Search

The gracilis myocutaneous flap is a versatile reconstructive option. Despite wide applicability, concerns are often raised regarding the unreliable vascular perfusion of the distal third of the flap’s skin paddle. This study presents our experience utilizing the pedicled gracilis myocutaneous flap for various oncologic defects to highlight the versatility, safety, and utility of this flap. A retrospective analysis was performed for patients who underwent reconstruction utilizing a gracilis myocutaneous flap over the course of 20 years (January 1998–June 2018). Postoperative outcomes were reviewed to determine the incidence of infection, dehiscence, seroma, or hematoma for both donor and recipient sites. Incidence of flap skin or muscle loss was also recorded. A total of 37 patients met our inclusion criteria, and data from 41 vertically oriented gracilis myocutaneous flaps was analyzed. A majority of our patients had a previously irradiated wound bed (73%). The overall donor site complication rate was 19.5%. The recipient site complication rate was 41.5% and included partial flap loss (14.6%). Partial flap loss included distal flap skin necrosis incidence (9.7%). When taking into account the size of the primary defect prompting reconstruction and prior recipient bed irradiation history, our cohort shows reasonable complication rates. Distal tip skin necrosis rate was also low, which suggests that the distal third’s vascular supply should not be a limiting factor. Level of evidence Level IV, therapeutic study.

Optimizing esthetics in delayed breast reconstruction is a challenge, as there is a lack of breast volume and native breast skin. Abdominal flaps are commonly used for patients desiring autologous reconstruction, but the result is an unnatural appearing breast as non-breast skin is used to recreate the breast mound. To improve esthetics for these patients, we propose a two-staged approach utilizing prepectoral tissue expander placement. A retrospective analysis of all patients undergoing delayed breast reconstruction with prepectoral tissue expander placement at our single tertiary-care institution was performed. We collected demographics, complication rates, and surgical information from both the first and second stage surgeries for all patients. Charts were further reviewed to determine whether patients pursued revisions. Five patients (eight breasts) met inclusion criteria. Following tissue expander placement, there was one incidence of seroma (n = 1), and no other complication occurred. Complications after autologous reconstruction included donor-site hematoma (n = 1), recipient-site dehiscence (n = 1), and recipient-site fat necrosis (n = 1). No flap losses or other complications occurred for our series of patients. Delayed, two-staged autologous breast reconstruction requires an additional short, surgical procedure that results in a lifelong improved breast esthetic and better lower-pole ptosis. Complication rates remain low, which makes this a viable and safe option to improve outcomes for patients seeking delayed autologous reconstruction. Our study utilizes prepectoral expander placement, which we believe will further enhance the quality of patient care. Level of evidence: Level V, therapeutic study.

Wound complication following gastrointestinal surgery substantially impacts the quality and costs of surgical care. The impact of wound complication on subsequent long-term healthcare utilization has not been fully studied. We assessed the impact of surgical wound complication on inpatient and outpatient healthcare utilization in the 2 years after gastrointestinal (GI) surgery. An observational retrospective cohort study was conducted on Veterans Affairs health system patients who underwent an inpatient GI surgical procedure, were assessed by the Veterans Affairs Surgical Quality Improvement Program (VASQIP), and were discharged alive from Veterans Affairs (VA) hospitals between October 1, 2007 and September 30, 2014. Population-based A total of 64,351 patients underwent a GI surgical procedure in the VA system between 2007 and 2014. The cohort was 93.5% male, with a median age of 63.0 years (interquartile range (IQR) 57.0–70.0). A total of 7880 patients (12.2%) had at least one reported wound complication, 5460 of which had their postoperative wound complication classified by a VASQIP nurse. VASQIP-assessed or ICD-9-coded wound complication in the 30 days after surgery Inpatient visits, total inpatient days, outpatient visits, and emergency department visits, and operative interventions up to 2 years after discharge from index admission Patients with a postoperative wound complication had greater inpatient healthcare utilization compared with no-wound complication for up to 2 years after surgery: inpatient admissions (mean number 3.5 vs. 2.8; P

Quality of life (QOL) is an important outcome measure after ventral hernia repair (VHR). The Hernia-Related QOL Survey (HerQLes) is a specific survey tool for QOL after VHR. Studies comparing QOL in patients with biologic mesh repairs (BMRs) and synthetic mesh repairs (SMRs) are lacking.A survey based on the HerQLes was administered via e-mail to 974 patients who had undergone VHR at Stanford Medical Center. From 175 patients who were included in the study, the mean HerQLes scores and postoperative complications were compared between patients with suture repairs (SR), BMR, SMR, with and without component separation, and different types of SMR.Quality of life was lower in patients with hernias of 50 cm or greater, obesity, history of tobacco use, previous abdominal surgeries, hernia recurrences, and postoperative complications (P0.05). Patients with SR and SMR had a comparable QOL (71.58 vs 70.12, P = 0.75). In patients with Modified Ventral Hernia Working Group grade 2 hernias, a significantly lower QOL was found after BMR compared with SMR. Postoperative complications did not significantly differ between the groups. Recurrence rates were comparable between MR (10.4%) and SR (8.3%, P = 0.79), but higher in BMR (21.7%) compared with SMR (6.6%, P0.05).Previous abdominal surgeries, previous hernia repairs, tobacco use, and hernia sizes of 50 cm or greater negatively affect QOL after VHR. Our data indicate that QOL is comparable between patients with SMR and SR, however, is lower in patients with Modified Ventral Hernia Working Group grade 2 and BMR compared with SMR, raising the benefit of BMR in light of its higher cost into question.

The decision to intubate acute burn patients is often based on the presence of classic clinical exam findings. However, these findings may have poor correlation with airway injury and result in unnecessary intubation. We investigated flexible fiberoptic laryngoscopy (FFL) as a means to diagnose upper airway thermal and inhalation injury and guide airway management. A retrospective chart review of all burn patients who underwent FFL from 2013 to 2017 was performed. Their charts were reviewed to determine the indications for FFL including the historical data and physical exam findings that indicated airway injury as well as patient age, TBSA, type and depth of burn injury, carboxyhemoglobin level, and clinical course. Fifty-one patients underwent FFL, with an average TBSA of 6.5% (range 0.5-38.0%) and carboxyhemoglobin level of 3.5%. Burn mechanism was flame (35.3%) or flash (51.0%), with 50% occurring in enclosed spaces. In all cases, the decision to perform FFL was based on physical exam findings meeting criteria for intubation, including facial burns, singed nasal hairs, nasal soot, voice change, throat pain or abnormal sensation, shortness of breath, carbonaceous sputum, wheezing, or stridor. Based on FFL, 9 patients (17.7%) were treated with steroids, 28 patients (54.9%) received supportive care, and 6 patients (11.8%) had repeat FFL for monitoring. One patient was intubated after repeat FFL examination. All patients who underwent FFL met traditional criteria for intubation based on exam, however 98% were monitored without issues based on FFL findings. FFL is a valuable tool that can lead to fewer intubations in acute burn patients with a stable respiratory status for whom history and physical exam suggest upper airway injury.

Background: Zinc performs many biochemical and physiological functions; however, toxicological studies demonstrate that Nano-zinc oxide has harmful effects on human health and environmental species in high concentrations. Objective: The aim of this study was to investigate the toxicity of zinc oxide nanoparticles on reproductive tissues of female rat. Materials and Methods: Eighty female Wistar adult rats weighing 180–200 gr, divided into eight groups (n= 10 in each group) including control, sham (treated with saline), and six groups injected with different doses of zinc oxide nanoparticle with 10–30 nanometer size (4, 8, 25, 50, 100, and 200 mg/kg) twice a week for four weeks. At the end of the study, the rats were bled and slaughtered; the Ovary and Uterus were taken for histopathology studies and blood samples were transferred to the laboratory for biochemical analysis. Results: Microscopic diagnoses in ovary tissue were included; increase in the corpus luteum, follicular cysts, inflammatory cells infiltration and fibrosis. Histopathological changes in ovary in a dose-dependent manner. In uterus tissue the lesions consisted; epithelial destruction, hyperplasia of endometrial glands. The Estrogen and Progesterone level in the serum of rats increased in low doses and reduced in a dose-dependent manner at high doses. Conclusion: The results of the current study proved the toxicity of zinc oxide nanoparticles on the ovary and uterus organs at high concentrations, so further investigation is needed to reduce these effects. Key words: Zinc oxide, Nanoparticles, Ovary, Uterus, Toxicity.

BackgroundThe first step in assembling an artificial ovary is supporting the in vitro growth of ovarian cells/follicles. Therefore, proliferation of granulosa or cumulus cells (CCs) is important and due to limited proliferation, improving the mediums for in vitro propagation of these cells is helpful. ObjectiveThis study aimed to characterized the appropriate media and supplements for in vitro culture of ovarian cells (OCs) and CCs. Material & MethodsCortical, medullar and hilar cells of ovary were cultured and their conditioned medium (CMs) collected. The expression of GDF9, as a key factor for ovarian follicular growth, was evaluated. CCs were collected from healthy women, who referred due to male factor infertility. To choose the optimum basal medium, a mixture of OCs was cultured with basal mediums, supplemented with two concentrations of fetal bovine serum (FBS) and human serum albumin (HSA). The cocktails were as follows: [Serum free mediums], [mediums+10%FBS], [mediums+20%FBS], [mediums+1%Alb)], [mediums+2%Alb], [mediums+10%FBS+1%Alb], [mediums+10%FBS+2%Alb], [mediums+20%FBS+1%Alb] & [mediums+20%FBS+2%Alb]. The same process was repeated for CCs. Also, the effect of various concentrations of L-Glutamine, bovine serum albumin (BSA), HSA, insulin transferrin selenium (ITS), Follitropin alfa® and Pregnyl® was evaluated on the growth of CCs. As well, CCs were treated with various concentrations of follicular fluids (FFs) and CMs. CMs were collected from ovarian, testicular, adipose & amniotic derived and ovarian carcinoma cells. FFs were collected from women with poor responders, endometriosis, advanced age, polycystic ovarian syndrome, male factor and unknown infertility. Then, CCs morphology, proliferation capacity and culture duration were evaluated. ResultsAll the ovarian cells expressed GDF9. αMEM+20%FBS and DMEMF12+20%FBS were the most suitable cocktails for OCs and CCs, respectively. 20%FBS was superior to 10% for both OCs and CCs. HSA could not support the growth of OCs and CCs, alone. The cocktail of mediums with 20%FBS superior to the others. The CMs of cortical and (hillar+medullar) cells and FFs from male factor and unknown infertility patients caused higher CCs proliferation. 17 mM/l L-Glutamine, 24 mg/ml BSA, 20 mg/ml HSA, 10 ng/ml ITS, 300 mIU/ml Follitropinα and 3.5 IU/ml Pregnyl led to higher proliferation of CCs. ConclusionCMs, serums and FFs can support the CCs growth alongside with basal mediums, supplemented with hormones, ITS and L-Glutamine, which are cheaper and more accessible.

Random Telegraph Noise (RTN) is a stochastic phenomenon which leads to characteristic variations in electronic devices. Finding features of this signal may result in its modeling and eventually removing the noise in the device. Measuring this signal is accompanied by some noise and therefore we require a method to improve the Signal to Noise Ratio (SNR). As a result, the extraction of an accurate RTN is a remarkable challenge. Empirical Mode Decomposition (EMD) as a fully adaptive and signal dependent method, with no dependency to the specific function, can be an appropriate solution. In this paper, we evaluate the most recent methods and compare them with our proposed approach for the artificial and actual RTN signals. The results show the higher accuracy and efficiency by about 54%, 61% and 39% improvement in SNR, Mean Square Error (MSE) and Percent Root mean square Difference (PRD) respectively for the optimized wited method. Finally, an indicator to evaluate the reliability in digital circuits is introduced.

SUMMARY Virtual reality and other technological advancements both inside and outside the operating room have shown an exponential increase in the past two decades. Surgical technique and finesse in delicate procedures have become ever more important, and the onus is on plastic surgeons and plastic surgery residents to meet these needs to provide the best outcomes possible to patients. The ability to learn, simulate, and practice operating in a fashion that poses no harm to any patient is truly a gift from technology to surgery that any surgeon could benefit from, whether trainee or attending. This application of technology and simulation has been demonstrated in other fields such as in the airline industry with flight simulation. The ability to learn, synthesize, and incorporate learned materials and ideas through virtual, augmented, and mixed reality tools offers a great opportunity to put our field at the forefront of a paradigm shift in surgical education. The critical utility of digital education could not be further emphasized any more than in the unfortunate and infrequent situation of a worldwide pandemic. This article reviews some of the important recent technologies that have developed and their applications in plastic surgery education and offers a look into what we can expect in the future.

Emboli detection and denoising have been the focus of attention from many years. Emboli can be occurred because of the air bubbles, concentrated fat particles or blood clotted in a vessel. The detection of this issue can be possible by employing Doppler ultrasonic transducers. However, this method would be very sensitive to peripheral noise. In this paper for emboli denoising, CEEMDAN as one of the newest and effective methods is introduced. Then, an algorithm for emboli detection based on Bayesian estimation is proposed. The results are compared with a recent method, showing that the proposed method yields an SNR that this improved by 45% and an accuracy rate of 94%.

Patient: Male, 48-year-old Final Diagnosis: Hemophaocytic lymphohistiocytosis Symptoms: Abdominal pain • nausea • vomiting • weight loss Medication:— Clinical Procedure: — Specialty: Rheumatology Objective: Rare disease Background: Sarcoidosis is a systemic inflammatory disorder characterized by a classic pathologic feature of non-caseating granulomas involving any organ system. Hemophagocytic lymphohistiocytosis (HLH) is a catastrophic cytokine surge characterized by dysregulation of the macrophage response, which can be rapidly fatal. Recognition of HLH has been increasing over the past decade. HLH can present with features of sepsis that can make the diagnosis challenging and requires high clinical suspicion. Case Report: We report a case of a 48-year-old African American male with a past medical history of sarcoidosis infiltrating the lymph nodes, liver, and bone marrow with initial presentation of abdominal pain, nausea, vomiting, and weight loss of 100 pounds over 8 months. Sepsis was suspected, but the patient clinically deteriorated with vancomycin and cefepime. Fevers, bone marrow biopsy, anemia, thrombocytopenia, elevated ferritin, and elevated soluble receptor interleukin 2 confirmed HLH. The patient was treated with etoposide and dexamethasone with poor response and died from cardiac arrest. Conclusions: Sarcoidosis associated with HLH is an extremely rare phenomenon with only 10 cases reported in the literature. Early clinical suspicion can be challenging as this condition is a sepsis-mimicker. To reduce mortality, prompt initiation of therapy is a key determinant in patients who are clinically deteriorating despite treatment for sepsis.

BACKGROUND Delayed-immediate breast reconstruction has traditionally involved placement of tissue expanders (TE) in the subpectoral (SP) position. Development of acellular dermal matrices has renewed interest in the prepectoral (PP) pocket, which avoids extensive muscle manipulation. We compare complication rates between PP and SP TE placement in autologous delayed-immediate breast reconstruction. METHODS A retrospective chart review of patients undergoing autologous, delayed-immediate breast reconstruction at our institution (June 2009 to December 2018) was performed. Demographics, comorbidities, perioperative information, and complication incidence ≤12 months' follow-up were collected from first- and second-stage surgeries. Complications were modeled using univariable and multivariable binary logistic regressions. RESULTS A total of 89 patients met the inclusion criteria, and data from 125 breast reconstructions were evaluated. Complication rates following TE placement trended lower in the PP cohort (28.8% vs 37%, P = 0.34). Overall complication rates following autologous reconstruction were significantly lower for PP reconstructions (7.7% vs 23.3%, P = 0.02). Multivariable regression showed TE position (P = 0.01) was a significant predictor of ≥1 complication following autologous reconstruction. Time delay between first- and second-stage surgeries was greater for SP reconstructions (199.7 vs 324.8 days, P < 0.001). Postoperative drains were removed earlier in the PP cohort (8.6 vs 12.0 days, P < 0.001). Mean follow-up time was 331.3 days. CONCLUSIONS Prepectoral reconstruction in the delayed-immediate autologous reconstruction patient leads to significantly lower complication rates, shorter duration between first- and second-stage surgeries, and shorter times before removal of breast drains compared with SP reconstructions.

Patient: Female, 21-year-old Final Diagnosis: Diffuse alveolar hemorrhage Symptoms: Cough • dyspnea • fever • rash • sore throat Medication: — Clinical Procedure: — Specialty: Rheumatology Objective: Rare disease Background: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by autoantibody production leading to inflammation in multiple organs; it commonly affects young women in their child-bearing years. Clinical manifestations are diverse and range from mild arthritis to diffuse alveolar hemorrhage (DAH). DAH is a rare and devastating complication of SLE that carries a mortality rate of up to 50%, despite aggressive therapy. Case Report: A 21-year-old primigravida at 16 weeks gestation presents with a productive cough, rash, sore throat, and high-grade fever. Chest x-ray suggested multifocal pneumonia. Patient deteriorated despite antibiotics and intravenous (IV) fluids. She developed worsening anemia, leukopenia, and thrombocytopenia. Autoimmune work-up was positive for Coombs, antinuclear antibody, anti-smith antibody, and hypocomplementemia. Skin biopsy was consistent with SLE. SLE vasculitis was suspected. She required mechanical intubation for rapid respiratory deterioration, with CT thorax suggesting ARDS. Bronchoscopy was done and confirmed DAH. Her course was further complicated with retinopathy and acute pancreatitis associated with SLE. She was treated with IV steroids, IV cyclophosphamide, and plasmapheresis, with significant clinical improvement and successful extubation. She delivered a healthy baby at 32 weeks gestation. Conclusions: Early recognition and initiation of treatment is critical to survival in DAH and requires a high index of clinical suspicion. Treatment includes high-dose steroids, cyclophosphamide, and plasma exchange. Pregnancy increases the risk of adverse outcome in SLE. Seven cases of DAH in pregnant patients with SLE have been reported. Here, we report a catastrophic presentation of DAH, acute pancreatitis, and retinopathy in a pregnant patient with newly diagnosed SLE.

Breast implants have been related to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). While some research has been conducted to study BIA-ALCL incidence, little is known regarding surgeon concern about the disease. This study aims to determine surgeon concern about BIA-ALCL within the European plastic surgeon community as related to their practice of breast plastic surgery. A 27-question online survey was sent to 2353 members of the European Plastic Surgery Society and EURAPS. 240 surgeons responded (10.2%) from 18 different societies. Questions were related to demographics, exposure to BIA-ALCL cases, clinical practices, awareness, and concern. Univariate and multivariable analyses were used. Of surveyed surgeons, 8% had encountered a case of BIA-ALCL, while 73% were concerned about the disease. The rate of concern seemed to be influenced by seven of the variables studied. However, multivariate analysis demonstrated that none of the combined variables analyzed predicted concern or disclosure of the risks of BIA-ALCL to patients. Textured silicone-filled implants were implicated in the disease (56.5% of cases, P = 0.005). Mentor® and Polytech® were the two brands involved in most of the reported cases (20% each). Consistent with epidemiological reports worldwide, this study confirms that BIA-ALCL is more prevalent in patients undergoing placement of textured silicone implants, the use of which was greater among surgeons not concerned about the risks of BIA-ALCL. Surgeons appear to approach their patients with similar risk disclosures regardless of practice pattern and type of breast implant used, but not regardless of their concern about the disease. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background: Proper nutrition is critical in healing burn wounds. Tube feeding is routinely employed to help meet nutritional goals; however, the complexities of burn care frequently involve pausing feeds. Volume-based tube feeding delivers a 24-h goal volume compared to administering a fixed hourly rate. This study aims to assess whether volume-based tube feeding is superior to traditional rate-based tube feeding at meeting nutritional goals. Methods: Starting in January 2016, a single burn center implemented a volume-based tube feeding protocol. All patients for the calendar year 2016 who required tube feeds for at least 5 continuous days were compared to all patients from the prior calendar year 2015. Demographics, burn characteristics, and tube feeding details were compared with univariable analysis. Daily tube feed goals were the primary outcome and length of stay was assessed as a secondary outcome; both were evaluated with multivariable analysis using linear modeling. Results: Thirty patients met study criteria. The cohort was 30.0% female and 93.3% were flame burns, with a mean age of 44.2 years and mean total body surface area (TBSA) of 30.6%. All patients suffered 3rd degree burns. Pausing tube feeds for fasting before an operation was the most common reason feeds were held accounting for 33.7% of all held days. Volume-based tube feeding was the only independent predictor of increasing tube feed goals with an average goal met of 91.4% vs. 74.1%, (linear coefficient 10.05, 95% CI 4.49–15.61, p-value 0.001). Tube feed hours held was the only independent predictor of lower tube feed goals (linear coefficient −5.52, 95% CI −7.73–−3.31, p-value

To have met inclusion criteria, the patient must have undergone delayed breast reconstruction without having had any prior breast reconstruction The transverse rectus abdominis Muscle (TRAM) flap was used in 2 breasts, and the muscle-sparing TRAM flap was used in 6 breasts (Table 1) Dear Sir, We thank Mantelakis et al [[1]] for their interest in our article "Delayed, two-staged autologous breast reconstruction: an approach to improving delayed reconstructive outcomes" [[2]] [Extracted from the article] Copyright of European Journal of Plastic Surgery is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Uncontrolled expansion of combustion wave in spark ignited internal combustion engine causes knock effect which seriously degrades efficiency and lifetime of the engine. Thus, accurate knock detection and control are essential for obtaining a desired performance from the engine. Usually, knock sensor is used to detect this phenomenon but it has limited accuracy especially at engine high-speed rotations because of natural vibration and external noises. In this study an effective method based on Non-Local Mean (NLM) algorithm has been proposed to improve the knock detection accuracy. This method is evaluated based on four different indicators and four engine cylinders. The results show 52.9 % improvement in knock detection. Also feasibility of real time execution of this method based on embedded hardware has been studied.

Aim Scientists have tried to culture and transplant the ovarian tissues (OT), to preserve fertility in cancer patients. However, one of the main limitations to the applicability of this technique is the folliculogenesis disruption after transplantation. Due to the roles exerted by growth differentiation factor-9β (GDF9β), we decided to determine the most effective dose of GDF9β on promotion of folliculogenesis and angiogenesis in sheep OT grafted onto the chick chorioallantoic membrane (CAM). Methods Fresh sheep OT were grafted onto the CAM for 5 days, and divided into four groups based on the addition of increasing doses of GDF9β (0, 150, 200 and 250 ng/mL). Following culture, histological (hematoxylin and eosin [H&E] staining) and immunohistological studies (Ki-67) were done. Fibrotic and necrotic regions were measured using MICROVISIBLE software. For comparing the follicle development rates between the groups as well as differences in the Ki-67-positive follicles, analysis of variance was applied. Results In both 200 and 250 ng/mL GDF9β groups, significantly higher rates of intermediary and primary follicles were observed, also the numbers of good quality follicles increased in the aforementioned groups and the rates of fibrotic and necrotic areas decreased. Moreover, in the 200 and 250 ng/mL GDF9β groups, the number of capillaries and the proliferative activity increased. The lower dose of GDF9β (150 ng/mL) neither activated the primordial follicles nor lead to an increase in the number of growing follicles. Conclusion Addition of high dosages of GDF9β to the OT, grafted onto the CAM resulted in higher folliculogenesis and better transplantation features due to improvement in angiogenesis.

Spirocerca lupi is an international nematode of Canine and wild carnivores. The generic clinical symptoms are regurgitation, vomiting, and pursiness. The parasite usually procreates nodular masses in the esophagus and pectoral aorta. On July 2014, a four-month male sandy fox was found accidentally killed on the road in Bafgh City, Southeast of Yazd, Yazd Province, Iran during necropsy, referring to esophagus, parasites were collected from esophagus and transmissive up to 70% of alcohol. Parasites were recognized as S. lupi. After clarification of lactophenol and staining, the nematodes were recognized as S. lupi according to key guidelines of Taylor. Besides, the tissue samples were isolated from esophagus wall - the appendix site of nematode for histopathological investigation - so they were transmissive up to 10% of buffered formalin and stained with haematoxylin and eosin. Microscopic diagnoses in esophagus were included epithelial destruction, wall thickening, inflammatory cells infiltration, necrosis and vascular thrombosis. With the author’s knowledge, this is the first report and histopathological investigation of S. lupi in sandy fox.

Renewable energy sources such as wind and solar play a significant role in generating the electricity for rural areas in developing country. However, they are intermittent, which can result in the instability of the electrical power system. This paper investigates a hybrid energy storage system (HESS) based on a small scale compressed air energy storage (SS-CAES) system including a battery, which is used to store excess energy for later use. The SS-CAES system is connected to a boost converter and a small battery through a bidirectional buck-boost converter. The boost converter’s output current is controlled such that the speed of the air motor is set by a maximum power tracking controller. The battery’s bidirectional dc/dc converter controls the dc link voltage: it charges the battery if the CAES power is greater than the load; and it discharges if the load demand is greater than the CAES supply. This paper discusses the design of such system. Simulation results show acceptable performance.

In this paper, a novel hybrid energy harvester is investigated by using a rotational generator and a surface permanent magnet linear generator (SPMLG). The rotational generator that was developed by Hendijanizzaded [1] can harvest maximum power under the optimum design process with constrain on the relative displacement of the mass. The aim of adding the SPMLG is to increase electrical damping that will affect the displacement of the moving mass. This idea is different than the existing hybrid systems in which energy is harvested from two different sources, such as sunlight and sound or heat and light to increase power extracted. The interactions between different electromechanical parameters can be taken advantages of to improve the power harvesting of the device. By adding SPMLGs to a rotational generator, electrical damping of the system will be increased while the mechanical parameters of the system, for example, the resonant frequency, the spring stiffness and the seismic mass are unchanged. The system model of the rotational and the hybrid harvesters will be established and numerically simulated. Also, the power extraction between the original rotational generator and the hybrid harvester under the same conditions will be compared to confirm the viability of the method. Obviously, the trade-off for this power increase is the additional weight of the SPMLGs that must be considered in the calculations of the power density which is outside the scope of this paper.

This paper is concerned with the maximum power tracking of a pneumatically driven electric generator in a standalone small-scale compressed air energy storage system. In this system, an air motor is used to drive a permanent-magnet direct-current generator, whose output is controlled by a buck converter supplying power to a resistive load. The output power of the converter is controlled such that the air motor operates at a speed corresponding to the maximum power. A maximum power point (MPP) tracking controller employs a hybrid perturb and observe method. The rate of change of the converter's output power with respect to its duty cycle and the change of the power and the duty cycle are used to correct the search direction under transient input power fluctuations. Small speed step changes are used in the vicinity of the MPP to improve the accuracy of the search algorithm. However, relatively coarse speed step changes are used when the operating point is far from the MPP to improve the dynamic response of the controller and to increase its speed of convergence. The analysis and design of the controller are based on a small injected-absorbed current signal model of the power converter. The controller is experimentally implemented using a real-time digital signal processor system. Test results are presented to validate the proposed design and to demonstrate its capabilities.

Objective: In early gestation, fetal wounds heal without fibrosis in a process resembling regeneration. Elucidating this remarkable mechanism can result in tremendous benefits to prevent scarring. Fetal mouse cutaneous wounds before embryonic day (E)18 heal without scar. Herein, we analyze expression profiles of fetal and postnatal wounds utilizing updated gene annotations and pathway analysis to further delineate between repair and regeneration.

Background: Fetal bovine serum (FBS) is widely used in cell culture laboratories, risk of zoonotic infections and allergic side effects create obstacles for its use in clinical trials. Therefore, an alternative supplement with proper inherent growth-promoting activities is demanded. Objective: To find FBS substitute, we tested human umbilical cord blood serum (hUCS) for proliferation of human umbilical cord matrix derived mesenchymal stem cells (hUC-MSCs) and human bone marrow-derived mesenchymal cells (hBM-MSCs). Materials and Methods: Umbilical cord blood of healthy neonates, delivered by Caesarian section, was collected and the serum was separated. hUC-MSCs and hBM-MSCs were isolated and characterized by assessment of cell surface antigens by flow cytometry, alkaline phosphatase activity and osteogenic/adipogenic differentiation potential. The cells were then cultured in Iscove's Modified Dulbecco's Medium (IMDM) by conventional methods in three preparations: 1- with hUCS, 2- with FBS, and 3- without serum supplements. Cell proliferation was measured using WST-1 assay, and cell viability was assessed by trypan blue staining. Results: The cells cultured in hUCS and FBS exhibited similar morphology and mesenchymal stem cells properties. WST-1 proliferation assay data showed no significant difference between the proliferation rate of either cells following hUCS and FBS supplementation. Trypan blue exclusion dye test also revealed no significant difference for viability between hUCS and FBS groups. A significant difference was detected between the proliferation rate of stem cells cultured in serum-supplemented medium compared with serum-free medium. Conclusion: Our results indicate that human umbilical cord serum can effectively support proliferation of hBM-MSCS and hUC-MSCs in vitro and can be used as an appropriate substitute for FBS, especially in clinical studies.

Summary Background Autologous breast reconstruction is considered by many to be the gold standard reconstructive modality following mastectomy. Despite the advantages of autologous reconstruction, however, surgeons have been cautious in recommending this approach to patients who desire to become pregnant postoperatively because of concerns related to abdominal wall morbidity. While intuitive, this approach does not appear to be based on robust data. Hence, the authors examined the clinical outcome in patients who became pregnant following autologous breast reconstruction. Methods Patients who underwent autologous breast reconstruction with free abdominal flaps that required an incision in the anterior rectus sheath were identified. Of them, patients who became pregnant post reconstruction were included for subsequent analysis. Of particular interest were any peripartal and postpartal complications that could be attributed to the preceding abdominal flap harvest. Additionally, a systematic review of the literature was performed. Results We identified five patients who met inclusion criteria. All five patients underwent bilateral breast reconstruction with free muscle-sparing transverse rectus abdominis musculocutaneous (MS-TRAM) flaps. None of the patients had any preexisting abdominal wall morbidity. All five patients proceeded to full-term pregnancy and successfully delivered newborns, four of which were delivered by normal vaginal delivery and one by cesarean section. No abdominal wall complications were noted during pregnancy, delivery, or postpartum. Conclusion Contemporary data do not support the notion that breast reconstruction with free abdominal flaps is contraindicated in the setting of desired or planned pregnancy.

The current paper is prepared based on a descriptive study and through it, the integrity between total quality management (TQM) and technology, research and development (TIM), along the prediction of organization's functions in quality and innovation field, are examined. This investigation shows the relationship between TQM and TIM with focusing on two important issues: first, the integrity between TQM and TIM is focused via studying the gap between these two important sections, which are separated in organizations and have different duty descriptions. Second, the impacts of integrity between TQM and TIM on function indices of quality and innovation, which are the first and most important resources in taking competitive advantages for organizations, are examined. The required information for this study is collected from 148 managers of productive companies with more than 500 personnel, in Kerman province, and the constitutive equations model technique is used to analyze the collected information. The results show that: TQM has strong predictive power for qualitative functions of organization but it has not any clear and significant relationship with innovation functions. TIM also has predictive power for qualitative functions of organization but its intensity is lower than TQM. However, TIM has a stronger relationship for predicting the innovation functions of organization than TQM. Finally, TQM and TIM have a correlation with each other. The most important result obtained from the current study is that technology, research and development management is a suitable resource for applying along with and in accordance with TQM which the result of this cooperation is improvement of qualitative functions, and with higher importance, is support of innovation functions in organizations.

one of the factors, which affect efficiency, and life time of internal combustion engine is knock. Knock sensor is considered as a common sensor for detection of this phenomenon and it normally has low accuracy due to noise contamination of the knock signal. Nowadays, wavelet decomposition is used as a powerful method for noise reduction in signal processing. In this study, by employment of wavelet and adaptive filter denoising, detection accuracy of this effect has been improved. This method is applied to real knock signal, which shown superiority compare to previous works and led to 13.2% improvement in detection accuracy.

Purpose: Since its discovery in December 2019, the novel coronavirus SARS-CoV-2 has spread globally, causing the current COVID-19 (coronavirus disease-19) pandemic. As there is an increase of infections in the male population, concerns have emerged about the potential impact of COVID-19 on male reproductive organs and male fertility. Therefore, this study systematically investigates the current evidence of SARS-CoV-2 impact on male reproduction and pregnancy outcomes, discussing them in light of the evidence published on other coronaviruses. Materials and Methods: Literature search was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 24 original articles were included for the analysis, investigating the effects of the infection on semen parameters, male reproductive hormones, and pregnancy outcomes. Further, a Strengths-Weaknesses- Opportunities-Threats (SWOT) analysis was conducted based on the available evidence linking the virus with male reproduction and conception. Results: Although there is limited data, viral mRNA has been identified in semen of infected men, with some evidence of altered seminal parameters. Low testosterone and dihydrotestosterone with raised luteinizing hormone has been reported as well as preterm delivery in pregnant women; however, data regarding vertical transmission remains contradictory and inconclusive. Conclusions: The recent literature provides evidence that male gonads may be potentially vulnerable to SARS-CoV-2 infection, recommending caution to pregnant women and couples planning natural pregnancy or assisted reproduction.

A bewildering variety of methods for analysing sleep EEG signals can be found in the literature. This article provides an overview of these methods and offers guidelines for choosing appropriate signal processing techniques. The review considers the three key stages required for the analysis of sleep EEGs namely, pre-processing, feature extraction, and feature classification. The pre-processing section describes the most frequently used signal processing techniques that deal with preparation of the sleep EEG signal prior to further analysis. The feature extraction and classification sections are also dedicated to highlight the most commonly used signal analysis methods used for characterising and classifying the sleep EEGs. Performance criteria of the addressed techniques are given where appropriate. The online supplementary materials accompanying this article comprise an extended taxonomy table for each section, which contains the relevant signal processing techniques, their brief descriptions (including their pros and cons where possible) and their specific applications in the field of sleep EEG analysis. In order to further increase the readability of the article, signal processing techniques are also categorised in tabular format based on their application in intensively researched sleep areas such as sleep staging, transient pattern detection and sleep disordered breathing diagnosis.

Respiratory cycle related EEG change (RCREC) is characterized by significant relative EEG power changes within different stages of respiration during sleep. RCREC has been demonstrated to predict sleepiness in patients with obstructive sleep apnoea and is hypothesized to represent microarousals. As such RCREC may provide a sensitive marker of respiratory arousals. A key step in quantification of RCREC is respiratory signal segmentation which is conventionally based on local maxima and minima of the nasal flow signal. We have investigated an alternative respiratory cycle segmentation method based on inspiratory/expiratory transitions. Sixty two healthy paediatric participants aged 7-17 (11.6±3) years (35M:27F) were recruited through staff of local universities in Bolivia. Subjects underwent attended polysomnography on a single night (Compumedics PS2 system). Studies were sleep staged according to standard criteria. C3/A2 EEG channel and timelocked nasal flow (thermistor) were used in RCREC quantification. Respiratory cycles were segmented using both the conventional and novel (transition) methods and differences in RCREC derived from the two methods were compared in each frequency band. Significance of transition RCREC as measured by Fisher's F value through Analysis of Variance (ANOVA) was found to be significantly higher than the conventional RCREC in all frequency bands (P

Background: Two-spotted spider mite, Tetranychus urticae Koch (Acari: Tetranychidae), is one of the most destructive cosmopolitan pests of many plant families. This pest has shown resistance to many synthetic acaricides applied in the field and glasshouse. Consequently, increased global efforts have been undertaken to develop other methods of pest control such as botanical insecticides. Methods: The effects of ethanol (95%) and ethanolic extract of six plant species (Aloe vera, Calendula officinalis, Melia azedarach, Peganum harmala, Syzygium aromaticum and Juglans regia) on T. urticae were investigated under laboratory condition. Leaf disks of bean (3.3 cm diameter) were sprayed by ethanol, as negative control, control without spray and plant extracts with 5 mg.mL -1 concentration as treatments. Then new hatched larva were placed on the leaves and surveyed daily. Developmental times and mortalities of each treatment were evaluated until adult emergence. Results: The susceptibility of each developmental stage fluctuated for each plant extract. Among the applied plant derived chemicals, the greatest total mortality was recorded in M. azedarach (87.5%) and P. harmala (81.25%) treatments. Moreover, larval developmental time of the spider mite significantly increased in the both above-mention extracts.

This paper is concerned with maximum efficiency or power tracking for pneumatically-driven electric generator of a stand-alone small scale compressed air energy storage system (CAES). In this system, an air motor is used to drive a permanent magnet DC generator, whose output power is controlled by a buck converter supplying a resistive load. The output power of the buck converter is controlled power such that the air motor operates at a speed corresponding to either maximum power or maximum efficiency. The maximum point tracking controller uses a linearised model of the air motor together with integral control action. The analysis and design of the controller is based on a small injected-absorbed current signal-model of the buck converter. The controller was implemented experimentally using a dSPACE system. Test results are presented to validate the design and demonstrate its capabilities.

1 Traditional and Herbal Medicines Research Center, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran 2 Pharmaceutics Research center, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran 3 Student Research Committee, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran 4 Department of Plant Protection, Faculty of Agriculture, Shahid Bahonar University of Kerman, Kerman, Iran

Vibration isolation of aerospace structures that support high precision instrumentations demand a novel design approach. In order to create a design that is suitable for use in harsh environments with no risk of drift in alignment of the structure, the commonly used viscoelastic elements should ideally be eliminated. The novel isolator proposed here is a space-frame structure that is folded in on itself to act as a mechanical filter over a defined frequency range. The design uses a genetic algorithm based geometric optimisation routine to maximise passive vibration isolation hybridised with a geometric feasibility search. To complement the passive isolation, an active system is incorporated in the design which in effect adds damping to the system. The active-passive structure is shown to achieve transmissibility of about 19 dB over a range of 1–250 Hz. The design has no or little consequent weight and cost penalties whilst maintaining its effectiveness with the vibration levels. The results indicate the promise of a new breed of anti-vibration mounting design.

The aim of this study was to investigate the effects of transplanted Wharton's jelly mesenchymal stem cells (WJMSCs) of caprine umbilical cord on cutaneous wound healing process in goat. After collection of caprine pregnant uterus of mixed breed goats from abattoir, the Wharton's jelly (WJ) of umbilical cord was harvested. The tissues were minced in ventilated flasks and explant culture method was used for separating mesenchymal stem cells (MSCs). The isolated cells were immunostained for Actin protein, histochemically assayed for the presence of alkaline phosphatase activity, and analyzed for detection of matrix receptors (CD44) and hematopoetic lineage markers (CD34), using flow cytometery. After The isolated cells, 3×10(6) MSCs were stained with BrdU and prepared for transplantation to each wound. Four 3-cm linear full thickness skin incisions were made on both sides of thoracic vertebrate of four Raeini goats (two wounds on each side). The left wounds were implanted with MSCs in 0.6 ml of Phosphate buffer saline (PBS), and the right wounds considered as control group that received 0.6 ml of PBS. The samples were taken from the wounds 7 and 12 days after the wounding, and healing process was compared histologically between the two groups. Anti-BrdU staining showed that the transplanted cells were still alive in the wound bed during the study. The histopathological study revealed that re-epithelialization was complete at days 7 in treated wounds with WJMSCs, whereas in control wound the wounds still showed incomplete epithelialization 12 days after wounding. Also, microscopic evaluation showed less inflammation, thinner granulation tissue formation with minimum scar in the treated wounds in comparison with control wounds. In conclusion, this study demonstrates the beneficial effect of caprine WJMSCs in cutaneous wound healing in goat.

Background Atherosclerotic changes within the coronary artery wall can affect vessel distensibility. Objective This study evaluated the relationship between the coronary distensibility index (CDI) and the severity of coronary artery disease (CAD) measured by computed tomographic angiography (CTA). Methods One hundred thirteen subjects, age 63 ± 10 years, 32% women, who underwent coronary artery calcium (CAC) scanning and CTA, were studied. Early diastolic and mid diastolic (MD) cross-section area (CSA) of the left anterior descending (LAD) artery were measured 5 mm distal to the left main bifurcation. CDI was defined as Δlumen CSA/[lumen CSA in MD × estimated central pulse pressure (eCPP)] × 10 3 {eCPP = 0.77 × peripheral pulse pressure}. LAD diameter measured by CTA and quantitative coronary angiography (QCA) was compared in 19 subjects without CAD. CAD was defined as normal (no stenosis and CAC 0), mild (stenosis ≤ 30%), moderate (stenosis 31%–69%), and severe (stenosis ≥ 70%) on CTA. Results Excellent correlation was observed between CTA and QCA measured by CDI ( r 2 = 0.96, P = 0.0001). CDI decreased from normal coronaries (6.75 ± 1.43) to arteries with mild (5.78 ± 1.45), moderate (3.96 ± 1.06), and severe (3.31 ± 1.06) disease ( P = 0.004). The risk factor adjusted odds ratio of lowest versus 2 upper tertiles of CDI was 1.28 for mild, 8.47 for moderate, and 10.59 for severe CAD compared with the normal cohort. The area under the ROC curve to predict obstructive CAD (stenosis ≥ 50%) increased significantly from 0.71 to 0.84 by addition of CDI to CAC ( P Conclusion CTA-measured CDI is inversely related to the severity of CAD independent of age, sex, cardiovascular risk factors, and CAC.

Ultrasonic guided wave technology is one of the more recent developments in the field of non-destructive evaluation. In contrast to conventional ultrasonic, this technology requires exposing only the areas where the transducers will be placed, hence requiring minimal insulation removal and excavation for buried pipes. This paper discusses how this technology can be used to detect defects in pipes under different conditions. Here the experiments were performed on small diameter pipes ( Experiments were conducted using two dry coupled piezoelectric transducers, where one of them transmitted guided waves along the pipe and the other received them. The transducers produced tangential displacement, thereby generating the fundamental torsional mode T(0,1). In order to assess whether having multiple transducers has any effect on the resultant waveform, the receiving transducer was rotated around the circumference of the pipe.

This paper reports on an investigation into the feasibility of using active and passive means of vibration control in aerospace structures. In particular, attention is focused on controlling vibration transmission through light weight satellite structures at medium frequencies. The initial structure under test here is a 4.5-meter long satellite boom consisting of 10 identical bays with equilateral triangular cross sections. This structure is typical of those that might be used in space telescopes, space stations or synthetic aperture radar systems. Such a structure is typically used to support sensitive instruments in precise alignments spaced tens of metres apart. While a great deal of work has been done on this problem at low frequencies, relatively little has been achieved to date at medium frequencies (here taken to be between 150Hz and 250Hz). Nonetheless, this is of importance to new space missions. Using the techniques described here, an overall reduction in vibration transmission of 31.0dB is achieved in an essentially undamped structure using passive means alone. The amounts of attenuation achievable for active control with one, two and three actuators are found to be 15.1dB, 26.1dB and 33.5dB, respectively. With the combined passive control (using 10% geometric deviations) and active control (using three actuators) an overall reduction of 49.5dB is achievable in practice.

In this paper, results for active vibration control predicted from experimental measurements on a lightweight structure are compared with purely computational predictions. The structure studied is a 4.5m long satellite boom consisting of 10 identical bays with equilateral triangular cross sections. First, the results from a Fortran code that is based on a receptance analysis are validated against the experimental forced response of the boom structure. Exhaustive searches are then carried out to find the optimum positions for one and two actuators. Finally, a genetic algorithm is employed to find high-quality positions for three actuators on the structure that will achieve the greatest reductions in vibration transmission. Having found these actuator positions, experiments are then carried out to verify the quality of the theoretical predictions. It was found that the attenuation achievable in practice for one, two and three actuators were, respectively, 15.1, 26.1 and 33.5 dB.

In this paper, the superior mid-frequency vibration isolation of a geometrically optimized lightweight structure is demonstrated. The initial structure under test here was a 4.5 m long satellite boom consisting of 10 identical bays with equilateral triangular cross-sections. An unusual geometric variant of this, with inherent isolation characteristics, has been designed by the use of genetic algorithm (GA) methods. In order to obtain the best design, the joints in the boom were allowed to move around by 20% of the length of each bay (i.e., ±9 cm in all three translational directions). This work is based on results from a Fortran code (which was derived from receptance analysis) that are fully validated against detailed finite element (FE) models of the structure. The experimental forced response of the regular boom structure has been measured and compared with predicted curves. Finally, having obtained the geometrically optimized boom structure, its experimental response is compared with the theoretical results predicted by the receptance method. It is shown that the average of 30 dB isolation in the vibration energy transfer between the ends of the network of beams, over a 100 Hz bandwidth predicted in the design process, is achieved experimentally in an essentially undamped structure.

Characteristics of Human Amniotic Epithelial Cells and Bone Marrow Mesenchymal Stem Cells in a Parallel Study: Hanging Drop Colony Formation and Doubling Time Amniotic epithelial cells exhibit pluripotent capacity with some unique properties. They are considered as a good candidate in regenerative medicine. Human bone marrow mesenchymal stromal cells (hBM-MSC) are the gold standard in cell therapy procedures, but whether these cells could be replaced with hAEC remains a debate? We compared the stem cell characteristics of hAEC with hBM-MSC considering isolation, morphology, population doubling time, colony formation on substratum and in suspension, alkaline phosphatase activity and expression of some CD Markers. hAEC were round and cubical but hBM-MSC appeared spindle-shaped in culture. Both groups of cells expressed mesenchymal stem cells markers (CD44, CD90) and they did not express CD34. OCT4 was highly expressed in hAEC but not in hBM-MSC. Their proliferation rate was slower than hBM-MSC. Either of the cell groups could form colonies on substratum as well as suspension with a positive alkaline phosphatase activity. Our results showed that biological properties of human amniotic epithelial cells are to some extent similar to human bone marrow mesenchymal cells.

Primary cutaneous γδ T-cell lymphoma and hemophagocytic syndrome (HPS) is a very rare disease process with only 41 cases of this type of lymphoma published to date. We report the case of a 56-year-old woman who developed high-grade fevers and multiple nonhealing bilateral lower extremity ulcers associated with a recent diagnosis of Ackerman syndrome. Multiple lesion biopsies yielded a differential diagnosis including sarcoidosis and lupus panniculitis. Each biopsy site developed into a poorly healing wound. After extensive rheumatologic and dermatologic workup, failed courses of hyperbaric oxygen and corticosteroids, and the development of worsening fevers, the diagnosis of γδ T-cell lymphoma was made. The objective of this article was to illustrate a very rare case of a rapidly progressing cutaneous lymphoma while stressing the importance of a surgical approach to nonhealing wounds and biopsy in chronic wounds.An aggressive multidisciplinary approach including infectious disease, hematology/oncology, nephrology, plastic surgery, and interventional pulmonology was used. Medical approaches included several courses of corticosteroids and antineoplastics. Our surgical approach included numerous excision and debridements of her nonhealing ulcers with removal of necrotic tissue. It also included placement of cadaveric epidermal graft, and bovine tendon collagen cross-linked with glycosaminoglycans with a silicone matrix bilayer (Integra, Plainsboro, NJ) combined with multiple local myocutaneous advancement flaps. This approach demonstrated clinical improvement in wound healing. Pathological examination of several lesions included immunohistochemistry staining, flow cytometry, and molecular studies.The diagnosis of primary cutaneous γδ T-cell lymphoma was made based on a pathology specimen. Subsequent imaging showed numerous pulmonary nodules later determined to be pulmonary Aspergillosis. Additionally, she developed a constellation of clinical and laboratory features defined as the HPS. Despite medical therapy and improved wound healing, she died to seizures that left her comatose, thought to be secondary to central nervous system advancement of her HPS. The patient eventually died after care was withdrawn.Cutaneous forms of lymphoma must be considered in the differential diagnosis of atypical cutaneous lesions or nonhealing wounds. There should be no delay in performing a skin biopsy to obtain a tissue diagnosis. A surgical approach to wounds clearly demonstrates improved wound healing.