplasty patients were selected randomly from the senior author's (B.G.) practice. Nasal deviation from the midpoint of the intercanthal distance was measured at standardized levels on anteroposterior views corresponding to the nasal bones, upper lateral cartilages, and nasal tip. The maximally deviated parameter was noted., Results: Of the 27 men and 73 women studied, 96 patients had measurable eyebrow asymmetry, including 96 percent of men and 96 percent of women. All 100 patients had at least one level of nasal deviation. The direction of eyebrow shift correlated significantly with the direction of nasal deviation for nasal bones (p = 0.0018), nasal tip (p = 0.0032), and maximally deviated parameter (p = 0.039), but not for upper lateral cartilages (p = 0.54). Mean eyebrow shift distance for male patients (1.8 mm) and female patients (1.3 mm) was not significantly different (p = 0.056)., Conclusions: The frequency of eyebrow asymmetry and the significant correlation between eyebrow position and nasal deviation direction suggest that eyebrows can camouflage nasal deformities. Furthermore, the alarmingly high incidence of nasal deviation in rhinoplasty candidates emphasizes the value of a circumspect preoperative nasal analysis in reducing the incidence of residual postoperative nose deviation., Clinical Question/level of Evidence: Risk, IV.

Object: A study was conducted to elucidate anatomical variations of the GON and surrounding occipital tissues., Methods: Anatomical and surgical variations were prospectively recorded for 272 patients who underwent greater occipital nerve (GON) decompression by a single surgeon between 2003 and 2012. Data collection was performed intraoperatively and specifically for the purposes of this study. Documented anatomical variations of the GON and surrounding occipital region included the extension of trapezius musculature to the midline, abnormal lymph nodes, and GON branching. Necessary variations in the surgical procedure were also noted, including resection of a lateral portion of semispinalis capitis muscle and occipital arterectomy., Results: The GON pierced the semispinalis muscle in all patients bilaterally. The extension of trapezius musculature to the midline was discovered in 67.3 percent of patients and lymph node enlargement was discovered in 1.5 percent of patients. Branching of the GON was noted in 7.4 percent of patients and muscles or vessels between GON branches were noted in 3.7 percent of patients. Occipital arterectomy was required in 64.0 percent of patients and resection of a lateral segment of semispinalis muscle was required in 10.7 percent of patients., Conclusions: The new anatomical variations described in this study improve understanding of the intraoperative anatomy of the occipital region and prevent difficulty in finding the GON due to dissection in the wrong plane, ensuring that MH patients receive maximal benefit from surgical treatment., (Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: This study sought to identify genes in nontypical meningiomas with gains in copy number (CN) that correlate with earlier age of onset, an indicator of aggressiveness., Methods: Among 94 adult patients, 91 had 105 meningiomas that were histologically confirmed. World Health Organization grades I (typical), II (atypical), and III (anaplastic) were assigned to tumors in 76, 14, and 1 patient, respectively. Brain invasion indicated that two World Health Organization grade I meningiomas were biologically atypical. DNA from 15 invasive/atypical/anaplastic meningiomas and commercial normal DNA were analyzed with multiplex ligation dependent probe amplification. The CN ratios (fold differences from normal) for 78 genes were determined. The CN ratio was defined as [tumor CN]/[normal CN] for each gene to normalize results., Results: Characteristic gene losses (CN ratio < 0.75) occurred in >50% of the invasive/atypical/anaplastic meningiomas at 22q11, 1p34.2, and 1p22.1 loci. Gains (CN ratio ≥ 2.0) occurred in each tumor for 2 or more of 19 genes. Each of the 19 genes' CN ratio was ≥ 2.0 in multiple tumors, and their collective sums (up to 49.1) correlated inversely with age (r = -0.72), minus an outlier. In patients ≤ 55 versus >55 years, 5 genes (BIRC2, BRAF, MET, NRAS, and PIK3CA) individually exhibited significantly higher CN ratios (P < 0.05) or a trend for them (P < 0.09), with corrections for multiple comparisons, and their sums correlated inversely with age (r = -0.74)., Conclusions: Low levels of amplification for selected oncogenes in invasive/atypical/anaplastic meningiomas were higher in younger adults, with the CN gains potentially underlying biological aggressiveness associated with early tumor development., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Müller's muscle-conjunctival resection is used to correct mild to moderate ptosis commonly encountered in the rejuvenation patient population. The authors examined its efficacy and analyzed variables that potentially affect outcomes., Methods: Patients who underwent ptosis correction using Müller's muscle-conjunctival resection with greater than 10-month follow-up were included. Amount of ptosis reduction, eyelid symmetry, effects of concomitant facial aesthetic operations, and adverse outcomes were analyzed. Patients were grouped into medium- (<24 months after surgery) and long-term follow-up (>24 months) cohorts to determine whether outcomes changed over time., Results: Forty patients with a mean follow-up of 28 months combined for a total of 70 resection operations. Resection significantly reduced ptosis by a mean of 1.48 ± 0.88 mm (p < 0.001), corresponding to 0.19 mm of eyelid elevation for every 1.0 mm of Müller's muscle resected. The procedure successfully corrected 84 percent of eyelids to within 0.5 mm and 94 percent to within 1.0 mm of normal eyelid position. On patients with asymmetric ptosis, it significantly improved eyelid symmetry to within 1.0 mm from 85 percent of patients before surgery to 95 percent after surgery, and to within 0.5 mm from 53 percent before surgery to 75 percent of patients after surgery (p = 0.036). Furthermore, the mean correction of ptosis was not significantly different between medium- (1.58 ± 0.93 mm) and long-term (1.32 ± 0.93 mm) follow-up patients (p = 0.258)., Conclusions: Müller's muscle-conjunctival resection is an effective long-term solution to mild to moderate eyelid ptosis and asymmetry, and can be effectively performed concomitantly with other aesthetic facial procedures., Clinical Question/level of Evidence: Therapeutic, IV.