Type Of Closure Research Articles

Novel En Face OCT-Based Closure Patterns in Idiopathic Macular Holes

To determine the postoperative en face OCT pattern of closure in idiopathic macular holes (MHs). Retrospective, multicentric, observational study. Patients aged > 18 years with a diagnosis of idiopathic MH, with well documented en face OCT images. Baseline characteristics and preoperative OCT and en face OCT parameters like horizontal and vertical minimum linear diameter (MLD), horizontal and vertical basal hole diameter (BHD), hole height, acircularity index, and hole orientation were measured. The type of hole closure on en face OCT, and a comparison of baseline parameters and final visual acuity among the en face closure types. A total of 64 eyes of 62 patients (24 men and 40 women) with a mean age of 63.8 ± 12.4 years. The median duration of symptoms was 3 months (interquartile range, 1.75-10.5). The eyes had a mean baseline visual acuity of 0.97 ± 0.46 logarithm of minimum angle of resolution (logMAR). The baseline horizontal MLD was 591.7 ± 219.4 μm and the vertical MLD was 552.9 ± 198.2 μm. Baseline horizontal and vertical BHD were 1240.3 ± 521.1 μm and 1142.1 ± 478.1 μm, respectively. The mean hole height was 394.8 ± 123.2 μm. Two different patterns were noted on en face OCT: round, or linear. A total of 38 eyes had a round/centripetal closure and 26 eyes had a linear closure (17 eyes had a horizontal closure, 7 eyes had an oblique closure, while 2 eyes had a vertical closure). The mean final visual acuity was 0.80 ± 0.43 logMAR (Snellen equivalent of 20/125). Eyes with linear closure (0.76 ± 0.23 logMAR) had a significantly (P= 0.03) better visual acuity than the round closure group (1.07 ± 0.28 logMAR), only in eyes with horizontal MLD of > 650 μm, but not when other MLD cut-offs were used. We describe 2 different patterns of hole closure (linear and round) on en face OCT. Further studies will be required to determine its functional significance. Proprietary or commercial disclosure may be found after the references.

Impact of the Closure Oxygen Transfer Rate on Volatile Compound Composition and Oxidation Aroma Intensity of Merlot and Cabernet Sauvignon Blend: A 10 Year Study

This study evaluated the impact of closure type on unoaked 100 %-Merlot, oak-aged 70%-Merlot/30%-Cabernet Sauvignon, and 30%-Merlot/70%-Cabernet Sauvignon during a 10 year period. Closures were microagglomerate corks, screw caps, and synthetics with the known oxygen transfer rate (OTR), ranging from 0.1 to 4.6 mg/y, including natural corks. Oxidation intensity perception, dissolved oxygen, sulfite, and 3-methyl-2,4-nonanedione (MND) were monitored on a regular basis. After 10 years of aging, additional aroma impact markers were evaluated (3-sulfanylhexan-1-ol, H2S, DMS, methional, and phenylacetaldehyde). Low OTR levels (≤0.3 mg/y) delayed the oxidation of red wines in this long-term experiment. In addition, our results led us to hypothesize that the MND concentration in young wines might be linked with their ability to produce it during bottle aging that is with their aging potential. Finally, we found that the kinetic accumulation of MND in wines was first strongly impacted by its intrinsic composition and thereafter by the OTRT0 of the stopper.

Revisiting abdominal closure in mesenteric ischemia: is there an association with outcome?

Current guidelines advocate liberal use of delayed abdominal closure in patients with acute mesenteric ischemia (AMI) undergoing laparotomy. Few studies have systematically examined this practice. The goal of this study was to evaluate the effect of delayed abdominal closure on postoperative morbidity and mortality in patients with AMI. We performed a retrospective cohort study of the ACS-NSQIP 2013-2017 registry. We included patients with a diagnosis of AMI undergoing emergency laparotomy. Patients were divided into two groups based on the type of abdominal closure: (1) delayed fascial closure (DFC) when no layers of the abdominal wall were closed and (2) immediate fascial closure (IFC) if deep layers or all layers of the abdominal wall were closed. Propensity score matching was performed based on comorbidities, pre-operative, and operative characteristics. Univariable analysis was performed on the matched sample. The propensity-matched cohort consisted of 1520 patients equally divided into the DFC and IFC groups. The median (IQR) age was 68 (59-77), and 836 (55.0%) were female. Compared to IFC, the DFC group showed increased in-hospital mortality (38.9% vs. 31.6%, p = 0.002), 30-day mortality (42.4% vs. 36.3%, p = 0.012), and increased risk of respiratory failure (59.5% vs. 31.2%, p < 0.001). The delayed fascial closure technique was associated with increased mortality compared to immediate fascial closure. These findings do not support the blanket incorporation of delayed closure in mesenteric ischemia care or its previously advocated liberal use.

On ventilated supercavities moving horizontally near free surface

By means of open source CFD tool OpenFOAM platform, a multiphase solver capable to deal with two phases flows is used to investigate ventilated supercavities. The VOF (volume of fraction) method is employed in order to capture cavity interface and the free surface. The main objective of this work is to investigate ventilated supercavity generated after a disk-cavitator which moves horizontally near a free surface. Most of the work in this research has been focused on the shape of supercavity and its asymmetry. Furthermore, two distinct cavity closure types, i.e. the re-entrant jet (RJ) and the twin vortex (TV) and are discussed separately to compare their gas leakage mechanisms at different submergence ratio. Numerical results indicate that the air-water free surface will have a significant influence on the cavity surface curvature and gas shedding process. Under the influence of free surface, the length diameter ratio of ventilated cavitation increases with H‾ decrease with decrease. The influence of free boundary on the upper surface of cavitation interface is greater than that on the lower surface. When Fr number and ventilation volume are constant, when approaching the free surface, the interface curvature of ventilation cavitation will increase. The deflection of cavitation axis is mainly affected by gravity and free surface. When the Fr number is small, the cavitation axis will be slightly disturbed. When the Fr number is large, the cavitation axis deflects reversely. These may give meaningful references for the design of surface vehicles.

ХИРУРГИЧЕСКАЯ РЕАБИЛИТАЦИЯ ПАЦИЕНТА С НЕБНО-ГЛОТОЧНОЙ НЕДОСТАТОЧНОСТЬЮ ПРИ ВРОЖДЕННОЙ РАСЩЕЛИНЕ НЕБА ПОСЛЕ УРАНОПЛАСТИКИ (клинический случай)

Objectives. A clinical case of surgical rehabilitation of a patient with palatopharyngeal insufficiency with congenital cleft palate after uranoplasty.&#x0D; Purpose. Description of the long-term result of surgical treatment of congenital cleft palate, the causes of complications and the rationale for the method of treatment of palatopharyngeal insufficiency.&#x0D; Methodology. The paper presents the results of a clinical observation of a patient aged 12 years with congenital cleft palate after uranoplasty and formed palatopharyngeal insufficiency. A child at the age of 2 years 8 months underwent sparing uranoplasty. Since the child lived in a remote area from the city, he did not have the opportunity to engage in logotherapy. On examination, the soft palate is moderately shortened, postoperative scars are not rough. Speech is vile. To select the most optimal method of treating this pathology, it was necessary to visualize the causes of palato-pharyngeal insufficiency.&#x0D; Results. When conducting an examination using nasopharyngoscopy, a sphincter type of closure of the palatopharyngeal ring was revealed. When pronouncing sounds, the soft palate rose slightly, but the lateral walls of the pharynx with the posterior palatine arches actively contracted, narrowing the palatopharyngeal ring. Taking into account the data obtained during nasopharyngoscopy, a surgical method for eliminating palatopharyngeal insufficiency proposed by M. Orticochea was chosen — “speech-improving surgery”, or sphincter pharyngoplasty, with suturing of the distal ends of the mobilized posterior palatine arches on the posterior pharyngeal wall. According to the control examination for 6 months, there was a significant improvement in speech function, there was no nasalization.&#x0D; Conclusions. Nasopharyngoendoscopy makes it possible to objectively assess the causes of palatopharyngeal insufficiency, which makes it possible to choose the most optimal method of surgical treatment. One of the methods of choice in the surgical treatment of palatopharyngeal insufficiency is the method of sphincter pharyngoplasty.

A comparison between different suture techniques in lumbar spine surgery.

As a result of solicited muscles, strong friction, and tensile force on cutaneous tissue, the difference in closure procedure and management strategies and complications of surgical incision healing is a real challenge in lumbar spine surgery. We performed a retrospective study to compare different types of wound closure in lumbar spine surgery. 4383 patients were included in this study. Wound dehiscence was more common in the intracutaneous suture group than in the far- near-near-far suture group. Delayed wound healing occurred more in the far-near near-far suture group than intracutaneous suture group. Also, the far-near near-far interrupted point suture group showed a higher ratio of delayed wound healing compared with crossover suture. The superficial wound infection rate was roughly the same in all types of sutures with an average value of 0.79% with 0.81% SD. This is a preliminary study to compare different types of operative wounds showing the pros and cons related to each option.

Evaluation of Multimodality LAA Leak Closure Methods Following Incomplete Occlusion: The LAA Leak Study

BackgroundIncomplete left atrial appendage (LAA) closure is an evolving topic of clinical significance and thromboembolic potential, with recent long-term studies suggesting lower cutoffs for relevant leak size. ObjectivesThe aim of this prospective observational study was to assess 3 different closure techniques for persistent peridevice leaks after incomplete LAA closure and compare their efficacy and safety outcomes. MethodsWe studied 160 patients (mean age 72 ± 9 years; 71% men) who underwent 1 of the 3 available modalities (detachable embolization coils, vascular plugs or septal occluders, and radiofrequency ablation) for residual central or eccentric leak closure. Both acute postprocedural success (closure or <1-mm leak at the end of the procedure) and closure at 1-year follow-up transesophageal echocardiography imaging were evaluated. ResultsOf 160 patients, 0.6%, 41.3%, and 58.1% had mild (1-2 mm), moderate (3-5 mm), and severe (≥5 mm) leaks, respectively. Baseline LAA closure type was 72.5% Watchman FLX, 16.3% Lariat, 5.6% surgical ligation, 1.9% AtriClip, and 1.9% Amulet. Successful closure (0- or <1-mm leak) was seen in 100% of patients in all cohorts following intervention, with overall complete closure (0-1 mm) or mild or minimal leaks (1-2 mm) on 1-year follow-up transesophageal echocardiography seen in 100% of the atrial septal occluder or vascular plug cohort, 85.9% of the coil cohort, and 83.3% of the radiofrequency ablation cohort (P < 0.001). Two patients (1.3%) experienced cardiac tamponade, and there were no deaths or other complications. ConclusionsPeridevice leaks can safely and effectively be closed using 3 different modalities depending on size and location.

Experimental study on the collapse of tail cavity induced by underwater ventilation

Tail cavities are common in gas-propelled underwater cold emission and jet-propelled underwater vehicles. They can also provide a stable working environment for solid rocket motors. In this study, a 2-mm-diameter ventilation hole was provided at the vehicle's rear for a ventilation-induced cavity. Then, the effect of different initial ventilation flows (Q) and Froude numbers (Fr) on cavity collapse after the air supply was stopped was studied. Three different tail cavity closure types are observed: the intact cavity (IC), partially broken cavity (PBC), and pulsating foam cavity (PFC). The IC changes from a twin vortex tube closure to a reentrant jet closure, eventually collapsing entirely. The cavity collapse time decreases with increasing Fr and increases with increasing Q. The dimensionless cavity length (L/D) has an exponential relationship with time when Fr is small and becomes linear with time when Fr is large. The cavity collapse velocity increases with increasing Fr, while Q has little effect. For PBC collapses, the cavity first transforms into an IC and then collapses as an IC. L/D first increases to a local maximum and then decreases. The effect of the reflux gas on the cavity length is critical. During PFC collapses, the cavity first transforms into a PBC, then into an IC, and finally collapses as an IC. L/D first increases to a local maximum and then decreases exponentially.

Surgery, Limb Edema and Health-related Quality of Life: A Prospective Follow-up Study on Patients With Cutaneous Malignant Melanoma.

The latest developments in oncological therapies for malignant melanoma, and the discovery that complete lymph node dissection offers no survival benefit, are changing the landscape of melanoma surgery. There is a need for more information on health-related quality of life (HRQoL) consequences of melanoma surgery. This longitudinal cohort study was carried out from 2004 to 2009 in the Helsinki and Uusimaa Hospital District and patients were followed-up at 6, 12 and 24 months. The patients were asked to fill in the generic 15D questionnaire and the cancer-specific European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30). In addition, they were asked selected questions from the EORTC Item Library regarding upper and lower limb edema. A total of 169 (64.5%) patients with local or locally advanced melanoma referred for surgical treatment responded, of whom 161 were included in the final analysis. For the whole patient group, distress, depression and emotional function improved over time. Worse HRQoL in some of the dimensions were associated with female sex, skin transplant versus direct wound closure and complications 30 days or more after surgery, but none was associated with worse overall HRQoL. Postoperative complications, type of wound closure or lymph node surgery had no effect on overall HRQoL. Patient-reported limb edema was associated with worse overall HRQoL at baseline and during follow-up by both instruments. Patients reporting limb edema reported worse mobility and more pain throughout the study. Patient-reported limb edema, regardless of the cause, seems to be an important predictor of worse HRQoL among patients with melanoma.

Purse-String Closure vs Conventional Direct Closure of Wounds after Stoma Reversal: A Prospective Randomized Controlled Study

INTRODUCTION: Surgical site infection (SSI) is one of the most frequent complications after ileostomy closure. Our prospective randomized controlled trial aims to compare 2 operative techniques used to close the wound after ileostomy closure, the direct suture and purse-string suture. The main endpoint was the SSI rate. Secondary endpoint was cosmetic outcomes. METHODS: A total of 100 patients were enrolled and included in the statistical analysis; 50 patients were randomized into the purse-string suture group and 50 were randomized into the direct suture group. Follow-up was performed within 2 days after operation, at discharge, 1 month and 3 months after the operation. RESULTS: The purse-string suture group had a lower number of SSI compared with the direct suture group (2 vs 14, p = 0.007). The secondary outcome of cosmesis was similar in the 2 groups, with no statistically significant difference. CONCLUSION: In our experience, the purse-string suture has a lower risk of stoma site SSI. This type of closure should be considered as standard of care after ileostomy reversal.

P-107 DOES BARBED SUTURE REDUCE THE RATE OF EVISCERATIONS IN EMERGENCY MIDLINE LAPAROTOMIES?

Abstract Introduction Evisceration is a frequent consequence after performing midline laparotomies (ML) in urgent abdominal surgeries. The aim of this study was to compare and evaluate the results obtained after the introduction of barbed sutures in abdominal wall closure. Materials and methods We performed a retrospective analysis of patients undergoing emergency surgery in our hospital following a midline laparotomy approach in the last 5 years. Preoperative variables were compared between both groups and related to early surgical wound complications, depending on the type of abdominal wall closure performed. Results 222 patients underwent surgery (Polydioxanone (P); 128; Barbed (B); 94) after ruling out exclusion factors such as neuromuscular disease, recent abdominal surgeries and whose follow-up had been lost. There were no significant differences between the two groups in terms of preoperative baseline characteristics or associated comorbidities. Furthermore, there were no statistically significant differences in type of surgery performed; the most frequent was small bowel obstruction. After data analysis, no differences were found in terms of hospital stay (P; 7.43 days vs B; 6.05 days, p=0.421) or mortality (P; 3.125% vs B; 4.25, p=0.655). Concerning immediate complications, there were no differences regarding surgical wound infection (P; 18.75% vs B; 10.63%, p=0.061) and seroma (P; 3.125% vs B; 2.12, p=0.651). Evisceration rates turned out to be more frequent in the polydioxanone group (P; 20.31% vs B; 8.51%, p=0.016). Conclusions The use of barbed sutures reduced the incidence of evisceration, therefore it can be considered as recommended sutures for aponeurotic closure in emergent ML.

Primary vs patch-based skin closure for in-utero spina bifida repair.

During in-utero spina bifida (SB) repair, closure of large defects is often challenging, requiring tissue graft for watertight skin closure. No prior studies have compared primary skin closure vs patch-based repair. Our objective was to compare neonatal and 1-year outcomes associated with these two types of skin closure for in-utero SB repair. This was a prospective cohort study of 102 patients undergoing open prenatal SB repair from September 2011 to August 2021 at a single institution. All patients met the inclusion criteria of the Management of Myelomeningocele Study (MOMS), and the surgical procedure for in-utero SB repair was similar to that described in the MOMS trial. During the surgery, if primary skin approximation was not feasible due to the large size of the defect, the decision was at the discretion of the pediatric neurosurgeon to utilize a patch for closure. Neonatal outcomes at birth and 1-year outcomes were compared between the primary skin and patch-based closure groups. Of 102 patients included in the study, 70 (68.6%) underwent primary skin closure and 32 (31.4%) patch-based closure. The patch type included acellular bovine skin matrix (Durepair®; n = 31) and human acellular dermal matrix (Alloderm®; n = 1). Fetuses with myeloschisis were more likely to require patch-based repair than those with myelomeningocele. The median time of fetal repair was 4 min longer for patch-based compared with primary skin closure (37 vs 33 min; P = 0.001). Following patch-based repair, neonates had a longer length of stay in the neonatal intensive care unit (NICU) by 24 days (adjusted risk ratio, 2.40 (95% CI, 1.41-4.29)) compared to those that underwent primary skin closure. There was no difference between the two groups in the other neonatal outcomes, including the need for ventriculoperitoneal shunt placement and cerebrospinal fluid leakage. Outcome at 1 year of age was available for 90 infants. Need for wound revision within their first year after birth was more common in infants who underwent patch-based vs those with primary skin closure (19.4% vs 5.1%; P = 0.05). There was no difference between the two groups in other 1-year outcomes, including the need for ventriculoperitoneal shunt placement by 1 year of age and surgery for tethered cord. Patch-based closure during SB repair is often needed in fetuses with myeloschisis and is associated with prolonged fetal surgery time, long NICU stay and need for wound revision within the first year after birth. Further studies are required to identify optimal patches for SB repair or alternative methods to improve outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Complications of hidradenitis suppurativa after surgical management: A systematic review and meta-analysis.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease that affects the apocrine glands in the axillary, groin, and breast regions, with apparent physiological and psychosocial sequelae. As many studies have reported, surgical management is one of the treatment options. A comprehensive systematic review of surgical treatment for HS is provided in this study. Literature retrieval was conducted on MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI) and clinical registries from their inception to 1 May 2022. The principles of the PRISMA were adhered to in the process of literature search and the reference lists of the articles retrieved were also checked for further reference. Heterogeneity was assessed in meta-analysis by means of the Q-test and I2 index. A total of 13 studies were finally included which involved 535 participants in total. The average estimated complication rate was 11.1% (95% confidence interval [CI], 6.4%-16.9%). The meta-analysis was conducted on pooled complication sample studies and pooled recurrence sample studies. The recurrence was 16.2% (95% CI, 9.1%-24.9%). Subgroup analysis revealed significant differences in HS complications among different closure types. Among different locations, the highest rate of 16.0% (95% CI, 6.8%-28.2%) was multiple locations. Besides, differences were also observed in diverse excision methods and the highest was deroofing 13.9% (95% CI, 2.2%-33.2%). Extensive resection, using skin flaps or skin grafts as a closure method, was associated with a higher incidence of complications. Providers should consider carefully the use of extensive resection or using skin flaps or skin grafts as a closure method so as to minimise the risk of adverse events.

Seeing household chemicals through the eyes of children—Investigating influential factors of preschoolers’ perception and behavior

Introduction: Children who encounter household chemicals run the risk of unintentional injury. The aim of this study was to understand which factors heighten children’s attention or misguide their decision-making concerning household chemicals. We hypothesized that certain product attributes (i.e., label, packaging, closure types), storage context, and parental beliefs play a role in this setting. Method: We conducted a laboratory study with N = 114 children (M = 45 months, SD = 6.5) and their parents (M = 38 years, SD = 4.92). Children completed a series of behavioral tasks in which they had to choose between products with different attributes, identify products in different storage contexts, and sort household chemicals. Results: The results confirmed that the children preferred products with cartoon-style labels compared to products without such labels. However, children’s decision-making did not differ for products with different closure types (child-resistant vs sprayer-type closures). Regarding the storage context, our results showed that the children particularly struggled to identify dishwashing tabs when they were stored with other food items rather than household chemicals. In terms of parental beliefs, our study found that parents rated more household chemicals as child-safe than their children did. Practical Application: Parents should buy household chemicals with neutral labels and pay attention to how their household chemicals are stored. Manufacturers should consider potential adverse effects when developing new product designs.

The Role of Nature in Human Healing

In musing on what Freud would have thought about the contributions of social dysfunction to psychological pathology Paul Goodman (1991) concluded that “it would become increasingly evident to him, would it not, that cure could not depend merely on talk, revival of affect, and reconsideration, but must also pass over into practical behavior, and therefore must involve a change of the social rules so as to make such curative behavior possible” (40). One can find similar references to the importance Goodman placed on the crucial role of sociopolitical functioning in all areas of the human condition throughout his vast array of political essays, educational theories, poetry, and in the 1951 tome, Gestalt Therapy: Excitement and Growth in the Human Personality. And it was through such a search that I eventually provided myself with sufficient theoretical support for including social and political issues into the therapeutic process.The Gestalt perspective that seemed most relevant in this regard had to do with Goodman’s concept of self-formation, a psychologically dynamic process in which the momentary creations of self at any given time, are formed “OF” rather than “AT” the organism/environment boundary. To form “AT” the boundary would imply an additive dynamic in which individual entities join together. To form “OF” the organism/environmental field implies a more holistic fusing: one in which more novel, and existential gestalten are formed, ones that contain elements and interactions determining lively wholes; as such, they are capable of including social and political variables which, similar to other aspects of self-functioning, can qualify as legitimate grist for the psychotherapeutic mill.When employing such a paradigm in therapy, I will often find it important to redefine the term “political” to facilitate its integration into the treatment. I present political functioning in Gestalt-based process terminology rather than through the more formal nomenclature typically applied to political party identification. When successful, the therapy becomes free to explore inquiries such as the following: What type of sociopolitical processes do you feel would be helpful and supportive to you with respect to the work you have done here? Are there ways in which you can imagine yourself becoming active in movements or organizations that support such principles and practices?I often find this sort of inquiry most effective toward the end of therapy, in that it adds a welcomed complexity to a lot of the psychological work already accomplished. In addition, it sends off the important, yet implicit, message that indeed it is difficult if not impossible to maintain one’s sanity in an insane environment. In addition, I often find that this type of closure instills a spontaneous and comprehensive understanding of more global environmental concerns. And here again, Gestalt therapy can be useful; a factor highlighted by Theodore Roszak (1992) who, in assessing various schools of psychology that attempt to incorporate environmental awareness into their theoretical structure, believed that: “Only the Gestalt school has introduced a larger, more fully biological context for therapy that seeks to unite figure with ground, organism with environment; it is the only school that uses the concept of ecology in its theories” (304).

The Role of Nature in Human Healing

In musing on what Freud would have thought about the contributions of social dysfunction to psychological pathology Paul Goodman (1991) concluded that “it would become increasingly evident to him, would it not, that cure could not depend merely on talk, revival of affect, and reconsideration, but must also pass over into practical behavior, and therefore must involve a change of the social rules so as to make such curative behavior possible” (40). One can find similar references to the importance Goodman placed on the crucial role of sociopolitical functioning in all areas of the human condition throughout his vast array of political essays, educational theories, poetry, and in the 1951 tome, Gestalt Therapy: Excitement and Growth in the Human Personality. And it was through such a search that I eventually provided myself with sufficient theoretical support for including social and political issues into the therapeutic process.The Gestalt perspective that seemed most relevant in this regard had to do with Goodman’s concept of self-formation, a psychologically dynamic process in which the momentary creations of self at any given time, are formed “OF” rather than “AT” the organism/environment boundary. To form “AT” the boundary would imply an additive dynamic in which individual entities join together. To form “OF” the organism/environmental field implies a more holistic fusing: one in which more novel, and existential gestalten are formed, ones that contain elements and interactions determining lively wholes; as such, they are capable of including social and political variables which, similar to other aspects of self-functioning, can qualify as legitimate grist for the psychotherapeutic mill.When employing such a paradigm in therapy, I will often find it important to redefine the term “political” to facilitate its integration into the treatment. I present political functioning in Gestalt-based process terminology rather than through the more formal nomenclature typically applied to political party identification. When successful, the therapy becomes free to explore inquiries such as the following: What type of sociopolitical processes do you feel would be helpful and supportive to you with respect to the work you have done here? Are there ways in which you can imagine yourself becoming active in movements or organizations that support such principles and practices?I often find this sort of inquiry most effective toward the end of therapy, in that it adds a welcomed complexity to a lot of the psychological work already accomplished. In addition, it sends off the important, yet implicit, message that indeed it is difficult if not impossible to maintain one’s sanity in an insane environment. In addition, I often find that this type of closure instills a spontaneous and comprehensive understanding of more global environmental concerns. And here again, Gestalt therapy can be useful; a factor highlighted by Theodore Roszak (1992) who, in assessing various schools of psychology that attempt to incorporate environmental awareness into their theoretical structure, believed that: “Only the Gestalt school has introduced a larger, more fully biological context for therapy that seeks to unite figure with ground, organism with environment; it is the only school that uses the concept of ecology in its theories” (304).

Nerve changes associated with post thoracotomy pain syndrome.

Chronic post-thoracotomy pain (PTPS) is a frequent complication of thoracic operations. Sometimes the pain is excruciating enough to impair activities of daily living (ADL). All thoracic procedures have the potential to cause trauma to the intercostal nerves due to retractor use, chest closure techniques, and or wound healing. In our study, we analyzed the microscopic aspects of the nerves involved in the healing process, to better understand the histopathology of chronic pain. 29 patients with PTPS underwent intercostal neurectomy to alleviate the symptoms. Microscopic specimens harvested during the surgeries were sent to our pathology unit for evaluation. The following data regarding the surgical procedures was collected: surgical approach, chest closure type, number of excised nerves, and time interval from previous surgery to neurectomy. A mean of 2.34±1.11 nerves were excised. Microscopy of the specimens revealed: fibrosis, hyalinization of the epineurium and perineurium, intense hyperemia of the blood capillaries, and interstitial edema. 7 cases presented with myxoid degeneration of epineurium and perineurium. In all the cases, endoneurium, myelin sheaths, and axons were interrupted. The endoneurium showed the presence of hyperemic dilated capillaries. The segmental cytoplasmic vacuolization of Schwann's cells with the total disappearance of axons was also noted. 60% of the examined specimens had intraneural myxoid degeneration, with highly dense irregular connective tissue around nerve fibers. The pathologic findings in the structure of the intercostal nerves obtained from the patients are indicative of the involvement of the wound healing mechanisms in PTPS. The negative impact of wound healing could be considered a key component in the development of intense chronic pain.

Cone beam computed tomography evaluation of sphenoid sinus in different sagittal skeletal pattern.

The purpose of this study is to explore sphenoid sinus variations in individuals with various sagittal skeletal anomalies using cone-beam computed tomography (CBCT). We retrospectively analyzed sphenoid sinus pneumatization on CBCT images of 126 patients aged 18-86 years. The anteroposterior skeletal relationships of the maxilla and mandible were classified as skeletal class I, II or III using the A point-nasion-B point (ANB) angle measured in the sagittal plane. The extensions of the sphenoid sinus were evaluated on three planes including axial, sagittal and coronal sections. The study population consisted of 84 females (66.7%) and 42 males (33.3%), including 52 (41.3%) class I, 38 (30.1%) class II, and 36 (28.6%) class III cases. The conchal type of sphenoid sinus was not encountered. Presellar sinuses were detected in only 3 (5.8%) class I cases. Incomplete sinuses were detected in 16 (30.8%) class I, 7 (18.4%) class II, and 15 (41.7%) class III cases. Complete sinuses were detected in 33 (63.4%) class I, 31 (81.6%) class II, and 21 (58.3%) class III cases. Lateral extensions were found in 103 (40.9%) of the 252 sinus walls: 33 (31.7%) in class I, 45 (59.2%) in class II, and 25 (34.7%) in class III sinuses. Regional sphenoid sinus anatomy can be carefully examined via CBCT. The sphenoid sinus pneumatization did not differ significantly in patients exhibiting different types of sagittal skeletal closure, with the exception of the lesser wing type.

Wine Closure Performance of Three Common Closure Types: Chemical and Sensory Impact on a Sauvignon Blanc Wine

A Napa Valley Sauvignon blanc wine was bottled with 200 each of a natural cork, a screw cap, and a synthetic cork. As browning is an index for wine oxidation, we assessed the brown color of each bottle with a spectrophotometer over 30 months. A random-effects regression model for longitudinal data on all bottles and closure groups found a browning growth trajectory for each closure group. Changes in the wine’s browning behavior at 18 months and 30 months showed that the browning of the wine bottles appeared to slow down later in the storage period, especially for natural corks. The between-bottle variation was the highest for the natural cork. At 30 months, we separated the bottles by the extent of browning and samples were pulled from the high, mid, and low levels of browning levels for each closure. The degree of browning is inversely correlated with free SO2 levels ranging from 5 to 12 mg/L. However, a Quantitative Descriptive Analysis (QDA™) sensory panel could not detect any difference in their aroma and flavor profile between closure types regardless of browning level. Even low levels of free SO2 retain protection against strong oxidation aromas, and visual browning detected by spectrophotometer seemed to precede oxidative aroma and flavor changes of the aging Sauvignon blanc.

Femoral Artery Closure Devices vs Manual Compression During Cardiac Catheterization and Percutaneous Coronary Intervention.

Femoral arterial access remains widely used despite recent increase in radial access for cardiac catheterization and percutaneous coronary intervention (PCI). Various femoral artery closure devices have been developed and are commonly used to shorten vascular closure times, with variable rates of vascular complications observed in clinical trials. We sought to examine the rates of contemporary outcomes during diagnostic catheterization and PCI with the most common femoral artery closure devices. We identified patients who had undergone either diagnostic catheterization alone (n = 14,401) or PCI (n = 11,712) through femoral artery access in the Indiana University Health Multicenter Cardiac Cath registry. We compared outcomes according to closure type: manual compression, Angio-Seal, Perclose, or Mynx. Access complications and bleeding outcomes were measured according to National Cardiovascular Data​Registry standard definitions. The use of any vascular closure device as compared to manual femoral arterial access hold was associated with a significant reduction in vascular access complications and bleeding events in patients who underwent PCI. No significant difference in access-site complications was observed for diagnostic catheterization alone. Among closure devices, Perclose and Angio-Seal had a lower rate of hematoma than Mynx. The use of femoral artery access closure devices is associated with a reduction in vascular access complication rates as compared to manual femoral artery compression in patients who undergo PCI.