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Background: Pulmonary hemorrhage is a rare cause of morbidity and mortality in children. Extracorporeal membrane oxygenation (ECMO) can be used as a rescue mode of support in children with life-threatening respiratory failure. However, the dilemma arises as to how to balance anticoagulation to prevent circuit thrombosis while avoiding bleeding complications or worsening hemorrhage. Clinical Description: We present an adolescent with a history of Noonan syndrome, orthotopic heart transplant, and mechanic mitral valve that required emergent veno-venous (VV) ECMO support due to life-threatening hypoxia related to severe pulmonary hemorrhage secondary to anticoagulation for his prosthetic mitral valve. Management and Outcome: The patient remained on ECMO for 28 days with no anticoagulation and did not receive any anticoagulant or antiplatelet agents postdecannulation for 4 months despite the presence of a mechanical valve. No thrombotic complications to the mechanical valve or the ECMO circuit occurred. Conclusion: Prolonged anticoagulation-free VV-ECMO support may be used as a rescue strategy in patients with massive pulmonary hemorrhage resulting in refractory respiratory failure.

Sanusi Umar,1– 3 Raveena Khanna,3,4 Alejandro Gonzalez,5 Kavish Chouhan,6 Juan Carlos Maldonado,7 Osman Tayfun Oguzoglu,8 Aron Nusbaum9 1Department of Medicine, Dermatology Division, University of California, Los Angeles, CA, USA; 2Division of Dermatology, Harbor-UCLA Medical Center, Torrance, CA, USA; 3Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA; 4Department of Dermatology, Howard University College of Medicine, Washington, DC, USA; 5Mxcapilar Clinic, Chulavista, Sonora, Mexico; 6Department of Dermatology, DermaClinix, New Delhi, India; 7Hair Evolution Robotics, Medellin, Colombia; 8Dr. T Hair Transplant, Istanbul, Turkey; 9Hair Transplant Institute, Miami, Coral Gables, FL, USACorrespondence: Sanusi Umar, Dr. U Hair and Skin Clinic, 2121 N Sepulveda Blvd, Suite 200, Manhattan Beach, CA, 90266, USA, Tel +1-310-480-0490, Fax +1-310-318-1590, Email drumar@dru.comBackground: Current no-shave long hair-follicular unit excision (LH-FUE) techniques employ recesses (slots, notches, or grooves) in punch tips to reduce the long-hair shaft break rate (SBR) and graft transection rate (GTR). However, these methods demand advanced skills and extended procedure time.Objective: We aimed to evaluate a skin-responsive FUE technique without the use of recess-tipped punches, accommodating diverse hair and skin types in LH-FUE procedures.Methods and Materials: We retrospectively analyzed patients who underwent this technique using a UGraft Zeus device at five multinational clinics (Mexico, Colombia, India, United States, and Türkiye) from August 9, 2021, to April 11, 2023. Donor zones were pre-operatively graded for expected difficulty using the Sanusi FUE Scoring (SFS) Scale, ranging from class I (low difficulty) to V (high difficulty).Results: Among 152 patients (mean age, 46 years; 146 straight-wavy, 6 curly-coiled hair), most (n=107) were class I donors. The GTR ranged 2.2%– 4.3%, and was highest in class IV donors and those with thick-firm scalps. The SBR was 12.2%, and the average graft excision rate (GER; speed) was 440 grafts/h. Only 19G and 18G punches were used. All patients were satisfied with the procedure, with 57.4% reporting that they were “very happy”. Surgeon willingness to perform no-shave LH-FUE significantly increased from 1.25 to 4.20 (on a scale of 1– 5) after adopting this device. SFS class, skin thickness, and firmness, more than hair curliness, influenced the GTR, SBR, torque, and punch movement duration.Conclusion: Our findings reveal consistent success in conducting no-shave LH-FUE using this skin-responsive device across diverse patients. Notably, success was achieved without recess-tipped punches, resulting in low GTR and SBR, along with a high GER and increased patient satisfaction. These outcomes suggest enhanced procedure speed and ease of use, contributing to a greater willingness among surgeons to adopt this technique.Plain Language Summary: Despite the increasing popularity of no-shave long-hair follicular unit excision (FUE) as a hair transplant technique for its advantages in preserving the donor area and immediately assessing results after implanting long hairs, its adoption by surgeons has been slow due to its demanding nature. It is time-consuming and skill-intensive because it requires specialized punches with recesses (slots, notches, or grooves) on their tips that must align to accommodate and protect the long hair shafts from breakage during each extraction.Our study reports a novel skin-responsive FUE device for performing nonshaven long-hair FUE called the UGraft Zeus, whose recess-free punch (The intelligent Punch) features a minimal-assist-navigation capability to simplify the procedure and enhances performance parameters, including speed, graft transection rate, hair shaft break rate, and its easy adoption rate by surgeons, including novices. Additionally, patient satisfaction is high.Additionally, skin characteristics, specifically thickness and firmness, play a more critical role than the degree of hair curliness. Thicker and firmer skin requires increased torque and a longer punch movement duration during surgery. Furthermore, the skin-responsive FUE device was successful in performing no-shave long hair FUE in patients with Afro-textured hair, a population typically considered to be a hair transplant challenge.Keywords: follicular unit extraction, nonshaven FUE, unshaven FUE, long-hair FUE, hair transplantation, hair restoration surgery

Wilms tumor (WT) is the most common kidney tumor in pediatric patients. Intravascular extension of WT above the level of the renal veins is a rare manifestation that complicates surgical management. Patients with intravascular extension are frequently asymptomatic at diagnosis, and tumor thrombus extension is usually diagnosed by imaging. Neoadjuvant chemotherapy is indicated for thrombus extension above the level of the hepatic veins and often leads to thrombus regression, obviating the need for cardiopulmonary bypass in cases of cardiac thrombus at diagnosis. In cases of tumor extension to the retrohepatic cava, neoadjuvant therapy is not strictly indicated, but it may facilitate the regression of tumor thrombi, making resection safer. Hepatic vascular isolation and cardiopulmonary bypass increase the risk of bleeding and other complications when utilized for tumor thrombectomy. Fortunately, WT patients with vena caval with or with intracardiac extension have similar overall and event-free survival when compared to patients with WT without intravascular extension when thrombectomy is successfully performed. Still, patients with metastatic disease at presentation or unfavorable histology suffer relatively poor outcomes. Dedicated pediatric surgical oncology and pediatric cardiothoracic surgery teams, in conjunction with multimodal therapy directed by a multidisciplinary team, are preferred for optimized outcomes in this patient population.

Sanusi Umar,1– 3 Ade Waterman,3 Donna Ton,3 Paul Shitabata1,2,4 1Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; 2Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA; 3Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA; 4Dermatopathology Institute, Torrance, CA, USACorrespondence: Sanusi Umar, Dr. U Hair and Skin Clinic, 2121 N. Sepulveda Avenue, Suite 200, Manhattan Beach, CA, 90266, USA, Tel +1 310 318-1500, Fax +1 310 318-1590, Email drumar@dru.comPurpose: Folliculitis decalvans (FD) is a difficult-to-treat, localized scarring alopecia characterized by an expanding area of chronically inflamed purulent plaques or masses. Current treatment modalities vary and often result in only temporary remission. There are no reports of surgical therapies for FD. Here, we describe FD treatment using surgical excision and second-intention healing aided by guarded high-tension sutures.Methods: Five patients (one woman and four men) with histologically confirmed FD were treated by surgical lesion excision. All wounds were allowed to heal via second-intention. Guarded high-tension sutures were employed to minimize tissue tears while aiding and guiding wound contraction.Results: All wounds healed with a 47– 83% spatial contraction of the maximum wound diameters. Three patients healed entirely by second-intention, while two required a minor skin graft to close the wound completely. No disease recurrence was noted at 10– 24 months.Conclusion: Surgical excision with second-intention healing aided by guarded high-tension sutures effectively treated small and extensive FD lesions with no recurrence at long-term follow-up. To our knowledge, this is the first report of successful surgical treatment of FD.Plain Language Summary: Current treatment modalities of folliculitis decalvans, including steroids, antibiotics, and isotretinoin, are suboptimal, typically resulting in recurrence following the withdrawal of treatments. In this case series, we report a first account of treatment success of refractory folliculitis decalvans using surgical excision with second intention healing aided by guarded high-tension suturing. The outpatient procedure resulted in long-term remission at 10– 24 months follow-up.Keywords: folliculitis decalvans, treatment, surgical treatment, alopecia, primary cicatricial alopecia, acne keloidalis nuchae, lichen planopilaris, surgery, therapy, second intention healing, tension sutures, scaring alopecia, hair loss

Sanusi Umar,1– 3 Donna Ton,3 Marissa J Carter,4 Paul Shitabata1,2,5 1Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; 2Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA; 3Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA; 4Strategic Solutions, Inc., Bozeman, MT, USA; 5Dermatopathology Institute, Torrance, CA, USACorrespondence: Sanusi Umar, Dr. U Hair and Skin Clinic, 2121 N. Sepulveda Boulevard, Suite 200, Manhattan Beach, CA, 90266, USA, Tel +1-310-318-1500, Fax +1-310-318-1590, Email drumar@dru.comPurpose: Small observational studies suggest subclinical disease occurrence in the normal-appearing scalp zones of several primary cicatricial alopecias. To aid patient management, we began routinely evaluating the entire scalp of patients with acne keloidalis nuchae (AKN), including trichoscopy-guided biopsies.Patients and Methods: This retrospective study evaluated 41 patients sequentially presenting with AKN at a single clinic between June and December 2022. Primary lesions and normal-appearing scalp in the superior parietal scalp at least 5 cm away from AKN-affected zones were clinically evaluated, and areas showing perifollicular erythema or scales/casts on trichoscopy were biopsied and histologically analyzed.Results: Forty-one men with AKN, including 20 men of African descent, 17 Hispanic, and 4 European-descended Whites, were evaluated. All patients, including 22% with associated folliculitis decalvans, showed scalp-wide trichoscopy signs of perifollicular erythema or scaling in normal-appearing scalp areas. All patients showed histologic evidence of perifollicular infundibulo-isthmic lymphocytoplasmic infiltrates and fibrosis (PIILIF), with 96% showing Vellus or miniaturized hair absence. PIILIF was often clinically mistaken for seborrheic dermatitis (44– 51%). All White patients had mild papular acne keloidalis nuchae lesions mistaken for seborrheic dermatitis.Conclusion: PIILIF may be a precursor to a wide spectrum of primary cicatricial alopecias, including AKN and folliculitis decalvans. This finding carries implications for the early diagnosis and management of AKN and other primary cicatricial alopecias.Plain Language Summary: Acne keloidalis nuchae (AKN) is a type of hair loss and scalp condition marked by scarring and inflammation. This condition falls under a group of chronic hair and scalp issues known as primary cicatricial alopecia (PCA). Current treatments for AKN and similar PCAs often do not work well, and the condition tends to return. We have found a hidden scalp condition that could be causing AKN and other PCAs. It’s a subtle disease that affects the entire scalp, even though it might not show noticeable symptoms. We have observed this condition in all 41 AKN patients in our study, and it’s characterized by certain changes in the hair and scalp’s structure and immune system response. Other studies have linked this condition to various other PCAs. We believe this hidden condition could be causing AKN and making it come back after treatment. This study suggests that treating AKN might require a broader approach beyond just treating the visible symptoms. Since this hidden condition exists in other PCAs, it might be a common cause.Keywords: folliculitis decalvans, lichen planopilaris, subclinical, central centrifugal cicatricial alopecia, frontal fibrosing alopecia, scarring alopecia

The exponential growth in road accidents has led to a need for continuous driver monitoring to enhance road safety. Existing techniques rely on vehicle sensor-based and behavior analysis-based approaches, where the behavior analysis-based approaches are generally considered more desirable as they enable reliable detection of a more elaborate set of driver behaviors. They are categorized as intrusive and non-intrusive approaches. Unlike intrusive approaches that generally rely on constant direct human contact with sensors (physiological signals) and are sensitive to artifacts, non-intrusive approaches offer a more effective behavior monitoring using computer vision-based techniques. This paper proposes an end-to-end non-intrusive IoT-based automated framework to monitor driver behaviors, designed specifically for logistic and public transport applications. It consists of an embedded system, edge computing and cloud computing modules, and a mobile phone application, in an attempt to provide a holistic unified solution for drowsiness detection, monitoring, as well as evaluation of drivers. Drowsiness detection is based on detecting sleeping, yawning, and distraction behaviors using an image processing-based technique. To minimize the effects of latency, throughput, and packet losses, edge computing is performed using commercial off-the-shelf embedded boards. Moreover, a cloud-hosted real-time database for remote monitoring on interactive Android mobile application has been set up, where admin can add multiple drivers to get drowsiness notifications along with other useful related information for driver evaluation. An extensive experimental testing has been performed, obtaining encouraging results. An overall accuracy of 96% is achieved along with an enhanced robustness, portability, and usability of the proposed framework.

In precision farming, weed detection is required for precise weedicide application, and the detection of tobacco crops is necessary for pesticide application on tobacco leaves. Automated accurate detection of tobacco and weeds through aerial visual cues holds promise. Precise weed detection in crop field imagery can be treated as a semantic segmentation problem. Many image processing, classical machine learning, and deep learning-based approaches have been devised in the past, out of which deep learning-based techniques promise better accuracies for semantic segmentation, i.e., pixel-level classification. We present a new method that improves the precision of pixel-level inter-class classification of the crop and the weed pixels. The technique applies semantic segmentation in two stages. In stage I, a binary pixel-level classifier is developed to segment background and vegetation. In stage II, a three-class pixel-level classifier is designed to classify background, weeds, and tobacco. The output of the first stage is the input of the second stage. To test our designed classifier, a new tobacco crop aerial dataset was captured and manually labeled pixel-wise. The two-stage semantic segmentation architecture has shown better tobacco and weeds pixel-level classification precision. The intersection over union (IOU) for the tobacco crop was improved from 0.67 to 0.85, and IOU for weeds enhanced from 0.76 to 0.91 with the new approach compared to the traditional one-stage semantic segmentation application. We observe that in stage I shallower, a smaller semantic segmentation model is enough compared to stage II, where a segmentation network with more neurons serves the purpose of good detection.

Abstract This research work focuses on the synthesis, characterization through spectra (FT-IR, UV–vis, and 1H-NMR) investigations, and the use of density functional theory (DFT) along with time-dependent density functional theory (TD-DFT) to investigate the electronic, structural, reactivity, photophysical properties, and the photovoltaic properties of a novel (E)-6-(4-(dimethylamino)phenyl)diazenyl)-2-octyl-benzoisoquinoline-1,3-dione. The structure of the synthesized compound was modeled using the Gaussian09W and GaussView6.0.16 softwares employing B3LYP and 6–31 + G(d) basis set. The DFT studies was performed in order to investigate the Frontier Molecular Orbital (FMO), Natural Bond Orbital (NBO), charge distribution, Nonlinear Optics (NLO), and stability of the titled molecule. The HOMO–LUMO energy gap which corresponds to the difference between HOMO and LUMO energies of the studied compound was found to be 2.806 eV indicating stiff and smooth nature of the titled molecule. This accounts for the less stability and high chemical reactivity of the compound. The photovoltaic properties were conducted to evaluate the light harvesting efficiency (LHE), short circuit current density (JSC), Gibbs free energy of injection ( $$\Delta {G}_{inj}$$ Δ G inj ), open cycled voltage (VOC) and Gibbs free energy regeneration ( $$\Delta {G}_{reg}$$ Δ G reg ) and solar cell conversion efficiency. Interestingly, the results obtained were found to be in good agreement with other experimental and computational findings.

Sanusi Umar,1– 3 Jenna J Lullo,2 Marissa J Carter,4 Paul K Shitabata,2,5 Delphine J Lee1,2 1Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; 2Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA; 3Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA; 4Strategic Solutions, Inc., Bozeman, MT, USA; 5Dermatopathology Institute, Torrance, CA, USACorrespondence: Sanusi Umar, Dr. U Hair and Skin Clinic, 2121 N. Sepulveda Avenue, Suite 200, Manhattan Beach, CA, 90266, USA, Tel +1-310 318-1500, Fax +1-310 318-1590, Email drumar@dru.comPurpose: Both acne keloidalis nuchae (AKN) and cutis verticis gyrata (CVG) are scalp conditions predominantly affecting men. Both are characterized by dermal thickening and fibroblast hyperactivity. AKN typically occurs in the nuchal area, often involving the naturally occurring folds in the occipital region. The aim of this study was to determine the relationship between excessive scalp folding (CVG) and AKN.Patients and methods: A total of 108 patients with AKN seen over 11 years from July 2009 and November 2020 were retrospectively evaluated. Patients with AKN concomitant with CVG were selected for analysis.Results: Seven of the 108 AKN patients had scalp-wide (widespread) AKN lesions, including 4 with CVG. In 3 of the 4 patients with concomitant AKN and CVG, the AKN was widespread, and its onset had preceded CVG by 1– 2 years. In the fourth CVG patient, AKN lesions were confined to the nuchal area, and the CVG preceded AKN onset by several years. All patients were male, with a mean age of 35.8 years (overall) and 38.0 years (CVG group).Conclusion: We describe a previously unreported relationship between widespread AKN and CVG, with the development of AKN preceding CVG formation.Keywords: transforming growth factor, cicatricial alopecia, fibroblasts, syndromic

Sanusi Umar,1– 3 Paul Shitabata,2,4 Paul Rose,5 Marissa J Carter,6 Rattapon Thuangtong,7– 9 Boudine Lohlun,10 Hind Benhiba,11 Tayfun Oguzoglu,12 Maria Marta Zollinger,13 Juan Maldonado,14 Alejandro Gonzalez,15 Myroslava Novosilska,16 Alba Gómez Zubiaur,17 Miguel Marti18 1Department of Medicine, Dermatology Division, University of California, Los Angeles, CA, USA; 2Division of Dermatology, Harbor-UCLA Medical Center, Torrance, CA, USA; 3Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA; 4Dermatopathology Institute, Torrance, CA, USA; 5Miami Skin and Hair Institute, Coral Gables, FL, USA; 6Strategic Solutions, Inc., Bozeman, MT, USA; 7Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand; 8Department of Medicine, Division of Dermatology, Mahidol University, Bangkok, Thailand; 9Hairderma Clinic, Bangkok, Thailand; 10HairFront Clinic, Cape Town, South Africa; 11Dermatologic Private Practice, Rabat, Morocco; 12Dr. T Hair Transplant, Istanbul, Turkey; 13Instituto Capilar Marta Zollinger, Salvador, BA, Brazil; 14Hair Evolution by Robotics, Medellín, Colombia; 15Mxcapilar Clinic, Chulavista, Sonora, Mexico; 16Department of Dermatology and Oncology, Aesthetic Medical Clinic Myroslava Novosilska, Lviv, Ukraine; 17Trichology Unit, Ricart Medical Institute, Madrid, Spain; 18Dr. Marti Hair and Scalp Diseases Group, Buenos Aires, ArgentinaCorrespondence: Sanusi Umar, Dr. U Hair and Skin Clinic, 2121 N. Sepulveda Boulevard, Suite 200, Manhattan Beach, CA, 90266, USA, Tel +1-310-318-1500, Fax +1-310-318-1590, Email drumar@dru.comIntroduction: The difficulty of the follicular unit excision (FUE) hair transplantation procedure is currently attributed to hair curliness and subsurface angulation. Patients possessing the curliest hair shafts are considered the most challenging. Consequently, patients with these features are often denied FUE. However, this practice does not consider intrapatient variation in the graft attrition rate and the rates themselves, which are frequently low in very curly hair where the skin firmness/thickness is average. To better aid practitioners in predicting FUE performance, we have developed a new scoring system (the Sanusi FUE Score Scale [SFS Scale]) based on two major donor variables (hair and skin characteristics).Material and Method: The scale assigns scores to each of three hair subtypes (straight-wavy, curly, and coily-kinky) and each of three skin subtypes (thick/firm, soft/thin, and medium thickness/firmness). The scores were weighted based on the assessment of 13 experienced FUE practitioners from around the globe, who were asked to score each of the three skin and hair characteristics for their contribution to FUE difficulty.Results: On the contribution of skin characteristics to FUE difficulty, 12/13 (92%) practitioners assigned the highest (most difficult) score to thick/firm skin, with medium skin thickness/firmness being the least challenging. The same percentage of practitioners gave the highest difficulty score to coiled-kinky hair subtypes regarding the contribution of hair characteristics to FUE difficulty. All agreed that straight-wavy hair presents the least challenge to FUE performance. Tallying the scores of the skin and hair variables generates a final score range of 2– 9, which is associated with five grades/classes of challenge in the FUE procedure, influencing the need for a specialized skill/nuanced approach or equipment.Conclusion: We developed a universal FUE donor scoring scale that accounts for the diversity of human hair and skin types. Further evaluation to determine the validity of this new classification system in predicting and grading FUE difficulty and patient outcomes is warranted.Keywords: follicular unit extraction, hair transplant, scoring, scale, grading, hair type, skin type, African hair, curly hair, coiled hair, kinky hair, straight hair, wavy hair, dermis, epidermis

Sanusi Umar,1– 3 Petrina Kan,4 Marissa J Carter,5 Paul Shitabata1,2,6 1Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; 2Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA; 3Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA; 4Department of Molecular Biology, University of California at Los Angeles, Los Angeles, CA, USA; 5Strategic Solutions, Inc, Bozeman, MT, USA; 6Dermatopathology Institute, Torrance, CA, USACorrespondence: Sanusi Umar, Dr. U Hair and Skin Clinic, 2121 N. Sepulveda Avenue, Suite 200, Manhattan Beach, CA, 90266, USA, Tel +1 (310) 318-1500, Fax +1 (310) 318-1590, Email drumar@dru.comPurpose: Central centrifugal cicatricial alopecia (CCCA) is the most common cause of scarring alopecia in women of African descent. However, current treatments for CCCA, such as immunosuppressants and immunomodulatory pharmaceutical agents, have suboptimal efficacy and undesirable side effects. This case series reports the therapeutic effect of a new botanical formulation (Dr. UGro Gashee) in four patients with histologically supported diagnoses of CCCA. The formulations contain at least three phytoactive ingredients that affect multiple targets in the cascade of pathophysiologic events contributing to CCCA. Possible mechanisms of action include anti-inflammatory effects, inhibiting proinflammatory cytokines, and the net antifibrotic effect of inhibiting transforming growth factor-beta while upregulating AMP-activated protein kinase and peroxisome proliferator-associated receptor-gamma activity.Patients and Methods: Four African American women with treatment-refractory CCCA were treated with a new topical botanical formula (cosmeceutical) alone or in combination with its oral formulation (nutraceutical) for 8 weeks to 1 year. The cosmeceutical and nutraceutical treatments contain similar phytoactive ingredient profiles. Treatment outcomes were collected using documented patient reports and images and by direct observation.Results: In all patients, scalp pruritus cessation occurred within 2 weeks of treatment, and significant hair regrowth was observed within 2 months. All patients reported a high satisfaction level without adverse effects.Conclusion: Patients with treatment-refractory CCCA responded to the novel botanical treatment reported in this study. Further evaluations in a controlled trial with more patients are warranted.Keywords: scarring alopecia, follicular degeneration syndrome, hot comb alopecia, African American women, hair loss, cosmeceutical, nutraceutical, phytoactive

Gait analysis identifies the posture during movement in order to provide the correct actions for a normal gait. A person’s gait may differ from others and can be recognized by specific patterns. Healthy individuals exhibit normal gait patterns, while lower limb amputees exhibit abnormal gait patterns. To better understand the pitfalls of gait, it is imperative to develop systems capable of capturing the gait patterns of healthy individuals. In this research, spatio-temporal parameters were computed using the concepts of static and dynamic equilibrium to analyze the gait cycle. A relationship was also developed among static equilibrium, dynamic equilibrium, speed, and body states. A sensing unit was installed on the designed metal-based leg mounting assembly on the lateral side of the leg. An algorithm was proposed based on two variables: the position of the leg in space and the angle of the knee joint measured by using an inertial measurement unit (IMU) sensor and a rotary encoder. It was acceptable to satisfy the static conditions when the body was in a fixed orientation, whether lying down or standing. While walking and running, the orientation was determined by the position and knee angle variables, which fulfill the dynamic condition. High speed reveals a rapid change in orientation, while slow speed reveals a slow change in orientation. The proposed encoder-based feedback system successfully determined the flexion at 47°, extension at 153°, and all seven gait cycle phases were recognized within this range of motion. Computed spatio-temporal parameters may help individuals avoid slipping or falling.

Wilms tumor (WT) is the most common kidney tumor in pediatric patients. Intravascular extension of WT above the level of the renal veins is a rare manifestation that complicates surgical management. Patients with intravascular extension are frequently asymptomatic at diagnosis, and tumor thrombus extension is usually diagnosed by imaging. Neoadjuvant chemotherapy is indicated for thrombus extension above the level of the hepatic veins and often leads to thrombus regression, obviating the need for cardiopulmonary bypass in cases of cardiac thrombus at diagnosis. In cases of tumor extension to the retrohepatic cava, neoadjuvant therapy is not strictly indicated, but it may facilitate the regression of tumor thrombi, making resection safer. Hepatic vascular isolation and cardiopulmonary bypass increase the risk of bleeding and other complications when utilized for tumor thrombectomy. Fortunately, WT patients with vena caval with or with intracardiac extension have similar overall and event-free survival when compared to patients with WT without intravascular extension when thrombectomy is successfully performed. Still, patients with metastatic disease at presentation or unfavorable histology suffer relatively poor outcomes. Dedicated pediatric surgical oncology and pediatric cardiothoracic surgery teams, in conjunction with multimodal therapy directed by a multidisciplinary team, are preferred for optimized outcomes in this patient population. [ABSTRACT FROM AUTHOR]

Sanusi Umar,1– 3 Boudine Lohlun,4 Tayfun Ogozuglu,5 Marissa J Carter6 1Department of Medicine, Dermatology Division, University of California, Los Angeles, CA, USA; 2Division of Dermatology, Harbor-UCLA Medical Center, Torrance, CA, USA; 3Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA; 4HairFront Clinic, Cape Town, South Africa; 5Dr. T Hair Transplant, Istanbul, Turkey; 6Strategic Solutions, Inc., Bozeman, MT, USACorrespondence: Sanusi UmarDr. U Hair and Skin Clinic, 2121 N. Sepulveda Boulevard, Suite 200, Manhattan Beach, CA, 90266, USATel +1-310-318-1500Fax +1-310-318-1590Email drumar@dru.comPurpose: A challenge in follicular unit excision (FUE) is the lack of a single device that can adequately meet the requirements of a range of patient donor variables, such as hair curliness, race, body and head hair locations, and non-shaven short- and long-hair FUE. This study aimed to describe a novel FUE device developed based on skin responsiveness to serve as a single all-purpose FUE donor harvester.Patients and Methods: We describe an all-purpose FUE device that consists of an all-purpose punch and a functionally complementing punch driver. The mechanism of action and method of use are reported. Several patients with a diversity of FUE challenges for three experienced FUE practitioners using the novel device are presented using photos and videos. The practitioners also reported their comparative experiences with using prior FUE systems in similar situations.Results: The novel device demonstrated success in a variety of FUE scenarios without requiring specialized provider skills. The device responds to changing skin firmness and thickness, which are the primary causes of inconsistent performance in FUE devices between patients and within patients from one body/head area to another. It also minimized challenges of unpredictable hair curliness and angles by its innate ability to self-navigate the subsurface course of hair follicles, to which the FUE practitioner is typically blinded.Conclusion: We describe a novel FUE device that overcomes the challenges of previous FUE technologies and has potential applicability to a diverse range of FUE scenarios. Our experience suggests that further validation is warranted.Keywords: follicular unit extraction, hair transplant, African American, long hair, curly hair, body hair, non-shaven