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Background: Birth injuries to the brachial plexus are highly rare; however, they necessitate treatment and follow-up from infancy until skeletal maturity. Many complications may arise as a result of primary nerve surgery. Objectives: To study the long-term complications of nerve repair procedures in patients with obstetric brachial plexus palsy. Patients and methods: This was retrospective research that was performed on 8 cases having obstetric brachial plexus palsy and underwent nerve surgery procedure. The ages ranged from 3 to 20 months. The assessment of the surgical procedure outcomes involves post-operative evaluation of both short and long-term complication. Results: Our study showed that the most frequent long-term complications were decreased innervation (25%), followed by decreased strength and stamina and balanced discoordination (12.50%) while there were no complications encountered in 50% of cases. The short-term complications included wound infection, seroma and hematoma. Conclusion: The nerve surgery procedure is an efficient primary approach in the management of cases with brachial plexus injury. However, a long-term follow-up is usually associated with late squeal such as reduced innervation and decrease in the overall strength and stamina.

The square flap method has been successful in releasing contracture bands at various body regions. However, the original square flap method alone may not be efficient in releasing long contracture bands. We, therefore, proposed an extended design to the traditional design, which is called the “square-plus flap.” A 4-year-old girl presented with a postburn web-like contracture band over the right axilla. We marked a square flap technique at the center of the contracture band and then two additional Z-plasties were placed on both edges of the flap. After the release and securing of the square flap, the adjacent distal Z-plasty was then transposed and sutured in their new locations. We do not need to incise the proximal Z-plasty as we could achieve complete relaxation of the contracture band. This novel modification can be added to the plastic surgeon's armamentarium for releasing long postburn contracture bands involving distinct body regions.

Background Free tissue transfer is considered the gold standard option for the reconstruction of distal leg defects. Free tissue transfer using recipient vessels in the contralateral leg (cross-leg bridge) is a potential option to supply the flap if there are no suitable recipient vessels in the injured leg. Most studies have described this technique using end-to-end anastomosis which sacrifices the main vessel in the uninjured leg. This study evaluated the use of a cross-leg free latissimus dorsi muscle flap for the reconstruction of defects in single-vessel legs, using end-to-side anastomosis to recipient vessels in the contralateral leg without sacrificing any vessel in the uninjured leg.

Replication is a fundamental aspect of cancer, and replication is about reproducing all the elements and structures that form a cell. Among them are DNA, RNA, enzymes, and coenzymes. All the DNA is doubled during each S (synthesis) cell cycle phase. This means that six billion nucleic acids must be synthesized in each cycle. Tumor growth, proliferation, and mutations all depend on this synthesis. Cancer cells require a constant supply of nucleotides and other macromolecules. For this reason, they must stimulate de novo nucleotide synthesis to support nucleic acid provision. When deregulated, de novo nucleic acid synthesis is controlled by oncogenes and tumor suppressor genes that enable increased synthesis and cell proliferation. Furthermore, cell duplication must be achieved swiftly (in a few hours) and in the midst of a nutrient-depleted and hypoxic environment. This also means that the enzymes participating in nucleic acid synthesis must work efficiently. pH is a critical factor in enzymatic efficiency and speed. This review will show that the enzymatic machinery working in nucleic acid synthesis requires a pH on the alkaline side in most cases. This coincides with many other pro-tumoral factors, such as the glycolytic phenotype, benefiting from an increased intracellular pH. An increased intracellular pH is a perfect milieu for high de novo nucleic acid production through optimal enzymatic performance.

Background: The hand is an intricate part of the body that plays an essential role in social functioning, expression, productivity, and interactions with our environment.Many flap options have been described to address the specific functional and anatomic requirements in soft tissue reconstruction of the hand. The aim of this study isto find the ideal donor tissue for coverage of soft tissue defects of the hand to achieve wound closure and maintain joint and hand function. Patients and methods: A prospective study wasconducted betweenfrom April 2018 and May 2019, on all patients with soft tissue defects of the hand presented to plastic surgery department, Qena faculty of medicine,South Valley University. Results:There were 62 hand injuries in 50 patients with a mean age of 35 years (range, 1- 69 years). The etiologies of the injuries were mostly due to post-traumatic raw areas (86%). In our study we divided cases into 4 main groups, the first group including fingertip injuries, second group proximal to fingertips, third group palm and fourth group dorsum of the hand. The distribution of the hand injuries were 48 fingertips injury, 8 injuries proximal to fingertips, palm injury in one patient and injuries over hand dorsum in 5 patients.The follow up period was ranged 1 to 6 months. Conclusion:An algorithmic approach for coverage of the hand soft tissue defect seems to provide predictable results regarding flaps survival and preservation of finger length.

Background: Obesity is a global epidemic. Laparoscopic greater curvature plication [LGCP] is a restrictive surgical procedure described for the first time on 1981 by Wilkinson. Fundectomy is a selective resection of the acid-producing segment of the stomach, with removal of peptide hormone-producing cells [the oxyntic mucosa] as a consequence of the fundectomy. Aim of the work: Our aim is to assess the feasibility and advantages of the novel modification for morbidly obese patients which include fundectomy with greater curvature plication. Patients and Methods: Ten patients were included in this study, which carried out at Al-Azhar University Hospital [New Damietta]. Results: Body mass index [BMI] ranged from 30 to 48 kg/m2 [the mean was 38.8 kg/m2]. Operative time ranged from 60 to 120 minutes [Mean time: 93.5 minutes]. The mean hospital stay time was 1.35 days. The mean estimated weight loss percentage [EWL%] was 29.1% at three months, 44.6% at six months, 60.4% at one year, and 72.4% at two years. EWL% was less than 50% for one patient which needs reoperation with Laparoscopic Sleeve Gastrectomy. Two patients [20%] developed heartburn due to gastroesophageal reflux disease [GERD]. Nine patients [90%] presented nausea, and vomiting was present in four patients [40%]. Conclusion: Fundectomy and Greater curvature plication is a feasible, safe, effective as a bariatric operation with avoidance of complications of other bariatric operations. As a new modification for bariatric surgery, this operation needs more investigations and longer periods for follow up.

COVID-19, a pandemic disease caused by a viral infection, is associated with a high mortality rate. Most of the signs and symptoms, e.g. cytokine storm, electrolytes imbalances, thromboembolism, etc., are related to mitochondrial dysfunction. Therefore, targeting mitochondrion will represent a more rational treatment of COVID-19. The current work outlines how COVID-19’s signs and symptoms are related to the mitochondrion. Proper understanding of the underlying causes might enhance the opportunity to treat COVID-19.

Background The pedicled anterolateral thigh (ALT) flap has become more popular for the reconstruction of soft-tissue defects in neighboring areas. Nonetheless, few studies in the literature have explored the use of this flap for trochanteric ulcer reconstruction. The aim of our study is to present the author’s experience of utilizing the ALT flap, with a focus on technical elements regarding the flap design and the tunneling method to maximize the reach of the flap. Methods The medical records of patients who received pedicled ALT flaps for the reconstruction of trochanteric pressure sores were retrospectively reviewed. The patients’ demographic data, operative details, and postoperative complications were evaluated. Results Between October 2018 and December 2019, 10 consecutive patients (age range, 13–45 years) underwent 11 pedicled ALT myocutaneous flaps for trochanteric pressure sore reconstruction. Each flap was designed around the most distal cutaneous perforator that was included in the proximal third of the skin paddle. The flaps ranged in size from 11×6 to 14×8 cm. The ALT flap was transposed through a lateral subcutaneous tunnel in five patients, while the open tunnel technique was used in six patients. All flaps survived, and no vascular compromise was observed. Conclusions The pedicled ALT flap is a safe and reliable option for reconstructing trochanteric pressure sores. An appropriate flap design and a good choice of the tunneling method are crucial for successful flap transposition.

Abstract Background The phyllodes tumors are rare neoplastic disease which exhibits a benign behavior in adolescents female. After resection of a large benign breast tumor, insufficient breast contour may result with nipple areola complex malposition. As symmetry of the breast is psychologically extremely crucial, especially in adolescents, in such cases, an immediate mammoplasty-like breast reduction or mastopexy technique of the affected breast will be necessary to provide symmetry of the bilateral breasts at the initial surgery. Case presentation A 16-year-old woman reported rapid enlargement of a large mass in her left breast over 12 months. The physical examination revealed a huge mass that occupied the lower quadrants of her left breast causing expansion of both the overlying skin and the nipple areolar complex. A biopsy was constant with a benign phyllodes tumor. We have applied a periareolar mastopexy technique to allow tumor resection through exposure incision at the lower half of the outer periareolar circular incision. At the same time, we reduced the expanded skin envelope and mobilized the nipple–areola complex to restore breast symmetry. Conclusion The periareolar mastopexy approach provides a wide surgical exposure, allows excision of benign giant breast tumor, and simultaneous restoration of the breast shape with favorable aesthetic results and minimal postoperative scarring.

The retina consists of various cell types arranged in eight cell layers and two membranes that originate from the neuroectodermal cells. In this study, the timing of differentiation and distribution of the cellular components and the layers of the rabbit retina are investigated using light and electron microscopy and immunohistochemical techniques. There were 32 rabbit embryos and 12 rabbits used. The rabbit retina begins its prenatal development on the 10th day of gestation in the form of optic cup. The process of neuro‐ and gliogenesis occurs in several stages: In the first stage, the ganglionic cells are differentiated at the 15th day. The second stage includes the differentiation of Muller, amacrine, and cone cells on the 23rd day. The differentiation of bipolar, horizontal, and rod cells and formation of the inner segments of the photoreceptors consider the late stage that occurs by the 27th and 30th day of gestation. On the first week of age postnatally, the outer segments of the photoreceptors are developed. S100 protein is expressed by the Muller cells and its processes that traverse the retina from the outer to the inner limiting membranes. Calretinin is intensely labeled within the amacrine and displaced amacrine cells. Ganglionic cells exhibited moderate immunoreactivity for calretinin confined to their cytoplasm and dendrites. In conclusion, all stages of neuro‐ and gliogenesis of the rabbit retina occur during the embryonic period. Then, the retina continues its development postnatally by formation of the photoreceptor outer segments and all layers of the retina become established. Research Highlights: The aim of this study is to investigate the morphogenesis of the rabbit retina during pre‐ and postnatal life.The primordia of the retina could be observed in the form of the optic cup. The ganglionic cells are the first cells to differentiate, while the photoreceptor cells are the last.S100 protein is expressed by the Muller cells and its processes. Calretinin is intensely labeled in the amacrine and displaced amacrine cells and moderately expressed in the cytoplasm and dendrites of ganglionic cells. [ABSTRACT FROM AUTHOR]

The current work was carried out during 2014/15 and 2015/16 seasons at the Experimental Farm of Agriculture Faculty, South Valley University, Qena Governorate, Egypt to study the direct and indirect effects of yield attributes on forage and seed yields of alfalfa. Six alfalfa genotypes from Egypt (Aswan population, Balady population, El-Dakhla population, Ismalia-1 cultivar, and nitrogen fixing population and Siwa population) beside one variety from USA (Genan) were used in this study. The experiments were laid out in randomized complete block design using split plot arrangement with three replications. Three sowing dates of 20th October (D1), 20th November (D2) and 20th December (D3) were allocated in the main plot while the seven alfalfa genotypes were arranged in the sub plots. Three cuts were taken from each sowing date at 80, 125 and 165 days after sowing at 80, 45- and 40-day intervals, respectively. After taking three cuts, the plants were left out until flowering and seed production which take place in the first week of April, May and June for studied sowing dates, respectively. The obtained results show that, the Ismalia-1 cultivar exceeded the other tested genotypes for seasonal fresh forage yield trait (6.16 kg m-2) under third planting date (20th December) while, El-Dakhla genotype superior with regard to seasonal dry forage yield (2.00 kg m-2) under the same planting date. Otherwise, Aswan population produced the maximum mean values of Seasonal protein forage yield (0.60 kg m-2) under second planting date (20th November). In addition, Genan cultivar which was introduced from USA gave the maximum seed yield plant (1.20 g) under the first planting date (20th October). Furthermore, the obtained results show that the fresh forage yield had the greatest influence on protein forage yield in each sowing date. Meantime, the results of path analysis show that, number of seeds/pod and number of pods/plant considered the most effective traits in seed yield/plant of alfalfa. Moreover, negative correlation between seed yield/plant and 1000-seed weight was observed. Therefore, selection for improving seed yield/plant may be carried directly through selection for number of seeds/pod and number of pods/plant.

The square flap method has been successful in releasing contracture bands at various body regions. However, the original square flap method alone may not be efficient in releasing long contracture bands. We, therefore, proposed an extended design to the traditional design, which is called the "square-plus flap." A 4-year-old girl presented with a postburn web-like contracture band over the right axilla. We marked a square flap technique at the center of the contracture band and then two additional Z-plasties were placed on both edges of the flap. After the release and securing of the square flap, the adjacent distal Z-plasty was then transposed and sutured in their new locations. We do not need to incise the proximal Z-plasty as we could achieve complete relaxation of the contracture band. This novel modification can be added to the plastic surgeon's armamentarium for releasing long postburn contracture bands involving distinct body regions. [ABSTRACT FROM AUTHOR]