Tissue Deficiency Research Articles

Use of De-Epithalialized Flap for Elevating the Alar Base in Patients With Cleft Lip.

Alar base asymmetry is a common problem in cleft lip patients. Caused by a lack of bone support and soft tissue deficiency, it is one of the problems that must be corrected during cleft lip repair. While it is encountered during primary lip repair, it can also be seen as a secondary cleft lip nasal deformity after repair. This study aimed to provide alar base symmetry with a de-epithelialized muscle-skin flap during the primary cleft lip repair of incomplete cleft lip patients and secondary cleft lip deformity repair. In incomplete cleft lip patients, the tissue under the incomplete part is de-epithelialized and elevated as a superiorly based flap. The flap is rotated and sutured under the alar base for the elevation. In secondary patients, scar tissue to be removed is de-epithelialized and elevated as a superiorly based flap. It is turned over and sutured under the alar base for augmentation. The effect of the surgery is monitored during the follow-up period. There were no complications related to the flap, and no volume loss was observed. Using a de-epithelialized musculocutaneous flap, the augmentation of the alar base and nasal sill can be achieved without additional incisions in patients undergoing primary incomplete cleft lip repair and in patients undergoing secondary cleft lip deformity repair. We think it is an effective and safe method, improving the esthetic outcomes of cleft lip patients.

Revision Reverse Total Shoulder Arthroplasty Using an Augmented Glenoid Baseplate: A Review of Current Glenoid Baseplate Options and a Case Report

Introduction: Total and hemi-shoulder arthroplasty have proved to be a safe and effective option for patients with symptomatic osteoarthritis. In some cases, glenoid implant failures or erosion can lead to acquired glenoid bone loss, complicating potential revision surgery. This paper presents a review of glenoid implant options for total shoulder arthroplasty and a case study which discusses a new augmented reverse baseplate for the revision of a failed hemi-shoulder arthroplasty. The patient was fully informed and gave written consent to submit the details of this case for publication in a peer-reviewed journal. Case Description: An 80-year-old retired professor with a prior history of right shoulder hemiarthroplasty presented with worsening right shoulder pain. She failed conservative care and wanted a conversion to a reverse total shoulder arthroplasty. The erosion on the patient's glenoid was severe enough for the surgeon to elect for the use of a metal augmented baseplate to fill the acquired defect and correct version and inclination. After an uneventful postoperative and recovery progression, at her one-year follow-up visit, she was pain-free and active, with significant improvements in her visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (ROM). Discussion: The advent of metal augmentation with advanced glenoid preparation instruments allows shoulder specialists the ability to address implant-associated acquired glenoid bone loss and soft tissue deficiencies with ease and confidence and reduce additional clinical challenges.

7228 Pregnancy Complications in Women with Lipodystrophy: The Role of Typical and Lipodystrophy-specific risk factors

Abstract Disclosure: B. Tracey: None. T. Neal: None. M. Lightbourne: None. M.S. Startzell: None. E. Cochran: None. P. Stratton: None. R.J. Brown: None. Lipodystrophy (LD) is characterized by partial (PL) or total (generalized, GL) deficiency of adipose tissue, leading to diabetes mellitus (DM), dyslipidemia, and polycystic ovary syndrome. Prior reports suggest increased risk of gestational DM (GDM), preeclampsia, and miscarriage in PL; infertility is common in GL. We explored if pregnancy complications in LD were related to typical risk factors (age, race) and/or LD-specific risk factors (GL vs PL; genotype of PL). Pregnancy data in patients with LD obtained by interview and chart review included: number of pregnancies, use of assisted reproduction technology (ART), miscarriage, GDM or pre-gestational DM (pre-GDM), preeclampsia, and weight gain. 28 patients (22 White, 6 BIPOC) had 74 pregnancies at ages 19-39y. 7 with GL (6 AGPAT2, 1 BSCL2) had 21 pregnancies (3.0±2.4 per person). 13 pregnancies in 6 patients with GL occurred on metreleptin; 1 had 8 pregnancies (3 miscarriages) without metreleptin. 21 patients with PL (7 LMNA, 4 PPARG, 10 unknown genotype) had 53 pregnancies (17 LMNA, 10 PPARG, 26 unknown; mean 2.5±1.3 per person); none were on metreleptin. No pregnancy in GL and 10 (19%) in PL used ART (P=0.053). In PL with LMNA, PPARG, and unknown genotype, ART was used in 3 (18%), 3 (30%), and 4 (15%) pregnancies (P=0.6). 10 (48%) of pregnancies in GL and 18 (34%) in PL ended in miscarriage (P=0.3). 11 patients (3 GL [43%], 8 PL [38%]) had recurrent (≥2) miscarriages. 2 ectopic pregnancies and 1 elective abortion occurred in PL. In PL with LMNA, PPARG, and unknown genotype, miscarriage occurred in 7 (41%), 3 (30%), and 8 (31%) of pregnancies (P=0.7). Pre-GDM preceded all 13 pregnancies in 6 patients with GL; 1 patient had 8 pregnancies without pre-GDM. In all LD, pre-GDM preceded 7 (25%) pregnancies in patients ≤25y and 22 (48%) in those >25y (P=0.08). Among 30 pregnancies continuing ≥20 weeks without pre-GDM, GDM developed in 3 (25%) ≤25y, and 9 (50%) >25y (P=0.3). GDM did not differ by genotype: LMNA 3 (43%), PPARG 4 (57%), unknown 5 (45%); P>0.99. Among 44 pregnancies continuing ≥20 weeks, preeclampsia developed in 5 (45%) in GL and 13 (39%) in PL (P>0.99). Preeclampsia incidence did not differ by genotype in PL (22% LMNA, 14% PPARG, 41% unknown genotype; P=0.4), race (26% White, 56% BIPOC, P=0.1), or age (23% ≤25y, 35% >25y, P=0.7). Gestational weight gain was less in GL than PL (mean 6.8±3.7 kg GL, 14.3±8.3 kg PL, P=0.0002) but was similar by PL genotype (LMNA 13.8±6.2 kg, PPARG 12.1±5.5 kg, unknown 15.4±8.5 kg; P=0.6). In this large study of pregnancy in LD, overall complication rates were high compared with healthy US women (with rates of miscarriage of 20%, recurrent miscarriage of <5%, pre-GDM of 4%, GDM of 15%, preeclampsia of 6%), but few were enhanced by LD-specific or typical risk factors; sample size was small. Gestational weight gain was lower in GL than PL, likely due to low fat mass in GL. These findings provide guidance for monitoring pregnancies in LD. Presentation: 6/1/2024

7654 Unusual Case of Lipodystrophy: A Novel Disease Phenotype?

Abstract Disclosure: M. Celik Guler: None. E.D. Frontera: None. K. Hoose: None. M.C. Foss de Freitas: Advisory Board Member; Self; PTC Therapeutics. Speaker; Self; Amryt. L. Douyon: None. E.A. Oral: Advisory Board Member; Self; Amryt, Regeneron Pharmaceuticals. Consulting Fee; Self; Regeneron Pharmaceuticals, Amryt, Third Rock Ventures. Grant Recipient; Self; Regeneron Pharmaceuticals, Amryt. Research Investigator; Self; Novo Nordisk, Ionis Pharmaceuticals Inc., Fractyl, GI Dynamics, Rhythm Pharmaceuticals. Other; Self; Amryt. Background: Lipodystrophy syndromes (LD) are rare disorders characterized by varying degrees of adipose tissue deficiency that can predispose individuals to severe metabolic complications. Although these syndromes are traditionally subclassified based on inheritance patterns and the degree of adipose tissue loss, patients may exhibit highly heterogeneous clinical presentations. In this context, we report a unique case of partial lipodystrophy with an unusual distribution of adipose tissue that likely represents a novel syndrome and challenges conventional phenotypes. Clinical Case: A 60-year-old Puerto Rican female patient with medical history of type 1 diabetes mellitus (DM), obesity, hyperlipidemia, irritable bowel syndrome, asthma, and coronary artery disease was referred to us for unexplained asymmetric distribution of adipose tissue. She had chronic left posterolateral hip pain and lipoatrophy in her left lower extremity. Her medical history showed that she was born approximately 7 lbs., with no evidence of trauma during delivery. Her mother was given an unknown medication for improving circulation to the placenta. She had a morphea like rash on the arms and chest wall more prominent on the left upper body at birth. In addition, a dimple on her hip was noticed by her mother during the early stages of infancy. Despite the normal progression of neurological development (walking/climbing stairs), she always had a very mild limp. Also, her right arm was always 2 inches larger than her left arm. When she gained weight, she also put on more asymmetric weight on the left side of the abdomen and left lower torso. She had been treated with insulin injections since she was diagnosed with diabetes at the age of 11. She never demonstrated any islet cell specific antibodies. She had a normal weight until pregnancy at the age of 27, during which she gained 20 lbs. Her weight continued to increase over time, and the maximum was 212 lbs. Her examination reveals a BMI of 41.46 kg/m² with excess fat in the right arm, mid-section, left thigh, and left mons pubis. Conversely, only the left leg appears to demonstrate specific fat atrophy, with a near-total loss of adipose tissue starting from the mid-gluteal region. The hip MRI result reported moderate osteoarthritis of the left hip. EMG revealed signs of length-dependent sensorimotor axonal polyneuropathy and long duration/large amplitude motor unit potentials isolated only in the left medial gastrocnemius muscle. Triglyceride level was 73 mg/dL, HbA1c level was 6.8%, with an average total insulin dosage of around 43 IU/day. There was no history of pancreatitis due to hypertriglyceridemia. Conclusion: Our case highlights the heterogeneity of the lipodystrophy spectrum with a novel presentation of lipodystrophy. In addition, there may be homeostatic control of deposition of fat to seek symmetry between upper versus lower and right versus left sided depots. Presentation: 6/1/2024

High-temperature emulsification coupled with low-temperature gelation for fabrication of agarose microsphere implants with well-controlled size for skin tissue enhancement.

Soft tissue deficiencies profoundly impact the daily lives, and mental well-being of patients. Microspheres facilitate collagen synthesis by establishing a conducive environment for fibroblast growth. Existing synthetic polymer microspheres are typically prepared through emulsification and cross-linking at normal temperatures. However, residues of cross-linking agents can adversely affect biocompatibility, thereby limiting their biomedical applications. Agarose has garnered significant attention owing to its biodegradability and excellent biocompatibility. We have for the first time developed high-temperature emulsification coupled with low-temperature gelation for fabrication of agarose microsphere implants with well-controlled size for skin tissue enhancement. The agarose microspheres exhibited favorable sphericity and dispersion, possessing a uniform particle size with an average diameter of 37.24 μm. Furthermore, the microspheres demonstrated commendable injectability and biodegradability. Additionally, the implants displayed remarkable biocompatibility, effectively promoting the proliferation of human foreskin fibroblast-1 (HFF-1) cells. The microspheres exhibited no systemic toxicity and induced no hemolytic or thermogenic reactions. In photoaged mice skin models, the agarose microspheres augmented dermal density, and enhanced skin elasticity. The microspheres showed the capacity to stimulate the regeneration of collagen fibers. The agarose microspheres offer a novel avenue for soft tissue filling and hold significance in the field of tissue engineering and skin regeneration.

Impact of BMI on childhood growth, pubertal timing, and bone maturation: A comprehensive review and clinical implications

Introduction: Childhood obesity and undernutrition significantly affect growth patterns, pubertal timing, and bone maturation, leading to long-term health implications. Materials and Methods: A comprehensive literature review was conducted using databases such as PubMed, Google Scholar, and Scopus. Twenty-four studies, including a total of 40,732 patients, were analyzed from two tables examining the impact of BMI, growth patterns, pubertal timing, and bone maturation. Results: Children with high BMI exhibit accelerated linear growth during early childhood, that may be driven by elevated leptin levels, which stimulate growth before puberty. Despite early growth advantages, these children experience reduced height gain during adolescence due to advanced bone maturation and earlier closure of growth plates. High BMI is strongly linked to early puberty, especially in girls, as increased adipose tissue raises leptin levels, triggering early pubertal onset. Boys, however, show variability in pubertal timing, with severe obesity sometimes delaying puberty. In contrast, children with low BMI or undernutrition demonstrate delayed linear growth and delayed puberty. Nutritional deficits lead to reduced growth velocity, delayed pubertal onset, and extended pubertal periods due to a lack of adipose tissue and hormonal deficiencies in leptin and kisspeptin. Nutritional rehabilitation promotes catch-up growth, allowing for extended growth potential by delaying growth plate closure. However, full recovery may not occur in cases of prolonged or severe undernutrition. Advanced bone age in high BMI children shortens the pubertal growth spurt, while delayed bone maturation in undernourished children offers a prolonged period for potential growth, contingent on timely nutritional support. Conclusion: Timely interventions for childhood obesity and undernutrition are critical to improving growth outcomes and preventing long-term developmental delays. Early identification, nutritional rehabilitation, and lifestyle modifications can help optimize growth and pubertal development by addressing both advanced and delayed growth trajectories.

Is revision to anatomic shoulder arthroplasty still an option? A systematic review

Background With the historical complications when using total shoulder arthroplasty (TSA) to revise failed arthroplasties, and the success of the reverse prosthesis in the revision setting, the question arises whether revision to TSA is still a reasonable option? This systematic review examines revision to TSA and the factors associated with outcomes. Methods A systematic review was performed for studies of TSA used to revise a failed hemiarthroplasty or TSA. The primary outcome was implant failure leading to a repeat revision arthroplasty. Secondary outcomes included visual analog scale (VAS) pain scores, shoulder motion and other clinical outcomes of shoulder function. Data were pooled to generate representative frequency-weighted means. Results Thirteen studies were included, totaling 312 shoulders. Etiologies for revision included glenoid arthrosis (62%), glenoid component failure (36%), and other (2%). Of which, 39% of cases experienced complications and 12% required another arthroplasty revision. Secondary outcomes such as VAS pain, Constant, ASES and UCLA score improved, but none were statistically significant. Unsatisfactory outcomes were higher among patients with glenoid bone loss, instability, and soft tissue deficiencies. Discussion Revision to anatomic TSA can be an acceptable option in certain patients. However, the high rate of complications and glenoid loosening, makes this a limited approach for a revision to anatomic TSA procedure.

Implant-Supported Vertical Soft Tissue Augmentation for Severe Hard and Soft Tissue Deficiencies at Malpositioned Implants: A Case Report of a Mucogingival and Restorative Approach.

The management of severe mucogingival deformities surrounding malpositioned implants represents a complex issue with a high risk of aesthetic failure. The present case report describes a mucogingival and restorative approach for the treatment of severe localized peri-implant tissue deficiencies with interproximal bone loss combined with an interproximal gingival recession on the adjacent natural tooth. This consists of maintaining a non-restorable malpositioned implant, submerging it through one or multiple vertical soft tissue augmentations, according to the defect severity, and delivering a tooth supported bridge involving the adjacent natural teeth. The step-by-step surgical technique adopted for implant submergence and vertical soft tissue grafting, as well as the subsequent surgical and prosthetic interventions, are described, presenting results at 5 years from implant submergence and 3 years from prosthetic finalization.

Implant-Supported Vertical Soft Tissue Augmentation for Severe Hard and Soft Tissue Deficiencies at Malpositioned Implants: A Case Report of a Mucogingival and Restorative Approach.

Implant-Supported Vertical Soft Tissue Augmentation for Severe Hard and Soft Tissue Deficiencies at Malpositioned Implants: A Case Report of a Mucogingival and Restorative Approach.

Hemifacial microsomia – a review of the literature of current hypotheses of pathogenesis, and possible therapeutic methods

<b>Introduction:</b> Hemifacial microsomia (HFM) is the second most common congenital craniofacial anomaly.<b>Aim:</b> The aim of this study is to review data related to HFM.<b>Materials and methods:</b> Materials for the review were selected based on an analysis of publications published in the last 10 years.<b>Results:</b> There are three possible models of pathogenesis – vascular abnormalities, Meckel’s cartilage damage, and abnormal development of cranial neural crest cells – caused by genetic, maternal, and external factors. Symptoms results from disorders of structures originating from the first, and second branchial arches, most commonly resulting in mandibular hypoplasia, microtia or anotia, hypoplasia of the auditory ossicles, facial nerve paralysis, and soft tissue deficiency. The severity of the disorder varies greatly, depending on the number of structures involved, and the degree of penetration. The most common classification system (Orbit, Mandible, Ear, Nerve, Soft tissue; OMENS) has recently been proposed to assess the temporomandibular joint disc, and to assess disturbances originating from another structures. Other classifications such as FACIAL or ICHOM criteria have also been developed. The approach to treating each case should be individualized, primarily focusing on reconstructing the underdeveloped mandible, orthodontic treatment, creating the external ear, and filling soft tissue deficiencies.<b>Discussion:</b> The complexity of the condition is noted, as well as the need for interdisciplinary patient care.<b>Conclusions:</b> Through analysis of existing research, and clinical data, significant information regarding etiology, symptoms, possible classification systems, and therapeutic options has been gathered.

Abstract Mo031: Tissue deficiency and altered eicosanoids levels in rodent and human heart failure.

Introduction: The role of eicosanoids, especially epoxyeicosatrienoic acids (EETs), metabolites of arachidonic acid with cardio-renal activity, in heart failure (HF) remains unclear. Hypothesis: Altered eicosanoids turnover, both in rodent and human heart failure, is a part of the pathophysiology of HF and contributes to poor prognosis. Methods: We measured active EETs and their biologically inactive metabolites, dihydroxyeicosatrienoic acids (DHETs) in the left ventricle (LV) and renal tissue obtained from a rodent heart failure model induced by aortocaval fistula (ACF). We measured protein expression of CYP2C23 and CYP2J3 in the kidney cortex and LV tissue by Western blot analysis to evaluate EETs production and mRNA expression of soluble epoxide hydrolase (sEH), the enzyme responsible for the degradation of EETs to DHETs. In the translational part, firstly, we enrolled 50 patients with HF to measure plasma 14,15-epoxyeicosatrienoic acid (14,15-EET) and 14,15-dihydroxyicosatrienoic acid (14,15-DHET) levels using commercial ELISA kits and compared them with 25 age- and sex-matched controls. Secondly, 11 consecutive patients with HFrEF indicated to cardiac resynchronization therapy (CRT) were enrolled to measure plasmatic 14,15-EET and 14,15-DHET levels in venous, arterial, and coronary sinus (CS) blood samples and correlate them with N-terminal pro-B-type natriuretic peptide (NT-proBNP) from the same compartments. Results: ACF rats exhibited tissue deficiency of EETs in the LV and kidney compared to controls, probably mainly caused by increased EETs degradation by sEH (unchanged expressions of CYP2C23 and CYP2J3, increased mRNA of sEH and EETs/DHETs ratio). In humans, both of the measured eicosanoids were significantly higher in the HF group: 14,15-EET (91.3 ±25.7 vs. 64.95 ±35.4 ng/ml) and 14,15-DHET (10.58 ±2.06 vs. 9.07 ±1.60 ng/ml), p for both < 0.001. HF patients with 14,15-EET levels less than 60 ng/ml had worse short term mortality compared to those above. In CS, NT-proBNP levels negatively correlated with plasmatic 14,15-EET levels (r = -0.63, p = 0.03) and positively with the DHET/EET ratio (r = 0.73, p = 0.02). Plasmatic 14,15-EET nor 14,15-DHET levels in measured compartments did not differ statistically (p = 0.21, p = 0,64, respectively). In individual patients, the levels of both eicosanoids correlated across all compartments. Conclusions: Tissue deficiency of active eicosanoids and their altered turnover may play an important role in HF pathophysiology.

A novel surgical technique to resolve mucosal fenestration of a root apex: Apical tunnel surgery: A case report.

Endodontic surgery, which includes apex resection, retro-fill and some regeneration procedures, is a traditional way to deal with apex fenestration. The endodontic surgery could bring large flap, curtate root length, non-healing mucosa and soft tissue deficiency in the apex area. Other treatment options might be considered according to different etiological factors. Mucogingival surgery provides some ideas in accumulation of soft and hard tissues, especially some unique methods such as "tunnel technique" bringing us a view of minimal invasive surgery approach. A novel surgery named "apical tunnel surgery" was reported here to resolve a root apex exposure with the tunnel-like technique. A young female complained about root exposure of upper right anterior tooth without history of trauma or orthodontic treatment. The intraoral examination revealed a buccal root apex exposure about 3mm in diameter of #12 (FDI teeth numbering system). The tooth was slightly dark with Class 1 mobility. The periodontal situation was good and the occlusion check revealed no traumatic bite on #12. The cone-beam computed tomography (CBCT) showed a bone fenestration from the buccally lower 1/2 root surface to the apex and bone absorption around the apex. It also revealed a bone contour deficiency in #12 area. Root canal treatment, root surface debridement, and soft tissue combined with hard tissue accumulation were carried out in one tunnel-like surgery. Examination of 12-month follow-up showed a healed and thickened mucosa in the buccally apical region and CBCT showed the continuous lamina dura occupied the buccal aspect of #12 root apex. This new apical tunnel surgery provided soft and hard tissue accumulation in one minimal invasive way in the apex exposure case caused by bone fenestration and thin mucosa.

An apically positioned flap and free gingival graft around an implant

Following the ‘2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions,’ hard and soft tissue deficiencies have been debated in the literature with keratinized mucosa at the forefront. In this case report, the present author investigated whether an apically positioned flap and free gingival graft to increase keratinized mucosa and vestibular depth improved oral hygiene and patient comfort around an implant-retained upper complete denture. Using an apically positioned flap in combination with free gingival graft to augment the soft tissues around implants with hard and soft tissue deficiencies, increased both the keratinized mucosa and vestibular depth to correct the soft tissue deficiencies. This case report highlights the importance keratinized mucosa and vestibular depth has at the patient and site level in improving oral hygiene and patient comfort. This case report also supports the growing evidence that the ideal periodontal phenotype around implants is to have keratinized mucosa ≥2 mm and vestibular depth ≥4 mm. CPD/Clinical Relevance: This case report supports growing evidence that the ideal periodontal phenotype around implants is to have keratinized mucosa ≥2 mm and vestibular depth ≥4 mm.

Aesthetic and Functional Reconstruction of Periorbital Region Using Radial Forearm Free Flap.

This study describes the utilization of the radial forearm free flap (RFFF) for the restoration of severe soft tissue deficiency involving the upper and lower eyelids in three patients. This study is a retrospective review of the senior authors' clinical records for patients who presented with periorbital defect and underwent reconstruction with RFFF between 2018 and 2022. As a part of a comprehensive reconstructive surgery, we used the RFFF to deliver an ample amount of well-vascularized soft tissue. The flap's vessels were anastomosed to the ipsilateral facial vessels in all cases. Patients showed significant functional improvement, with complete eyelid closure achieved. No immediate postoperative complications were noted. RFFF demonstrated optimal outcomes in upper eyelid reconstruction.

Use of thigh fascia autograft for repairing a through-and-through soft tissue defect in the alveolar process: a clinical case

Relevance. In most cases, soft tissue defects can be addressed using standard local flap transposition methods. However, large defects and/or those with scar tissue changes, through-and-through defects involving destruction of both vestibular and palatal cortical plates, defects penetrating into the nasal cavity, and similar situations necessitate unconventional solutions utilizing external graft materials.Clinical case description. This clinical case details the use of an autograft from the wide fascia of the thigh (Fascia lata) to repair an atypical defect of the alveolar process in the maxilla, specifically in the area of teeth 1.2 and 1.1. This defect exhibited through penetration between the vestibule of the oral cavity and the oral cavity proper, along with a significant deficiency of local tissues required for defect closure. The results of clinical, instrumental, and CT examinations conducted before and after the surgical intervention are presented.Results. Objective clinical studies conducted three months post-operation showed complete closure of the defect in the alveolar process of the maxilla, with full epithelization in the postoperative intervention area.

Infections of reproductive organs in female rabbits

Symptomatic infertility is a temporary or permanent disturbance in reproductive function wherein the animal cannot become pregnant due to diseases of genital organs or systemic diseases. Since female rabbits, due to their precociousness and fertility, are often used for reproduction, the leading causes of symptomatic infertility in them are the absence of estrous cycles or their deficiency and inflammation of tissues of the reproductive system. Infertility is observed in female rabbits developing such infectious diseases as pasteurellosis, spirochetosis, and myxomatosis. It is due to these diseases that obstetric and gynecological pathology (vulvitis, vulvovaginitis, metritis, pyometra, mastitis), long-term infertility, and death of animals are recorded most often. External genitalia (vulva) and mammary glands are the main routes of infection in female rabbits. The most common microorganisms causing inflammatory processes in reproductive organs are non-specific, such as Staphylococcus and Pasteurella, and specific microbes, such as toxoplasma. Spirochetes, Listeria, and Salmonella are much less common. It has been found that on farms of different forms of ownership in the Dnipropetrovsk region, the most common infectious diseases in rabbits are myxomatosis (20 %), viral hemorrhagic disease (13 %), eimeriosis (30 %), pasarulosis (10 %), and spirochetosis (10 %). Inflammation of genital tissues, especially inflammatory processes in the uterus, is the most common disease in female rabbits. The general frequency of uterine diseases increases with age, reaching more than 50% in aged female rabbits. Endometritis was the most frequent inflammatory process diagnosed in 10 % of cases and was potentially purulent, catarrhal, lymphoplasmacytic, or enterohemorrhagic. Metritis was observed in 5 % of cases and pyometra in 3 %. Autopsy of forcibly slaughtered or dead animals revealed such uterine diseases as hydrometer and mucometer. Hydrometers and mucometers comprised 8 % of uterine diseases, and the average age of sick female rabbits was 3 years. The etiology remains unclear but is potentially related to endometrial hyperplasia or endometritis. However, in some cases, no underlying uterine disease was found. During acute infection of the organs of the reproductive system of female rabbits, a serous mucocatarrhal or mucopurulent exudate is released from the genital slit. Chronic inflammatory processes of the genital organs often occur without signs of disease or are manifested by decreased fertility or abortion.

Modifications to the WHISTLE Flap Procedure for Correction of Secondary Cleft Lip Deformities.

The whistle deformity, a deficiency of tissue in the central upper lip, is a consequential outcome of primary cleft lip repair. Among multiple described reconstructive options, the wide-hinged island swing transposition labial enhancement (WHISTLE) flap procedure by Grewal et al has been shown to be a reliable technique that restores the continuity of the orbicularis oris muscle and creates a more natural appearing tubercle and central lip element. This article aims to refine the WHISTLE flap procedure with the addition of tailored mucomuscular flaps and an upper lip-lengthening mucosal Z-plasty. A total of 11 patients with a whistle deformity were examined. All underwent the WHISTLE flap procedure with tailored mucomuscular flaps and a mucosal Z-plasty. The patients were followed for a period of from 6 to 51.5 months. Pre- and postoperative photographs were used for objective outcome comparison. From 2018 to 2023, a total of 11 patients with a whistle deformity were included in the final cohort, comprised four bilateral and seven unilateral cleft lips. Ten cases (90.1%) resulted in satisfactory postoperative cosmetic appearance and did not require further interventions. A single patient with a significant preoperative discrepancy between the upper and lower lip volumes had a postoperative residual deformity. None of the patients demonstrated any functional deficits associated with the procedure. The WHISTLE flap procedure with the proposed individual tailoring of the mucomuscular flap and Z-plasty for mucosal scar lengthening has excellent cosmetic outcomes and can be considered as the primary treatment modality in most patients with a whistle deformity.

EARLY RESULTS OF SHOULDER ARTHRODESIS WITH 3D-TITANIUM IMPLANTS FOR TREATMENT OF SEVERE GUNSHOT WOUNDS OF THE SHOULDER GIRDLE

As a result of large-scale war in Ukraine, the frequency of gunshot wounds of the upper extremities has increased dramatically, accompanied by massive damage to soft tissue, neurovascular plexuses, and significant bone deficiency, so their treatment with traditional methods is risky. This leads to the development of new treatment methods, in particular, techniques for shoulder arthrodesis. Objective. To investigate the effectiveness of shoulder arthrodesis using an individual 3D-titanium implant and or a locked compression plate (LCP) with bone autoplasty for the treatment of severe combat trauma of the upper extremity. Methods. In 2022–2023, 19 men aged 36.2 (24–52) years with severe combat trauma of the upper extremity underwent shoulder arthrodesis using individual 3D-titanium implants (n = 9) or LCP with bone autoplasty (n = 10). The follow-up period was 18 months. Individual 3D-implants were created in the CAD program Autodesk Fusion 360 and made of Ti6AI4V alloy by three- dimensional metal 3D-printing. The functional status of the shoulder joint was assessed by the Oxford Shoulder Score, VAS at 6 and 12 months after surgery. Fusion was checked radiographically at 1, 3, 6 and 12 months. Results. The average follow-up period was 12 months. Ankylosis of the shoulder joint was formed in 18 (95 %) patients, and clinical consolidation without final restructuring with a positive tendency to bone fusion was detected in one patient (5 %). Radiologically confirmed fusion in 8.5 months (6–12). After 12 months, a decrease in pain (VAS: 5 to 1 points; p < 0.001) and improvement in the condition of the shoulder (Oxford Shoulder Score: 25 to 40 points, p < 0.001) were found compared with 6 months. Conclusions. Treatment of severe combat trauma of the upper extremity by shoulder arthrodesis allows to eliminate pain and restore sufficient function to perform daily tasks one year after surgery. The combination of shoulder arthrodesis with individual 3D-implants resulted in the restoration of upper limb function in all 9 patients with massive bone and muscle defects.

The mechanical effects of chemical stimuli on neurospheres.

The formulation of more accurate models to describe tissue mechanics necessitates the availability of tools and instruments that can precisely measure the mechanical response of tissues to physical loads and other stimuli. In this regard, neuroscience has trailed other life sciences owing to the unavailability of representative live tissue models and deficiency of experimentation tools. We previously addressed both challenges by employing a novel instrument called the cantilevered-capillary force apparatus (CCFA) to elucidate the mechanical properties of mouse neurospheres under compressive forces. The neurospheres were derived from murine stem cells, and our study was the first of its kind to investigate the viscoelasticity of living neural tissues in vitro. In the current study, we demonstrate the utility of theCCFA as a broadly applicable tool to evaluate tissue mechanics by quantifying the effect that oxidative stress has on the mechanical properties of neurospheres. We treated mouse neurospheres with non-cytotoxic levels of hydrogen peroxide and subsequently evaluated the storage and loss moduli of the tissues under compression and tension. We observed that the neurospheres exhibit viscoelasticity consistent with neural tissue and show that elastic modulus decreases with increasing size of the neurosphere. Our study yields insights for establishing rheological measurements as biomarkers by laying the groundwork for measurement techniques and showing that the influence of a particular treatment may be misinterpreted if the size dependence is ignored.

Multiple biomaterials for immediate implant placement tissue repair: Current status and future perspectives

AbstractImmediate oral implant placement is a widely accepted technique, known for its efficacy in reducing treatment duration, surgical visits, and overall healing time. One of the primary challenges associated with immediate implant placement is the attainment of initial stability. The inevitable loss of bone and soft tissue after extraction poses a risk to implant osseointegration in both vertical and horizontal dimensions. Guided tissue regeneration/guided bone regeneration (GTR/GBR) is a well‐established method for periodontal regeneration. However, current GTR/GBR membranes lack tissue inherent regeneration properties and necessitate combination with grafts to enhance tissue recovery. In this context, biomaterials have emerged as a promising option due to their good biocompatibility, biodegradability, and bioactive properties. They present a potential alternative to standard autologous/allograft procedures. The field of biomaterials for bone regeneration has rapidly evolved, developing new guiding materials and engineering techniques. These advances have become integral in addressing tissue defects at the immediate implant site. Various materials such as bioceramics, natural polymers, and synthetic polymers have been used for tissue repair. This article undertakes an etiological examination of tissue deficiency associated with immediate implant placement. Additionally, it reviews the advantages and disadvantages of a variety of biomaterials, aiming to provide references for clinical treatment and areas for further investigation.