Direct Vasoconstrictor Effect Research Articles

Stakeholder pressure and SMEs sustainability information disclosures: why perceived benefits and sustainability knowledge matter

Purpose Sustainability research has become important than ever, due to the visible effects of business operations on the environment, and the increasing green consciousness among the various stakeholder groups. These stakeholder groups mount pressure on organizations, to inculcate sustainable practices in their operations. In light of the stakeholder-resource-based view, this paper aims to examine the direct effect of stakeholder pressure on sustainability information disclosures. The mediation effect of perceived benefits in the nexus amidst stakeholder pressure and sustainability information disclosures was also assessed. Lastly, the paper assessed the moderation effect of sustainability knowledge in the nexus between perceived benefits and sustainability information disclosures. Design/methodology/approach This research is quantitative in nature. Structured questionnaire was deployed as the data collection tool. Small and Medium Enterprises in Ghana formed the population. Data set from 258 Ghanaian small and medium enterprises was analyzed by the use of structural equation modeling. Findings Contrary to expectation, the study revealed that the effect of stakeholder pressure on sustainability information disclosures is positive, but statistically insignificant. The nexus between stakeholder pressure and sustainability information disclosures was revealed to be fully mediated by perceived benefits. Lastly, sustainability knowledge was revealed to positively moderate the relationship amidst perceived benefits and sustainability information disclosures. Originality/value This paper contributes to sustainability literature by demonstrating how stakeholder pressure influences sustainability information disclosures in the context of small and medium enterprises in an emerging economy.

“Thriving at work” or not? Research on the effects of performance pressure based on achievement motivation theory and two-factor theory

PurposeBased on achievement motivation theory and two-factor theory, this research aimed to synergize cooperative goal interdependence (refer to possessing incentive factors) and illegitimate tasks (refer to the absence of security factors) and build a triple interaction model in the process of performance pressure affecting employees’ thriving at work.Design/methodology/approachThis research collected 291 valid data through a two-point time-lagged method to test the direct effect of performance pressure on employees’ thriving at work and its moderating mechanism.FindingsPerformance pressure has a significant positive effect on employees’ thriving at work. Cooperative goal interdependence imposes an enhanced moderating effect between performance pressure and employees’ thriving at work. Illegitimate task imposes an interfering moderating effect between performance pressure and employees’ thriving at work and further interferes the enhanced moderating effect of cooperative goal interdependence.Practical implicationsUnder the premise of advocating for employees to internalize performance pressure originating from the organizational performance management system into their own achievement motivation, leaders should establish incentive systems and security systems for employees to realize self-achievement through the process of goal management and task management.Originality/valueThis research confirmed the joint determination of incentive effect and insecurity effect on employees’ achievement motivation by cooperative goal interdependence and illegitimate task and revealed the boundary conditions of employees’ choice of thriving at work.

Why and when does performance pressure encourage employee expediency? A moderated mediation model

PurposeEmployee expediency is a ubiquitous, unethical phenomenon in the workplace that is largely underresearched. Based on the tenets of conservation of resources (COR) theory, this study investigates the influence of excessive performance pressure on employees' expedient behaviour via moral disengagement. It further examines the moderating role of employees' moral identity in the relationship between performance pressure and employee expediency.Design/methodology/approachThe data were collected using a multi-wave paper-and-pencil survey amongst 388 sales associates working in pharmaceutical manufacturing companies in Bangladesh. A series of hierarchical regression analyses and bootstrapping techniques of the PROCESS macro were conducted to test the hypotheses.FindingsThe findings reveal that performance pressure significantly and positively affects employees' expediency. Additionally, moral disengagement partially mediates the positive relationship between performance pressure and employee expediency. Furthermore, moral identity moderates the direct effect of performance pressure on moral disengagement and the indirect effect of performance pressure on employee expediency through moral disengagement.Practical implicationsManagers are advised to consider the compatibility of economic and moral principles when defining performance targets or evaluating staff performance, as immoral behaviours harm organisations in the long run. Additionally, managers should emphasise candidates with high levels of sensitive moral qualities, such as integrity and moral behaviour, and their abilities should be given preference when hiring new employees, e.g. moral reasoning.Originality/valueThis pioneering study investigates the underlying psychological mechanisms and moral characteristics to unravel the association between performance pressure and employee expediency using the lens of COR theory. The study identified the moral consequences of performance pressure and mitigating strategies to reduce employee expedient behaviour.

부모의 성취압력이 아동 삶의 만족도에 미치는 영향

Objectives The primary objective of this research is to investigate the potential moderated mediating effect of grit in the relationship between parental achievement pressure, children's academic stress, and life satisfaction.
 Methods In pursuit of this aim, the research employed the data from the 11th wave (2018) of the Korean Children Panel Study conducted by the Korea Institute of Child Care and Education (KICCE), with a sample size of N=1,262. To ascertain the relationships between the main variables, preliminary descriptive statistics and Pearson correla-tion coefficients were examined. Mediation effects and moderated mediation effects were tested using the Process Macro programs 1, 4, and 7.
 Results Firstly, the direct effect of parental achievement pressure on children's life satisfaction was found to be non-significant. However, a significant indirect effect was observed, mediated by children's academic stress, in-dicating an indirect influence on life satisfaction. Secondly, children's grit was identified as a significant moderator, mitigating the impact of parental achievement pressure on children's stress and exerting a positive influence on their life satisfaction. Specifically, higher levels of children's grit were associated with a diminished conditional in-direct effect of parental achievement pressure on children's stress, ultimately leading to elevated levels of child-ren's life satisfaction.
 Conclusions To mitigate children's academic stress and enhance their life satisfaction, it is imperative to mitigate parental achievement pressure and foster children's grit.

Neuropeptide Y: Direct vasoconstrictor and facilitatory effects on P2X1 receptor-dependent vasoconstriction in human small abdominal arteries

Neuropeptide Y (NPY) is co-released with norepinephrine and ATP by sympathetic nerves innervating arteries. Circulating NPY is elevated during exercise and cardiovascular disease, though information regarding the vasomotor function of NPY in human blood vessels is limited. Wire myography revealed NPY directly stimulated vasoconstriction (EC50 10.3 ± 0.4 nM; N = 5) in human small abdominal arteries. Maximum vasoconstriction was antagonised by both BIBO03304 (60.7 ± 6%; N = 6) and BIIE0246 (54.6 ± 5%; N = 6), suggesting contributions of both Y1 and Y2 receptor activation, respectively. Y1 and Y2 receptor expression in arterial smooth muscle cells was confirmed by immunocytochemistry, and western blotting of artery lysates. α,β-meATP evoked vasoconstrictions (EC50 282 ± 32 nM; N = 6) were abolished by suramin (IC50 825 ± 45 nM; N = 5) and NF449 (IC50 24 ± 5 nM; N = 5), suggesting P2X1 mediates vasoconstriction in these arteries. P2X1, P2X4 and P2X7 were detectable by RT-PCR. Significant facilitation (1.6-fold) of α,β-meATP-evoked vasoconstrictions was observed when submaximal NPY (10 nM) was applied between α,β-meATP applications. Facilitation was antagonised by either BIBO03304 or BIIE0246. These data reveal NPY causes direct vasoconstriction in human arteries which is dependent upon both Y1 and Y2 receptor activation. NPY also acts as a modulator, facilitating P2X1-dependent vasoconstriction. Though in contrast to the direct vasoconstrictor effects of NPY, there is redundancy between Y1 and Y2 receptor activation to achieve the facilitatory effect.

Negative-pressure helmet restores cerebral hemodynamic parameters in sinking skin flap syndrome: a case report

Background: Sinking skin flap syndrome (SSFS) is a rare complication of decompressive craniectomy (DC) and causes a wide range of neurological deficits. Its pathophysiology remains debatable, however cranioplasty may decrease the symptoms of SSFS by reducing the direct effect of atmospheric pressure on the brain and allowing the correction of cerebral blood flow (CBF) and cerebral metabolism.Case Report: A 36-year-old woman underwent DC for a right frontal hematoma and signs of increased intracranial pressure following the resection of a right frontal arteriovenous malformation. Subsequently, she developed SSFS, altered neurological status with a Glasgow Coma Scale (GCS) score of 8/15, and bacterial-resistant meningitis. We applied a custom-shaped negative pressure helmet on the bone defect and used invasive and noninvasive techniques to measure the changes in intracranial pressure, CBF and cerebral oxygen saturation. Despite improvements in the cerebral physiological parameters, the neurological status did not improve (GCS score, 8/15).Conclusions: To our knowledge, this is the first reported case of SSFS treated with a negative-pressure helmet and subsequent changes in cerebral parameters that were monitored invasively and noninvasively.

Investigating the Key Drivers of Impulsive Buying Behavior in Live Streaming

Live streaming has become popular among various e-commerce models. As an efficient way of marketing, live streaming can stimulate consumers' impulse purchasing behavior by creating a compelling experience, flow experience. Even though research on flow experience has been applied to understand consumer behavior in e-commerce, few studies have been conducted in live streaming e-commerce, let alone the influencing factors. Drawing on the stimulus-organism-response (S-O-R) model, this paper examines the impact of cognitive stimuli and perceptive stimuli on the urge to buy impulsively via flow experience. The results indicate that information content, website design, time pressure, and personalized recommendation positively relate to flow experience and the urge to buy impulsively. They also find the direct effect of time pressure and personalized recommendation on the urge to buy impulsively. The theoretical contributions and the practical implications for e-commerce live streaming are presented.

Corneal endothelium, retinal nerve fiber layer, ganglion cell complex, and perimetry measurements in normal eyes and those with primary open-angle glaucoma.

Corneal endothelial cell (CEC) loss in glaucoma can be attributed to the direct compressive effect of elevated intraocular pressure. Herein, we aimed to evaluate specular microscopic changes in CEC count and morphology in correlation to retinal nerve fiber layer (RNFL) changes detected by spectral-domain optical coherence tomography (SD-OCT) in early and advanced primary open-angle glaucoma (POAG). This descriptive-analytical study involved patients with medically controlled POAG versus non-glaucomatous patients of the same age group. Specular microscopy, visual field testing, and SD-OCT of the RNFL and macular ganglion cell complex (GCC) were performed. Eyes with POAG were further subcategorized into early and advanced stages. The study included 130 eyes of 130 participants; 70 were eyes with POAG (40 eyes with early-stage POAG, 30 eyes with advanced-stage POAG), and 60 were healthy eyes. The groups were comparable regarding mean age and sex. No significant difference was found in corneal parameters between healthy eyes, eyes with early POAG, and eyes with advanced POAG (all P > 0.05). In eyes with early-stage POAG, a significant negative correlation was found between the coefficient of variation (CV) and superior RNFL thickness (r = - 0.5; P = 0.018), and between the percentage of hexagonal cells (hexagonality) and vertical cup-to-disc ratio (r = - 0.43; P = 0.035). A significant positive correlation was found between hexagonality and superior as well as inferior RNFL thickness (r = + 0.53; P = 0.008 and r = + 0.50; P = 0.015, respectively). However, in the advanced glaucomatous eyes, no significant correlation was found between RNFL thickness and CEC parameters. CEC parameters were not affected in eyes with early or advanced POAG compared with healthy eyes, despite a significant thinning of RNFL and macular GCC. In eyes with early-stage POAG, a significant correlation was found between morphological characteristics of CECs, such as CV and hexagonality, with superior and inferior RNFL thickness in the optic nerve head on SD-OCT images. Future longitudinal studies with larger sample sizes are needed to verify our results.

Supercritical carbon dioxide utilization in drug delivery: Experimental study and modeling of paracetamol solubility

In the present study, the solubility of paracetamol in supercritical CO2 is measured at temperatures between 311 and 358 K and pressures between 95 and 265 bar. It was shown that the solubility of paracetamol through a static solubility measurement method was between 0.3055 × 10−6 to 16.3582 × 10−6 based on mole fraction. The obtained experimental solubility data revealed the direct effect of pressure on the paracetamol experimental data, while the temperature has a dual effect of both increasing and decreasing effect considering the shifting point known as crossover pressure which was measured to be around 110 bar for paracetamol. Besides, two theoretical approaches were applied to predict the paracetamol experimental results. The experimental data were modeled with two various equations of state (EoSs) i.e. Peng-Robinson EoS and the simplified perturbed chain statistical associating fluid theory (sPC-SAFT) EoS, which their binary interaction parameters were optimized by using genetic algorithm. The obtained results demonstrated the sPC-SAFT EoS predicted the solubility of paracetamol with more accuracy (the average percent deviation was equal to 2.5215), especially at higher pressures. Furthermore, four well-known semi-empirical density-based correlations namely Mendez-Santiago and Teja (MST), Kumar-Johnston (KJ), Bartle et al., and Garlapati and Madras models were applied for modeling the solubility of paracetamol experimental data. According to self-consistency test, KJ model presented more accurate correlative capability with average percent deviation about 4.09%. As a final point, the rapid expansion of supercritical solution process was performed to reduce particle size of paracetamol and mean particle size of paracetamol was calculated based on EoSs and mathematical modeling.

Determinants of Chinese Provincial Governments’ Responses to the 2018 Vaccine Scandal

Scholars who study governance in authoritarian countries have long highlighted the importance of fiscal capacity and pressure from the central government in determining the responsiveness and policy changes of subnational governments. However, policy orientation is also important in shaping how subnational governments react to a crisis. Using provincial governments’ responses during the 2018 Chinese vaccine scandal, I find strong evidence that an emphasis on public health, as well as early responses by neighboring provinces, increased the likelihood of a quick response. Moreover, issue salience minimized the direct effect of pressure from the national government. An additional paired case study of the provinces of Hubei and Hunan shows that the importance accorded by the provincial government to public health policy was implemented at the sub-provincial level through China’s one-level-down cadre management system; it also may explain Hubei’s delay in responding to COVID-19 at an early stage.

The Anti-CGRP Antibody Fremanezumab Lowers CGRP Release from Rat Dura Mater and Meningeal Blood Flow.

Monoclonal antibodies directed against the neuropeptide calcitonin gene-related peptide (CGRP) belong to a new generation of therapeutics that are effective in the prevention of migraine. CGRP, a potent vasodilator, is strongly implicated in the pathophysiology of migraine, but its role remains to be fully elucidated. The hemisected rat head preparation and laser Doppler flowmetry were used to examine the effects on CGRP release from the dura mater and meningeal blood flow of the subcutaneously injected anti-CGRP monoclonal antibody fremanezumab at 30 mg/kg, when compared to an isotype control antibody. Some rats were administered glycerol trinitrate (GTN) intraperitoneally to produce a migraine-like sensitized state. When compared to the control antibody, the fremanezumab injection was followed by reduced basal and capsaicin-evoked CGRP release from day 3 up to 30 days. The difference was enhanced after 4 h of GTN application. The samples from the female rats showed a higher CGRP release compared to that of the males. The increases in meningeal blood flow induced by acrolein (100 µM) and capsaicin (100 nM) were reduced 13–20 days after the fremanezumab injection, and the direct vasoconstrictor effect of high capsaicin (10 µM) was intensified. In conclusion, fremanezumab lowers the CGRP release and lasts up to four weeks, thereby lowering the CGRP-dependent meningeal blood flow. The antibody may not only prevent the released CGRP from binding but may also influence the CGRP release stimulated by noxious agents relevant for the generation of migraine pain.

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association.

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association.

The Effect of Work Environment and Work Pressure on Job Satisfaction and the Impact on Employees Performance of West Jakarta DJP Regional Office

This study aims to determine the effect of work environment and work pressure on employee performance, the effect of the work environment on employee performance, the effect of job pressure on employee performance, the effect of job satisfaction on employee performance, the influence of the work environment on employee performance through job satisfaction variables, the effect of job pressure on employee performance through job satisfaction variables. The study was conducted on employees of the West Jakarta DJP Regional Office. The sampling technique used the saturated sample method involving 86 people. Data analysis using path analysis. The results of the study indicate that the work environment and work pressure variables affect employee performance. The calculated F value is 32.598 and the significance is 0.05. This value is smaller than 0.05. The r-squared value of 44.0% means that the work environment and work pressure variables affect employee performance by 44.0% while the rest is influenced by other variables that are not included in the equation model. Work environment variables affect employee performance partially. The t value is 7,310. The significance value is 0.00. This significance value is smaller than 0.05. The value of r squared is 38.9%. This means that the effect of work environment variables on employee performance is 38.9% and the rest is influenced by other variables that are not included in the equation model. The work pressure variable partially affects employee performance. The t value is 2.055. The significance value is 0.043. This significance value is smaller than 0.05. The value of r squared is 0.048. This means that the influence of the work pressure variable on employee performance is 4.8% and the rest is influenced by other variables that are not included in the equation model. Job satisfaction variable affects employee performance partially. The t value is 5,610. The significance value is 0.00. This significance value is smaller than 0.05. The value of r squared is 0.273. This means that the influence of the satisfaction variable on employee performance is 27.3% and the rest is influenced by other variables that are not included in the equation model. The effect of the work environment on employee satisfaction is 0.624. The effect of the work environment on employee satisfaction through job satisfaction is 0.385 x 0.522 = 0.201. In this case, the direct effect is greater than the indirect effect, so it can be said that the job satisfaction variable is not an intervening variable. The direct effect of work pressure on employee satisfaction is 0.219. While the effect of work pressure on employee performance through job satisfaction is 0.164 x 0.522 = 0.086. In this case, the direct effect is greater than the indirect effect, so it can be said that the job satisfaction variable is not an intervening variable.

DİYALİZ İLİŞKİLİ PNÖMOSEFALİ VAKASINDA HİPERBARİK OKSİJEN TEDAVİSİ

The presence of gas in the cranial cavity is called “pneumocephalus”, and is usually seen after invasive surgical procedures. Although symptoms are non-specific, such as headache, it can cause neurological distortion, coma, and death. Oxygen therapy is the most effective way to treat pneumocephalus and accelerates the reabsorption of the air. Hyperbaric oxygen treatment (HBOT), with its direct high pressure effect, causes the air mass to shrink. In the case reported in this paper, the pneumocephalus manifested with the symptom of sudden loss of consciousness and the etiology was an invasive intervention of dialysis catheter placement while the patient was in a sitting position. HBOT was applied as an emergency treatment, after which a dramatic radiological improvement was detected with computed tomography. Although this patient needed consecutive HBOT sessions for the best result, only a single session of HBOT could be applied because she was under the observation in the intensive care unit of another hospital due to the lack of space in the intensive care unit of our hospital. One of the main points is that the clinicians should not decide to cease HBOT only after the first session. Consecutive HBOT sessions can dramatically improve the radiological and clinical findings in these case

Adoption of green supply chain management practices in multi-tier supply chains: examining the differences between higher and lower tier firms

Customer pressure has been widely discussed as the primary driver of green supply chain management (GSCM) practices. However, relatively little is known about supplier capabilities as a key mediator for GSCM practice adoption. Drawing from the resource dependence theory (RDT), we investigate how the interplay between customer pressure and supplier capabilities affects GSCM practice adoption along multi-tier supply chains. We test our hypotheses using multiple regression analysis based on a sample of 284 manufacturing firms operating at different tiers of a supply chain. Our results indicate that the supplier capabilities mediate the direct effect of customer pressure on the adoption of GSCM practices for focal firms. Specifically, we find a full mediation effect of supplier capabilities for higher-tier (i.e. OEM and system supplier) firms and a partial mediation effect for lower-tier (i.e. component and raw material) firms. Our findings provide support for the RDT perspective regarding GSCM. The focal firm’s adoption of GSCM practices as a response to customer pressure is dependent on the level of green resources and capabilities available from their suppliers. The level of such resource dependence varies between focal firms at higher- and lower-tier positions in a multi-tier supply chain.

Elusive Toxin in Cleistanthus collinus Causing Vasoconstriction and Myocardial Depression: Detailed NMR Analyses and Biological Studies of Cleistanthoside A.

Cleistanthus collinus leaf extracts are consumed for suicidal purposes in southern India. The boiled decoction is known to be more toxic than the fresh leaf juice. Although several compounds have been isolated and their toxicity tested, controversy remains as to which compounds are responsible for the high level of toxicity of C. collinus. We report herein that cleistanthoside A is the major toxin in the boiled aqueous extract of fresh leaves and causes death in rats in small doses. The toxicity of the boiled extract prepared in the manner described can be attributed entirely to cleistanthoside A. Cleistanthin A could also be isolated from the boiled extract, albeit in trace amounts. As hypotension not responding to vasoconstrictors is the cause of death in patients who have consumed the boiled extract, effects of cleistanthoside A on the determinants of blood pressure, namely, force of cardiac contraction and vascular resistance, were tested in isolated organ experiments. Cleistanthoside A has a direct vasoconstrictor effect; however, it inhibits ventricular contractility. Therefore, the notion that the shock in C. collinus poisoning is of vascular origin must be considered carefully, and the possibility of cardiogenic shock must be studied. We present the crystal structure of cleistanthin A and show the potency of fast NMR methods (NOAH4-BSCN-NUS) in the full spectral assignment of cleistanthoside A as a real-world sample of a natural product. We also compare the results of the NOAH4-BSCN-NUS NMR experiments with conventional NMR methods.

Modelling tilt noise caused by atmospheric processes at long periods for several horizontal seismometers at BFO—a reprise

SUMMARY Tilting of the ground due to loading by the variable atmosphere is known to corrupt very long period horizontal seismic records (below 10 mHz) even at the quietest stations. At BFO (Black Forest Observatory, SW-Germany), the opportunity arose to study these disturbances on a variety of simultaneously operated state-of-the-art broad-band sensors. A series of time windows with clear atmospherically caused effects was selected and attempts were made to model these ‘signals’ in a deterministic way. This was done by simultaneously least-squares fitting the locally recorded barometric pressure and its Hilbert transform to the ground accelerations in a bandpass between 100 and 3600 s periods. Variance reductions of up to 97 per cent were obtained. We show our results by combining the ‘specific pressure induced accelerations’ for the two horizontal components of the same sensor as vectors on a horizontal plane, one for direct pressure and one for its Hilbert transform. It turned out that at BFO the direct pressure effects are large, strongly position dependent and largely independent of atmospheric events for instruments installed on piers, while three post-hole sensors are only slightly affected. The infamous ‘cavity effects’ are invoked to be responsible for these large effects on the pier sensors. On the other hand, in the majority of cases all sensors showed very similar magnitudes and directions for the vectors obtained for the regression with the Hilbert transform, but highly variable from event to event especially in direction. Therefore, this direction most certainly has to do with the gradient of the pressure field moving over the station which causes a larger scale deformation of the crust. The observations are very consistent with these two fundamental mechanisms of how fluctuations of atmospheric surface pressure causes tilt noise. The results provide a sound basis for further improvements of the models for these mechanisms. The methods used here can already help to reduce atmospherically induced noise in long-period horizontal seismic records.

Design and Testing of a High Frequency Thermoacoustic Combustion Experiment

This paper presents a novel experiment in an atmospheric cylindrical single-jet combustor, designed to exhibit high-frequency radial thermoacoustic instabilities. The experimental configuration was designed based on an a priori set of comprehensive numerical investigations, the experiments were conducted with pressure and temperature probes, and large-eddy simulations of the final experiments were performed. The results from simulation and experiment were compared and showed reasonable agreement in the amplitude, frequency, and mode shape of the self-excited instability in the unstable operating point and no thermoacoustic oscillations in the stable operating point. Various parameters have been varied to assess their effect on thermoacoustics, including variations of mass flow rate, of equivalence ratio, and combustor wall temperatures. For the unstable cases, direct effect of pressure on density was found to drive the thermoacoustic oscillations.

A review of the Turned-down Onto Pericapsular-tissue Hemisectioned Amputated Toe (TOPHAT) flap for wound coverage during ray amputations of the toes

IntroductionExposure of the adjacent Metatarsal-Phalangeal Joint (MTPJ) commonly occurs after application of Topical Negative Pressure Wound Therapy (TNPWT) for a ray amputation wound. This is due to mechanical soft tissue erosion or trauma to the adjacent digital artery from direct pressure effect. This results in toe gangrene requiring a ray amputation and ultimately a larger wound bed. We describe the use of the Turned-down Onto Pericapsular-tissue Hemisectioned Amputated Toe (TOPHAT) flap – a filleted toe flap to protect the adjacent MTPJ capsule combined with a novel Negative Pressure Wound Therapy with instillation and dwell-time (NPWTi-d) dressing technique. The flap protects the adjacent joint capsule and reduces the wound burden whilst allowing the wound to benefit from TNPWT, thereby accelerating wound healing. Material and methodsA retrospective review was conducted of patients with toe gangrene requiring ray amputation that underwent the TOPHAT flap on in our institution from 2019 and 2020. Complications such as wound dehiscence, hematoma, flap necrosis and secondary infection were recorded. Other outcomes recorded were time taken to final skin grafting and time taken for complete wound epithelialization. Results9 patients underwent treatment with the TOPHAT flap. 2 patients had flap necrosis. 7 patients progressed to definitive skin coverage with skin grafting. One patient subsequently had progressive arterial disease despite successful skin grafting and required above knee amputation. The mean time to final skin grafting and complete wound epithelialization was 49.5 days and 107.5 days respectively. All patients were satisfied with the outcomes and were able to return to their pre-morbid function. ConclusionsThe TOPHAT flap has a consistent vascular supply that provides durable soft tissue coverage. It is a robust and easily reproducible technique to accelerate wound healing after ray amputations even in patients with peripheral vascular disease.

Auto-amputated ovary- rare cause of intestinal obstruction in a neonate: A case report

Background: Congenital ovarian cysts rarely auto amputate. An unusual complication of this event is secondary intestinal obstruction. The mechanism may be consequent to a direct pressure effect or to adhesions induced by the cyst. Case Presentation: A neonate presented with an abdominal mass and intestinal obstruction. On exploration, she had a mass hanging over the small intestine and one ovary was absent. Mass was excised and it turned out to be an auto-amputated ovary Conclusion: Although it is a rare pathology in neonates, surgeons must suspect it, particularly if an ovary is absent.