Search

Anal stenosis is a rare but frustrating condition that usually occurs as a complication of hemorrhoidectomy. The severity of anal stenosis can be classified into three categories: mild, moderate, and severe. There are two main surgical treatments for this condition: scar revision surgery and anoplasty; however, no studies have compared these two approaches, and it remains unclear which is preferrable for stenoses of different severities.To compare the outcomes of scar revision surgery and double diamond-shaped flap anoplasty.Patients with mild, moderate, or severe anal stenosis following hemorrhoidectomy procedures who were treated with either scar revision surgery or double diamond-shaped flap anoplasty at our institution between January 2010 and December 2015 were investigated and compared. The severity of stenosis was determinedWe analyzed 60 consecutive patients, including 36 men (60%) and 24 women (40%). The mean operative time for scar revision surgery was significantly shorter than that for double diamond-shaped flap anoplasty (10.14 ± 2.31 [range: 7-15] minScar revision surgery may be preferable for mild anal stenosis upon conservative treatment failure. Anoplasty is unavoidable for moderate or severe stenosis, where cicatrized tissue is extensive.

Mirror mode waves with anticorrelated density and magnetic field perturbations have been widely observed in the planetary magnetosheaths and solar wind. In this study we examine the time evolution of proton mirror instability based on the hybrid particle simulation with the focus being on the thermodynamics of mirror waves. A set of double-polytropic (DP) laws are adopted to infer the corresponding thermodynamic conditions characterized by the polytropic exponents, γ⊥and γ. It is shown that the γ⊥, values at the saturation stages are in the ranges of γ⊥ = 0.64±0.21 and γ = 1.07±0.12 which are consistent with the observations and linear kinetic theory (Hau et al. 2021). The saturated plasma β are well fitted by the modified DP MHD mirror condition of γβ = β⊥2/(2+γ⊥β⊥) with γ⊥ ≈ 0.8, γ ≈ 1.3 which may be used as a new mirror criterion for the mirror waves observed in the solar system.

Silica particles are widely used as a support material for chemically-bound stationary phases in chromatographic separation processes. The tuning of textural properties and surface chemistry of stationary phase materials (SPMs) is crucial to enhance their selectivity to certain compounds and the efficiency of the separation process. Silica supports have the advantage that their surface can be modified with a large variety of hydrophilic and hydrophobic functional groups, but their influence on the silica surface properties has not been evaluated in detail. In this sense, the contact angle is a key parameter for the assessment of surface chemistry but its quantification in the pore walls is particularly challenging and requires a combination of various tools and experimental techniques. In this work we demonstrate that by combining water adsorption and intrusion measurements is possible to derive reliable information of the effective contact angle θ of adsorbed water for wetting (θ = 0°), partial wetting (θ < 90°), and non-wetting situations (θ > 90°) observed on the pore walls of the SPMs under study. Furthermore, NMR relaxometry experiments reveal that the T1,ads.film/T2,ads.film-ratio can be correlated with the effective adsorption strength of water on the surface. Indeed, we find a linear correlation between the negative inverse of the T1,ads.film/T2,ads.film -ratio (-T2,ads.film/T1,ads.film) with the contact angle determined from water vapor adsorption and intrusion experiments for the investigated SPMs. Our work clearly demonstrates for the first time that water vapor adsorption experiments and novel water intrusion technique coupled with NMR relaxometry can be used as complementary techniques to quantitatively analyze the wettability behavior and surface chemistry of nanoporous materials.

Introduction Proper wound care along with the use of skin grafts over deep burn wounds has been the standard treatment. However, the goal in burn wound care has shifted from achieving a satisfactory survival rate to improving long-term form and function of the healed wound, which is sometimes hindered by scar contracture. This has prompted surgeons to find alternative ways to treat burn wounds without compromising function. Among burn cases, hand injuries are the most problematic when it comes to delicate function recovery. Methods This study presents the results of conjunctive use of a bilayer artificial dermis, negative pressure wound therapy, and split-thickness skin grafts for grafting over acute burn wounds and scar-releasing defects after severe hand burns. Results Three months after the operation, the scar was soft and pliable, the aesthetic outcome was good, and the patients gained much improvement in hand function and quality oflife. Conclusions The combined technique achieved a good scar quality and aesthetic effect on burned hands as well as excellent functional outcome, which resulted in major improvements and an independent life for the patient.

The consideration of directional hydrogen bonding in the COSMO-SAC model based on the minima in the molecular electrostatic potential has been shown to significantly improve the description of solv...

This research investigates both the steady-state and transient dynamic characteristics of polyvinylidene fluoride (PVDF), which is one of the most commonly used piezoelectric polymers. In steady-state vibration, the visible resonant mode fringe patterns are obtained using the amplitude-fluctuation electronic speckle pattern interferometry experiment, and the point-wise displacement data are measured by laser Doppler vibrometer–dynamic signal analysis. Finite element analysis is also performed, and the numerical results are compared with the experimental ones for the steady-state vibration. In a transient dynamic experiment, the history of dynamic impact generated by a steel ball is measured by the PVDF, and the experimental results are compared with the theoretical results obtained by the Hertz contact law. The comprehensive information about steady-state and transient dynamic properties of PVDF membranes obtained in this study is expected to contribute to the further development of the PVDF piezoelectric element.

(1) Background: Betel nut chewing injures bodily health. Although, the relationship between betel nut chewing and kidney stone disease (KSD) is unknown. (2) Methods: We analyzed 43,636 men from Taiwan Biobank. We divided them into two groups on the status of betel nut chewing, the never-chewer and ever-chewer groups. Self-reported diagnosed KSD was defined as the subject’s medical history of KSD in the questionnaire. Logistic regression was used to analyze the association of betel nut chewing and the risk of KSD. (3) Results: The mean age of subjects in the present study was 50 years, and 16% were ever-chewers. KSD was observed in 3759 (10.3%) and 894 (12.6%) participants in the group of never-chewer and ever-chewer groups, respectively. Higher risk of KSD was found in participants with betel nut chewing compared with to without betel nut chewing (odds ratio (OR), 1.094; 95% confidence interval (95% CI), 1.001 to 1.196). Furthermore, the daily amounts of betel nut chewing >30 quids was associated with a more than 1.5-fold increase (OR, 1.571; 95% CI, 1.186 to 2.079) in the odds of KSD; (4) Conclusions: Our study suggests that betel nut chewing is associated with the risk of KSD and warrants further attention to this problem.

Programming logic controllers (PLCs) are vital components for conveyors in production lines, and the sensors and actuators controlled underneath the PLCs represent critical points in the manufacturing process. Attacks targeting the exploitation of PLC vulnerabilities have been on the rise recently. In this study, a PLC test platform aims to analyze the vulnerabilities of a typical industrial setup and perform cyberattack exercises to review the system cybersecurity challenges. The PLC test platform is a sorting machine consisting of an automatic conveyor belt, two Mitsubishi FX5U-32M PLCs, and accessories for material sorting, and Modbus is the selected protocol for data communication. The O.S. on the attacker is Kali ver. 2022.3, runs Nmap and Metasploit to exploit the target Modbus registers. On the other hand, the target host runs the O.S., Ubuntu 22.04 in the cyberattack exercises. The selected attack method for this study is packet reply which can halt operations sending custom data packets to the PLC. In summary, this study provides a basic step-by-step offensive strategy targeting register modification, and the testbed represents a typical industrial environment and its vulnerabilities against cyberattacks with common open-source tools.

Introduction: Fluoroquinolone exposure is reportedly associated with a higher risk of tendon disorders, tendonitis, or tendon rupture. However, studies in East Asian populations have not confirmed these risks in patients with comorbidities or concomitant medication use. This cohort study was designed to investigate the associations among fluoroquinolone exposure, comorbidities, medication use, and tendon disorders in Taiwan.Materials and Methods: This population-based, nationwide, observational, cohort study used data from the National Health Insurance Research database in Taiwan, a nationwide claims database that covers more than 99% of the Taiwanese population. The study period was from January 2000 to December 2015, and the median follow-up time was 11.05 ± 10.91 years. Patients who were exposed to fluoroquinolones for more than three consecutive days were enrolled, and patients without fluoroquinolone exposure who were matched by age, sex, and index year were enrolled as controls. The associations of comorbidities and concomitant medication use with tendon disorder occurrence were analyzed using Cox regression models.Results: The incidence of tendon disorders were 6.61 and 3.34 per 105 person-years in patients with and without fluoroquinolone exposure, respectively (adjusted hazard ratio, 1.423; 95% confidence interval [1.02,1.87]; p = 0.021). Sensitivity analyses yielded similar results. Patients under 18 and over 60 years with fluoroquinolone exposure; those with chronic kidney disease, diabetes, rheumatologic disease, cardiac disease, lipid disorder, or obesity; and those who concomitantly used statins, aromatase inhibitors, or glucocorticoids, had a significantly higher risk of tendon disorders.Conclusion: The long-term risk of tendon disorders was higher in patients with fluoroquinolone exposure than in those without fluoroquinolone exposure. Clinicians should assess the benefits and risks of fluoroquinolone use in patients at high risk of tendon disorders who require fluoroquinolone administration.

Diabetes-related lower extremity amputations are an enormous burden on global health care and social resources because of the rapid worldwide growth of the diabetic population. This research aimed to determine risk factors that predict major amputation and analyse the time interval from first hospitalisation to amputation by using standard management protocols and Kaplan-Meier survival curves. Data from 246 patients with diabetes mellitus and diabetic foot ulcers from the Division of Plastic and Reconstructive Surgery of the Department of Surgery at XXX Hospital between January 2016 and May 2020 were analysed. Univariate and multivariate analyses of 44 potential risk factors, including invasive ulcer depth and C-reactive protein levels, showed statistically significant differences for those at increased risk for major amputation. The median time from hospitalisation to lower extremity amputation was approximately 35 days. Most patients with abnormal C-reactive protein levels and approximately 70% of patients with ulcers invading the bone were at risk for lower extremity amputations within 35 days. Therefore, invasive ulcer depth and C-reactive protein levels are significant risk factors. Other potential risk factors for major amputation and the time intervals from first hospitalisation to amputation should be analysed to establish further prediction strategies.

Mirror-mode waves driven by the large temperature anisotropy of T ⊥/T ∣∣ > 1 have been widely observed in the solar wind, planetary magnetosheaths, heliosheath, etc. Recent studies have shown that the phase relations and thermodynamics of the mirror waves observed in the terrestrial magnetosheath may well be interpreted by the linear mixed kinetic–MHD theory of proton mirror instability. In particular, the energy laws possess the form of double-polytropic closures with the thermodynamic exponents being functions of β ⊥,∣∣ = p ⊥,∣∣/(B 2/2μ 0). In this study, we examine the time evolution of proton mirror instability based on the hybrid particle simulations for twenty sets of β ⊥,∣∣ values. Quantitative comparisons between the kinetic simulations, linear Vlasov theory, and observations are made in terms of the growth rates, phase relations, thermodynamic conditions, etc., which show high agreements. In particular, the dependences of various compressibility and thermodynamic exponents on β ⊥,∣∣ are confirmed by the kinetic simulations, which show that the polytropic exponents are in the ranges of γ ⊥ = 0.64 ± 0.21, and γ ∣∣ = 1.07 ± 0.12 consistent with the theoretical predictions and mirror observations of γ ⊥ < 1 and γ ∣∣ ≳ 1. It is shown that the observed features, including the various perturbations and wavelengths, may indeed be reproduced by the nonlinear simulations. The saturated temperature anisotropy β ⊥/β ∣∣ and plasma β ∣∣ show an anticorrelation, which may well be fitted by the modified mirror instability threshold of γ ∣ ∣ β ∣ ∣ = β ⊥ 2 / 2 + γ ⊥ β ⊥ with γ ⊥ ≈ 0.8, γ ∣∣ ≈ 1.3, and the saturated magnetic field of δ B/B ≈ 0.26 ∼ 0.97 increases with increasing values of β ≈ 1.6 ∼ 8.3.

The complications of percutaneous nephrolithotomy (PNL) include hemorrhage, damage to adjuvant organs, and other medical issues, although intracardiac migration of ureteral double-J stent has never been found during PNL and delaying the diagnosis might cause mortality. We report the case of a 60-year-old male who was admitted to receive one-stage PNL for right renal stones. During operation, an unexpected atrial fibrillation with a drop in blood pressure was suddenly encountered and the chest X-ray subsequently showed that the ureteral double-J had penetrated deep into the heart. Emergent endovascular intervention was performed to remove the stent and the patient was uneventfully discharged 2 days later.

The efficacy of botulinum toxin A (BTX-A) therapy in axillary hyperhidrosis has been documented; however, there are a few studies reporting the efficacy of BTX-A in treating axillary bromhidrosis. The histological changes occurring in sweat glands after BTX-A treatment are also unknown.The authors report on the efficacy and safety of BTX-A in the treatment of axillary bromhidrosis and on the histological changes in sweat glands after BTX-A treatment.Nineteen patients were included in this study. The patients were administered BTX-A injection in one axilla and sterile normal saline as placebo in the other axilla. The degree of malodor was evaluated subjectively by the patients before and 3 months after treatment. Sweat secretion was quantified by the gravimetric method. All patients underwent standard apocrinectomy in both axillary regions.The mean degree of malodor and mean sweat production in the BTX-A-treated axilla were significantly lower than those in the control axilla (2.42 vs 8.00; p.0001 and 13.33 vs 33.75 mg/min; p = .0028, respectively) at 3 months after therapy. The histological studies showed apocrine sweat glands with atrophic changes and hypoplasia in treated axilla.BTX-A injection is an easy, fast, noninvasive method of treating axillary bromhidrosis.

This work presents an activity-based formulation for Langmuir adsorption isotherm. Treating adsorption as a chemical reaction between the gas molecule and the adsorption vacant site, the classical Langmuir isotherm model expresses the reaction in terms of the species concentrations. Designed to capture the surface heterogeneity, the proposed thermodynamic Langmuir isotherm model substitutes the species concentrations with the species activities and calculates the species activity coefficients with the adsorption non-random two-liquid activity coefficient model. The resulting isotherm model accurately represents pure component adsorption isotherms for gases with wide varieties of adsorbents including silica gels, activated carbons, zeolites and metal organic frameworks at various temperatures. With three physically meaningful parameters, the model outperforms the classical Langmuir isotherm model for the 98 isotherms of 33 systems examined.

In this work, we propose an extension of the Pitzer–Debye–Huckel (PDH) model for solutions containing ionic species at all concentrations. In the original PDH model, the ionic species are excluded ...

Preserving both esthetic and functional outcome remains challenging in facial burn injuries. The major issue is the initial treatment of injury. In this study, we focused on patients with partial-thickness facial burns admitted to the burn unit of Tri-Service General Hospital, Taipei, from November 2016 to November 2018. In 21 included patients, customized mask-style, transparent hydrogel-based dressing was applied to the burns. The mean age of included patients was 37.4 years. The mean area of burn injury was 11.9% of total body surface area, and the mean area of second-degree facial burns was 162.3 cm2. Full reepithelialization took, on average, 10.86 days. Scarring was acceptable in terms of texture and color, and no hypertrophic or keloidal scarring was noted. The mean Vancouver Scar Scale score was 2.07. Use of the hydrogel-based dressing masks seems to be a promising means of reducing pain, providing uninterrupted wound healing, facilitating observation, and positively affecting scarring in patients with second-degree facial burns.

Skin grafts are not suitable for closing tendon- or bone-exposing wounds, which require flap surgery. Dermal regeneration templates have value for closing such wounds, but the disadvantages of the technique include implantation failures because of infection, hematoma formation, or inappropriate immobilization. Negative-pressure wound therapy was reported to increase graft acceptance in difficult wounds. This retrospective case series of 65 patients evaluated negative-pressure therapy combined with artificial dermis for the treatment of acute or chronic tendon- or bone-exposing wounds. The artificial dermis was placed after adequate wound-bed preparation, with simultaneous application of a vacuum-assisted closure system. Split-thickness skin grafting was performed after the implanted artificial dermis had become established. The overall success rate was 88.1% (59/67): 88.6% (39/44) in the chronic wounds group and 87% (20/23) in the acute-trauma group separately. The overall mean survival time of artificial dermis in success cases was 13.24 ± 7.14 days. In separately, the survival time of artificial dermis had no statistically difference in chronic wound group (13.64 ± 7.53 vs 12.60 ± 5.86. P = .943), but had significant statistical difference in acute trauma group (12.45 ± 6.44 days vs 23.33 ± 4.04 days, P = .018). Also, comorbidity of PAOD was found a strong risk factor of failure in chronic wound group (100% vs 23.1%, P

With aging, pressure ulcers become a common health problem causing significant morbidity and mortality for physically limited or bedridden elderly persons. Here, we present our strategy for such patients. Between August 2010 and March 2019, 117 patients were enrolled. Patient age, etiology, defect size and location, flap reconstruction, outcome, and follow-up period were reviewed. Of these patients, 64 were female and 53 were male, with an age range of 21 to 96 years (mean 75.6). The mean area of defect was 61.5 cm2. The most common etiology was dementia (33.3%), and ulcers were most frequently caused by sacral pressure (70.3%). The commonest surgical treatment was a V–Y advancement flap (50%). The complication rate was 27.5%, including dehiscence and late recurrence. Negative pressure wound therapy could be used if the initial defect was large. V–Y advancement flap is the most frequent surgical treatment for sacral pressure ulcers because it is simple and available for most types of defect. Primary closure may be considered as the simplest method if the defective area is

Early excision and autografting have been the principles in managing acute burn wounds. Despite the known benefits of early autografting, there are situations in which the placement of autograft is unsafe or even unavailable. In these clinical situations, skin substitutes like artificial dressings and human skin allografts are considered as useful for temporary wound coverage. We present an immunosuppressed patient with deep lower limb burn wound who received human skin allograft for wound management. The applied human skin allograft persisted for a longer period without infection or rejection and successfully improved her wound healing. Large and well-designed prospective studies are needed to confirm the encouraging results of the present case report.

In a recent work, Chen and Lin showed that the consideration of directional hydrogen bonding in the COSMO-SAC model significantly improves the description of solvation properties of the associating fluids. In their method, the direction of a hydrogen bond was determined based on VSEPR theory; however, this geometric approach does not reflect the local electronic environment of the lone pairs and cannot be applied to certain molecules such as DMSO and HF. In this work, we adopt a new scheme that determines the hydrogen bond acceptors of a molecule based on the minima in the molecular electrostatic potential (MESP). The hydrogen bonding directions thus determined result in improvements (about 5–7% for VLE) in the prediction of the COSMO-SAC model for a variety of thermodynamic properties and phase equilibria, such as vapor–liquid equilibrium (VLE), liquid–liquid equilibrium (LLE), the infinite dilution activity coefficient (IDAC), and the octanol–water partition coefficient (Kow) calculations.

The basic principle of donor site selection is to take skin from areas that will heal with minimal scarring while balancing the needs of the recipient site. For skin loss from the lower legs and feet, the most common harvest site for split-thickness skin grafts is the anterior or posterior thigh; grafts from the plantar areas have been mostly used to cover the volar aspect of digits and palms. Between September 2015 and September 2017, 42 patients with areas of skin loss on the legs or feet were treated with plantar skin grafts because of their cosmetic benefits and the convenience of the surgical procedure and postoperative wound care. Our technique of harvesting a single layer of split-thickness skin graft (0.014 in. thick) from a non-weight-bearing area of the foot of the injured leg is simple and provided good functional and cosmetic outcomes at both the donor and recipient sites. All patients were very satisfied with the recovery progress and final results. Therefore, in the management of skin defects in the lower legs or feet that comprise less than 1.5% of the total body surface area, our surgical method is a reliable alternative to anterior or posterior thigh skin grafting.

Introduction Plantar hyperkeratosis, such as corns and calluses, is common in older people and associated with pain, mobility impairment, and functional limitations. It usually develops on the palms, knees, or soles of feet, especially under the heels or balls. There are several treatment methods for plantar hyperkeratosis, such as salicylic acid plaster and scalpel debridement, and conservative modalities, such as using a shoe insert and properly fitting shoes. Methods We present an effective method of reconstructing the wound after corn excision using a split-thickness sole skin graft (STSSG). We harvested the skin graft from the arch of the sole using the dermatome with a skin thickness of 14/1000th inches. Results Because the split-thickness skin graft, harvested from the sole arch near the distal sole, is much thicker than the split-thickness skin graft from the thigh, it is more resistant to weight and friction. The healed wound with STSSG coverage over the distal sole was intact, and the donor site over the sole arch had healed without complication during the outpatient follow-up, 3 months after surgery. Conclusions The recovery time of STSSG for corn excision is shorter than that with traditional treatment. Therefore, STSSG can be a reliable alternative treatment for recurrent palmoplantar hyperkeratosis.

In this research, we demonstrate novel inverted light-emitting devices based on n-typed tungsten trioxide (WO3) nanostructures. Two different types of WO3 nanostructures, including nanocluster layer (NCL) and nanorod arrays (NAs), were grown on the indium-tin oxide (ITO) substrates by the hydrothermal method. An ultra-thin polyethylenimine ethoxylated (PEIE) layer was deposited on top of WO3 nanostructures as the buffer layer for improving device performance. Inverted devices with the configuration of ITO/WO3 NCL or NAs/PEIE/poly(2-methoxy-5-(2′-ethylhexyloxy)-1,4-phenylene vinylene)/poly(3,4- ethylenedioxythiophene):poly(styrene sulfonate)/WO3 film/Au were constructed and evaluated. The best device based on WO3 NAs with height of 300 nm showed a max brightness of 3079 cd/m2 and current efficiency of 0.22 cd/A. Our observation and results open up new opportunities to fabricate hybrid light-emitting devices.

By changing the transverse-mode spectral linewidth of vertical cavity surface emitting lasers (VCSELs) at 850 nm, the directly encoded four-level pulse amplitude modulation data transmission performance over 100-m-long OM4 multimode fiber (MMF) are demonstrated and compared. The multi-mode VCSEL chip with the largest aperture of $11~\mu \text{m}$ reveals the widest spectral linewidth and the highest optical power, but provides the smallest modulation bandwidth to support only 44- and 28-Gb/s data rates for back-to-back (BtB) and 100-m OM4 MMF transmission cases, respectively. By shrinking the aperture size to reduce transverse-mode number, the few-mode VCSEL with the strongest throughput power enables a BtB transmission capacity as high as 52 Gb/s. However, its modal dispersion induced after OM4 MMF transmission inevitably degrade the data rate to 32 Gb/s. In contrast, the single-mode VCSEL with the smallest aperture of $3~\mu \text{m}$ reveals the highest modulation bandwidth and negligible modal dispersion to show competitive BtB transmission capacity with that of the few-mode VCSEL. In particular, the single-mode VCSEL successfully achieves a data rate of 34 Gb/s with a power penalty as low as 1.4 dB, after 100-m OM4 MMF transmission.