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Controversy remains regarding the optimal technique and suture type for wound closure after carpal tunnel surgery. Adult patients undergoing open carpal tunnel release were prospectively randomized to receive either interrupted, buried Monocryl sutures or traditional nylon horizontal mattress sutures for their wound closures. At the 2-week and 6-week postoperative visits, Patient and Observer Scar Assessment Scale questionnaires were completed. At 2 weeks, patients and observers had a significantly better opinion of incisions closed with Monocryl. By 6 weeks, neither patients nor observers found a difference between suture types in any category. Scars of wounds closed with Monocryl did not change appreciably in appearance between 2 and 6 weeks. However, patients and observers noted significant improvement in scar appearance in the nylon group over time. Monocryl suture represents an effective method for carpal tunnel closure that leads to improved patient- and observer-reported outcome scores in the early postoperative period compared with nylon.Level of evidence: II.

The aim of this study was to compare the effect of the application of a flowable resin composite coating, over a collagen sponge stabilized with suture, on postoperative pain after free gingival graft harvesting. Thirty-two free gingival grafts were harvested from the palate in 32 patients, who were subsequently randomized to have only a collagen sponge stabilized with sutures applied to the palatal wound (control), or to have the collagen sponge coated with a flowable resin composite (test). Patients were observed for 14 days, and the pain level was evaluated by using a numerical rating scale. The consumption of analgesics during the postoperative period and the characteristic of the graft were also analyzed. The patients in the test group reported having experienced significantly less pain statistically than the patients in the control group throughout the study. The consumption of analgesics was lower in the test group. The dimensions of harvested grafts in the control and test groups showed no significant differences in height, width, and thickness. In conclusion, the addition of flowable resin composite coating to the hemostatic collagen sponge on the palatal wound following free gingival graft harvesting helped to minimize postoperative pain., Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Revisión por pares

Arthroscopically assisted techniques for the treatment of foveal triangular fibrocartilage complex (TFCC) injuries offer a less invasive option. Reports of the ulnar tunnel technique on a larger patient population are needed. This prospective cohort study of 44 patients aimed to evaluate the clinical and patient-reported outcome after arthroscopic foveal re-attachment using a novel, modified ulnar tunnel technique. Furthermore, preoperative magnetic resonance imaging findings were compared with the findings from the arthroscopic evaluation. History of ulnar sided wrist pain, positive fovea-sign at the clinical examination and positive hook test at the surgery were the main inclusion criteria for the study. Pain, grip strength, wrist motion and patient-reported outcomes were assessed pre-and postoperatively. The follow-up of this study was 31 months (range 18-48). No complications occurred during the surgery. All outcomes improved besides the range of motion, which remained unchanged. Pain on a visual analogue scale was 63 before, and 14 after the surgery (p = .0004). Pre- and postoperative values of Disability of Arm, Shoulder and Hand Questionnaire were 41/6, respectively (p=.007). Grip strength, measured in Kilogram-force were 29 and 36, pre-and postoperatively (p = .0004). Conspicuously, all patients achieved stability. Six patients needed re-operation, three for renewed injury. Thirty-nine of 44 patients scored excellent or good on the satisfaction score. We found the devised method to be with fewer complications and with favourable results compared with other techniques for the treatment of TFCC injuries.

Background: The choice of whether to perform a palatal disjunction in constricted maxilla has traditionally been decided based on the age of the patients, although there are gradually increasing references to the fact that this is not a determining factor. The main goal of this study was to evaluate the frequency of the different stages of midpalatal suture maturation in a sample of young adults between 15 and 30 years of age. Other objectives also included analyzing the possible correlation the maturation stages could maintain with sex and age groups. Methods: 142 Cone Beam Computed Tomography (CBCT) scans of young adults were performed. The images were divided into four age groups based on age ranges of 15–18, 19–22, 23–26, and 27–30 years. Each group consisted of 26, 41, 39, and 36 patients, respectively, which were classified using Angelieri’s method. In addition, sex and age groups were considered as variables, and the possible correlation of the prevalence of each one, according to age and sex, was studied. Results: the sample was classified into 4.9% stage B; 52.1% stage C; 27.5% stage D; and 15.5% stage E. In addition, no statistically significant correlation between sex and the maturation stages was found, but more advanced stages did appear to be related to the chronological age of the subjects. Conclusions: The frequency of maturational stages where the suture is shown to be consolidated did not appear to be as high as expected; therefore, the idea of rejecting transverse plane treatment in a conventional manner in an out-of-growth patient should be discarded.

Background: The aim of this study was to report the outcome and the complications for patients operated on for craniosynostosis using the dura split technique. Specifically, the authors aimed to evaluate the safety of this technique, which is currently not in use, and to determine whether it is still useable. Methods: The data was collected from the hospital patient records of all children surgically treated for craniosynostosis using the dura split technique in Turku University Hospital during the period 1975 to 2015. The data was analyzed to determine the clinical and radiological outcomes of the surgical procedure, the need for reoperations, and the rate of complications. Results: During the study period, the dura split technique was used in the surgery of 65 patients. The outcome was either good or acceptable in most patients and reoperation was needed in only 2 patients (3.1%). Surgical complications included significant blood loss (26.2%), lesions on the inner layer of the dura (21.5%), leakage of cerebrospinal fluid (13.8%), and persistent bone defects (15.4% on palpation and 63.1% radiologically). Conclusions: Although the outcome of surgery for craniosynostosis using the dura split technique was mostly acceptable and the need for reoperations rare, the technique cannot, however, be recommended in the future due to high rates of bone defects, frequent problems with lesions on the inner layer of the dura, and consequent perioperative leakage of cerebrospinal fluid.

Purpose: Traditional tension band fixation of patella fracture is associated with high reoperation rates. The purpose of the study was to assess strength of fixation in patella fractures treated with either a non-metallic all suture-based technique or traditional metallic tension band wiring. Methods: Ten paired human cadaveric specimens were included. A transverse fracture was created, reduced and fixated with a non-metallic or metallic approach. Non-metallic fixation was done according to a previously published technique, metallic fixation was done according to AO description. Specimens were fixed in 90° of flexion and underwent 200 cycles of loading by pulling the Quadriceps tendon to 300 Newton. Fracture displacement was optically monitored. Primary outcome was fracture displacement after 200 cycles compared to the first cycle. Subsequently, load-to-failure was assessed by a monotonic pull to 1000 N. Results: For cyclic loading analysis, one specimen from each group was excluded due to machine synchronization, resulting in a total population of 18 specimens. Median (min-max) fracture displacement was 0.65 mm (0.06-1.3) in the non-metallic group and 0.68 mm (0-1.23), (p=0.931) in the metallic group. No difference in displacement was found between the two groups in the repeated measures analysis of variance (p=0.5524). For load-to-failure analysis one specimen was excluded due to machine synchronization, resulting a total population of 19 specimens. 2/9 specimens failed in the non-metallic group (at 979 and 635 N) and 2/10 failed in the metallic group (745 and 654 N). Conclusion: Non-metallic technique is a biomechanically viable alternative to traditional tension band fixation and it can hopefully lead to fewer implant-related complications.

Purified fungal chitosan and crustacean chitosan were wet spun by using adipic and lactic acids as solvent. The lowest viscosity at which fiber formation was possible was 0.5 Pa·s; below this value, aggregates from low molecular weight fungal chitosan (32 kDa) formed, which could not be collected and dried. Fiber formation was achieved with high molecular weight fungal (400 kDa) and shrimp (406.7 kDa) chitosans as well as low molecular weight shrimp chitosan (50–190 kDa). Fibers made of high molecular weight chitosans with adipic acid as the solvent generally exhibited higher tensile strength; the highest observed tensile strength and Young’s modulus were 308.0 ± 18.4 MPa and 22.7 ± 4.0 GPa, respectively. SEM images indicated the formation of cylindrical chitosan fibers. The survival (viability) of human skin fibroblasts in presence of different fibers was measured using tetrazolium-based colorimetric assay and results confirmed that chitosan fibers have better biocompatibility than common conventional sutures, regardless of the chitosan and acid type. Accordingly, chitosan fibers from fungal and shrimp sources serve as good candidates for application as sutures.

Purified fungal chitosan and crustacean chitosan were wet spun by using adipic and lactic acids as solvent. The lowest viscosity at which fiber formation was possible was 0.5 Pa·s; below this value, aggregates from low molecular weight fungal chitosan (32 kDa) formed, which could not be collected and dried. Fiber formation was achieved with high molecular weight fungal (400 kDa) and shrimp (406.7 kDa) chitosans as well as low molecular weight shrimp chitosan (50–190 kDa). Fibers made of high molecular weight chitosans with adipic acid as the solvent generally exhibited higher tensile strength; the highest observed tensile strength and Young’s modulus were 308.0 ± 18.4 MPa and 22.7 ± 4.0 GPa, respectively. SEM images indicated the formation of cylindrical chitosan fibers. The survival (viability) of human skin fibroblasts in presence of different fibers was measured using tetrazolium-based colorimetric assay and results confirmed that chitosan fibers have better biocompatibility than common conventional sutures, regardless of the chitosan and acid type. Accordingly, chitosan fibers from fungal and shrimp sources serve as good candidates for application as sutures.

Accretionary orogens, such as the North American Cordillera, form by repeated collisions of allochthonous oceanic and continental fragments (terranes). Due to the closure of ocean basins that is required for far-traveled terranes to become part of the orogen, fault systems at the boundaries of allochthonous terranes commonly form as plate boundaries and experience multiple phases of reactivation after collision. The repeated phases of reactivation along the terrane-boundary fault systems often mask the earlier deformation events and lead to uncertainty regarding the location of the main lithospheric-scale geologic boundary between terranes. In this dissertation, I present the geologic evolution of the master reactivated plate boundary structure in the Alaska Range suture zone of southern Alaska. In the first chapter, I use detailed geologic mapping, structural analysis, U-Pb and 40Ar/39Ar geochronology, geochemistry of spinel-group minerals, and receiver function seismology to parse metamorphic rocks in the suture zone. With these methods, I show that the main suturing structure is located along the boundary between amphibolite grade schists and gneisses associated with North America in the north and greenschist grade metagreywacke and slate associated with allochthonous oceanic terranes in the south. The main suturing structure was reactivated after ca. 32 Ma and nucleated an imbricate thrust system that progressed southward. I argue that reactivation along the boundary between the metasedimentary belts is the third phase of activity on this structure, owing to the penetration of that boundary through the lithosphere. In the second chapter, I use regional geologic mapping, U-Pb and 40Ar/39Ar geochronology, Hf isotope analysis, and statistical tests to confirm the correlation between Alaska Range suture zone metamorphic rocks in the Alaska Range and hypothesized correlative metasedimentary and plutonic belts in southwestern Yukon Territory. After confirming the corr

During the transition from the 20th to the 21st century, the city of Rosario undertook the configuration of its riverfront. This was possible through the adaptation of the remnants of the railway port interface, the production of polyfunctional public space, the channeling of socio-cultural dynamics, and the landscape re-imagination of Paraná river. The present work analyzes the reconversion of the port warehouses of the central riverbank based on the attribution and condensation of cultural, juvenile, and fluvial signifiers. We conceptualize the link between culture-youth-river regarding the refunctionalization of said infrastructures as a signifier suture. Disengaged from their old port role, the spaces were used for certain types of (cultural) activities carried out by/for particular age agents (young people) in a specific landscape (riverside). Those links were woven between government projections, individual agents, social appropriations, and urban imaginaries. The cases of Centro de Expresiones Contemporáneas (CEC) (1995), Centro de la Juventud (CJ) (1998), and Escuela Municipal de Artes Urbanas (EMAU) (2001) will be studied. The article is structured in five parts. First, an introduction and the construction of the category of signifier suture. Second, an introduction to the context and the antecedents of the studied process. Third, an analysis of CEC, CJ, and EMAU. Fourth, the comparison of the symbolic appropriation of the suture with of the urban inequalities and violences on which is mounted. Fifth, a brief description of the readjustment of the spaces to the context of COVID-19. The data used for the research comes from in-depth interviews with participants of the experiences and written sources and images., Durante el tránsito del siglo XX al XXI, la ciudad de Rosario emprendió la configuración de su frente ribereño. Ello fue posible mediante la adecuación de los remanentes de la interfaz ferroportuaria, la producción de espacio público polifuncional, el encauce de dinámicas socioculturales y la re-imaginación paisajística del Paraná. El presente trabajo analiza la reconversión de los galpones portuarios de la ribera central a partir de la atribución y la condensación de sentidos culturales, juveniles y fluviales. Llamamos sutura significante al enlace juventud-cultura-río que orientó la refuncionalización de dichas infraestructuras. Desafectados de su antiguo rol portuario, los espacios fueron destinados a cierto tipo de actividades (culturales) llevadas a cabo por/para determinados agentes etarios (jóvenes) en un paisaje específico (ribereño). Esos vínculos se tramaron entre proyecciones gubernamentales, agentes individuales, apropiaciones sociales diferenciales e imaginarios urbanos. Se estudiarán los casos del Centro de Expresiones Contemporáneas (CEC) (1995), el Centro de la Juventud (CJ) (1998) y la Escuela Municipal de Artes Urbanas (EMAU) (2001). El artículo se estructura en cinco partes. Primero, una introducción y la construcción de la categoría de sutura significante. Segundo, la ubicación del contexto y los antecedentes del fenómeno estudiado. Tercero, el análisis del CEC, el CJ y la EMAU. Cuarto, el cotejo de la apropiación simbólica de la sutura con las desigualdades y violencias urbanas sobre las que se monta. Quinto, una somera descripción de la readecuación de los espacios al contexto del COVID-19. Los insumos utilizados para la pesquisa son una serie de entrevistas en profundidad a participantes de las experiencias, trianguladas con fuentes escritas e imágenes.

Background: Patella fractures requiring surgery are traditionally treated using metallic implants, which are associated with high re-operation rates, mainly due to implant prominence. To overcome the problem of prominent metallic implants, we present a technique based purely on braided sutures. Methods: This technique is described in a step-wise, standardised way based on our findings on six patients treated at our institution. Results: This technique can be adapted to all types of patella fractures. The described suture configuration allows maintenance of inter-fragmentary reduction until bony union without symptoms from the suture material. Conclusions: We believe that this technique is a safe and promising alternative to traditional metallic fixation methods.

Introduction: Recurrent urethral diverticulum has been reported in 23% of cases after primary repair and can be difficult to manage. The aim of this video is to demonstrate a surgical technique of repairing a recurrent diverticulum in a woman who had two previous procedures, one with a Martius labial fat pad graft. Method(s): A 40-year-old woman presented with a symptomatic recurrent urethral diverticulum after two previous repairs. She underwent surgery with excision of the diverticular mucosa and multilayer urethral closure using the diverticulum wall after mobilization and then repositioning of the Martius labial fat pad interposition. Result(s): There were no surgical complications intra- or postoperatively, and the patient had improvement of her symptoms postoperatively with resolution of the diverticulum on ultrasound. Conclusion(s): Mobilizing and repositioning a Martius labial fat pad is a feasible technique for complex recurrent urethral diverticulum repairs. The graft alone without meticulous urethral repair will not prevent diverticulum recurrence, fistula formation or stress urinary incontinence. This procedure requires experienced surgeons to minimize surgical complications and optimize outcome.Copyright © 2020, The International Urogynecological Association.

Introduction: Recurrent urethral diverticulum has been reported in 23% of cases after primary repair and can be difficult to manage. The aim of this video is to demonstrate a surgical technique of repairing a recurrent diverticulum in a woman who had two previous procedures, one with a Martius labial fat pad graft. Method(s): A 40-year-old woman presented with a symptomatic recurrent urethral diverticulum after two previous repairs. She underwent surgery with excision of the diverticular mucosa and multilayer urethral closure using the diverticulum wall after mobilization and then repositioning of the Martius labial fat pad interposition. Result(s): There were no surgical complications intra- or postoperatively, and the patient had improvement of her symptoms postoperatively with resolution of the diverticulum on ultrasound. Conclusion(s): Mobilizing and repositioning a Martius labial fat pad is a feasible technique for complex recurrent urethral diverticulum repairs. The graft alone without meticulous urethral repair will not prevent diverticulum recurrence, fistula formation or stress urinary incontinence. This procedure requires experienced surgeons to minimize surgical complications and optimize outcome.Copyright © 2020, The International Urogynecological Association.

Accretionary orogens, such as the North American Cordillera, form by repeated collisions of allochthonous oceanic and continental fragments (terranes). Due to the closure of ocean basins that is required for far-traveled terranes to become part of the orogen, fault systems at the boundaries of allochthonous terranes commonly form as plate boundaries and experience multiple phases of reactivation after collision. The repeated phases of reactivation along the terrane-boundary fault systems often mask the earlier deformation events and lead to uncertainty regarding the location of the main lithospheric-scale geologic boundary between terranes. In this dissertation, I present the geologic evolution of the master reactivated plate boundary structure in the Alaska Range suture zone of southern Alaska. In the first chapter, I use detailed geologic mapping, structural analysis, U-Pb and 40Ar/39Ar geochronology, geochemistry of spinel-group minerals, and receiver function seismology to parse metamorphic rocks in the suture zone. With these methods, I show that the main suturing structure is located along the boundary between amphibolite grade schists and gneisses associated with North America in the north and greenschist grade metagreywacke and slate associated with allochthonous oceanic terranes in the south. The main suturing structure was reactivated after ca. 32 Ma and nucleated an imbricate thrust system that progressed southward. I argue that reactivation along the boundary between the metasedimentary belts is the third phase of activity on this structure, owing to the penetration of that boundary through the lithosphere. In the second chapter, I use regional geologic mapping, U-Pb and 40Ar/39Ar geochronology, Hf isotope analysis, and statistical tests to confirm the correlation between Alaska Range suture zone metamorphic rocks in the Alaska Range and hypothesized correlative metasedimentary and plutonic belts in southwestern Yukon Territory. After confirming the corr

The next-generation sutures should provide in situ monitoring of wound condition such as temperature while reducing surgical site infection during wound closure. In this study, functionalized nanodiamond (FND) and reduced graphene oxide (rGO) into biodegradable polycaprolactone (PCL) are incorporated to develop a new multifunctional suture with such capabilities. Incorporation of FND and rGO into PCL enhances its tensile strength by about 43% and toughness by 35%. The sutures show temperature sensing capability in the range of 25–40 °C based on the shift in zero-splitting frequency of the nitrogen-vacancy (NV–) centers in FND via optically detected magnetic resonance, paving the way for potential detection of infection or excessive inflammation in healing wounds. The suture surface readily coats with antibiotics to reduce bacterial infection risk to the wounds. The new suture thus is promising in monitoring and supporting wound closure.

Background: Patella fractures requiring surgery are traditionally treated using metallic implants, which are associated with high re-operation rates, mainly due to implant prominence. To overcome the problem of prominent metallic implants, we present a technique based purely on braided sutures. Methods: This technique is described in a step-wise, standardised way based on our findings on six patients treated at our institution. Results: This technique can be adapted to all types of patella fractures. The described suture configuration allows maintenance of inter-fragmentary reduction until bony union without symptoms from the suture material. Conclusions: We believe that this technique is a safe and promising alternative to traditional metallic fixation methods.

Sensors based on electrochemical methods have gained an important role in the field of biomolecular detection over the last decades. Sensing of molecules of high biological interest such as dopamine, glucose or lactate has been effectively achieved by electrochemical devices, thanks to their high processability and excellent electric performance. As a consequence of these outstanding qualities, their use in biomedical devices is in continuous development. In this sense, the present project reports the surface modification of light and mid-weight isotactic-propylene (i-PP) meshes for hernia repair, and polypropylene-polyethylene (PP/PE) sutures, for the electrochemical detection of nicotinamide adenine dinucleotide (NADH). Functionalization of the i-PP and PP/PE substrates by oxygen plasma allowed their modification through a layer of poly(hydroxymethyl-3,4-ethylenedioxythiophene) (PHMeDOT) nanoparticles, that serve as nucleation sites for the coating of poly(3,4- ethylenedioxythiophene) (PEDOT). The resulting samples acquired a noticeable electrical conductivity thanks to the conjugated structure of the PEDOT, that enables the electrochemical detection of NADH oxidation to NAD+. The developed devices reach sensitivities of 0.63 mA/(cm2·mM) and limits of detection (LOD) of 0.35 mM, hence they are capable of sensing NADH concentrations in the extracellular media of bacterial cultures. The synthesis of these smart biomedical devices is aimed to be of great interest for the prevention of infections through the monitoring of bacterial growth. This preventive role acquires even more importance if we take into consideration that the involved bacteria produce biofilms, that may difficult antibiotic treatments., Los sensores basados en métodos electroquímicos han ganado un papel importante en el campo de la detección biomolecular durante las últimas décadas. La detección de moléculas de alto interés biológico como la dopamina, la glucosa o el lactato se ha logrado eficazmente mediante dispositivos electroquímicos, gracias a su alta procesabilidad y excelente rendimiento eléctrico. Como consecuencia de estas cualidades sobresalientes, su uso en dispositivos biomédicos está en continuo desarrollo. En este sentido, el presente proyecto reporta la modificación superficial de mallas ligeras y de peso medio isotáctico-propileno (i-PP) para la reparación de hernias, y suturas polipropileno-polietileno (PP / PE), para la detección electroquímica de nicotinamida adenina dinucleótido ( NADH). La funcionalización de los sustratos i-PP y PP / PE por plasma de oxígeno permitió su modificación a través de una capa de nanopartículas de poli (hidroximetil-3,4-etilendioxitiofeno) (PHMeDOT), que sirven como sitios de nucleación para el recubrimiento de poli (3,4 - etilendioxitiofeno) (PEDOT). Las muestras resultantes adquirieron una conductividad eléctrica notable gracias a la estructura conjugada del PEDOT, que permite la detección electroquímica de la oxidación de NADH a NAD +. Los dispositivos desarrollados alcanzan sensibilidades de 0.63 mA / (cm2 · mM) y límites de detección (LOD) de 0.35 mM, por lo que son capaces de detectar concentraciones de NADH en los medios extracelulares de cultivos bacterianos. La síntesis de estos dispositivos biomédicos inteligentes pretende ser de gran interés para la prevención de infecciones mediante el seguimiento del crecimiento bacteriano. Esta función preventiva adquiere aún más importancia si tenemos en cuenta que las bacterias implicadas producen biopelículas que pueden dificultar los tratamientos antibióticos., Els sensors basats en mètodes electroquímics han guanyat un paper important en el camp de la detecció biomolecular en les darreres dècades. La detecció de molècules d'alt interès biològic com la dopamina, la glucosa o el lactat s'ha aconseguit amb eficàcia mitjançant dispositius electroquímics, gràcies a la seva elevada capacitat de processament i al seu excel·lent rendiment elèctric. Com a conseqüència d'aquestes qualitats excepcionals, el seu ús en dispositius biomèdics està en continu desenvolupament. En aquest sentit, el present projecte informa de la modificació superficial de les malles isotàctiques de propilè isotàctic (i-PP) lleuger i mitjà per a la reparació d'hèrnia i de sutures de polipropilè-polietilè (PP / PE), per a la detecció electroquímica de dinotice ( NADH). La funcionalització dels substrats i-PP i PP / PE mitjançant plasma d'oxigen va permetre la seva modificació a través d?una capa de nanopartícules de poli (hidroximetil-3,4-etilendioxitiofè) (PHMeDOT), que serveixen de llocs de nucleació per al recobriment de poli (3,4 - etilendioxiitiofè) (PEDOT). Les mostres resultants van adquirir una conductivitat elèctrica notable gràcies a l?estructura conjugada del PEDOT, que permet la detecció electroquímica de l'oxidació de NADH a NAD +. Els dispositius desenvolupats aconsegueixen sensibilitats de 0.63 mA / (cm2 · mM) i límits de detecció (LOD) de 0.35 mM, per tant són capaços de detectar concentracions de NADH en els medis extracel·lulars de cultius bacterians. La síntesi d'aquests dispositius biomèdics intel·ligents pretén ser de gran interès per a la prevenció d'infeccions mitjançant el control del creixement bacterià. Aquest paper preventiu adquireix encara més importància si tenim en compte que els bacteris implicats produeixen biofilms, que poden dificultar els tractaments amb antibiòtics.

Southern India lies in an area of Gondwana where multiple blocks are juxtaposed along Moho-penetrating structures, the significance of which are not well understood. Adequate geochronological data that can be used to differentiate the various blocks are also lacking. We present a newly acquired SIMS U–Pb, Lu–Hf, O isotopic and trace element geochemical dataset from zircon and garnet from the protoliths of the Nagercoil Block at the very tip of southern India. The data indicate that the magmatic protoliths of the rocks in this block formed at c. 2040 Ma with Lu–Hf, O-isotope and trace element data consistent with formation in a magmatic arc environment. The zircon data from Nagercoil Block are isotopically and temporally distinct from those in all the other blocks in southern India, but remarkably correspond to rocks in East Africa that are exposed on the southern margin of the Tanzania–Bangweulu Block. The new data suggest that the tip of southern India has an African affinity and a major suture zone must lie along its northern margin. All of these blocks were finally brought together during the Ediacaran-Cambrian amalgamation of Gondwana where they underwent high to ultrahigh temperature metamorphism.

Primary closure of suborbital skin defects can cause tension along the closure resulting in ectropion. The bicycle wheel analogy is a simple yet effective guide to aid in reducing tension vectors resulting in ectropion.

Biological composites provide valuable design guidelines to produce the next generation of engineering materials. Incorporating readily available resources in environmentally friendly method, these biological organisms produce lightweight, strong, and tough materials with superior mechanical properties to engineering counterparts. The key to this success results from their hierarchical organization as well as structural and compositional gradients imparted by an ordered self-assembly of organic material. In this work we study the structure-mechanical property relationship and multifunctional nature of a compression resistant beetle elytra able to withstand crushing and piercing attacks from predators while thriving in an arid desert environment. We uncover the macro and microstructural architectural features responsible for transferring stress and imparting localized stiffness and compliance to toughen the bulk biological composite. These insights are then subsequently applied to the fabrication of bioinspired fiber reinforced composites using conventional engineering materials and additive manufacturing. Validating their performance, mechanical testing was used to highlight the enhanced performance of these biological materials compared to industry standard designs. This work may further provide insights into the fabrication of lightweight, strong, and tough structural materials for use in engineering applications.

Background: Tissue adhesive (TiA), adhesive tape (AdT), and sutures can be used to close surgical wounds and lacerations in children. However, it is unclear which technique produces the best results. Method(s): In this prospectively registered study, the PubMed, Ovid MEDLINE, Cochrane Library, Centre for Reviews and Dissemination Database, and ScienceDirect databases were searched. English language studies published between January 1980 and August 2017 evaluating TiA and/or AdT for primary skin closure of surgical wounds or lacerations in patients aged <= 18 years were included. Study endpoints included clinician-rated wound cosmesis and incidence of wound complications. Result(s): Thirty-one studies were included in the systematic review and 16 studies in the meta-analysis. Amongst heterogeneous studies, AdT yielded marginally better cosmetic outcomes than TiA (p = 0.04). There was no difference in cosmesis between sutured wounds and those closed with TiA (p = 0.2). No difference in overall risk of wound infection or dehiscence was identified when comparing TiA with AdT (p = 0.3), and TiA with sutures (p = 0.9 and 0.3 respectively). Conclusion(s): TiA, AdT, and sutures can all be used for wound closure with equivalent risk of wound infection and dehiscence. AdT appears to convey better cosmesis. Further adequately powered studies directly comparing techniques are required. Levels of Evidence: Level IV.Copyright © 2020 Elsevier Inc.

Background: Tissue adhesive (TiA), adhesive tape (AdT), and sutures can be used to close surgical wounds and lacerations in children. However, it is unclear which technique produces the best results. Method(s): In this prospectively registered study, the PubMed, Ovid MEDLINE, Cochrane Library, Centre for Reviews and Dissemination Database, and ScienceDirect databases were searched. English language studies published between January 1980 and August 2017 evaluating TiA and/or AdT for primary skin closure of surgical wounds or lacerations in patients aged <= 18 years were included. Study endpoints included clinician-rated wound cosmesis and incidence of wound complications. Result(s): Thirty-one studies were included in the systematic review and 16 studies in the meta-analysis. Amongst heterogeneous studies, AdT yielded marginally better cosmetic outcomes than TiA (p = 0.04). There was no difference in cosmesis between sutured wounds and those closed with TiA (p = 0.2). No difference in overall risk of wound infection or dehiscence was identified when comparing TiA with AdT (p = 0.3), and TiA with sutures (p = 0.9 and 0.3 respectively). Conclusion(s): TiA, AdT, and sutures can all be used for wound closure with equivalent risk of wound infection and dehiscence. AdT appears to convey better cosmesis. Further adequately powered studies directly comparing techniques are required. Levels of Evidence: Level IV.Copyright © 2020 Elsevier Inc.

Surgical site infection (SSI) is a frequent complication of surgical procedures. The aim of this study was to analyze the clinical evidence for SSI prevention with triclosan-coated sutures (TCS) in abdominal surgery and to investigate the economic impact of TCS in this type of procedure compared with conventional absorbable sutures (CS). A literature review was carried out to identify meta-analyses that were published between 1990 and 2019 that assessed the use of TCS in abdominal surgery. A budget impact analysis was performed from an Italian hospital perspective based on the most recently published evidence to simulate the financial impact of TCS in a general surgery unit. Uncertainty was explored through scenario analysis, as well as deterministic and probabilistic sensitivity analyses. Nine meta-analyses and two additional randomized clinical trials were retrieved. All meta-analyses described a reduction (range 19%-44%) in the risk of SSI when TCS were used. The use of TCS was associated with an overall annual net saving for the general surgery unit of ¿14,785 and a reduction of 3.2 SSIs compared with CS. Sensitivity analyses resulted in a positive annual saving associated with TCS in 98% of scenarios. TCS are a valuable, cost-saving SSI prevention strategy. TCS additional costs would be offset by the reduction in SSIs.

Biological composites provide valuable design guidelines to produce the next generation of engineering materials. Incorporating readily available resources in environmentally friendly method, these biological organisms produce lightweight, strong, and tough materials with superior mechanical properties to engineering counterparts. The key to this success results from their hierarchical organization as well as structural and compositional gradients imparted by an ordered self-assembly of organic material. In this work we study the structure-mechanical property relationship and multifunctional nature of a compression resistant beetle elytra able to withstand crushing and piercing attacks from predators while thriving in an arid desert environment. We uncover the macro and microstructural architectural features responsible for transferring stress and imparting localized stiffness and compliance to toughen the bulk biological composite. These insights are then subsequently applied to the fabrication of bioinspired fiber reinforced composites using conventional engineering materials and additive manufacturing. Validating their performance, mechanical testing was used to highlight the enhanced performance of these biological materials compared to industry standard designs. This work may further provide insights into the fabrication of lightweight, strong, and tough structural materials for use in engineering applications.

Primary closure of suborbital skin defects can cause tension along the closure resulting in ectropion. The bicycle wheel analogy is a simple yet effective guide to aid in reducing tension vectors resulting in ectropion.

Background: Appendectomy is amongst the most common general surgical procedures and the laparoscopic approach is recognized and recommended by international guidelines as a valid option. The different closure techniques of the appendicular stump constitute a matter of debate since their possible implication in determining postoperative infectious complications. The aim of the present meta-analysis is to compare endostapler versus endoscopic loop ties for stump closure during laparoscopic appendectomy. Methods: This is a systematic review with meta-analysis of randomized trials and cohort studies comparing endostapler with endoscopic loop ties for the closure of appendicular sump in laparoscopy appendectomy. Subgroup analysis of pediatric patients and patients with complicated appendicitis were performed when data were available. Complicated acute appendicitis was defined as in case of gangrenous/necrotic appendix or perforated appendix. Main outcomes were wound infection rate, intra-abdominal infection rate, length of stay, readmission and reoperation rates. Results: a total of 5934 patients from 14 studies were included in the analysis. Endostapler was associated with a similar intra-abdominal abscess rate (RR 0.88, 95%C.I. 0.54–1.43) but a lower incidence of wound infection (RR 0.54, 95%C.I. 0.22–0.97) Length of stay, readmission and reoperation rates were similar. In subgroups analysis endostapler reduces significantly the wound infection rate in pediatric patients; no differences in main outcomes were observed in patients with complicated acute appendicitis. Conclusion: In complicated acute appendicitis the stump closure technique did not affect outcomes; the use of endostapler seems to be associated to a reduction of wound infection rate in pediatric patients with non-complicated acute appendicitis.

This thesis contains chapters about different types of repair of abdominal wall hernias. In this thesis, abdominal wall hernias include umbilical, inguinal, incisional, and complex abdominal wall hernias. There are mainly two techniques to repair hernias: by suture repair, only successful in small hernias, and by mesh repair. In this thesis, the indications for various treatments will be discussed.

The need to improve the results in the midline laparotomy´s closure lead us to analyze the results of variations according to the technique and the materials used. The analysis of the studies collected in the literature serves to confirm the need to more accurately reflect in our daily activity the determining factors of this activity such as suture material and length, needle and type of points, La necesidad de mejorar los resultados en el cierre de la laparotomía media nos llevan a analizar los resultados de variaciones según la técnica realizada y los materiales utilizados. A su vez nos sirve el análisis de los estudios recogidos en la literatura para constatar la necesidad de reflejar de forma más precisa en nuestra actividad diaria los factores determinantes de esta actividad como material de sutura y longitud, aguja y tipo de puntos realizados.

With the development in recent years of the laparoscopic approach for the treatment of abdominal wall hernia, there are multiple prosthesis fixation systems that have been developed seeking optimal anchorage. The need to reduce postoperative complications, mainly chronic pain without increasing the rate of recurrence, is what has driven the use of tissue adhesives in recent years. Although there is consensus for its use in certain cases, there are still no studies that demonstrate which is the ideal fixation system. The use, therefore, of one or the other system should be personalized according to the type of patient and characteristics of the hernia to be treated., Con el desarrollo en los últimos años del abordaje laparoscópico para el tratamiento de la hernia de pared abdominal, son múltiples los dispositivos de fijación de la prótesis que se han desarrollado buscando un anclaje óptimo. La necesidad de disminuir las complicaciones postoperatorias, fundamentalmente el dolor crónico sin incrementar el índice de recidiva, es lo que ha impulsado en los últimos años el empleo de adhesivos tisulares. Aunque existe consenso para su uso en determinados supuestos, aún no existen estudios que demuestren cual es el sistema de fijación ideal. El uso, por tanto, de uno u otro sistema deberá ser personalizado en función del tipo de paciente y características de la hernia a tratar.

Craniosynostosis is defined as congenital premature fusion of one or more cranial sutures. While the genetic basis for about 30% of cases is known, the causative genes for the diverse presentations of the remainder of cases are unknown. The recently discovered cranial suture stem cell population affords an opportunity to identify early signaling pathways that contribute to craniosynostosis. We previously demonstrated that enhanced BMP signaling in neural crest cells (caA3 mutants) leads to premature cranial suture fusion resulting in midline craniosynostosis. Since enhanced mTOR signaling in neural crest cells leads to craniofacial bone lesions, we investigated the extent to which mTOR signaling is involved in the pathogenesis of BMP-mediated craniosynostosis by affecting the suture stem cell population. Our results demonstrate a loss of suture stem cells in the caA3 mutant mice by the newborn stage. We have found increased activation of mTOR signaling in caA3 mutant mice during embryonic stages, but not at the newborn stage. Our study demonstrated that inhibition of mTOR signaling via rapamycin in a time specific manner partially rescued the loss of the suture stem cell population. This study provides insight into how enhanced BMP signaling regulates suture stem cells via mTOR activation.

Anastomotic leakage in digestive sutures determines high morbidity and mortality, but its early diagnoses is critical and controversial. There is an important interest on finding an early detection biomarker that allows early diagnoses without clinical evidences. Many studies have shown the eficacy of Procalcitonin (PCT) and C Reactive Protein (CRP) as early detection biomarkers of anastomotic leackeage, as they were demostrated as useful intraabdominal infection predictors. This prospective observational study took place in Hospital Maciel, Department of Surgery nº 3, in a period of 14 months, and included all patients undergoing elective surgery with a digestive suture. CRP and PCT were measured preoperatively and on postoperative days (POD) 1, 2, 3, 4, 5 and patients were followed for postoperative complications with the aim to determine if they were suitable as anastomotic leackage monitoring tool in the postoperative setting. We established two groups: with and without anastomotic leackage.28 patients were included. 14,3% corresponded to the anastomotic leackage group with a mortality of 3,6%. We found a statistically significative increase of both biomarkers in the leackage group (CRP p=0,001 and PCT p=0,003) with a remarkable increase specially POD 3. The main limitation of the study is the small number of patients. There was no statistically difference in demographic characteristics between groups. According to our results, postoperative PCT and CRP determination can be use as adecuated early predictors of anastomoticleackage from the POD 2., La falla de sutura digestiva conlleva alta morbi-mortalidad y su diagnóstico precoz es un punto crítico y controversial. Se ha considerado necesario encontrar un marcador bioquímico de valor diagnóstico en ausencia de cuadro clínico evidente.Hay creciente evidencia de la eficacia de la Procalcitonina (PCT) y Proteína C Reactiva (PCR) como marcadores precoces de falla de sutura digestiva, porque ambas han mostrado ser útiles para la predicción de infección intrabdominal.Se realizó en el Hospital Maciel/ Clínica quirúrgica “3” (perío-do: 14 meses) , un estudio observacional, prospectivo, inclu-yendo todos los pacientes intervenidos de coordinación a los que se realizó una sutura digestiva. Se realizo la medición dia-ria de PCT y PCR pre y postoperatoria por 5 días con el objeti-vo de determinar la utilidad de ambas como indicadores preco-ces de falla de sutura. Se identificaron las complicaciones y establecieron dos grupos según la aparición o no de fuga anas-tomótica, diagnosticada clínicamente y/o imagenológicamente.Se incluyeron 28 pacientes, 14,3% presentaron falla de sutura con una mortalidad de 3,6%. Se encontró un aumento significativo de ambos marcadores en el grupo de falla de sutu-ra (PCR p=0,001yPCT p=0,003) con un aumento específico en el 3er día de postoperatorio.La limitante de nuestro estudio es el bajo número de casos, en lo cual no se encontró diferencia significativa en el resto de las variables analizadas.Este estudio permite inferir que la PCR y la PCT deben consi-derarse adecuados predictores precoces de falla de sutura y de infección intra-abdominal, a partir de las 48 hs de postoperato-rio.

Introduction PPH is one of the leading cause of maternal mortality worldwide and uterine atony is accountable for 75-90% of PPH. Historically, B-Lynch suture was first used in 1989 but only described in 1997 and has been used as mechanical compression onto severely atonic uterus to control bleeding in view of preserving fertility. However, multiple case reports have cited numerous long-term complications. Clinical description 31-year-old G2P1 at 17-weeks of gestation, presented to ED following conscious collapse. She was pale, tachycardia and hypotensive. Abdominal examination identified a midline scar, distended and peritonitic. It was then identified that she has had a B-Lynch suture following a PPH post ventouse delivery. A FAST scan showed a large hemoperitoneum and live 'intrauterine' pregnancy. She promptly had explorative laparotomy that revealed a ruptured antero-fundal uterus with the placenta extruding approximately 6- 7 cm in size. Initial attempt to repair the ruptured site was performed. Unfortunately, she had a hysterectomy due to ongoing bleeding despite uterotonics. EBL was 5 litres, in which she received 18u PRBC, 5u cryoprecipitate and 3u FFP. Her postoperative course was uneventful and was discharged home on Day 4. She and her family had very extensive counselling which included surrogacy for future fertility. Discussion Uterine compression sutures have been theoretically taught as an established surgical method in management of severe postpartum haemorrhage despite the lack of hands on procedural opportunity. This led to the questioning of the correct technique in B-Lynch procedure following the variation of complications reported. At present, there are insufficient data on ongoing follow-up with regards to long-term outcomes. These data are essential seeing that the procedure is reserved for severe postpartum haemorrhage in view of conserving anatomical fertility, but there are emerging case reports published citing complications following the p

Introduction PPH is one of the leading cause of maternal mortality worldwide and uterine atony is accountable for 75-90% of PPH. Historically, B-Lynch suture was first used in 1989 but only described in 1997 and has been used as mechanical compression onto severely atonic uterus to control bleeding in view of preserving fertility. However, multiple case reports have cited numerous long-term complications. Clinical description 31-year-old G2P1 at 17-weeks of gestation, presented to ED following conscious collapse. She was pale, tachycardia and hypotensive. Abdominal examination identified a midline scar, distended and peritonitic. It was then identified that she has had a B-Lynch suture following a PPH post ventouse delivery. A FAST scan showed a large hemoperitoneum and live 'intrauterine' pregnancy. She promptly had explorative laparotomy that revealed a ruptured antero-fundal uterus with the placenta extruding approximately 6- 7 cm in size. Initial attempt to repair the ruptured site was performed. Unfortunately, she had a hysterectomy due to ongoing bleeding despite uterotonics. EBL was 5 litres, in which she received 18u PRBC, 5u cryoprecipitate and 3u FFP. Her postoperative course was uneventful and was discharged home on Day 4. She and her family had very extensive counselling which included surrogacy for future fertility. Discussion Uterine compression sutures have been theoretically taught as an established surgical method in management of severe postpartum haemorrhage despite the lack of hands on procedural opportunity. This led to the questioning of the correct technique in B-Lynch procedure following the variation of complications reported. At present, there are insufficient data on ongoing follow-up with regards to long-term outcomes. These data are essential seeing that the procedure is reserved for severe postpartum haemorrhage in view of conserving anatomical fertility, but there are emerging case reports published citing complications following the p

BACKGROUND: Commonly used contemporary orthopaedic sutures have been identified as a potential causative factor in the development of post-arthroscopic glenohumeral chondrolysis. Currently, little is known about the body's immune response to these materials. The aim of this study was to examine the biological response of synovial tissue to three commonly used orthopaedic sutures, using a murine airpouch model. METHODS: Fifty rats were used in this study (ten per group). An airpouch was created in each rat, and test materials were implanted. Test materials consisted of an intact polyethylene terephthalate suture with a polybutilate coating (suture A), an intact polyethylene suture braided around a central polydiaxannone core (suture B), an intact polyethylene/polyester cobraid suture with a silicone coating (suture C), and particles of suture C (particles C). Rats were sacrificed at 1 or 4 weeks following implantation. Histological (multinucleated giant cell count) and immunohistochemical (expression of matrix metalloproteinases MMP-1,-2,-3,-9,-13) markers of inflammation were examined. RESULTS: Multinucleated giant cells were present in all specimens containing suture material but not in the control specimens. No significant differences were found in the number of giant cells between the intact suture groups at either time point. Significantly higher numbers of giant cells were noted in the particles C group compared to the intact suture C group at both time points (p = 0.021 at 1 week, p = 0.003 at 4 weeks). Quantitative analysis of immunohistochemical staining expression at 4 weeks showed that significantly more MMP (-1,-2,-9,-13) was expressed in the particles C group than the intact suture C group (p = 0.024, p = 0.009, p = 0.002, and p = 0.007 for MMP-1, MMP-2, MMP-9, and MMP-13, respectively). No significant difference was seen in the expression of MMP-3 (p&

BackgroundWound complications (WC) following cesarean delivery (CD) result in significant morbidity. A randomized trial in 2013, which demonstrated lower WC rates with suture closure compared to staple closure, resulted in a practice change within our academic institution.ObjectiveTo determine the impact of this practice change on WC rates and identify other modifiable risk factors for WC.Study designThis is a retrospective cohort study of all women undergoing CD at the University of California, San Diego between 1 March 2011 and 28 February 2012 (primarily staple) and 1 March 2013 and 28 February 2014 (primarily suture). WC rates were compared between the two time intervals using Chi-square and Student's t-tests. Risk factors (OR, 95%CI) for WC were assessed using multiple logistic regression modeling.ResultsOf 1580 women delivered by CD, rates of WC were higher with staple closure compared to sutures (10.1% versus 4.5%; OR 2.4, 1.4-4.1). Additionally, WC were more likely with vertical skin incisions (OR 3.6, 1.6-8.1), CD for failed labor (OR 2.9, 1.1-7.4) and diabetes (OR 2.1, 1.4-3.9).ConclusionsAfter adjusting for confounders, there were over twofold increased odds of WC with staple closure. Vertical incisions, failed labor and diabetes also contributed to WC. Suture closure appears to decrease the risks of WC post CD.

Structural biological materials such as bone, teeth or mollusk shells draw their remarkable performance from a sophisticated interplay of architectures and weak interfaces. Pushed to the extreme, this concept leads to sutured materials, which contain thin lines with complex geometries. Sutured materials are prominent in nature, and have recently served as bioinspiration for toughened ceramics and glasses. Sutures can generate large deformations, toughness and damping in otherwise all brittle systems and materials. In this study we examine the design and optimization of sutures with a jigsaw puzzle-like geometry, focusing on the non-linear traction behavior generated by the frictional pullout of the jigsaw tabs. We present analytical models which accurately predict the entire pullout response. Pullout strength and energy absorption increase with higher interlocking angles and for higher coefficients of friction, but the associated high stresses in the solid may fracture the tabs. Systematic optimization reveals a counter-intuitive result: the best pullout performance is achieved with interfaces with low coefficient of friction and high interlocking angle. We finally use 3D printing and mechanical testing to verify the accuracy of the models and of the optimization. The models and guidelines we present here can be extended to other types of geometries and sutured materials subjected to other loading/boundary conditions. The nonlinear responses of sutures are particularly attractive to augment the properties and functionalities of inherently brittle materials such as ceramics and glasses.

BACKGROUND: Chronic pain is common after inguinal hernia repair and has become one of the most important outcome measures for this procedure. The purpose of this study was to determine whether or not there is a relationship between specific postoperative complications and risk for chronic pain after open inguinal hernia repair. METHODS: A prospective cohort study was designed in which participants responded to the Inguinal Pain Questionnaire regarding postoperative groin pain 8 years after inguinal hernia repair. Responses to the questionnaire were matched with data from a previous study regarding reported postoperative complications after open inguinal hernia repair. Participants were recruited originally from the Swedish Hernia Register. Response rate was 82.4% (952/1,155). The primary outcome was chronic pain in the operated groin at follow-up. Grading of pain was performed using the Inguinal Pain Questionnaire. RESULTS: A total of 170 patients (17.9%) reported groin pain and 29 patients (3.0%) reported severe groin pain. The risk for developing chronic groin pain was greater in patients with severe pain in the preoperative or immediate postoperative period (odds ratio 2.09; 95% confidence interval 1.28-3.41). Risk for chronic pain decreased for every 1-year increase in age at the time of operation (odds ratio 0.99, 95% confidence interval 0.98-1.00). CONCLUSION: Both preoperative pain and pain in the immediate postoperative period are strong risk factors for chronic groin pain. Risk factor patterns should be considered before operative repair of presumed symptomatic inguinal hernias. The problem of postoperative pain must be addressed regarding both pre-emptive and postoperative analgesia.

BackgroundWound complications (WC) following cesarean delivery (CD) result in significant morbidity. A randomized trial in 2013, which demonstrated lower WC rates with suture closure compared to staple closure, resulted in a practice change within our academic institution.ObjectiveTo determine the impact of this practice change on WC rates and identify other modifiable risk factors for WC.Study designThis is a retrospective cohort study of all women undergoing CD at the University of California, San Diego between 1 March 2011 and 28 February 2012 (primarily staple) and 1 March 2013 and 28 February 2014 (primarily suture). WC rates were compared between the two time intervals using Chi-square and Student's t-tests. Risk factors (OR, 95%CI) for WC were assessed using multiple logistic regression modeling.ResultsOf 1580 women delivered by CD, rates of WC were higher with staple closure compared to sutures (10.1% versus 4.5%; OR 2.4, 1.4-4.1). Additionally, WC were more likely with vertical skin incisions (OR 3.6, 1.6-8.1), CD for failed labor (OR 2.9, 1.1-7.4) and diabetes (OR 2.1, 1.4-3.9).ConclusionsAfter adjusting for confounders, there were over twofold increased odds of WC with staple closure. Vertical incisions, failed labor and diabetes also contributed to WC. Suture closure appears to decrease the risks of WC post CD.

Medical personnel should be able to do a correct minor surgery, so they have to consider the important points about precautions in pre- surgical, during and post-surgical, besides, medical staff should know the basic tools for minor surgery, differentiate and to know the use of each one: Scalpel Scissors (May / Metzembaum) Needle carrier Dissecting forceps / hemostat Cureta, El personal médico deba de saber realizar una correcta cirugía menor, para ello debe de tomar en cuenta los puntos importantes sobre precauciones pre quirúrgicas, durante y postquirúrgicas, además debe de saber los instrumentos básicos para cirugía menor, diferenciarlo y saber el uso de: Bisturí Tijeras (Mayo/Metzembaum) Porta agujas Pinzas de disección/Pinzas de Hemostasia Cureta

The foreign body granulomas are induced by relatively inert bodies, it is typical that form around material such as talc or sutures. Some studies report that nonabsorbable sutures especially silk has higher rate of complications such as the formation of foreign body granuloma and postoperative pain. the case of a female patient 40 years old, who consulted for abdominal pain of moderate intensity level epigastric two months of evolution accompanied by nausea and vomiting, presents as a surgical history myomectomy performed two months ago reported. Physical examination of the abdomen globose income at the expense of adipose tissue, bowel sounds present, soft, depressible, painful on palpation in epigastric where mobile tumor of 10 x 10 cm, with no signs of peritoneal irritation is evident. Exploratory laparotomy was performed with the following findings: tumor measuring 10 x 15 cm epigastric level consists of omentum attached to the transverse colon and sigmoid colon plastron forming around nonabsorbable suture., Los granulomas a cuerpo extraño son inducidos por cuerpos relativamente inertes, es típico que se formen alrededor de material como talco o suturas. Algunos estudios describen que las suturas no absorbibles especialmente la seda tiene mayor índice de complicaciones como son la formación de granuloma a cuerpo extraño y dolor postoperatorio. Se reporta el caso de una paciente femenino de 40 años de edad, quién consulta por presentar dolor abdominal de moderada intensidad a nivel de epigástrio, de dos meses de evolución acompañado de náuseas y vómitos, presenta como antecedente quirúrgico una miomectomía realizada hace dos meses. Al examen físico de ingreso abdomen globoso a expensas de panículo adiposo, ruidos hidroaéreos presentes, blando, depresible, doloroso a la palpación en epigástrico donde se evidencia tumoración móvil de 10 x 10 cm aproximadamente, sin signos de irritación peritoneal. Se realizó laparotomía exploradora con los siguientes hallazgos: tumoración de 10 x 15 cm a nivel de epigastrio formado por epiplón mayor adherido a colon transverso y colon sigmoides formando plastrón alrededor de sutura no absorbible.

The foreign body granulomas are induced by relatively inert bodies, it is typical that form around material such as talc or sutures. Some studies report that nonabsorbable sutures especially silk has higher rate of complications such as the formation of foreign body granuloma and postoperative pain. the case of a female patient 40 years old, who consulted for abdominal pain of moderate intensity level epigastric two months of evolution accompanied by nausea and vomiting, presents as a surgical history myomectomy performed two months ago reported. Physical examination of the abdomen globose income at the expense of adipose tissue, bowel sounds present, soft, depressible, painful on palpation in epigastric where mobile tumor of 10 x 10 cm, with no signs of peritoneal irritation is evident. Exploratory laparotomy was performed with the following findings: tumor measuring 10 x 15 cm epigastric level consists of omentum attached to the transverse colon and sigmoid colon plastron forming around nonabsorbable suture., Los granulomas a cuerpo extraño son inducidos por cuerpos relativamente inertes, es típico que se formen alrededor de material como talco o suturas. Algunos estudios describen que las suturas no absorbibles especialmente la seda tiene mayor índice de complicaciones como son la formación de granuloma a cuerpo extraño y dolor postoperatorio. Se reporta el caso de una paciente femenino de 40 años de edad, quién consulta por presentar dolor abdominal de moderada intensidad a nivel de epigástrio, de dos meses de evolución acompañado de náuseas y vómitos, presenta como antecedente quirúrgico una miomectomía realizada hace dos meses. Al examen físico de ingreso abdomen globoso a expensas de panículo adiposo, ruidos hidroaéreos presentes, blando, depresible, doloroso a la palpación en epigástrico donde se evidencia tumoración móvil de 10 x 10 cm aproximadamente, sin signos de irritación peritoneal. Se realizó laparotomía exploradora con los siguientes hallazgos: tumoración de 10 x 15 cm a nivel de epigastrio formado por epiplón mayor adherido a colon transverso y colon sigmoides formando plastrón alrededor de sutura no absorbible.

Diplomová práce je věnována tématu Spokojenost s kosmetickým výsledkem po gynekologických operacích a je rozdělena na dvě části. Teoretická část práce je zaměřena na oblasti týkající se gynekologických operací, jizev a dále je tato část práce věnována problematice ran a komplikacím, které jsou s hojením rány spojené. Praktická část diplomové práce se zabývá hodnocením výsledků dotazníkového výzkumného šetření, které bylo realizováno v pěti gynekologických ordinacích. Šetření bylo zaměřeno na spokojenost žen s jejich jizvou po velké gynekologické operaci nebo císařském řezu., The diploma thesis deals with the satisfaction of the cosmetics results after surgical procedures in gynecology. The diploma thesis is divided into two parts. The first part is the theoretical one and describes the main gynecological operations, scars and problems caused by complications associated with the wounds healing. The second part of the diploma thesis (the practical part) presents the results of the research realized by a questionnaire in five gynecological offices. The main intention of the questionnaire research was to find out the women's satisfaction with the scars after gynecological surgery incl. Caesarean section., Fakulta zdravotnických studií, Dokončená práce s úspěšnou obhajobou

Kidney transplantation in small animals has been crucial in the development of anti-rejection therapies. While there is no substitute for a skilled microsurgeon, there are many aspects of the transplant procedure that can be modified to optimize the reproducibility and utility of the technique. This article provides a detailed description, including video recording, of orthotopic kidney transplantation in the rat. The key variables in the technique are also discussed.Copyright © 2015 Asian Pacific Society of Nephrology.

Kidney transplantation in small animals has been crucial in the development of anti-rejection therapies. While there is no substitute for a skilled microsurgeon, there are many aspects of the transplant procedure that can be modified to optimize the reproducibility and utility of the technique. This article provides a detailed description, including video recording, of orthotopic kidney transplantation in the rat. The key variables in the technique are also discussed.Copyright © 2015 Asian Pacific Society of Nephrology.

PURPOSE: To compare recurrence and surgical complications following two dominating techniques: the use of suture and mesh in umbilical hernia repair. METHODS: 379 consecutive umbilical hernia repair procedures performed between 1 January 2005 and 14 March 2014 in a university setting were included. Gathering was made using International Classification of Diseases codes for both procedure and diagnosis. Each patient record was scrutinized with respect to 45 variables, and the results entered in a database. RESULTS: Exclusion <18 years-of-age (32), non-primary umbilical hernia (25), wrong diagnosis (7), concomitant major abdominal surgery (5), double registration (3) and pregnancy (1) left 306 patients eligible for analysis. Gender distribution was 97 women and 209 men. There was no difference between mesh and suture with regard to the primary outcome variable, cumulative recurrence rate, 8.4 %. Recurrence was both self-reported and found on clinical revisit and defined as recurrence when verified by a clinician and/or radiologist. Results presented as odds ratio (OR) with 95 % confidence interval (CI) show a significantly higher risk for recurrence in patients with a coexisting hernia OR 2.84, 95 % CI 1.24-6.48. Secondary outcome, postoperative surgical complication (n = 51 occurrences), included an array of postoperative surgical events commencing within 30 days after surgery. Complication rate was significantly higher in patients receiving mesh repair OR 6.63, 95 % CI 2.29-20.38. CONCLUSIONS: Suture repair decreases the risk for surgical complications, especially infection without an increase in recurrence rate. The risk for recurrence is increased in patients with a history of another hernia.

The Yarlung (India-Asia) suture zone in southern Tibet records Middle Jurassic—Late Cretaceous development of the Lhasa terrane (Eurasian) convergent margin and subsequent India-Asia collision beginning in Paleocene time. This dissertation reports data from field-based geologic investigation of the Yarlung suture zone in the Lopu Range and Lazi Regions, ~600 and ~300 km west of the city of Lhasa, respectively. Field data were combined with new geochronology (detrital and igneous zircon U-Pb, garnet Lu-Hf), thermochronology (white mica Ar-Ar and zircon U-Th/He), and metamorphic petrology data to develop a tectonic model involving multiple episodes of shallow underthrusting, rollback, and breakoff of both oceanic and continental lithosphere. Switches between extensional and contractional deformation along the Yarlung suture zone appear to be controlled by changes in subduction dynamics. If this tectonic model is representative, then the tectonic process of inter-continental collision is responsible for much larger magnitudes of crustal recycling that previously thought. A hornblende-plagioclase-epidote paragneiss block in ophiolitic mélange, deposited during Middle Jurassic time, records Late Jurassic or Early Cretaceous subduction initiation along the Eurasian margin followed by Early Cretaceous forearc extension. Detrital zircons from Xigaze forearc basin strata deposited unconformably atop ophiolitic mélange produced a maximum depositional age of 97 ± 1 Ma, providing a minimum age for establishment of an arc-forearc-trench convergent margin along the southern Lhasa terrane. Metasedimentary rocks that were originally deposited along the Indian passive margin were subducted beneath the Lhasa terrane to upper-mantle depths, reaching high-pressure (HP), low-temperature conditions (≥1.4 GPa at T≤600 °C). Garnet Lu-Hf geochronology indicates that prograde metamorphism of the Indian metasedimentary rocks was ongoing at 40.4 ± 1.4 Ma while white mica Ar-Ar thermochronology

Background: A variety of skin simulators are available on which to practice procedures; however, choice of a suboptimal substitute compromises realism and productive practice.Objective: Skin simulators for basic dermatological procedures are reviewed.Methods: The authors’ anecdotal experience with various skin simulators for different procedures is shared.Results: The following simulators are suggested: an unripe banana for elliptical excision, pork belly for undermining, pork belly for simple interrupted and buried suture, capped needle on a human shoulder for intramuscular injection, ripe tomato or hotdog with skin for intradermal injection, eggplant for shave biopsy, pork belly for punch biopsy, plastic tape over a dark surface for cryosurgery, and beef liver for electrosurgery. Flaps are best practiced with foam sandwiched between foam tape or artificial anatomical models created specifically for this purpose.Limitations: The utility of one simulator over another was not compared in a controlled study.Conclusion: Efficient, realistic skin simulators are readily available for practice, which should enhance the safety of the practitioner and improve outcomes of novices.

Integration of engineered musculoskeletal tissues with adjacent native tissues presents a significant challenge to the field. Specifically, the avascularity and low cellularity of cartilage elicit the need for additional efforts in improving integration of neocartilage within native cartilage. Self-assembled neocartilage holds significant potential in replacing degenerated cartilage, though its stabilization and integration in native cartilage require further efforts. Physical and enzymatic stabilization methods were investigated in an in vitro model for temporomandibular joint (TMJ) disc degeneration. First, in phase 1, suture, glue and press-fit constructs were compared in TMJ disc intermediate zone defects. In phase 1, suturing enhanced interfacial shear stiffness and strength immediately; after four weeks, a 15-fold increase in stiffness and a ninefold increase in strength persisted over press-fit. Neither suture nor glue significantly altered neocartilage properties. In phase 2, the effects of the enzymatic stabilization regimen composed of lysyl oxidase, CuSO4 and hydroxylysine were investigated. A full factorial design was employed, carrying forward the best physical method from phase 1, suturing. Enzymatic stabilization significantly increased interfacial shear stiffness after eight weeks. Combined enzymatic stabilization and suturing led to a fourfold increase in shear stiffness and threefold increase in strength over press-fit. Histological analysis confirmed the presence of a collagen-rich interface. Enzymatic treatment additionally enhanced neocartilage mechanical properties, yielding a tensile modulus over 6 MPa and compressive instantaneous modulus over 1200 kPa at eight weeks. Suturing enhances stabilization of neocartilage, and enzymatic treatment enhances functional properties and integration of neocartilage in the TMJ disc. Methods developed here are applicable to other orthopaedic soft tissues, including knee meniscus and hyaline articular cartila

Background: First-degree or second-degree perineal tears can heal with or without suture. With regard to these two options, only short-term healing effects are currently known. As long-term studies are lacking, evidence on their effects, or harms, is weak. No data from German-speaking regions are presently available to indicate how midwives treat first-degree or second-degree perineal tears.Methods: In the current online survey, undertaken for a master's degree, 117 independent midwives from Germany and Austria, who participated, were asked about the postpartal prerequisites for their decision on the treatment and the actual care of perineal tears. In addition, their interest in further training was investigated. Quantitative analysis of the multiple-choice questions was descriptive; additional items for free text were content-analysed according to Mayring.Results: Only 18% of the participants learned how to treat perinatal tears during formal training. 83% of the midwives felt confident when diagnosing the grade of the tear. Half of them had experience with first-degree perineal tears and 12% with second-degree perineal tears healing unsutured. About half of the midwives (45% in Germany) and (51% in Austria) were interested in further training. Conclusion: Both suturing and spontaneous perineal healing should be part of any formal training for midwives, as evidence for a preferred option does not currently exist., Hintergrund: Dammrisse ersten und zweiten Grades (DR I° und DR II°) heilen entweder mit oder ohne Naht. Zu diesen Versorgungsalternativen sind bislang Kurzzeiteffekte bekannt. Da Langzeitstudien fehlen, ist die Evidenzlage hinsichtlich ihrer (Neben-)Wirkungen unzureichend. Darüber hinaus liegen bislang für deutschsprachige Regionen keine Angaben vor, wie Hebammen einen DR I° oder DR II° versorgen.Methodik: Im vorliegenden Survey, der im Rahmen einer Masterarbeit durchgeführt wurde, wurde danach gefragt, welche Voraussetzungen nach der Geburt gegeben sein müssen, um die Dammrissversorgung festzulegen und wie Hebammen diese vornehmen. Zudem wurde der Frage nachgegangen, ob Hebammen in diesem Bereich Fortbildungsbedarf für sich sehen. Die Online-Befragung richtete sich an außerklinisch geburtshilflich tätige Hebammen in Deutschland und Österreich, von welchen sich 117 beteiligten. Die quantitative Analyse der Multiple-Choice Fragen erfolgte deskriptiv; die offenen Items mit Bemerkungen der Hebammen wurden inhaltsanalytisch nach Mayring ausgewertet.Ergebnisse: Nur ca. 18% der Befragten konnten auf Wissen aus ihrer Aus- und Fortbildung zurückgreifen. Insgesamt 83% waren sich in der Differenzierung nach Dammrissgraden sicher. Mit einer spontanen Heilung hatten über 50% der Hebammen Erfahrung bei DR I° und 12% bei DR II°. Rund die Hälfte aller Hebammen (45% in Deutschland, 51% in Österreich) hatte ein weiteres Fortbildungsinteresse.Schlussfolgerung: Beide Versorgungsarten sollten derzeit in der Aus- und Fortbildung vermittelt werden, da die Evidenzlage keine klare Präferenz vorgibt.