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The critical need in novel or alternative approaches to energy production, conversion, and harvesting, combined with the ongoing pursuit of device miniaturization, have revived interest in the long-known but "doomed" impractical caloric effects in solids. Contrary to the old belief that such effects, while common, are miniscule, a large variety of giant caloric effects has been recently discovered in some ferroic materials. These discoveries have opened the door to the use of these giant effects in an efficient and environmentally friendly solid-state refrigeration technology. Here we report first-principles simulations of multiple caloric effects in a typical ferroelastic ferroelectric PbTiO3 which offer insight into a multicaloric nature of this material. We predict the existence of unusual multicaloric effect in such electrically driven ferroelastic (extrinsic multiferroic) which far exceeds either electrocaloric or elastocaloric effect alone. Moreover, given a relative abundance of extrinsic multiferroics among ferroics with multiple order parameters, such prediction may open an unusual route to solid-state refrigeration advancement. [ABSTRACT FROM AUTHOR]

Background: This study was undertaken to analyze the clinical results and complication rate of patients undergoing outpatient total joint arthroplasty by a single orthopedic group. All surgeries were performed in the practice-owned ambulatory surgery center (ASC)., Methods: All patients indicated for outpatient total joint arthroplasty from 2016-2019 with complete pre and post-operative patient reported outcomes were enrolled in the study including hip, knee and partial knee replacements. Patient reported outcomes including HOOS, KOOS and VR-12 were collected at six months. Patient complication and satisfaction data was also collected., Results: There were 1007 patients enrolled in the study. At six months, THA HOOS and VR-12 scores improved to 82.2 and 54.5/45. TKA KOOS and VR-12 scores improved to an average of 74.3 and 54.0/43.6. At six months, UKA scores improved to an average of 73.6 and 55.1/41.2. All HOOS, KOOS and VR-12 PCS scores improvements were statistically significant (p < 0.001) and met MCID thresholds. A separate cohort of 1898 regionally tracked cases with comprehensive global complication data exhibited 111 complications (unplanned post-operative events generating a medical expense) including manipulation 13 (0.68%), DVT/PE 4 (0.2%), medical 45 (2.4%), wound 8 (0.4%), infection 8 (0.4%). Sixty-six outpatient cases (3.5%) experienced clinical complications requiring some form of additional treatment., Conclusion: Outpatient joint arthroplasty performed in the ASC is safe and effective in appropriately selected patients with complication rates that compares favorably to inpatient procedures., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

We present a retrospective analysis of 32 patients admitted over a 5-year period to a metropolitan regional trauma center with recently induced subcutaneous ("skin pop") illicit drug injectional injuries involving the hand. Cocaine derivatives were the most frequently reported illicit drug used (75%). All patients had local disease manifested by subcutaneous abscess formation, and several had regional disease (cellulitis, lymphangitis, or lymphadenopathy), but only one patient had systemic illness. Microbiological analysis revealed endogenous integumentary and oral flora sensitive to oral preparations of several antibiotic medications including cephalosporins. Primary therapy included intravenous administration of antibiotic medications in all instances and simple incision and drainage under local anesthesia in 26 patients (81%). Six patients (19%) required more radical operative therapy. All patients were hospitalized and recovered without sequelae, with preservation of hand function after follow-up evaluation, which ranged from weeks to months, except for 1 patient who required digital amputation because of necrosis. Although the issue of compliance in terms of wound and general medical care for this patient population is problematic, analysis of the data suggested that patients with illicit drug injectional injuries of the hand confined to subcutaneous regions could be effectively and safely managed in outpatient settings by simple wound care and orally administered cephalosporin medications.

Oxygen free radicals are implicated to cause tissue injury during ischemia and reperfusion and may play a central role in the no-reflow phenomena. Modulation of these substances has been suggested as a means of decreasing the amount of tissue loss due to ischemia and subsequent reperfusion. Pretreatment of tissues with a variety of agents has been reported to minimize the production of oxygen radicals and augment tissue survival after an ischemic insult. Ischemic clinical situations, however, usually present unexpectedly and thus pretreatment is not feasible. Our study evaluated the activity and effect of free radical scavengers delivered systemically during the ischemic interval to an ischemia/reperfusion rat intestinal model. Superoxide dismutase and dimethylthiourea were given systemically after occlusion and reperfusion to simulate a clinical sequence of a failing flap, that is, the vascular compromise, the diagnosis, and the successful resolution of the vascular embarrassment. Measurements of malonyldialdehyde (MDA), the end product of lipoperoxidation of cell walls, were compared with controls. Tissue histology was assessed and correlated with the use of these agents. A third group of rats was systemically alkalinized to attempt to shift the Bohr curve and decrease free oxygen substrate in the ischemic tissues on reperfusion. Rats treated with superoxide dismutase and dimethylthiourea showed significant reductions of MDA compared with nontreated rats (p less than 0.05), indicating attenuation of reperfusion lipoperoxidation. Systemic alkalinization of the rats did not significantly change the levels of MDA. Tissue histology showed severe injury in all ischemic groups regardless of the level of MDA.(ABSTRACT TRUNCATED AT 250 WORDS)

Aesthetic platysma surgery during rhytidectomy has gained popularity for contour restoration of the jaw line, cervicomental angle, as well as anterior neck defects. The superficial musculoaponeurotic system-platysma flap is elevated and suspended in a cephaloposterior direction by suturing to the investing fascia overlying the sternocleidomastoid muscle and the mastoid bone. This procedure is usually performed without total visualization of the great auricular nerve, possibly placing this nerve at risk during suspension. Anatomical dissections of the great auricular nerve were performed bilaterally on 10 cadavers to delineate its course in the superior neck and identify anatomy pertinent to the elevation of flaps and placement of sutures during superficial musculoaponeurotic system-platysma suspension.