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Dermatofibrosarcoma protuberans (DFSP) is a rare, locally invasive dermal sarcoma. The management is generally surgical, with wide local excision (WLE) forming the mainstay of treatment. Large abdominal wall defects are most aesthetically reconstructed using pedicled or free flaps; however, these require tumour-free surgical margins, and are off-set by donor site morbidity. We describe an alternative, aesthetic and low-morbidity technique for reconstruction of a subfascial defect following WLE of DFSP in a young woman in her early 20s, using two layers of a novel synthetic dermal matrix (NovoSorbBTM). To our knowledge, a double-layer reconstruction using an artificial dermal matrix has never been described for trunk reconstruction. We found that double-layer biodegradable temporising matrix can restore the inherent thickness and pliability of skin in a partial-thickness abdominal wall defect and offers improved durability and cosmesis compared with skin grafting or indeed single layer skin substitutes alone.

MR fluids, also known as magnetorheological fluids, are a smart material that can adapt its rheological properties in the presence of a magnetic field. This unique characteristic allows MR fluids to be utilized in various active and semi-active control systems. The composition of MR fluids includes magnetizable iron particles of micron size, suspended in a base fluid that is non-magnetic, and additives to prevent sedimentation and clustering. Upon exposure to magnetic fields, MR fluids can modify their viscosity and shear strength, offering improved performance in various applications. Over the last few decades, MR fluids have garnered significant interest in the field of engineering, with numerous studies exploring their potential uses. They have been employed in systems such as vibration control, aircraft landing gears, helicopter lag dampers, dynamometers, brakes, and clutches, among others. MR fluids are considered a promising material in engineering due to their ability to change properties in response to magnetic fields. This versatility has opened up new possibilities and improved existing technologies, making MR fluids a valuable tool in the advancement of engineering systems.

Purpose Extended-release (ER) monthly injectable buprenorphine offers an alternative to daily sublingual (SL) dosing for treatment of opioid use disorder (OUD) that may be attractive to several patient populations, including those with barriers to adherence and the frequent follow-up that are necessary for traditional SL buprenorphine. Despite the potential benefits of ER-buprenorphine, there are significant barriers to healthcare provider adoption that may prevent utilization in the populations that would benefit. Summary Our health system began providing clinic-administered ER-buprenorphine as treatment for OUD in May 2018 at a single clinic. Expansion was limited due to difficulties with delayed and inaccurate medication delivery and heavy administrative burden. To facilitate uptake of ER-buprenorphine for patients who could benefit, our integrated health-system specialty pharmacy (HSSP) assumed responsibility for medication distribution and administrative management beginning in October 2019. The HSSP provided accurate medication delivery, alleviated administrative burdens of benefits investigation and Risk Evaluation and Mitigation Strategy compliance, and decreased medication wastage by implementing a medication return process. Subsequently, ER-buprenorphine services were expanded to 4 additional sites, allowing 244 more patients to receive treatment. Conclusion HSSP support can provide significant benefit to patients and the health system through coordinating ER-buprenorphine dispensing and delivery.

Voice control technology has revolutionized the way we interact with devices, and drone technology is no exception,through this system by the voice commands with any physical machine allows the human beings to acquiring new devices. This technology is useful in future to do certain task without physical human interaction. Technology to help them in daily life, control things via voice like a home assistant in a comfortable manner. This system will be useful to rescue, surveillance and many other areas which generally use drones as their operations. Key Words: ESP-32, gyroscope

Flexor tendon injuries of the hand and wrist involve complete or partial severance of the tendon, and primary repair is standard treatment. In cases of significantly delayed presentation, rupture of the repair or segmental tendon loss may require 1- or 2-stage secondary tendon reconstruction where a tendon graft is used. There is a risk of poor functional outcome due to stiffness and reduced range of motion which may affect patient's employment and activities of daily living. This study seeks to systematically evaluate the current evidence to determine outcomes of secondary flexor tendon reconstruction in terms of functional outcomes, complications, patient-reported outcome measures (PROMS) and costs.This is a PROSPERO registered study protocol for systematic review and meta-analysis of comparative and non-comparative studies. Outcomes of intrasynovial versus extrasynovial tendon grafting and seniority of the surgeon will be analysed in addition to comparing graft weaving at the wrist and palm for both single- and two-stage tendon reconstruction. The primary outcome is functional active range of motion. Secondary outcomes are complications, PROMs and resource use. A comprehensive literature search will be conducted from 2000 to present. All studies involving secondary flexor tendon repairs will be involved, without limitation on language, and will be screened by two independent reviewers. Tools to appraise the quality of study methodology and/or bias will be used (e.g., Cochrane Collaborative Risk of Bias tool) and if feasible, a random effects meta-analysis will be conducted.Ethical approval was not required for this study. The results of this systematic review and meta-analysis will be published in a peer-reviewed journal, and presented at both national and international conferences involving hand surgeons. The data collected will allow patients to be counselled more accurately by clinicians and may suggest areas where further research could be undertaken.PROSPERO CRD42021296009.Single- or two-stage secondary flexor tendon reconstruction is an important treatment modality in cases unsuitable for primary repair.This study seeks to systematically evaluate the current evidence to determine outcomes of secondary flexor tendon reconstruction in terms of functional. outcomes, complications, patient-reported outcome measures (PROMS) and costs.This is a PROSPERO registered study protocol for systematic review and meta-analysis of comparative and non-comparative studies.Outcomes of intrasynovial versus extrasynovial tendon grafting and seniority of the surgeon will be analysed in addition to comparing graft weaving at the wrist and palm for both single- and two-stage tendon reconstruction.This systematic review aims to evaluate and summarise the best current literature to determine outcomes of secondary flexor tendon reconstruction.

Severe malnutrition secondary to anorexia nervosa results in deeper burns and significantly impacts wound healing, which represents a major challenge to burn management. The use of acellular dermal matrices, such as biodegradable temporizing matrix (BTM), is a valuable tool to overcome the surgical limitations. We describe a case of a 36-year-old female with a background of anorexia nervosa (body mass index of 12.3) presenting with a 30% total burns surface area (TBSA) burn. All of her burns were excised down to fascia due to the absence of subcutaneous fat. Her thin skin and depleted nutritional status significantly impacted reconstructive options. BTM was utilized to create a neodermis and provide adequate time to optimize the nutritional status before autologous skin resurfacing 3 weeks later, which yielded robust coverage with minimal donor site morbidity. Despite initial surgical and nutritional challenges, excellent outcomes were achieved in terms of wound healing, scar contractures and mobility.

Summary The use of podcasting as a media format continues to grow on a global scale, but despite health being one of the top podcasting genres, nearly a third of the medical community are unfamiliar with the term. In a digital age of teaching, podcasts have fantastic potential as educational resources that can be shared on a global scale. In medical education, they are useful learning aids, particularly in keeping listeners up-to-date with the latest research. Although increasingly popular among some medical and surgical specialties, there is relatively little material aimed at the plastic and reconstructive surgeon. In our review of the major podcast hosting services, we only found seven educational podcasts aimed at plastic surgeons, with only two originating from the UK. The majority of these adopt a journal club format and, although generally excellent, the regularity and consistency of episodes are variable. With the continuing need to adapt our approach to education as a result of the ongoing Covid-19 pandemic and increasing ‘webinar-fatigue’, the podcast may represent a versatile teaching medium in plastic surgery education on an international scale.

Background: Drug information centre (DIC) is a facility specially developed to provide relevant, accurate and unbiased drug information (DI) to consumer and health care professionals regarding the proper use of the drugs, drug safety and all the critical problems regarding the drug information of their usage and side effects. Objective: The present study was about to access the knowledge of the primary care physicians and community pharmacists about the DIC and its facilities and to spread awareness regarding the same. Methodology: A cross-sectional, questionnaire-based study was conducted among the 88 participants of Vadodara city, Halol-Kalol town for 6 months of period. 68 pharmacist and 20 physicians took part in the study from these cities. The data was further Analysed by comparing the available data and resource to find out the awareness regarding the DIC. Result: During the study duration, a total of 88 participants took part in the study from various out of them 68 (77%) were community Pharmacist, and 20 (23%) were primary care physicians. In the end of the study, 48 (70.2%) pharmacist and 10 (50%) physicians know about the following data of DI, DIC, DIQ (Drug Information Query), resources and the role of pharmacist in DIC and it was clearly evaluated that the knowledge about the DIC, DI, DIQ was not thoroughly available for the pharmacist and physicians. Conclusion: The present study concludes that the awareness about Drug Information Centre (DIC), Drug Information, and its value and importance is not as much as it should be in Vadodara city, Halol-Kalol. Several awareness programme should be carried to bring the importance and value of DIC in limelight and to make it accessible easily for all to decrease several drug related problems.

A gallstone is a stone formed within the gallbladder from precipitated bile components. The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones. Among American adults the prevalence of cholelithiasis is about 10% while in Western Europe the prevalence ranges from 5.9% to 21.9%. Prevalence rates of 3.2% to 15.6% have been reported from Asia. The standard treatment for symptomatic gallstones is to remove the gallbladder entirely. Laparoscopic cholecystectomy can be the easiest or the most difcult laparoscopic operation. Conversion to open surgery has been a traditional marker of difcult Laparoscopic cholecystectomy and anticipation of conversion can help in consenting patients and preparing them for longer stay and complications. C-reactive protein (CRP) is an acute phase reactant protein secreted by the liver in response to interleukin-6 and other pro-inammatory cytokines in the context in inammation, infection, trauma, malignancy and tissue infarction. Its circulating concentration is determined by its rate of synthesis reecting the intensity of the pathological process, and hence it is a good indicator of severity of inammation.

Background Challenging perineal defects resulting from extralevator (ELAPE) and standard abdominoperineal excision (APE) have given rise to an emerging multidisciplinary approach between colorectal and plastic surgeons. At present, there is a relative paucity of evidence on best practice. This study sought to assess current national practice concerning perineal reconstruction following APE/ELAPE in the United Kingdom (UK) and to determine the factors involved in reconstruction choice. Methodology An anonymised survey was circulated to consultant plastic surgeons at all 48 UK centres performing perineal reconstruction following APE/ELAPE. Responses were collected between October 2021 and April 2022. Results Complete responses were received from 24 units nationally. All units had a dedicated APE/ELAPE service. Overall, 70% adopted a standardised reconstructive approach, the most common being the inferior gluteal artery perforator flap (n = 11). Significant variation was identified in the reconstructive technique. Similar differences were observed in the perceived importance of surgical factors guiding the reconstructive decision-making process, the top priorities being the size of the defect and previous radiotherapy. Conclusions The variability of responses suggests a lack of national consensus on optimal reconstruction following APE/ELAPE, despite the majority of centres employing a standardised approach to reconstruction. Our study highlights important surgical decision-making factors and provides valuable insight to aid in developing national collaborative evidence-based guidelines on best practice.

Aims Challenging perineal defects resulting from extralevator (ELAPE) and standard abdominoperineal excision (APE) have resulted in a growing multidisciplinary approach between colorectal and plastic surgery colleagues. Currently there is a paucity of evidence on best practice in this emerging field. This study aims to define and describe current national practice within the United Kingdom (UK) in perineal reconstruction following APE/ELAPE. Methods A national practice questionnaire was designed using ‘Google Forms' and circulated via email to 41 units across the UK performing perineal reconstruction following APE/ELAPE. Results Complete responses were received from 23 units (response rate 56%), representing 12 regions across the UK. All units had a dedicated APE/ELAPE service. 70% had a standardised approach to reconstruction, with the Inferior Gluteal Artery Perforator (IGAP) flap being the most common approach (n = 11). Significant variation was observed in the reconstructive approach with regards to flap choice and routine use of pelvic acellular dermal matrix or mesh. Similar differences were observed in the perceived importance of various surgical factors that guide the reconstructive decision making process. Conclusions Our national practice questionnaire responses report nationally well established local networks between colorectal and plastic surgeons. However, the variation in results reflects a lack of national consensus on the optimal reconstructive method after APE/ELAPE. Our study highlight the need for the development of collaborative evidence based national guidance on best practice.

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally invasive dermal sarcoma. The management is generally surgical, with wide local excision (WLE) forming the mainstay of treatment. Large abdominal wall defects are most aesthetically reconstructed using pedicled or free flaps; however, these require tumour-free surgical margins, and can cause donor site morbidity. We describe an alternative, aesthetic, and low-morbidity technique for abdominal wall reconstruction following WLE of DFSP, using 2 layers of a novel synthetic dermal matrix (NovoSorb® BTM). A 25-year-old women presented with a large DFSP involving the right anterior-abdominal wall. After WLE with 3cm margins, BTM was implanted to the large sub-fascial abdominal wall defect. At 6 weeks, after histological confirmation of tumour-free margins, a second layer of BTM was applied to improve the significant contour deformity of the wound bed. After complete integration by 7 weeks, a split-thickness skin graft was harvested from the right thigh and fixed to the new dermis. At 14-days postoperatively, the skin graft had fully taken, and donor site healed. By 8 weeks, the scar had started to mature with no obvious contour defect or contracture. Overall, the patient was satisfied with the functional and aesthetic outcome. To our knowledge, a two-layer reconstruction using an artificial dermal matrix has never been described for abdominal wall reconstruction. We found that double-layer BTM is able to restore the inherent thickness and pliability of skin in complex abdominal wall reconstruction following WLE of DFSP and offers improved durability and cosmesis compared to skin grafting or indeed single layer skin substitutes alone.

Splenic artery pseudoaneurysms (PAs) are uncommon and often occur as a complication of pancreatitis or trauma. Unlike true aneurysms, PAs are symptomatic in a majority of cases and patients can present with a constellation of non-specific symptoms. Diagnosis can be challenging due to variation in presenting features and mimicking pathologies. PAs are associated with a very high morbidity and mortality if left untreated. We present an unusual case of a 47-year-old gentleman diagnosed with a splenic artery pseudoaneurysm despite initial negative catheter angiography and discuss the challenges of splenic artery pseudoaneurysm diagnosis and management.

Purpose Adherence to self-administered biologic disease-modifying antirheumatic drugs (bDMARDs) is necessary for therapeutic benefit. Health-system specialty pharmacies (HSSPs) have reported high adherence rates across several disease states; however, adherence outcomes in rheumatoid arthritis (RA) populations have not yet been established. Methods We performed a multisite retrospective cohort study including patients with RA and 3 or more documented dispenses of bDMARDs from January through December 2018. Pharmacy claims were used to calculate proportion of days covered (PDC). Electronic health records of patients with a PDC of Results There were 29,994 prescriptions for 3,530 patients across 20 sites. The patient cohort was mostly female (75%), with a median age of 55 years (interquartile range [IQR], 42-63 years). The median PDC prior to chart review was 0.94 (IQR, 0.83-0.99). Upon review, 327 patients had no appropriate treatment gaps identified, 6 patients were excluded due to multiple unquantifiable appropriate gaps, and 420 patients had an adjustment in the PDC denominator due to appropriate treatment gaps (43 instances of days’ supply adjusted based on discordant days’ supply information between prescriptions and physician administration instructions, 11 instances of missing fills added, and 421 instances of clinically appropriate treatment gaps). The final median PDC after accounting for appropriate gaps in therapy was 0.95 (IQR, 0.87-0.99). Conclusion This large, multisite retrospective cohort study was the first to demonstrate adherence rates across several HSSPs and provided novel insights into rates and reasons for appropriate gaps in therapy.

This study reports occurrence of stem rot in sugarcane by Fusarium solani NVS671 in the south Gujarat, India. To study it, the pathogen was isolated and identified based on the morphology and internal transcribed spacer region. The pathogenicity of F. solani along with Colletotrichum falcatum strain cfNAV as a positive control was evaluated on cultivar CoC671 by cut cane assay and under pot conditions. The pathogenicity recorded for F. solani stain NVS671 and C. falcatum strain cfNAV indicated severe effect on the sugarcane growth in both the experimental runs in comparison with the untreated control. The study showed that F. solani also causes stem rot in sugarcane, and this is the first report on this pathogen causing stem rot in sugarcane.

We report on a wearable tear bioelectronic platform, integrating a microfluidic electrochemical detector into an eyeglasses nose-bridge pad, for non-invasive monitoring of key tear biomarkers. The alcohol-oxidase (AOx) biosensing fluidic system allowed real-time tear collection and direct alcohol measurements in stimulated tears, leading to the first wearable platform for tear alcohol monitoring. Placed outside the eye region this fully wearable tear-sensing platform addresses drawbacks of sensor systems involving direct contact with the eye as the contact lenses platform. Integrating the wireless electronic circuitry into the eyeglasses frame thus yielded a fully portable, convenient-to-use fashionable sensing device. The tear alcohol sensing concept was demonstrated for monitoring of alcohol intake in human subjects over multiple drinking courses, displaying good correlation to parallel BAC measurements. We also demonstrate for the first time the ability to monitor tear glucose outside the eye and the utility of wearable devices for monitoring vitamin nutrients in connection to enzymatic flow detector and rapid voltammetric scanning, respectively. These developments pave the way to build an effective eyeglasses system capable of chemical tear analysis.

Failing pancreas and subsequent loss of pancreatic β cells worsen diabetic conditions which are further alleviated by the mounting up of glucose levels. Inhibition of sodium glucose cotransporter 2 (SGLT2) in the kidney responsible for glucose reabsorption strikingly reduces blood glucose levels. Bioactive swertisin showed a promising glucose-lowering effect. Hence, we aimed to mechanistically dissect the glucose lowering property of swertisin. A systematic in silico, in vitro, and in vivo approach was directed for target analysis of swertisin. Molecular docking was performed with Swertisn-hSGLT2 complex. Glucose uptake assay and protein expression for SGLT2 and regulatory proteins were performed under swertisin effect. Various physiological and metabolic parameters were evaluated in STZ induced BALB/c mice using swertisin treatment. SGLT2 expression was evaluated in the kidney tissue of mice. Swertisn-hSGLT2 molecularly docked complex showed similar binding energy compared to the Canagliflozin-hSGLT2 complex. Swertisin inhibited glucose uptake and decreased expression of SGLT2 in HEK293 cells. Swertisin does not affect GLUT mediated glucose transport. Swertisin treated diabetic mice demonstrated remarkable improvement in overall glucose homeostasis. Reduced expression of SGLT2 was found in kidney tissue along with reduced PKC expression which is one of the key regulators of SGLT2. Our study explored SGLT2 as a selective target of swertisin for its swift glucose-lowering action which not only inhibits SGLT2 but also reduces its expression in diabetic condition. Thus, the potential property of swertisin as a glucose-lowering agent is remarkable which points towards the likelihood of a wider avenue of diabetes therapy.

Driving under the influence of cannabis and alcohol represents a major safety concern due to the synergistic or additive effect of these substances of abuse. Hence, rapid road-site testing of these substances is highly desired to reduce risks of fatal accidents. Here we describe a wearable electrochemical sensing device for the simultaneous direct, decentralized, detection of salivary THC and alcohol. The new ring-based sensing platform contains a voltammetric THC sensor and an amperometric alcohol biosensor on the ring cap, along with the wireless electronics embedded within the ring case. Rapid replacement of the disposable sensing-electrode ring cap following each saliva assay is accomplished by aligning spring-loaded pins, mounted on the electronic board (PCB), with the current collectors of the sensing electrodes. The printed dual-analyte sensor ring cover is based on a MWCNT/carbon electrode for the THC detection along with a Prussian-blue transducer, coated with alcohol oxidase/chitosan reagent layer, for the biosensing of alcohol. THC and alcohol can thus be detected simultaneously in the same diluted saliva sample within 3 min, with no cross talk and no interferences from the saliva matrix. The new wearable ring sensor platform should enable law enforcement personnel to screen drivers in a single traffic stop and offers considerable promise for addressing growing concerns of drug-impaired driving.

Database management has become an enormous tool for on-demand content distribution services, proffering required information and providing custom services to the user. Also plays a major role for the platforms to manage their data in such a way that data redundancy is minimized. This paper emphasizes improving the user experience for the platform by efficiently managing data. Keeping in mind all the new age requirements, especially after COVID-19 the sudden surge in subscription has led the stakeholders to try new things to lead the OTT market. Collection of shows being the root of the tree here, this paper improvises the currently existing branches via various tables and suggests some new features on how the data collected can be utilized for introducing new and much-required query results for the consumer.

Mobile edge computing (MEC) enables cloud-based services to extend to edge networks consisting of mobile base systems. MEC provides software and hardware platforms to incorporate seamless and decentralized data management schemes adjacent to base systems, thus reducing the end-to-end latency of the user. It is an integral component of the fifth-generation (5G) architecture and operates by providing innovative IT-based services. MEC spans across multiple authoritative domains where trust and interoperability among nodes is a prime concern between low power-enabled sensor nodes, as in the case of Internet of things (IoT)-based environments. The requirements of trust and interoperability make a blockchain framework applicable to MEC platform. In such platforms, miners can solve computationally expensive proof-of-work (PoW) puzzles containing mobile transactions as blocks added to immutable ledger so that a substantial amount of CPU computations and energy constraints are consumed. This article presents a systematic survey of MEC architecture and introduces a mobile blockchain framework that can be incorporated with the MEC architecture to facilitate the mining scheme. Then, the article analyzes the effects of integration of blockchain with MEC platform. Finally, concluding remarks and future work are provided.