Partial Incision Research Articles

Central Tunnel Technique and Fat Grafting for Surgical Correction of Inverted Nipples and Introduction of a Treatment Algorithm.

Inverted nipples are prevalent in 3% to 10% of women and can often cause functional, psychological, and aesthetic problems. The authors sought to treat inverted nipples and restore the aesthetic appearance of the nipple while minimizing ductal disruption, preserving the ability to breast-feed, and reducing recurrence rates. A retrospective review was performed on a total of 161 inverted nipples in 86 consecutive patients who underwent correction of inverted nipples at Oslo Plastic Surgery Clinic. Mean age at operation was 28.7 years and mean follow-up period was 14 months. A novel technique with central tunnelization of the retracted fibers/ducts was employed in 39 patients (45%); partial incision of the center of the inversion through a tunnel in 31 patients (36%); and total cut of the lactiferous ducts in 16 patients (19%). Fat grafting was utilized as support in 14 patients (26 nipples). Postoperatively, nipples were suspended for 4 weeks with a manually constructed device. Most patients had moderate (grade 2, 40 patients) or severe (grade 3, 52 patients) nipple inversion. Infection occurred in 4 patients and 2 patients had local irritation. Recurrence was seen in 32 patients (55 nipples) after the first operation, in 6 patients (6 nipples) after the second operation, and in 1 patient (1 nipple) after the third operation. The authors propose a treatment algorithm that addresses important therapeutic goals when treating inverted nipples. Clinical examination is crucial to determine the method to be employed. The new central tunnel method and fat grafting to support the nipple are promising, although additional follow-up is necessary.

Kocher-Langenbeck approach combined with partial proximal Watson-Jones incision for acetabular fractures involving weight-bearing area

Objective To evaluate clinical outcomes of the Kocher-Langenbeck (K-L) approach combined with partial proximal Watson-Jones incision for the treatment of acetabular fractures involving the weight-bearing area. Methods From January 2012 to January 2017, 20 patients were treated by the K-L approach combined with partial proximal Watson-Jones incision for acetabular fracture involving the weight-bearing acetabular dome. They were 13 males and 7 females, with an average age of 40.7 years (range, from 22 to 67 years). According to the Letournel-Judet classification, there were 8 posterior wall fractures, one transverse fracture, one T-shaped fracture, one transverse and posterior wall fracture, 3 posterior column and posterior wall fractures, and 6 double-column fractures. All patients received open reduction and internal fixation with plates and screws. The outcomes of reduction were evaluated at follow-ups according to the Matta criteria. The hip function was evaluated according to the modified Merle d'Aubigne-Postel criteria and the abductor strength by the American Medical Research Council criteria at final follow-ups. Results All the 20 patients were followed up for an average of 8.2 months (range, from 7 to 21 months). They all obtained bony union after 10 to 18 weeks (average, 11.4 weeks). No fracture displacement, internal fixation loosening or deep infection occurred. According to the Matta criteria, anatomic reduction was achieved in 13 cases, satisfactory reduction in 6 cases, and unsatisfactory in one (a satisfactory rate of 95%). The modified Merle d'Aubigne-Postel scoring for the hip function at the final follow-ups yielded 9 excellent cases, 7 good cases, 3 fair cases and one poor case (an excellent to good rate of 80%). Ectopic ossification of Brooker grade Ⅰ occurred in one case. The abductor strength was rated as grade Ⅳ in 3 cases and as grade Ⅴ in 17. Conclusions In the treatment of acetabular fractures involving the acetabular dome, the K-L approach combined with partial proximal Watson-Jones incision can increase the operation view of the weight-bearing area, enhance the anatomic matching of femoral head and acetabular roof, and reduce the difficulties in reduction and fixation. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Surgical approach

Punch 'scoring': a technique that facilitates melanoma diagnosis of clinically suspicious pigmented lesions.

Early recognition and accurate diagnosis underpins melanoma survival. Identifying early melanomas arising in association with pre-existing lesions is often challenging. Clinically suspicious foci, however small, must be identified and examined histologically. This study assessed the accuracy of punch biopsy 'scoring' of suspicious foci in excised atypical pigmented skin lesions to identify early melanomas. Forty-one excised pigmented skin lesions with a clinically/dermoscopically focal area of concern for melanoma, with the suspicious focus marked prior to excision with a punch biopsy 'score' (a partial incision into the skin surface), were analysed. Melanoma was diagnosed in nine of 41 cases (22%). In eight of nine cases (89%) the melanoma was associated with a naevus, and in seven of nine (88%) cases the melanoma was identified preferentially by the scored focus. In six of nine cases (67%), the melanoma was entirely encompassed by the scored focus. In one case of melanoma in situ, the diagnostic material was identified only on further levelling through the scored focus. In 28 of 32 of non-melanoma cases (88%), the scored focus identified either diagnostic features of a particular lesion or pathological features that correlated with the clinical impression of change/atypia including altered architecture or distribution of pigmentation, features of irritation or regression. The 'punch scoring technique' allows direct clinicopathological correlation and facilitates early melanoma diagnosis by focusing attention on clinically suspicious areas. Furthermore, it does not require special expertise in ex-vivo clinical techniques for implementation. Nevertheless, in some cases examination of the lesion beyond the scored focus is also necessary to make a diagnosis of melanoma.

Internal fixation for tibial plateau fractures involving anteromedial margin caused by hyperextension varus injury

Objective To report the operative procedures and clinical outcomes of open reduction and internal fixation for the treatment of tibial plateau fractures involving anteromedial margin caused by hyperextension varus injury. Methods From December 2013 to December 2015, 11 patients with tibial plateau fracture involving anteromedial margin caused by hyperextension varus injury were treated at our department. They were 6 males and 5 females with a mean age of 42.3 years (range, from 19 to 65 years). Simple medial column fracture happened in 2, fractures of medial and lateral columns in 4, fractures of medial and posterior columns in 3, and 3-column fractures in 2 cases. The cortical bone fractures of anteromedial margin were fixated by open reduction and internal fixation using self-clipped joint line plating. Bone grafting was conducted if necessary. Results The 9 patients were followed up for an average of 17.6 months (range, from 12 to 30 months). All the fractures healed. The average time for radiographic bony union and full weight bearing was 11.4 weeks (range, from 9 to 14 weeks) and 16.1 weeks (range, from 14 to 19 weeks), respectively. On average, the Rasmussen’s radiological grading scored 16.9 (range, from 14 to 18) immediately after operation; the Hospital for Special Surgery scores of all the patients at 12 months postoperatively averaged 89.1 (range, from 75 to 94), yielding an excellent to good rate of 92.3%. The average range of motion of the affected knee was from 2.3° to 125.1°. There were significant differences in both tibial plateau angle and posterior slope angle on radiography between preoperation and postoperation (P 0.05). Partial incision necrosis occurred postoperatively in one case which was uneventfully healed after wound management. One case complicated with preoperative common peroneal nerve injury reported dorsal sense of numbness which was healed after administration of neurotrophic drugs. No screw loosening, plate breakage or fixation failure was found during follow-ups. Conclusions It is difficult to treat the tibial plateau fractures involving anteromedial margin caused by hyperextension varus injury. Internal fixation with joint line plating is an appropriate treatment for this fracture pattern, leading to satisfactory clinical outcomes. Key words: Tibial fractures; Fracture fixation, internal; Bone plates; Hyperextension; Varus

Double-Fold Operation with a Partial Incision and Continuous Buried Suture

Double-Fold Operation with a Partial Incision and Continuous Buried Suture

Subclinical Ptosis Correction: Incision, Partial Incision, and Nonincision: The Formation of the Double Fold.

Surgery to create eyelid folds accounts for the highest percentage of surgeries in Asians and Koreans who receive the surgery on the upper eyelid 2 to 3 times during their lifetimes for functional or cosmetic reasons. Patients are generally satisfied with the results-the eyes becoming brighter and bigger via the improvement of pseudoptosis by fold creation. The recent trend is to seek the "perfect" eye: a vertically and horizontally big palpebral fissure with more than 90% cornea showing. Surgery of the levator aponeurosis-Müller muscle complex is required to expose the cornea, except in those patients who inherently have good levator-Müller function. However, many complications occur during surgeries of the levator aponeurosis-Müller muscle complex, which increase the reoperation rate. Here, the authors briefly summarize recent experiences correcting subclinical ptosis using the nonincision, incision, and partial incision methods.

133 Long-term results after partial plaque excision and grafting with collagen fleece in Peyronie's disease

INTRODUCTION AND OBJECTIVES: Grafting procedures are preferred for the surgical treatment in advanced Peyronie’s disease (PD) to avoid penile shortening. Autologous and non-autologous grafts are available for defect closure of the tunica albuginea after partial plaque excision or incision. Today, non-autologous grafts are widely used to reduce morbidity. We report long-term results of a prospective study analyzing the outcomes after partial plaque excision and grafting with a self-adhesive collagen fleece. METHODS: PD patients with penile deviation in stable disease and unable to fulfil coitus were included in this study at two institutions. After partial plaque excision, grafting was performed in all cases with a ready-to-use collagen fleece coated with tissue sealant (TachoSil , Takeda, Berlin, Germany). Results of correction were documented intraoperatively by artificial erection. Preand postoperative evaluation consisted of IIEF-5, penile length, sonography and artificial erection. RESULTS: From December 2004 to July 2013 n1⁄4290 patients underwent surgery. Mean patient age was 57.0 years (range: 33-73). 87.6% of patients had dorsal deviation and 12.4% lateral or ventral deviation. In 244/290 patients (84.1%) a partial plaque excision with collagen fleece grafting was performed. 46/290 patients (15.9%) underwent a Nesbit-procedure. Mean operating time was 80.8 minutes (range: 60-165) in patients with a grafting procedure. Totally straightness of the penis was achieved in 238/244 (97.5%) patients. After a mean long-term follow-up of 36.8 months (range: 3-100), erectile function improved in 23.3%, remained unchanged in 66.0%, and worsened in 10.7% of patients. Mean penile length before and after surgery was 14.3 cm (range: 6-21) and 15.0 cm (range: 8-22), respectively. 230/244 patients (94.3%) had normal glans sensibility. CONCLUSIONS: Grafting by a ready-to-use collagen fleece following partial plaque excision in PD is safe and successful. Longterm results are encouraging. A major advantage of the collagen fleece is reduced operating time and its easy application. Moreover an additional haemostatic effect is provided. The collagen fleece represents a feasible alternative to other grafts for PD reconstructive surgery.

Chemical and microstructural transformations in lithium iron phosphate battery electrodes following pulsed laser exposure

Multi-layer lithium iron phosphate (LFP) battery electrodes are exposed to nanosecond pulsed laser radiation of wavelength 1064nm. Test parameters are chosen to achieve characteristic interaction types ranging from partial incision of the active coating layers only to complete penetration of the electrodes with high visual cut quality. Raman spectroscopy is performed on unexposed regions and at points approaching each incision, highlighting changes in chemical composition and microstructure in the heat affected zone (HAZ). Thermogravimetric analysis is performed on the unexposed electrode active materials to distinguish the development of compositional changes under conditions of slow heating below the melting and sublimation temperatures. A brief theoretical description of the physical phenomena taking place during laser exposure is provided in terms of direct ablation during each laser pulse and vaporization or thermal degradation due to conductive heat transfer on a much longer time-scale, with characteristics of the HAZ reported in terms of these changes. For all laser exposures carried out in the study, chemical and microstructural changes are limited to the visible HAZ. Some degree of oxidation and LFP olivine phase degradation is observed in the cathode, while the polycrystalline graphite structure becomes less ordered in the anode. Where complete penetration is achieved, melting of the cathode active layer and combustion of the anode active layer take place near the cut edge due to thermal conduction from the metallic conductive layers. The presented results provide insight into the effects of laser processing on LFP electrode integrity.

XTH20 and XTH19 regulated by ANAC071 under auxin flow are involved in cell proliferation in incised Arabidopsis inflorescence stems.

One week after partial incision of Arabidopsis inflorescence stems, the repair process in damaged tissue includes pith cell proliferation. Auxin is a key factor driving this process, and ANAC071, a transcription factor gene, is upregulated in the distal region of the incised stem. Here we show that XTH20 and the closely related XTH19, members of xyloglucan endotransglucosylase/hydrolases family catalyzing molecular grafting and/or hydrolysis of cell wall xyloglucans, were also upregulated in the distal part of the incised stem, similar to ANAC071. XTH19 was expressed in the proximal incision region after 3 days or after auxin application to the decapitated stem. Horizontal positioning of the plant with the incised side up resulted in decreased ProDR 5 :GUS, ANAC071, XTH20, and XTH19 expression and reduced pith cell proliferation. In incised stems of Pro35S :ANAC071-SRDX plants, expression of XTH20 and XTH19 was substantially and moderately decreased, respectively. XTH20 and XTH19 expression and pith cell proliferation were suppressed in anac071 plants and were increased in Pro35S :ANAC071 plants. Pith cell proliferation was also inhibited in the xth20xth19 double mutant. Furthermore, ANAC071 bound to the XTH20 and XTH19 promoters to induce their expression. This study revealed XTH20 and XTH19 induction by auxin via ANAC071 in the distal part of an incised stem and their involvement in cell proliferation in the tissue reunion process.

Technique chirurgicale de création d’un double pli palpébral supérieur par voie semi-ouverte dans la paupière asiatique

Creation of a double upper eyelid is a popular procedure in Asian countries. Many incisional and non-incisional approaches have been described to create a new suprapalpebral fold. The authors recommended a short incision technique to create a double eyelid and evaluated the results. The location of the partial incision was determined pre-operatively with the patient. A one-centimeter partial incision was made on the middle one-third of the upper eyelid, and the orbicularis oculi muscle was dissected. Three anchoring stitches were placed for the creation of the permanent suprapalpebral fold. Those stitches were inverted single knots which linked the tarsal plate to the lower margin's dermis or dermomuscular junction of the incised skin. Intra-operative adjustment of position and curvature of the new fold was done by the active opening of the upper eyelid. Global results, symmetry and design were evaluated by the patient and one independent surgeon. Between January 2012 and January 2013, a total of 10patients were operated using this technique. All patients were satisfied, with 8results graded excellent and 2results graded good. The average operation time was 20minutes. There were no serious complications, the only unfavorable outcome was one persistent bruise. The follow-up period was one year. Recovery time varied from 2weeks to a month. No correction procedure was needed. The short central incisional technique for creation of a double eyelid described here provides excellent permanent and natural results, with no visible scar nor serious complications.

Single-Arm Evaluation of the AccuCirc Device for Early Infant Male Circumcision in Botswana

: Existing devices for early infant male circumcision (EIMC) have inherent limitations. We evaluated the newly developed AccuCirc device by circumcising 151 clinically well, full-term male infants with birth weight ≥2.5 kg within the first 10 days of life from a convenience sample in 2 hospitals in Botswana. No major adverse events were observed. There was 1 local infection, 5 cases of minor bleeding, and 1 case of moderate bleeding. In 3 cases, the device made only partial incisions that were completed immediately by the provider without complications. Parental satisfaction was high: >96% of mothers stated that they would circumcise a future son. The pre-assembled, sterile AccuCirc kit has the potential to overcome obstacles related to supply chain management and on-site instrument disinfection that can pose challenges in resource-limited settings. In our study, the AccuCirc was safe and it should be considered for programmatic EIMC in resource-limited settings.

Three Mini-Incision Double-Eyelid Blepharoplasty

Although there are many procedures reported in the literature regarding the partial incision double-eyelid blepharoplasty, the current methods still have potential problems such as unstable and limitation of application. In this study, the authors developed a 3-mini-incision technique that minimizes tissue injury and provides a tough connection between the levator aponeurosis and skin. With this method, 3 minute incisions (3-4 mm) are made in the upper eyelid. Through these incisions, the whole strip of pretarsal orbicularis oculi muscle under the inferior incision line and the excessive fat can be removed. This technique gives a stable and natural-looking supratarsal fold, with invisible scar, minimal complications, and a short recovery period; and can be applied to patients with fatty eyelids. This method has the benefits of both nonincisional and full-incisional techniques, and avoids the disadvantages of the current partial incisional methods.

Importance of Proximal A2 and A4 Pulleys to Maintaining Kinematics in the Hand: A Biomechanical Study

The A2 and A4 pulleys have been shown to be important in finger flexor tendon function. Other authors have suggested either reconstruction or venting of portions of these pulleys in an attempt to preserve finger function in certain clinical situations. This study examines the effects of partial incision of these pulleys on finger flexion kinematics and biomechanics. The index and ring fingers of 16 cadaveric hands were studied. The flexor digitorum profundus tendon was isolated and attached to a computer driven servo-motor. Micro-potentiometers measured flexion angles of the metacarpophalangeal, proximal inter-phalangeal and distal inter-phalangeal joints. Joint inertial torques were calculated making use of this experimental kinematic data. Proximal 50% incisions of either the A2 or the A4 pulleys resulted in a statistically significant decrease in overall finger motion. This effect was greatest in the proximal inter-phalangeal joint, with a decrease in joint motion, as well as an earlier time to initiation of motion. These changes in finger motion were more pronounced with A2 pulley incision than they were with A4 pulley incision, but the changes were statistically significant in either case. No significant changes in joint inertial torques were shown. Our data provides evidence to the importance of the proximal portions of the A2 and A4 pulleys, and may support partial distal incision of these pulleys in certain clinical situations.

Endoscopic fenestration of esophageal duplication cysts

cysts The esophageal duplication cyst is an unusual congenital disorder of the foregut, accounting for 10%–15% of duplications of all foregut cysts [1]. Up to 80% of esophageal duplication cysts are diagnosed in childhood and symptomatic cysts in adults are very rare [2]. Although surgical excision provides definitive treatment, we report two patients with esophageal duplication cysts successfully treated endoscopically. Both patients (a 51-year-old man and a 32-year-old woman) were admitted to our hospital because of recent development of dysphagia for solid food. Esophagogastroduodenoscopy (EGD) and esophagography demonstrated a protruding submucosal lesion in the lower third of the esophagus (● Fig.1). Endoscopic ultrasound demonstrated a hypoechogenic cystic lesion measuring 45mm and 65mm in the two patients, respectively (● Fig.2), surrounded by a multilayered wall, consistent with the diagnosis of esophageal duplication cyst. Based on our previous experience of endoscopic treatment of duodenal duplication cysts [3], we proposed using the same approach, and informed consent was obtained for both patients. After making the initial incision with a needle-knife (Olympus, Tokyo, Japan), the anterior wall of the duplication cyst was fenestrated with the ITknife (Olympus, Tokyo, Japan), resulting in the complete opening of the cystic cavity into the esophageal lumen (● Fig.3). The lateral margins were then clipped to close any gaps and to prevent delayed bleeding. A follow-up EGD demonstrated epithelialization of the posterior wall of the esophageal duplication cyst (● Fig.4). Small, pedunculated esophageal duplication cysts, located superficially, can be completely resected with a standard polypectomy snare [4]. However, for large duplication cysts buried deeper into esophageal wall, we propose careful fenestration with the IT-knife to avoid deep injury once the cyst has been emptied. Resection of the entire length of the cyst wall is essential, since partial incision can lead to recurrence of symptoms [5]. We believe that this report provides additional evidence of the safe and effective endoscopic treatment of esophageal duplication cysts.

Lumbopelvic fixation for U-Shaped sacral fractures

Objective To analyze the clinical characteristics,treatments and outcomes of U-shaped sacral fractures. Methods From December 2005 to February 2011,8 cases of U-shaped sacral fractures were operatively treated in our department. They were 6 males and 2 females,aging from 21 to 53 years (mean,36.9 years).There were 5 cases of H pattern,one case of U pattern,one case of lambda pattern and one case of T pattern,according to fracture shape.The transverse part of sacral fracture was diagnosed as type Ⅱ in 2 cases and as type Ⅲ in 6 cases,according to Roy-Camille and Strange-Vognsen sub-classification.The combined neurological impairments were judged as grade 3 in 2 cases and grade 4 in 6 cases,according to Gibbons' criteria.Seven patients were complicated with multiple injuries.After stabilization of vital signs,all were treated with open reduction,posterior sacral decompression and lumbopelvic or lumbosacral fixation using the segment pedicel system,whereby the transverse fixation was obtained using a 6 mm rod as cross-connector between the 2 main rods. Results All the patients were followed up for an average of 14.5 months (from 6 to 24 months).All demonstrated fracture healing on CT scan at 6 months.Two cases of partial incision necrosis and one case of superficial infection were managed successfully with surgical debridement and aggressive wound care.Five patients complained of symptoms related to the prominence of the iliac screws.Of the 6 patients with bowel and bladder deficits,3 obtained full recovery and 3 partial recovery.The average Gibbons score improved by 2.45 points.One case had mal-placement of iliac screws.No rupture of implants or loss of fracture reduction was seen at the final radiological follow-up. Conclusions U-shaped sacral fracture can result in spino-pelvic instability associated with neurological deficits.Good neurological recovery can be expected after early sacral decompression. Lumbopelvic fixation,providing multi-planer fixation,is effective in restoring the lumbopelvic stability. Key words: Sacrum; Fracture ; Pelvis ; Wounds and injuries; Fracture fixation, internal

Assessment of the diagnostic value of dual-energy CT and MRI in the detection of iatrogenically induced injuries of anterior cruciate ligament in a porcine model

Magnetic resonance imaging (MRI) is the standard of reference for the non-invasive evaluation of ligament injuries of the knee. The development of dual-energy CT (DE-CT) made it possible to differentiate between tissues of different density by two simultaneous CT measurements with different tube voltages. This approach enables DE-CT to discriminate ligament structures without intra-articular contrast media injection. The aims of this study were on the one hand to determine the delineation of the anterior cruciate ligament (ACL) and on the other hand to assess the diagnostic value of DE-CT and MRI in the detection of iatrogenically induced injury of the ACL in a porcine knee joint model. Twenty porcine hind legs, which were placed in a preformed cast in order to achieve a standardized position, were scanned using DE-CT. Thereafter, a 1.5-T MRI using a standard protocol was performed. The imaging procedures were repeated with the same parameters after inducing defined lesions (total or partial incision) on the ACL arthroscopically. After post-processing, two radiologists and two orthopedic surgeons first analyzed the delineation of the ACL and then, using a consensus approach, the iatrogenically induced lesions. The result of the arthrotomy was defined as the standard of reference. The ACL could be visualized both on DE-CT and MRI in 100% of the cases. As for the MRI, the sensitivity and specificity of detecting the cruciate ligament lesion respectively compared with the defined arthrotomy was 66.7% and 78.6% for intact cruciate ligaments, 100% and 75% in the case of a complete lesion, 33.3% and 78.6% for lesions of the anteromedial bundle, and 0% and 100% for lesions of the posterolateral bundle. In comparison, DE-CT demonstrated a sensitivity and specificity of 66.7% and 71.4% in the case of intact cruciate ligaments, 75% and 68.8% in the case of completely discontinued ACLs, 0% and 92.9% in the case of lesions of the anteromedial bundle, and 25% and 87.5% in the case of lesions of the posterolateral bundle. The present ex vivo experiment shows that both study modalities (DE-CT and MRI) are equal with regard to the delineation of the ACL, while MRI achieved higher sensitivity and specificity regarding iatrogenically induced complete ACL lesions. DE-CT could be a possible alternative to MRI for certain indications in the diagnosis of a knee ligament injury.

Vascular endothelial growth factor-loaded poly(lactic-co -glycolic acid) microspheres-induced lateral axonal sprouting into the vein graft bridging two healthy nerves: Nerve graft prefabrication using controlled release system

The most commonly used surgical technique for repairing segmental nerve defects is autogenous nerve grafting; however, this method causes donor site morbidity. In this study, we sought to produce prefabricated nerve grafts that can serve as a conduit instead of autologous nerve using a controlled release system created with vascular endothelial growth factor (VEGF)-loaded poly(lactic-co-glycolic acid) (PLGA) microspheres. The study was performed in vitro and in vivo. For the in vitro studies, VEGF-loaded PLGA microspheres were prepared. Thirty rats were used for the in vivo studies. Vein grafts were sutured between the tibial and peroneal nerves in all animals. Three groups were created, and an epineural window, partial incision, and microsphere application were performed, respectively. Walking track analysis, morphologic, and electron microscopic assessment were performed at the end of the eight weeks. Microspheres were produced in spherical shapes as required. Controlled release of VEGF was achieved during a 30-days period. Although signs of nerve injury occurred initially in the partial incision groups according to the indexes of peroneal and tibial function, it improved gradually. The index values were not affected in the other groups. There were many myelinated fibers with large diameters in the partial incision and controlled release groups, while a few myelinated fibers that passed through vein graft in the epineural window group. Thereby, prefabrication was carried out for the second and third groups. It was demonstrated that nerve graft can be prefabricated by the controlled delivery of VEGF.

Effect of Low‐Level Laser Therapy (660 nm) on Acute Inflammation Induced by Tenotomy of Achilles Tendon in Rats

In this study, we aimed to analyze the effects of low-level laser therapy (LLLT; 660 nm) on levels of protein expression of inflammatory mediators after cutting Achilles tendon of rats. Thirty Wistar male rats underwent partial incisions of the left Achilles tendon, and were divided into three groups of 10 animals according to the time of euthanasia after injury: 6, 24 and 72 h. Each group was then divided into control group and LLLT group (treated with 100 mW, 3.57 W cm(-2), 0.028 cm(2), 214 J cm(-2), 6 J, 60 s, single point). In LLLT group, animals were treated once time per day until the time of euthanasia established for each group. The group treated with LLLT showed a significant reduction of IL-1β compared with control groups at three time points (6 h: P=0.0401; 24 h: P=0.0015; 72 h: P=0.0463). The analysis of IL-6 showed significant reduction only in the LLLT group at 72 h compared with control group (P=0.0179), whereas IL-10 showed a significant increase in the treated group compared with control group at three experimental times (6 h: P=0.0007; 24 h: P=0.0256; 72 h: P<0.0001). We conclude that LLLT is an important modulator of inflammatory cytokines release after injury in Achilles tendon.

Potencial de inibição da regeneração de raízes e plântulas em sementes germinantes de Eugenia pyriformis

O objetivo deste trabalho foi avaliar o potencial de inibição da formação de raízes e plântulas, em sementes germinantes de uvaieira (Eugenia pyriformis), fragmentadas e fissuradas. As sementes foram separadas por tamanho em dois grupos. Cada grupo foi separado em dois subgrupos, um dos quais foi submetido a teste de germinação. As sementes de cada subgrupo foram submetidas a dois tipos de incisão (total ou parcial) e, em seguida, foram avaliadas quanto à produção de raízes e plântulas. Em sementes com incisão parcial, que apresentavam apenas uma plântula desenvolvida, completou-se a incisão até que as metades fossem separadas. A metade com a raiz foi descartada, e sua complementar foi colocada para germinar, para avaliação da produção de raízes e plântulas nessas frações sem raízes. Em todos os experimentos, utilizou-se o delineamento inteiramente casualizado, em arranjo fatorial 2x2 (tamanho das sementes x germinação visível) e 2x4 (tamanho das sementes x tipo de incisão). As sementes fracionadas de uvaieira apresentam potencial para regeneração de raízes e plântulas, e podem produzir mais de uma muda por semente. A germinação inicia processos de inibição da regeneração de novas raízes e plântulas na semente, e a incisão dos cotilédones pode bloquear essa inibição.

Combined ablation of atrial fibrillation and minimally invasive mitral valve surgery: a case report

A partial lower inverted J sternotomy and an extended transseptal incision provide excellent exposure for minimally invasive mitral valve surgery. However, the extended trasnsseptal incision causes dividing the sinus node artery, which may result in conduction system disturbance and need for permanent pacemaker implantation. Therefore, there is a challenge in the patient who requires concomitant ablation for atrial fibrillation because of possible conduction system disturbance caused by extended transseptal incision. We describe a new strategy for combined ablation of atrial fibrillation with minimally invasive cardiac surgery by a transseptal approach to the mitral valve through a partial lower sternotomy incision. Cryoablation was performed using a T-shaped cryoprobe with a lesion set of pulmonary vein isolation and ablation of the left and right isthmus in performing mitral annuloplasty, tricuspid annuloplasty, and atrial septal defect closure through a limited sternotomy incision. This technique might minimize possible conduction system disturbance and provide good surgical result for the patients who undergo mitral valve surgery and ablation of atrial fibrillation.