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Introduction Cucumis sativus L. (2n=2x=14) originates from the south of the Himalayan mountains and has at least 3000 years of history of cultivation in India. According to the latest statistics published by the Ministry of Agriculture, about 75% of greenhouse production belongs to greenhouse cucumbers. This plant, with a cultivated area of 7539 ha-1 and a production amounting to 1923865 t year-1, is considered one of the most important vegetable and summer greenhouse products in the country. Cucumber varieties should have characteristics such as high yield, quality of taste, shelf life and resistance to diseases. Based on this, modified cultivars and imported cultivars must pass compatibility tests in order to be able to enter commercial fields. Recent research in Japan shows that by creating suitable conditions for various factors in the greenhouse (light distribution, temperature, humidity, carbon dioxide, irrigation, nutrition and pruning), the yield of greenhouse cucumbers can be up to 40 kg m-2 year-1 year. The difference between different varieties of cucumber is primarily due to characteristics such as the number of fruits per plant, fruit size (fruit length and length-to-diameter ratio) and fruit surface characteristics (the presence of grooves, surface smoothness, and fruit color). The number of cucumbers per plant is one of the most important yield components. The study of 9 varieties of cucumbers in greenhouse conditions showed that the range of changes in the number of cucumbers per plant varied from 19 to 54.3, and Khasib variety had the highest yield with the production of 14.9 kg of fresh weight per square meter. Material and Methods In order to compare the yield, yield components and some morpho-physiological characteristics of greenhouse cucumber hybrids produced in the country, a research was conducted in 2022 under greenhouse conditions in Varamin city. In this research, 11 greenhouse cucumber hybrids along with 4 regional control cultivars were evaluated in a completely randomized block design with three replications. The initial tillage including plowing, disc and soil disinfection was done through sunning the soil. The width of the seed planting bed was considered to be 70 cm in order to provide the possibility of two-row cultivation. The width of the corridors was considered to be 80 cm in order to provide proper ventilation and access of workers to the bushes for operations and harvest during the period. The drip irrigation system was chosen so that one tape strip could be used for each row of crops. The plant needed fertilizer during the growth period and was determined based on the soil test and provided to the plant through the irrigation system. Fruit yield for different harvests (once every 10 harvests) and total fresh fruit yield based on the total area of the plot (after removing the margins) and traits such as plant height (meters), internode length (cm), leaf length (cm), Leaf width (cm), petiole length (cm), fruit length (cm), fruit diameter (mm), number of fruits per plant and fruit weight per plant (grams) based on the selection of 10 plants per plot was taken. The fruit shape index was obtained from the ratio of the length to the diameter of the fruit. For the experimental hybrids, after harvest fruit color was determined by grouping (light green to green), (green), (green to dark green) and dark green. Results and Discussion Based on the obtained results, the hybrid (IR4) with a total fresh fruit yield of 11.49 kg m-2 had a significantly higher performance than other hybrids, but there is not a significant difference between this hybrid and the hybrid (IR5) with a fruit weight of 10.61 kg m-2. 10 harvested stages for two hybrids (IR4) and (IR5) constituted 24.6 and 22.9% of the total yield, respectively. The hybrids (IR11) and (IR6) had the longest and shortest fruit length with 16.60 cm and 11.12 cm, respectively. The fruit shape index (the ratio of fruit length to diameter) in hybrid (IR11) had the highest value (6.35). The hybrids (IR4) and (IR5) that produced the highest yields per hectare had the highest number of fruits plant-1 with 108.72 and 84.22 cucumbers plant-1, respectively. The presence of this number of fruits is one of the important factors for producing high yields in these two hybrids, and the number of fruits in the rest of the hybrids is often in the range of 50 to 70 cucumbers per plant. Although in some studies the number of 135 fruits plant-1 is also mentioned for greenhouse cucumbers, but in most cases this number is less than 50. The color of the fruit is also an important quality attribute that is very important in the cucumber market. This trait varies from light green to dark green. Hybrid (IR9) dark green, hybrids (IR2), (IR6), (IR13) (IR15) dark green to green, hybrids (IR1), (IR3), (IR4), (IR5), (IR12) and (IR14) was green and hybrids (IR7), (IR8), (IR10) and (IR11) had light green to green color. The superior performance of two experimental hybrids and the equal performance of 7 other experimental hybrids (out of 11 studied hybrids) compared to the control hybrids can be a good promise for the production of greenhouse cucumber hybrid varieties by domestic companies.

Backgraound: Polysaccharides, particularly Carboxymethyl Cellulose (CMC) and Ammoniacum Gum (AMG), are considered valuable due to their thermal stability and non-toxicity. CMC has good film-forming ability but weak mechanical properties, while AMG shows promise with its unique chemical composition. Additionally, essential oils, such as Clove Essential Oil (CEO), are being used to enhance the antimicrobial properties of edible films, offering a natural way to extend the shelf life of food products. Methods: This study investigated the combined effect of CMC: 0.5-1.5 wt %, AMG: 1-5 wt %, as well as CEO: 0-30 v/v % on the physical characteristics of the CMC-AMG films by Response Surface Methodology. The optimization was performed with the aim of maximizing Whiteness Index, Ultimate Tensile Strength (UTS), and Strain at Break (SB) and minimizing total color difference (ΔE) values. Fourier-Transform Infrared Spectroscopy, film microstructure, Differential Scanning Calorimeter analysis, and antibacterial activity were investigated. The analysis was conducted using Design Expert software version 10.00 (STAT-EASE Inc., Minneapolis, USA). Result: The films with the highest UTS have been obtained through a composition of 5 g CMC, 1.5 g AMG, and 15% CEO. On the contrary, using a composition of 5 g CMC, 1 g AMG, and 30% CEO revealed the highest SB (115.41%). The highest UTS value of 13.17 MPa was obtained with a formulation consisting of 5% AMG, 1.5% CMC, and 15% CEO. Nevertheless, the maximum SB value of 115.41% was achieved with a formulation containing 5% AMG, 1% CMC, and 30% CEO. Moreover, heterogeneous microstructure and more opaque films were obtained as identified by the higher ΔE. The Differential Scanning Calorimeter results demonstrated that incorporating a CEO did not impinge on thermal stability. Furthermore, the addition of CEO led to a rise in antimicrobial activity against Salmonella enterica, Pseudomonas fluorescens, Escherichia coli, and Listeria monocytogenes. Conclusion: In conclusion, combination of CMC and AMG in optimum levels, led to the production of a film with acceptable mechanical properties. Also, these films showed significant antimicrobial activity. DOI: 10.18502/jfqhc.10.4.14178

Introduction: Infantile myofibroma (IM) is a benign mesenchymal disorder. Although it is the most common tumor of infancy, it is a relatively rare pathological entity. IM occurs predominantly before the age of two. It is characterized by tumor formation in skin, muscle, viscera, bone and subcutaneous tissues. The tumor can occur in either solitary or multicentric forms. The solitary form without visceral involvement usually has a benign course. Male gender predominates in the solitary form. Case presentation: We report a clinical case of an osseous infantile myofibroma of the zygomatico-maxillo-orbital complex in a 4 months old male. We also show the radiological spontaneous regression without surgical intervention. Clinical, radiological, and histopathological examinations established the diagnosis. Our treatment was conservative with clinical follow-up. No surgical intervention was carried out during the course of the disease. Significant spontaneous regression occurred after a year and was confirmed by CT scan. Conclusion: Radiologically aggressive infantile myofibroma has been previously treated by surgical intervention. In this case report there was a significant spontaneous regression. Conservative treatment and follow-up may be an appropriate alternative.

This work aims for the phytochemical study and evaluation of the antioxidant activity of phenolic compounds and essential oils of medicinal plant Pistacia lentiscus L. quantitatively and qualitatively. Through the results obtained, it appears that the leaves and fruits are rich in substances with a high antioxidant power. The yield of the phenolic compounds obtained from 10g to powder of plant is for leaves 116.49 % and 61.34 % for fruit . For essential oils, it is 0.253 ± 0.131 % for 100 g of plant material. The chromatographic profile of the essential oil of Pistacia lentiscus L. shows that monoterpenes are the major compound (9.675 % of identified molecules). The strong antioxidant activity of extracts obtained only confirms the traditional use of this plant by the local population.

This work aims for the phytochemical study and evaluation of the antioxidant activity of phenolic compounds and essential oils of medicinal plant Pistacia lentiscus L. quantitatively and qualitatively. Through the results obtained, it appears that the leaves and fruits are rich in substances with a high antioxidant power. The yield of the phenolic compounds obtained from 10g to powder of plant is for leaves 116.49 % and 61.34 % for fruit . For essential oils, it is 0.253 ± 0.131 % for 100 g of plant material. The chromatographic profile of the essential oil of Pistacia lentiscus L. shows that monoterpenes are the major compound (9.675 % of identified molecules). The strong antioxidant activity of extracts obtained only confirms the traditional use of this plant by the local population.

Objective: There is a general assumption that Muslim women refuse Down syndrome screening, and therefore, many health practitioners do not offer it or briefly discuss it with their participants. This study aims to objectively assess women's awareness, knowledge, and attitudes toward Down Syndrome screening (D.S.S) in a Muslim-majority population., Methods: We conducted a cross-sectional study among attendees of antenatal clinics at a major university hospital in Saudi Arabia, aiming for a sample size of at least 385 Muslim women. A semi-structured questionnaire assessed awareness of different D.S.S. options and the source of that information (2 items), specific knowledge of D.S.S. (14 items), and attitudes (4 items). The knowledge and attitudes scores were calculated using a five-level agreement Likert-type scale., Results: Among 434 participants, with an even distribution among all age groups and a majority of a college degree holder or higher (71%), 178 (41.0%) reported awareness of D.S.S. Factors associated with increased awareness were maternal age above 40 or those under 30, nulliparity, and extended family history of fetal congenital anomalies (P-value = 0.03,0.015, and 0.017, respectively). Recognized tests were ultrasound measurement of nuchal translucency (71.9%) and first-trimester serum screening (58.4%). The sources of knowledge were obstetricians (53.9%), followed by family and friends (27.0%). The overall mean ± SD knowledge score was 53.9 ± 8.7 out of 70, and the mean attitude score was 17.4 ± 2.9 out of 20. Having 1 or 2 children is associated with a higher knowledge score, and most participants who reported awareness of D.S.S. (51.7%) had a favorable attitude toward screening., Conclusion: Awareness of D.S.S. among Muslim women is associated with favorable attitudes towards testing, contradicting the general assumption and highlighting the need for systematic education to increase awareness and subsequent testing uptake., (© 2024. The Author(s).)

Background: Body contouring surgery (BCS) in adolescents, particularly following bariatric surgery, involves a complex array of ethical, psychological, and medical factors. This review focuses on adolescents who have experienced significant weight loss, often due to bariatric surgery, and subsequently require body contouring to address excess skin and soft tissue., Methods: A literature narrative review was conducted using PubMed and Google Scholar databases. Relevant articles were screened and selected based on their discussion of post-bariatric and massive weight loss body contouring surgeries in adolescents, focusing on prevalence, outcomes, and ethical considerations., Results: The prevalence of BCS among adolescents is rising, influenced by social media and societal perceptions of beauty. However, the percentage of adolescents receiving BCS after bariatric surgery remains low. Adolescents undergoing BCS experience improvements in physical functioning, body image, and psychological well-being. Complications, although common, are mostly minor. Ethical considerations include ensuring informed consent, assessing emotional maturity, managing patient expectations, and involving adolescents in decision-making. Comparative analysis reveals similar outcomes in adults and adolescents, but adolescents face unique ethical challenges related to autonomy, long-term effects, and ongoing physical and emotional development., Conclusion: BCS in adolescents following bariatric surgery can lead to improved physical and psychological outcomes. However, the decision to undergo BCS must be carefully considered, taking into account the adolescent's maturity, expectations, and long-term well-being. Ethical considerations are paramount, emphasizing the need for informed consent, realistic expectations, and a multidisciplinary approach. Further research is needed to assess long-term outcomes and the specific ethical implications of BCS in adolescents compared to adults., Level of Evidence V: 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Progesterone (P) and estradiol (E 2 ) regulate the immune status of the uterus. However, whether P and E 2 can affect the immune response of endometrial cell is still unknown. In the study, primary endometrial stromal cells (EndSCs) were treated with Poly(I:C), the pathogen-associated molecular pattern of double-stranded RNA (dsRNA) virus, to induce immune response, and then EndSCs were stimulated with P or/and E 2 . The results showed Poly(I:C) up-regulated the expression of immune cytokines IL-6, IL-8, IL-1β and TNF-α, and significantly down-regulated the expression of ERα and PGRMC1 in EndSCs. Moreover, P or low-dose of E 2 attenuate Poly(I:C)-induced immune response, and then the synergistic effects of P and E 2 decreased expression of ERα, ERβ and PGR, and alleviate the decease of PGRMC1 induced by Poly(I:C), but not alleviate the decease of ERα caused by Poly(I:C). The result provides a steroid therapeutic method to suppress dsRNA virtues-induced immune response through the synergistic effect of P and E 2 on endometrial stromal cells., Competing Interests: Declaration of Competing Interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Cleft palate repair is a common reconstructive procedure that can involve significant blood loss. Tranexamic acid (TXA) has been proposed to minimise blood loss during various surgical procedures, but its effectiveness in cleft palate repair remains unclear. This systematic review and meta-analysis aimed to assess the effectiveness of TXA to reduce postoperative blood loss. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive search across multiple databases, including PubMed, Cochrane, and Web of Science, to identify relevant studies published up to September 2023. Only randomised controlled trials (RCTs) were included. Primary outcomes measured were total blood loss, transfusion rates, and postoperative complications. We identified four relevant RCTs, which included 275 cleft palate patients with a mean (range) age of 28.7 (6-65) months. The pooled analysis found no significant difference in duration of surgery (MD -18.40 minutes, p = 0.09), preoperative haemoglobin (MD 0.46 g/dl, p = 0.27), or postoperative haemoglobin (MD 0.07 g/dl, p = 0.86) between TXA and control groups. Intraoperative blood loss was lower with TXA, but with TXA, the difference was not statistically significant (MD -16.63 ml, p = 0.15). TXA significantly improved surgical field visibility (p = 0.004). No adverse events occurred with its use. While no significant differences were found in surgical outcomes with TXA, surgical field visibility significantly improved, and TXA showed a promising safety profile. Larger and higher-quality RCTs are still needed to validate these preliminary findings before TXA can be considered as a standard treatment., (Copyright © 2024 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Introduction: Autologous costal cartilage harvest is a common procedure in craniofacial reconstruction due to its stability, dependability, and diversity. However, such a procedure is associated with severe donor-site pain postoperatively. Therefore, we aim through this study to compare the efficacy of intercostal nerve block in the management of postoperative pain in patients undergoing costal cartilage harvest for craniofacial reconstruction., Method: This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The study systematically reviewed MEDLINE, Cochrane, and EMBASE databases without time-limitation., Results: As a result of reviewing the literature, 33 articles were screened by full-text resulting in 14 articles which met our inclusion/exclusion criteria. However, only four high-quality RCT articles were included in the quantitative synthesis (meta-analysis). The findings of this study suggest that there is no significant difference in pain scores between ICNB and control groups at 12, 24, and 48 h postoperatively, both at rest and with coughing. Therefore, both techniques are considered safe and effective., Conclusion: Our results show evidence of favorable outcome of preventive donor-site analgesia with ICNB for harvesting autologous costal cartilage in multiple studies. However, the overall outcomes were insignificant between the two arms., No Level Assigned: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Introduction: There has been a rapid increase in the number of patients undergoing non-surgical gluteal augmentation in recent years, leading to an increase in the number of articles in the literature regarding the use of hyaluronic acid (HA) for gluteal augmentation. No systematic review has been published on the effectiveness of HA for gluteal augmentation. This study aimed to provide a comprehensive review regarding the effectiveness and role of using HA for gluteal augmentation., Methods: This review was conducted according to the PRISMA guidelines for reporting systematic reviews and meta-analyses. We conducted a search across MEDLINE, EMBASE, Cochrane, and Google Scholar, using the following search keywords: gluteus, buttocks, gluteoplasty, gluteal augmentation, hyaluronic acid, and filler., Results: Ten articles published between 2013 and 2022 that included 168 patients. The estimated duration of product effectiveness is 16.16 months. Most studies showed statistically significant improvements in patients' satisfaction. Mean volume of HA injected for optimal gluteal fat augmentation was 206.71 ml. Of included studies, two reported major complications, five patients experienced bruising and erythema as minor complications, five patients experienced effusion and inflammation at the injection site, three patients experienced gel dislocation, and one patient experienced irregular contours., Conclusions: Based on our findings, HA is a predictable method for gluteal augmentation. Patients were satisfied with their outcomes. Despite gluteal augmentation with HA having a modest complication rate, it can still involve serious complications such as diffuse alveolar hemorrhage and death. There is a need for further research in a randomized control trial., Level of Evidence Iii: 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 ., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Breast implant surgery is a popular procedure worldwide, and the same holds true for Saudi Arabia. Ensuring a sterile surgical environment is crucial to avert postoperative infections. This study explores the various antiseptic techniques adopted by Saudi plastic surgeons during breast implant procedures., Objectives: This study aims to assess Saudi plastic surgeons' adherence to antiseptic measures in breast implant surgery, and determine what types of antiseptic measures are most commonly used among Saudi plastic surgeons., Methods: The authors conducted a cross-sectional survey among board-certified plastic surgeons in Saudi Arabia, collecting data through a self-administered online questionnaire. This questionnaire, which covered their demographic information and their antiseptic practices during breast implant surgery, was disseminated via a WhatsApp (Menlo Park, CA) broadcast message from May 15 to June 27, 2023., Results: Of the 52 Saudi plastic surgeons who completed the questionnaire, all reported employing preoperative antibiotics and skin disinfection. Other measures included pocket irrigation (86.5%), implant irrigation (92.3%), sleeve/funnel usage (65.4%), nipple shield usage (51.9%), and glove change during the procedure (96.2%). Nearly, all respondents used only a surgical cap for head cover (96.2%) and postoperative antibiotics as prophylaxis (98.1%). However, more than half of them did not minimize door movement during the procedure (51.9%)., Conclusions: This study offers a valuable insight into the antiseptic practices during breast implant surgery in Saudi Arabia. The findings underline the need for further research to establish evidence-based guidelines for antiseptic practices in this field., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Aesthetic Society.)

In this study, a new polysaccharide was isolated from Ocimum album L. seed (OA), and its physicochemical and rheological properties were investigated. Ocimum album polysaccharide (OAP) was an acidic heteropolysaccharide with a molecular weight of 1935 kDa, and it was composed of five types of sugars: mannose (32.95 %), glucose (27.57 %), galactose (19.29 %), rhamnose, (15.96 %) and galacturonic acid (4.23 %). According to the results obtained from Huggins and Kraemer equations, the intrinsic viscosity was 6.9 dL/g in distilled water. The OAP solutions at a concentration between 0.1 and 1.5 %, showed shear-thinning behavior, and the Herschel-Bulkley and Cross models exhibited a high ability to describe the flow behavior of OAP solutions. The apparent viscosity of 1 % OAP solution was decreased in the presence of different concentrations of NaCl (0.1, 0.3, and 0.5 M), at different pHs (3-11), and in temperatures between 5 and 100 °C. Also, the pseudoplastic behavior was observed in all samples. In OAP solutions (0.1-1.5 %), the up and down curves in the shear stress-shear rate diagram did not coincide, which indicated time-dependent (thixotropic) behavior. Although, the thixotropic properties of 1 % OAP solution were weakened with adding NaCl (0.1-0.5 M) and at different pH (3-11). The results obtained from the dynamic oscillatory test showed that the OAP solutions at concentrations higher than 0.1 % had a gel-like behavior, and the viscoelastic moduli (G' and G″) were weakened in the presence of salt and with a change in pH. Also, in the temperature sweep test, the 1 % solution showed the behavior of thermally irreversible gels., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: This study aimed to investigate prenatal predictors of the need for cerebrospinal fluid diversion in infants following prenatal repair of open spina bifida., Data Sources: A systematic search was performed to identify relevant studies published from inception until June 2022 in the English language using the databases PubMed, Scopus, and Web of Science., Study Eligibility Criteria: We included retrospective and prospective cohort studies and randomized controlled trials reporting on prenatal repair of open spina bifida., Methods: The random-effects model was used to pool the mean differences or odds ratios and the corresponding 95% confidence intervals. Heterogeneity was assessed using the I 2 value., Results: A total of 9 studies including 948 pregnancies undergoing prenatal repair of open spina bifida were included in the final analysis. Prenatal factors that were significantly associated with the need for postnatal cerebrospinal fluid diversion were gestational age at surgery ≥25 weeks (odds ratio, 4.2; 95% confidence interval, 1.8-9.9; I 2 =54%; P=.001), myeloschisis (odds ratio, 2.2; 95% confidence interval, 1.1-4.1; I 2 =0.0%; P=.02), preoperative lateral ventricle width ≥15 mm (odds ratio, 4.5; 95% confidence interval, 2.9-6.9; I 2 =0.0%; P<.0001), predelivery lateral ventricle width (mm) (mean difference, 8.3; 95% confidence interval, 6.4-10.2; I 2 =0.0%; P<.0001), and preoperative lesion level at T12-L2 (odds ratio, 2.5; 95% confidence interval, 1.03-6.3; I 2 =68%; P=.04). Factors that significantly reduced the need for postnatal shunt placement were gestational age at surgery <25 weeks (odds ratio, 0.3; 95% confidence interval, 0.15-0.6; I 2 =67%; P=.001) and preoperative lateral ventricle width <15 mm (odds ratio, 0.3; 95% confidence interval, 0.2-0.4; I 2 =0.0%; P<.0001)., Conclusion: This study demonstrated that among fetuses that underwent surgical repair of open spina bifida, having gestational age at surgery of ≥25 weeks, preoperative lateral ventricle width of ≥15 mm, myeloschisis lesion type, and preoperative lesion level above L3 was predictive of the need for cerebrospinal fluid diversion during the first year of life., (Copyright © 2023. Published by Elsevier Inc.)

Performing local skin flaps is a challenging task that requires cognitive and technical skills to design flaps with proper orientation to avoid distorting normal anatomy. Junior trainees need adequate exposure to gain confidence and expertise in such procedures. This article systematically reviews the literature's different local skin advancement flap training models and describes a new, easy-to-use training model. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane, Web of Science, and Google Scholar databases were searched from their inception until August 2022 for articles about local skin advancement flap training models. The meta-analysis results were pooled across the studies using a random-effects model and presented as a weighted mean difference with a 95% confidence interval (95% CI). Out of 773 reviewed articles, 18 were included in the systematic review, and four reported enough data to be included in the meta-analysis. Rhomboid and Z-plasty flaps were the most commonly taught flaps by training models. The most commonly used training models were synthetic-based, followed by animal-based models. The training models significantly increased the trainees' confidence and expertise regarding local skin flap procedures (p<0.00001) for both domains. Training models, per our reported data, significantly improve the trainees' confidence and expertise in performing local skin advancement flap procedures; continuous efforts in developing and establishing new, simple-to-use, and effective training models are strongly encouraged to further improvement of surgical education and enhance the trainees' surgical skills., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mortada et al.)

Today, social media platforms are more popular than ever in Saudi Arabia. Despite the influence of social media on patients' decisions to undergo cosmetic surgery, it is still unclear how social media platforms affect the private practice of plastic surgeons around Saudi Arabia. This study aimed to assess Saudi plastic surgeons' use of social media and its impact on their practices., Methods: The study was based on a self-administered questionnaire that was built on previous literature and distributed to practicing Saudi plastic surgeons. A survey consisting of 12 items was conducted to assess patterns of social media use and its impact on plastic surgery practice., Results: This study included 61 participants. Thirty-four surgeons (55.7%) were using social media platforms in their practice. The use of social media was significantly different among surgeons with different levels of practice in cosmetic surgery ( P = 0.004) and reconstructive surgery ( P = 0.049). Social media presence was significantly more prevalent among surgeons in private practice (70.6%, P = 0.034). The use of social media in plastic surgery is overall positive for the field (60.7%)., Conclusions: Despite plastic surgeons' differing views on social media, its role within the field of plastic surgery is evidently on the rise. The use of social media is not equal across all practice types. Surgeons practicing in private hospitals and specializing in aesthetic surgery are more likely to view social media favorably and use it in their practice., Competing Interests: The authors have no financial interest to declare in relation to the content of this article. This work was supported by the College of Medicine Research Center, Deanship of Scientific Research, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Introduction: As the incidence of breast cancer and diabetes rises, so does the number of patients with diabetes undergoing breast reconstruction (BR). Patients with diabetes are at a higher risk for post-operative complications. The current study examined the effects of diabetes on BR wound outcomes and overall complications post-operatively., Methods: This study followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. We conducted a systematic search and meta-analysis for published articles on the effects of DM on BR in January 2022 using the PubMed, MEDLINE, and Cochrane databases. Diabetes, breast reconstruction, and complications were used as keywords., Results: Forty-three studies were included in the qualitative synthesis, and five provided data to be included in the meta-analysis published between 2006 and 2020. A total of 19,731 patients (9.07%) had diabetes, whereas 197,812 patients had no diabetes. The results of the pooled outcomes revealed no differences in the risk of total flap loss (p = 0.892) and wound infection (p = 0.579,). Nevertheless, the risk of wound dehiscence was significantly higher among patients with diabetes than their non-diabetic counterparts (p < 0.0001)., Conclusion: Diabetic patients undergoing BR have a significantly higher risk of wound dehiscence. As a result of the adverse effects of diabetes status on BR outcomes, patients need to be counseled about optimizing their diabetes management before surgery. Because of the heterogeneity in our results, prospective randomized studies are needed to shed light on the consequences of diabetes mellitus in BR surgeries., Level of Evidence Iii: 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 ., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Approximately 5% of the population has protruding ears. An antihelix deficiency or absence is a common cause of ear protrusion. Although there are over 200 techniques to manage prominent ears, there is no evidence to support using dermabraders in this situation. To the author's knowledge, this is one of the first articles to assess the clinical outcome of dermabrader use on patients with prominent ear deformities., Methods: An analysis of retrospective medical records was conducted by the senior author on patients with prominent ears treated with our novel dermabrasion technique between 2018 and 2021. The demographics, clinical assessment, and outcomes of the patients were assessed. Furthermore, the article provides a detailed description of the technique., Results: A total of 18 ears were operated on. Eight of the included patients had bilateral ear deformities, and two had unilateral deformities. The mean distance from the ear to the head at the superior helix was 29 mm (range, 25-35 mm). In our series, no complications were observed. During the most recent clinical evaluation, all patients had achieved acceptable ear positioning and excellent aesthetic results., Conclusions: Dermabrasion is a useful technique for otoplasty because no sutures are required and symmetry can be achieved in bilateral ears. Furthermore, this technology is safe, simple, reproducible, reliable, and versatile. We recommend that future studies be conducted in a prospective manner with larger sample sizes and longer follow-up periods to ensure the validity of the findings., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background: Craniosynostosis is a condition characterized by a premature fusion of one or more cranial sutures. The surgical repair of craniosynostosis causes significant pain for the child. A key focus of craniosynostosis repair is developing effective strategies to manage perioperative pain. This study aimed to review perioperative pain control strategies for craniosynostosis repair systematically., Methods: Guidelines for reporting systematic reviews and meta-analyses were used in the design of this review. In May 2022, the following databases were used to conduct the literature search: MEDLINE, Cochrane, EMBASE, and Google Scholar. A search was performed using MeSH terms "craniosynostosis," "pain management," and "cranioplasty.", Results: The literature review yielded 718 publications. After applying our inclusion criteria, 17 articles were included, accounting for a total of 893 patients. During the postoperative period, most studies used multimodal analgesia, primarily opioids, and acetaminophen. In the postoperative period, oral ibuprofen was the most commonly used NSAID, rectal codeine, and acetaminophen were the most commonly used weak opioids, and continuous remifentanil infusion was the most commonly used potent opioid., Conclusion: The authors determined the best pain management options for pediatric patients undergoing cranioplasty by analyzing the most commonly used analgesics. A high-quality clinical trial comparing different types of analgesic combinations would be a valuable addition to the present literature., (© 2022. The Author(s).)

Glutamine (GLN) has been proven to improve the prognosis of severely burned patients. GLN supplementation in critical illness has gained extreme popularity among researchers over the years, and its safety and efficacy are still under question. Therefore, we aim to study the role of GLN supplements in decreasing mortality, length of hospitalization (LOH), and infection in severely burned patients. PRISMA guidelines were used to design and conduct this systematic review. MEDLINE, Cochrane, and EMBASE databases were used to search for randomized controlled trials (RCTs) in January 2022. In order to assist in the search, MeSH terms such as burn injury, GLN, and RCT were used. As a result of reviewing the literature, 1112 publications were found. We included only 7 RCTs after implanting our inclusion criteria. There were 328 patients enrolled in the study, with 166 patients (50.61%) were allocated to GLN supplementation and 162 patients in the control groups (49.39%). The risk of infection was significantly lower among patients who received GLN supplementation than those in the control groups (RR = 0.41, 95% CI, 0.18 to 0.92,  p  = 0.030). The risk of death was significantly lower among GLN-receiving patients compared to non-GLN-receiving patients (RR = 0.09, 95% CI, 0.01 to 0.63,  p  = 0.016). GLN supplementation has been linked to lower hospital mortality and infection-related morbidity in burn patients. Furthermore, larger-scale and higher-quality studies are needed to assess whether there are any statistically and clinically significant changes., Competing Interests: The author(s) declare no potential competing of interest with respect to the research, authorship, and/or publication of this article, (© 2022 The Author(s).)

Knowing what attracts cosmetic patients to a specific surgeon can help current cosmetic surgeons and aspiring ones improve themselves and better market their practice. Hence, this study aimed to investigate the influential factors when selecting an aesthetic surgeon for a cosmetic procedure in Saudi Arabia., Methods: This is a cross-sectional, nationwide study targeting the public from all regions of Saudi Arabia. The study was conducted between September 21 and October 29, 2021. The self-structured electronic survey was based on previously published studies and was revised by two academic plastic surgeons., Results: This study included a total of 7190 participants from all regions of Saudi Arabia. The most influential factor for choosing an aesthetic surgeon was the surgeon's qualifications (39.9%), followed by friends and relatives' advice (24%) and hospital/clinic environment (10.2%), while the number of social media followers was the least favorable factor (0.8%). Additionally, the most preferred aesthetic surgeon was a surgeon with international board certification (mean score, 4.17)., Conclusions: This study showed that the most common factor for choosing an aesthetic surgeon was the surgeons' qualifications. Thus, Saudi aesthetic surgeons and aspiring Saudi aesthetic surgeons must focus on obtaining high qualifications to attract more patients. Furthermore, an internationally board-certified surgeon is the most preferred surgeon for Saudi Arabian patients; thus, traveling abroad to world-renowned institutions is recommended., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Competing Interests: None declared.

Among strategies for decreasing diseases, the use of larvicidal plant extracts against mosquito larvae gain an important place in vector control. The aim of the present study was to reveal the insecticidal effectiveness of an endemic medicinal plant on Mosquito-Borne Diseases. The chemical composition of the dried aerial part from Origanum floribundum Essential oil, obtained by hydrodistillation, was characterized by Fourier-transform infrared (FTIR) spectroscopy and gas chromatography-mass spectrometer (GC-MS) system. The potential larvicidal activity of this extract as bioinsecticide was assessed against Culex pipiens. Results showed many functional groups such as phenols and alcohols, besides, the chemical composition by GC-MS identified thymol (86.9%) and p-Cymene (5.1%) as major components. A significant larvicidal effect against the target mosquito species was noted, with values of LC 50 at 21.19 mg/l and LC 90 at 68.37 mg/l. The results obtained showed that the essential oil of Origanum floribundum with chemotype thymol possess a potent larvicidal activity and could be considered as an eco-friendly alternative for vector control.

Background: The circadian rhythm is unique to each individual. The time of the day when an individual is most productive is determined by several factors associated with circadian rhythm. Some evidence suggests that late-night surgeries are associated with a better prognosis and a lower rate of complications than those performed at other times of the day. However, the impact of surgeons' preferred operating time on patients remains unclear., Objective: The present study is the first to examine at what time of the day surgeons prefer to operate., Methods: This cross-sectional, questionnaire-based study involved 15 items designed to interrogate surgeons' preferred time of day to operate. The questionnaire was distributed electronically to the consultants of different surgical specialties after explaining the purpose of the study and obtaining their consent to participate., Results: A total of 226 surgeons participated in this study, of which 192 (85%) were men. Most (25.2%) consultants were general surgeons. The weekly workload for most (66.4%) surgeons was 41-60 h. The surgeons indicated their preference to operate in the early (11.9%) or late morning (71.2%), early (15.0%) and late (1.3%) afternoon, and evening (0.4%). The key determinant of their preference was the availability of hospital resources (36.3%). Men and women tended to prefer operating in the early morning and afternoon and late afternoon, respectively., Conclusions: In the present study, most surgeons preferred to operate between 8 am and 12 noon (late morning), and their preference was determined by the availability of hospital resources., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

Background: The number of breast implant-related procedures has rapidly increased. Given the current increase in social media coverage and its influence on the decision to undergo breast implant surgeries, it is critical to identify patients' misinformation about unusual complications related to breast implants. Therefore, the present study aimed to assess the perceptions and attitudes toward unusual complications related to breast implants among patients who underwent breast implant surgeries., Methods: In the present cross-sectional study, a questionnaire was distributed between April 2021 and May 2021 among patients who had undergone breast implant surgeries between 2016 and 2021 at King Saud University Medical City in Riyadh, Saudi Arabia. The 26-item questionnaire was distributed online to assess the participants' perceptions about breast implant illness (BII), capsular contracture, and breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). Data were analyzed using Statistical Package for the Social Sciences (SPSS), version 23.0., Results: In total, 106 patients who underwent breast implant surgeries were included in the present study (response rate: 73.6%). Their mean age was 43.68 ± 10.69 years. The reason for undergoing breast implant surgery was cosmetic in 41.5% of the participants and reconstructive in 58.5%. Moreover, 22.6%, 23.6%, and 24.5% of the participants had knowledge about BIA-ALCL, BII, and capsular contracture, respectively., Conclusions: The present findings indicate that it is important for plastic surgeons to discuss unusual complications related to breast implants with patients on a regular basis. Despite the obscurity of these complications, such discussions are important to provide best available information to patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)