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The keystone flap has become an established option that has been utilized recently to close significant myelomeningocele defects. Although the keystone flaps can be adapted to repair myelomeningocele defects of different sizes, the shape of the defect is also an essential factor to consider. In this study, the authors proposed an algorithmic approach for reconstructing significant meningomyelocele defects utilizing different types of keystone flaps based on the shape of the resulting defect. From September 2016 to March 2022, the authors retrospectively reviewed the medical records of 28 patients with meningomyelocele who underwent repair with the keystone flaps. The mean age was 28 days (3 days to 4.5 months). Twenty-one meningomyelocele defects were in the lumbosacral (75%) and 7 in the thoracolumbar regions (25%). The defect sizes ranged from 3.5×5 cm (area, 13.4 cm2) to 9×7 cm (area, 49.5 cm2), with an average of 26.2 cm2. Ten meningomyelocele defects were a vertically oriented oval shape, 16 defects were a transversely oriented oval shape, and 2 defects were circular. In addition, unilateral keystone flap was used in 7.1% of the patients (2 patients), bilateral keystone flap in 28.6% (8 patients), and rotation advancement keystone flaps in 64.3% (18 patients). According to these findings, an algorithm was created based on the defect shape. This algorithmic approach is used as a decision-making guide to select the correct type of keystone flaps to repair myelomeningocele according to the defect shape.

Nasal reconstruction has been a challenging problem for even the most experienced surgeon to provide excellent esthetic and functional outcomes. Although the bilobed flap offers distinct advantages for reconstructing these defects using an adjacent tissue with similar esthetic qualities, this flap has several potential limitations. The authors hypothesized that the conventional keystone flap and its variants provide a versatile and easily reproducible reconstructive option for nasal reconstruction after wide skin cancer excision. The authors retrospectively reviewed 12 consecutive soft tissue reconstruction data using 3 types of keystone flaps between May 2021 and July 2023. The authors reviewed all patients who underwent reconstruction with the keystone flap or its modification to repair cutaneous nasal defects following wide skin cancer excision. The authors reconstructed small- to medium-sized nasal defects ranging from 1×1 to 2.5×2.5 cm2with a mean size of 1.2×1.1 cm2using either a conventional keystone flap or its modification, including the Omega variant and rotation Hemi-keystone flap. All patients were satisfied with the esthetic outcomes. Keystone flaps are a versatile option for reconstructing the nose after cancer surgery. This strategy obviates the need for a bilobed flap after cancer removal in the nose.

Restoring the input text's diacritics is crucial in developing Arabic text-to-speech systems. A few rules can be used to implement phonetic transcription when diacritics are present. The preferred method for recovering Arabic diacritics is based on scoring $n$-gram language models. By utilizing maximum entropy (MaxEnt) language models, a novel procedure is presented in this work for restoring Arabic diacritics. The MaxEnt language models are used to score the diacritized words given previous words in a given sequence. Hence, dynamic programming (DP) efficient decoder retrieves the most probable word sequence conditioned on the input undiacritized word sequence. The Tashkeela corpus was used to evaluate the effectiveness of the suggested technique. Our methods were more efficient than the most sophisticated algorithms available at the time.

Flexion contracture affecting the knee joint is considered a challenging obstacle which usually affects patients’ quality of life with significant functional disability. Several surgical procedures have been described for proper closure of surgical defects following contracture release over popliteal fossa. Although keystone flap reported for closure of full thickness burns defects, to the best of our knowledge, it has never been used previously in management of hypertrophic scar contracture around the knee joint. We are presenting a two-case report with contracture hypertrophic scar over popliteal fossa where the keystone flaps were used to cover the soft tissue defects following excision of the scar contracture. After excision of contracture scar, the length and width of the defect were measured. Then, the keystone flap design was marked over popliteal fossa where the width of the flap was equal to two times the width of the defect. The flap length depends upon the length of elliptical excision which could change after release of the contracture scar. After contracture release, skin incision was made along the marked flap border and then deepened till deep fascia which was divided as well along the flap border. Undermining the flap should not be performed to avoid perforator injury. During closure, the first suture was done at the center of the flap where experiencing maximum tension while the remaining part of the flap was properly sutured to the defect. The popliteal keystone perforator flap can be a reliable method for correction of contracture scar over the popliteal fossa with relatively low complication or recurrence rates on long-term follow-up.

Obesity is a chronic condition that affects millions globally; consequently, bariatric surgery is the key to this serious issue. Bariatric procedures are rapidly expanding in number and methods to address the recognized problems. So, it would make a sense for surgeons and patients if there is a more physiological bypass surgery technique in Morbid obesity. This study aims to evaluate the outcome proposed technique.

The morphology and morphometry of camel testicular intertubular tissue are reported for different seasons of the year. The intertubular tissue occupies a comparatively large portion of the camel testis ranging from about 24% in autumn to about 39% in spring. The volume percentages of the different intertubular tissue constituents, namely Leydig cells, blood vessels, lymph vessels and various connective tissue components, also display clear seasonal changes. Early in winter, the intertubular tissue is richly vascularized by blood vessels (about 18% of the intertubular volume), whereas lymph vessels constitute only about 3%. This remarkable abundance of blood vessels coincides with the presence of voluminous and active Leydig cells that represent about 44% of the total. In spring, an immense expansion of the lymph vessels is observed (up to about 10% of intertubular tissue), but no change is seen in blood vessels. The Leydig cells in this season constitute only about 19% of the total. In summer, the vascular compartment occupies nearly the same volume as in early winter but with fewer blood and more lymph vessels. The Leydig cell volume percentage is markedly increased (39.3%) as compared with spring. In autumn, blood and lymph vessels record their lowest volume percentages (12% and 2.5%, respectively) and Leydig cell volume is also decreased as compared to summer. The Leydig cell morphology evidently points to two periods of elevated activity during the year. The first period occurs early in winter and is characterised by voluminous Leydig cells (average volume: 1614μm3) with a well developed and highly organised SER. By spring, the cells are reduced in size (926 μm3) due to a decrease in the amount of SER. The second period of elevated Leydig cell activity is observed in summer and is again characterised by an increased cell volume (1420 μm3) as a consequence of SER development. In summer, however, the SER is not as highly organised as in early winter. The absolute number of Leydig cells per testis also shows clear changes from season to season, being lowest in autumn (3.68×109cells) and highest in late winter and spring (6.04×109cells). Thus, camel Leydig cells are subject to a permanent turnover. Degenerating Leydig cells are replaced the year round by un-differentiated fibroblastic precursors, whereas Leydig cell mitoses are a rare observation. The strongest waves of replacement seem to follow the peaks of increased Leydig cell activity and occur between summer and autumn as well as in late winter and spring.

A common inbred tester was used to evaluate gametes selected from three complex hybrid populations using two different inbreds as elite lines. The results support Stadler'S contention that gamete selection is an efficient method for extracting superior gene combinations from hybrid populations. The inbred tester increases the resolving power of the method by eliminating extraneous genetic variability and by providing a homogeneous check population for comparative purposes.