Reliable Option Research Articles

Nasal tip rotation flap for reconstruction of surgical defects on the distal nose.

The nose is a common site for the development of skin cancers. Mohs micrographic surgery (MMS) is a highly curative treatment for skin cancer of the nose. Reconstruction of MMS defects on the nose, especially on the distal aspect, can be challenging given the proximity of multiple subunits and limited adjacent tissue reservoirs. Our goal was to describe our experience using a nasal tip rotation flap (NTRF) for MMS defects on the distal nose. A retrospective review of all MMS cases at multiple institutions between June 2018 and June 2022 was undertaken. Cases that used an NTRF to repair the MMS defect(s) were selected, and data were collected on patient demographics, tumor type, anatomical location of the tumor, preoperative and postoperative size, number of stages needed to clear the tumor, repair dimensions, and any postoperative complications. A total of 66 cases that utilized an NTRF for reconstruction were included. The mean preoperative tumor size was 0.8 cm (range: 0.3-1.6 cm), and the mean defect size was 1.2 cm (range: 0.7-1.9 cm). The defects were most commonly on the nasal tip. There were no significant complications observed. The nasal tip rotation flap is a reliable reconstruction option for MMS defects of the distal nose. This flap can be used for defects that involve the nasal tip, soft triangle, and/or portions of the ala, including the alar rim.

Mini-Craniotomy for Chronic Subdural Hematoma: A Reliable Surgical Option

Abstract Introduction Chronic subdural hematoma (SDH) is one of the most common conditions encountered in the neurosurgical practice. Surgical modalities like twist drill craniostomy, burr hole evacuation, mini-craniotomy, and craniotomy are practiced in the management of chronic SDH. Mini-craniotomy without excision of membranes may help to achieve best results with decreased complication rate. Materials and Methods Patients with chronic SDH operated from September 2013 to September 2022 were included in the study. Mini-craniotomy (40–60 mm) was done and cruciate incision was given over the dura. Dura was left wide open by reflecting and suturing the cut edges of the dural leaflets to the craniotomy edge allowing to evacuate subdural space under vision during surgery and to allow any residual collection to drain out freely in the postoperative period. A drain was placed between the inner membrane and the bone flap. Preoperative and postoperative clinical and radiological parameters were recorded. Complications, recurrence, and residual collections were noted. Results Seventy-seven patients were included in the study. Mean age was 57.32 years. Median Glasgow Coma Scale (GCS) at presentation was 13 while median GCS at discharge was 15. Two patients with preexisting comorbidities expired after surgery due to medical causes. No recurrences were noted. Fourteen patients had residual collections which resolved by 6 weeks. Two patients had wound infection. One of these patients later needed a bone flap removal due to osteomyelitis. Conclusion Mini-craniotomy without membranectomy is a good option for complete evacuation of chronic SDH under vision mainly avoiding the complication of membranectomy. It is not associated with increased complications rate. It needs fewer follow-ups as brain expansion can be established radiologically in a short period.

Tele-Trafficking of Virtual Data Storage Obtained from Smart Grid by Replicated Gluster in Syntose Environment

One of the most important developments in the energy industry is the evolution of smart grids, which record minute details of voltage levels, energy usage, and other critical electrical variables through General Packet Radio Service (GPRS)-enabled meters. This phenomenon creates an extensive dataset for the optimization of the grid system. However, the minute-by-minute energy details recorded by GPRS meters are challenging to store and manage in physical storage resources (old techniques lead to a memory shortage). This study investigates using the distributed file system, replicated Gluster, as a reliable storage option for handling and protecting the enormous volumes of data produced by smart grid components. This study performs two essential tasks. (1) The storage of virtual data received from GPRS meters and load flow analysis of SynerGee Electric 4.0 software from the smart grid (we have extracted electrical data from 16 outgoing feeders, distributed lines, in this manuscript). (2) Tele-trafficking is performed to check the performance of replicated Gluster (RG) for virtual data (electrical data received from the smart grid) storage in terms of User Datagram Protocol (UDP), Transmission Control Protocol (TCP), data flow, and jitter delays. This storage technique provides more opportuni11ty to analyze and perform smart techniques efficiently for future requirement, analysis, and load estimation in smart grids compared to traditional storage methods.

TAVI in younger patients: is it a reliable option?

Abstract Funding Acknowledgements None. Background/Introduction Severe aortic stenosis is the most common valve disease requiring intervention. It has very poor prognosis, and early intervention is recommended. Either surgical or percutaneous transcatheter intervention is possible. According to European guidelines, surgical aortic valve replacement (SAVR) is usually indicated for patients younger than 75 years old. However, some patients are refused surgery, and transcatheter aortic valve implantation (TAVI) might be an option of treatment for these patients, however medium-long term results are still uncertain. Purpose This study intends to evaluate the efficacy and safety of TAVI in younger patients with severe symptomatic aortic stenosis. Methods Retrospective cohort of 224 patients were submitted to TAVI in the last 3 years, of which 21 patients were younger than 75 years old. The primary endpoints are mortality, major adverse cardiovascular events (MACE) and rehospitalization (related to the procedure, valve, or heart failure). Efficacy and safety were evaluated during a follow-up of at least 6 months, compared with the traditional group. Results A total of 224 patients underwent TAVI during the last 3 years at our center. Of these, 21 patients (9%) were younger than 75 years. The mean age was 72,1±3 [62-75] years old and 33% were female (n=7). 95% (n=20) of the TAVI procedures were due to degenerative severe aortic stenosis and 5% (n=1) due to degenerative aortic surgical valve prothesis. The mean euroscore risk value was 6,2±1,3%, and 18 patients were refused for surgery (86%) and 3 patients refused surgery (14%). All procedures were performed by transfemoral access, with 2 peripheral access complications (9,5%), 1 hemorrhagic (4%), solved with covered stent, and 1 closure device occlusion solved with wire crossing and balloon inflation (4%). It was necessary to implant 3 temporary pacemakers, however, only 2 patients required a definitive pacemaker implantation (9,5%). There were no cases intraprocedural death, MACE or aortic severe complications. There was a statistically significant reduction of risk of peripheral complications and pacemaker implantation on younger patients comparing with older patients (p=0,04 and p=0,05 respectively). Mean follow-up time was 14±8,3 months [6-39 months]. During follow-up there were no deaths, MACE or episodes of rehospitalization due to heart failure recorded. Regarding echocardiographic evaluation, there were no cases of significant valve degeneration, with mean aortic gradient of 13±4,1mmHg, no significant leakage or other echocardiographic findings. In younger patients, TAVI appears to be also valid therapeutic option, with less risk of peripheral access complication or need of permanent pacemaker implantation. During the follow-up there was no cases of prothesis degeneration, proving to be a reliable option for the medium to long term.

Performance evaluation of off-grid solar systems for critical medical instruments in remote regions

In areas with limited access to electricity or during power outages, ensuring continuous and reliable use of grid-powered electrical instruments is challenging, especially in remote emergency centers. A stable source of electricity is crucial to prevent disruptions in power supply, as they can lead to severe medical complications, jeopardize patient well-being, and even result in fatal incidents. To address this issue, integrating renewable electricity sources such as off-grid solar systems into existing power supply infrastructure can be a viable solution. Recent studies suggest that off-grid solar systems can be reliable and sustainable options for powering medical facilities, particularly in areas lacking uninterrupted grid connectivity. Therefore, this research aims to evaluate the feasibility, benefits, and challenges of integrating off-grid power to support critical medical instruments. Based on an extensive literature review, interviews with experts, and surveys among relevant users, this study finds that the system has the capability to maintain a consistent, dependable power supply, even during adverse weather conditions. Cost and feasibility are highlighted as paramount considerations, based on surveys and focus group results. The study concludes that off-grid solar systems offer an economical, low-maintenance, and environmentally sustainable alternative for remote medical facilities. Finally, this study proposes recommendations to optimize critical device performance during power outages and improve overall system functionality and efficiency.

Clinical features and treatment outcomes of liver involvement in paediatric Langerhans cell histiocytosis

Langerhans cell histiocytosis (LCH) is the most common histiocytic disorder in children, and liver involvement in LCH is rare. This retrospective study reported the clinical features and prognosis of patients with hepatic LCH. Liver involvement was defined by histopathological findings, liver dysfunction or abnormalities, or ultrasound imaging. A total of 130 patients (14.5%) with hepatic LCH out of 899 in the LCH population were enrolled. Patients with liver involvement had greater frequencies of skin, lung, hearing system, and haematologic system involvement, and hemophagocytic lymphohistiocytosis (P<0.001, 0.001, 0.002, 0.009, and <0.001, respectively). Overall survival and progression-free survival were lower in LCH patients with liver involvement than in those without liver involvement (P<0.001 and <0.001). In patients with liver involvement, the overall survival (OS) and progression-free survival (PFS) rates were lower in patients with cholangitis than in those without cholangitis (P<0.020 and 0.030). For the treatment response, the response rate of hepatic LCH patients to initial first-line therapy (n=89) was 22.5%. However, there was no significant difference in the response rate or recurrence rate between patients who shifted from first-line treatment to second-line treatment (n=29) or to targeted therapy (n=13) (P=0.453 and 1.000). The response rate of hepatic LCH patients who received initial second-line therapy (n=13) was 38.5%. Two of these patients subsequently experienced bone recurrence. The response rate of hepatic LCH patients who received initial targeted therapy (n=16) was 75.0%. Three patients subsequently experienced recurrence, including 2 in the bone and 1 in the liver and skin. A total of 39.3% of patients who received second-line treatment had severe myelosuppression (grade III-IV), and 50.8% had varying degrees of gastrointestinal events, whereas there was no severe toxicity in patients who received first-line treatment and targeted therapy. Four patients underwent liver transplantation because of liver cirrhosis. The patients’ liver disease improved within a follow-up period of 18-79 months. This study demonstrated that LCH with liver involvement, especially cholangitis, indicates a poor prognosis. Targeted therapy provides a good treatment response and less toxicity. However, it may relapse after withdrawal. Liver transplantation is still a reliable salvage option for patients with end-stage liver disease.

"Feed-and-wrap" technique versus deep sedation for neonatal magnetic resonance imaging: a retrospective comparative study.

Neonatal MRI is usually performed under deep sedation, which is challenging-especially in low-weight premature patients. In addition, long-term side effects, such as neurotoxicity, are of concern. An alternative to sedation is to induce natural sleep by feeding and immobilising the child, the "feed-and-wrap" technique (FWT). The objective of this study was to evaluate differences in image quality between neonates examined under sedation and by using the FWT during the first four months of life. We retrospectively assessed image quality (based on a 4-point semiquantitative scale) of all MRI examinations in neonates performed at our institution between July 2009 and August 2022. Differences in image quality between examinations under sedation versus FWT were evaluated. We included 432 consecutive patients, 243 (56%) using sedation and 189 (44%) using the FWT. Corrected age and body weight (mean ± SD: 3.7 ± 1.1 versus 4.5 ± 1.3 kg, p < 0.001) were significantly lower in the FWT group. The overall success rate in the FWT group was 95%. Image quality was slightly lower when using the FWT (mean ± SD: 3.7 ± 0.43 versus 3.96 ± 0.11, p < 0.001). Multivariate analysis showed a higher risk of acquiring sequences with diagnostic limitations in the FWT group (p < 0.001), increasing with corrected age (p = 0.048). The FWT is a highly successful method to perform MRI scans in term and preterm neonates. Overall image quality is only slightly lower than under sedation. Especially in immature low-weight preterm patients, the FWT is a reliable option to perform MRI studies without exposing the child to risks associated with sedation. The "feed-and-wrap" technique enables high-quality MRI examinations in neonates, including low-weight premature patients. Deep sedation for diagnostic MRI procedures in this age group, which has the risk of short- and long-term complications, can often be avoided. Deeply sedating neonates for MR examinations comes with risks. Image quality is only slightly lower when using the "feed-and-wrap" technique. The "feed-and-wrap" technique is feasible even in low-weight premature infants.

Clinical and radiographic performance of late placed and early loaded dental implants with a conditioned hydrophilic surface in posterior mandible sites: A prospective case series with an 8.5- to 9.5-year follow-up.

To assess the clinical outcomes by means of implant and prosthetic survival of late placed and early loaded implants with a hydrophilic, moderately rough surface for partially edentulous patients after a follow-up of 8.5 to 9.5 years. A prospective case series study involving 15 patients with single, late placed and early loaded implants in the posterior mandible was performed. Clinical and radiographical parameters, including biological and technical complications and patient satisfaction, were assessed. From an initial sample of 15 patients, 12 were included. A total of 16 implants were observed. After a mean follow-up of 9 years and 7 months (SD ± 3.8 months), implant success and survival rate were 100%. The prosthetic survival rate was 100%, and the prosthetic success rate was 93.8% since a major chipping was observed. No biological complications were observed, and the mean modified plaque index was 0.03 (SD ± 0.09) with a mean probing pocket depth of 2.95 mm (SD ± 0.09). A mean marginal bone level (MBL) of 0.04 mm (SD ± 0.88) and a mean VAS of 9.42 (SD ± 0.90) for patient satisfaction were recorded. Late placed and early loaded implants with a moderately rough endosseal surface are a reliable option for rehabilitating partially edentulous patients. An implant survival rate of 100% and a prosthodontic success rate of 93.8% were observed. Patient satisfaction scores were high and peri-implant hard and soft tissues remained healthy. The study findings should be carefully interpreted because of the small sample.

YouTube Videos Are a Moderately Comprehensive, Reliable, and Quality Option to Learn About “Multiple Sclerosis and Sexuality”

Objectives This study aimed to evaluate the performance, comprehensiveness, reliability, and quality of English-language YouTube videos addressing the subject of multiple sclerosis and sexuality. Methods In August 2023, a search was conducted on a computer using the keywords “multiple sclerosis and sexuality,” “multiple sclerosis and sexual health,” “multiple sclerosis and sexual health problems,” and “multiple sclerosis and sexual dysfunction” for this descriptive study. According to predetermined inclusion and exclusion criteria, 38 videos that met the research purpose were examined. The related URLs were recorded. For each video, the following information was collected: content producers, performance with YouTube statistics, comprehensiveness with a form developed by researchers, reliability with Singh’s Reliability Evaluation Form, and quality with Global Quality Scale. Two researchers independently evaluated the videos. Results Eighty-nine and a half percent of the videos contained information presented by professionals. The average number of views was 2699.132 ± 3382.848, the comprehensiveness score was 4.2 ± 1.711, the reliability score was 3.184 ± 1.182, and the quality score was 3.421 ± 1.2. Nearly half (42.2%) contained good and useful information for viewers, and half (50%) had high video quality. The reliability and quality scores of videos containing each item in terms of comprehensiveness were higher compared to videos that did not include that item (p < 0.05). In addition, the videos with higher comprehensiveness scores had higher quality and reliability scores (p < 0.001). Conclusion These results underscore the constrained performance attributes of YouTube videos addressing multiple sclerosis and sexuality, with their content exhibiting a moderate level of comprehensiveness, reliability, and quality. These results may provide a basis for increasing the effectiveness of YouTube videos on multiple sclerosis and sexuality.

A review of the benefits and limitations of waste nutrient treatment in aquaculture pond facilities

AbstractManaging waste nutrients from intensive freshwater and marine pond aquaculture is a global challenge. Nutrient‐enriched water released from farms can have detrimental effects on aquatic ecosystem health. There are a range of treatment options for discharge water from fish and crustacean ponds, and this review examines the benefits and limitations of these options. Much of the nutrient waste is derived from the addition of formulated feed. In recent years, reduction in waste from feeds and feeding has been largely incremental. In terms of treatment, there are low‐cost approaches, such as settlement ponds, but they are inefficient at reducing nutrients. Biological systems, using aquatic plants, microalgae and filter feeders to reduce nutrient release from farms have variable levels of effectiveness. Establishing wetlands requires considerable additional land area, and success to date has been highly variable. Overall, this review found no simple cost‐effective solution for managing nutrient enriched water from ponds. This is due, in many cases, to challenges with treating the large volumes of discharge water with relatively low nutrient concentrations. This means that more technologically advanced and reliable treatment options, for example, bioreactors, are prohibitively expensive. However, some systems, such as use of recirculation systems typically increase nutrient concentrations, and hence the efficiency and effectiveness of more expensive treatment methods. Biofloc systems can also provide a mechanism for in‐situ nutrient treatment as well as a supplementary food source for animals. Overall, there is scope to improve treatment of waste nutrients, but significant modifications to many production systems are needed to achieve this.

In-situ growth of Cs5Cu3Cl6I2 nanocrystals within AAO arrays for X-ray imaging

Lead-free halide perovskites have shown promising application for indirect X-ray detection as fascinating scintillator. The fabrication of pixelated scintillator films leveraging directional confinement allows high-resolution imaging, yet process complexity and the potential crystal structure damage pose challenges that compromises the corresponding scintillator performance. In this work, a facile in-situ strategy for growing scintillation perovskite of Cs5Cu3Cl6I2 within anodic aluminum oxide (AAO) membrane is developed as scintillator Cs5Cu3Cl6I2@AAO film. The as-fabricated pixelated scintillator array with an enhanced light directional confinement for high-resolution X-ray imaging is demonstrated. The corresponding film achieves a spatial resolution of approximately 20 lp mm−1 and a detection limit of 152 nGy·s−1. Moreover, the Cs5Cu3Cl6I2@AAO film performs excellent stability under long-term X-ray irradiation, making it a reliable option for cost-effective pixelated indirect X-ray imaging.

Narrative review of immediate salvage for penile prosthesis infection.

Implantation of a penile prosthesis is a reliable option for men with erectile dysfunction (ED) refractory to less invasive therapies. While the frequency of penile prosthesis infections have decreased, they remain a devastating complication. Herein we discuss why immediate salvage surgery is an essential technique for the management of implant infections. We will also describe the relevant advancements to this technique. We conducted a narrative review via computer based search of PubMed for all relevant articles on penile prosthesis infection management, including guidelines, case series, reviews, and expert opinions. Search terms used included: "inflatable penile prosthesis", "IPP", "penile prosthesis", "salvage", "treatment", "delayed", "immediate". Only English peer-reviewed publications were included. Historically, patients who presented with penile prosthesis infections were exclusively managed with complete removal of the prosthesis without replacement. Although this strategy is safe, it hastens immediate ED and corporal fibrosis, resulting in loss of penile length and increased difficulty with subsequent prosthesis replacement. Previous case series have reported successful treatment of localized penile prosthesis infections with nonsurgical treatment, but the role of conservative treatment remains limited. The current standard of immediate salvage entails removal of the infected prosthesis and washout followed by immediate replacement with a new penile prosthesis. This technique has been demonstrated to be safe and effective, thus allowing patients to resume intercourse and maintain penile length. Immediate salvage surgery is safe and effective, and has emerged as the preferred strategy for the management of most patients with a penile prosthesis infection.

Impact of Preoperative Symptom Duration on Patient-Reported Outcomes Following Cervical Disc Replacement for Cervical Radiculopathy.

Retrospective review of prospectively collected data. To determine the impact of preoperative symptom duration on postoperative functional outcomes following cervical disc replacement (CDR) for radiculopathy. CDR has emerged as a reliable and efficacious treatment option for degenerative cervical spine pathologies. The relationship between preoperative symptom duration and outcomes following CDR is not well established. Patients with radiculopathy without myelopathy who underwent primary 1- or 2-level CDRs were included and divided into shorter (<6mo) and prolonged (≥6mo) cohorts based on preoperative symptom duration. Patient-reported outcome measures (PROMs) included Neck Disability Index (NDI), Visual Analog Scale (VAS) Neck and Arm. Change in PROM scores and minimal clinically important difference (MCID) rates were calculated. Analyses were conducted on the early (within 3mo) and late (6mo-2y) postoperative periods. A total of 201 patients (43.6±8.7y, 33.3% female) were included. In both early and late postoperative periods, the shorter preoperative symptom duration cohort experienced significantly greater change from preoperative PROM scores compared to the prolonged symptom duration cohort for NDI, VAS-Neck, and VAS-Arm. The shorter symptom duration cohort achieved MCID in the early postoperative period at a significantly higher rate for NDI (78.9% vs. 54.9%, P=0.001), VAS-Neck (87.0% vs. 56.0%, P<0.001), and VAS-Arm (90.5% vs. 70.7%, P=0.002). Prolonged preoperative symptom duration (≥6mo) was identified as an independent risk factor for failure to achieve MCID at the latest timepoint for NDI (OR: 2.9, 95% CI: 1.2-6.9, P=0.016), VAS-Neck (OR: 9.8, 95% CI: 3.7-26.0, P<0.001), and VAS-Arm (OR: 7.5, 95% CI: 2.5-22.5, P<0.001). Our study demonstrates improved patient-reported outcomes for those with shorter preoperative symptom duration undergoing CDR for radiculopathy, suggesting delayed surgical intervention may result in poorer outcomes and greater postoperative disability. III.

IoT Based Real-Time Street Light Fault Detection and Maintenance System with Machine Learning Driven Solution Prediction

The proposed system provides a complete solution for fault prediction with suggested fixes, accurate position tracking, automated real-time streetlight fault detection, and an effective maintenance strategy. For both general city beauty and public safety, street lighting functionality is essential. Our technology makes use of the Internet of Things (IoT) to continuously monitor streetlights in real-time and quickly identify problems through machine learning. Every streetlight has sensors installed that can detect abnormalities instantly and provide information to a central control system for prompt defect finding. By ensuring a responsive and effective system, this method shortens the period between defect discovery and repair. The system's ability to provide accurate geographic information, offer remedies for errors that are recognized, and help maintenance workers locate and resolve problems more rapidly are some of its important features. By integrating geographic data, maintenance operations are directed and efficient, reducing downtime and improving system reliability overall. This study explores the technical features of the sensor-based system and highlights how effectively it functions as a reliable and straightforward option for regions trying to enhance their maintenance procedures for streetlights

A biomechanical analysis of novel endovascular implants for aortic valve replacement and ascending aortic repair

Advances in medical technology have enabled minimally invasive treatment of type A aortic dissection with accompanying aortic regurgitation. Implants include endovascular stent grafts (ESG) and heart valve substitute (HVS) modules. Traditional implants can be divided into two types based on the assembly relationship between ESG and HVS: separated z-shaped implants (SZ) and separated diamond-shaped implants (SD). This study proposes a novel linked diamond-shaped implant (LD). To evaluate the safety and effectiveness of this new implant, finite element simulation models were created to assess the risks of endoleak, migration, and vascular wall rupture under annulus displacement load. After the SZ, SD, and LD implants were grafted in virtual release method, all the implants can cover tear-entry located in the ascending aorta, but space distance (δ) which exposed to blood was 14.5, 13.1, and 7.4 mm, respectively; the maximum areas of contact gap was 76.5, 51.5 and 6.3 mm2; the maximum migration distance (ΔL1) were 1.27, 1.06, and 0.1 mm; the maximum stress on ascending aorta was 0.19, 0.24, and 0.51 MPa, which were lower than failure stress (0.9 MPa). This study showed that both SZ and SD implants had minimal effects on the ascending aorta; however, higher risks were associated with implant migration and proximal endoleak. In contrast, the LD implant can simplify the surgical procedure, has a lower risk of endoleak and migration, and limited stress stimulation of the aorta. This study validated the feasibility and effectiveness of this novel implant using the finite element method, indicating its potential as a secure and reliable treatment option.

Temperature-Controlled Laser Processing of Shape Memory Wires: Spherical Ends as Connectors for System Integration

AbstractNickel–Titanium-based shape memory alloys have reached a high technological relevance in the medical field and also for actuation/energy conversion. At present, the interest in new actuation solutions is steadily increasing. However, one important challenge for the design of new actuators is the lack of connection and coupling options, which often hinders a reliable system integration. To address this challenge, this study presents a temperature-controlled laser processing approach for the generation of spherical ends on shape memory wires, which allow a relatively simple integration into different types of systems (e.g., printed circuit boards) in a form-fitting manner. For this purpose, an experimental setup with an integrated pyrometer was used to establish spherical ends on thin NiTi wires with a diameter of 0.24 mm. The resulting microstructures and the functional properties were investigated using scanning electron microscopy, thermal analysis, uniaxial tensile testing, actuation fatigue testing, and hardness measurements. The results obtained in the present study indicate that our laser procedure successfully yields reliable connection options for NiTi wires, without harming the functional performance of the material.

THE BIGGER, THE BETTER? TWO-RING CIRCULAR FRAMES AND DURATION OF TREATMENT IN THE MANAGEMENT OF TIBIAL FRACTURES: A RETROSPECTIVE COHORT STUDY

IntroductionFrame configuration for the management of complex tibial fractures is highly variable and is dependent not only on fracture pattern and soft tissue condition but also surgeon preference. The optimal number of rings to use when designing a frame remains uncertain. Traditionally, larger, stiffer constructs with multiple rings per segment were thought to offer optimal conditions for bone healing, however, the concept of reverse dynamisation questions this approach.Materials &amp; MethodsWe compared clinical outcomes in 302 consecutive patients with tibial fractures treated in our unit with either a two-ring circular frame or a three-or-more-ring (3+) frame. The primary outcome measure was time spent in frame. Secondary outcomes were the incidence of malunion and the need for further surgical procedures to achieve bone union. The groups were evenly matched for age, co-morbidities, energy of injury mechanism, fracture classification, post-treatment alignment and presence of an open fracture.ResultsThe mean time in frame was 168 days for the 2-ring group and 200 days for the 3+ rings group (p=0.003). No significant difference was found in the rate of malunion (p=0.428) or the requirement for secondary surgical intervention to achieve union (p=0.363). No significant difference in time in frame was found between individual surgeons.ConclusionsThis study finds that 2-ring frame constructs are a reliable option associated with significantly shorter duration of treatment and no increase in rates of adverse outcomes compared with larger, more complex frame configurations. Although this study cannot identify the underlying cause of the difference in treatment time between frame designs, it is possible that differences in mechanical stability lead to a more favourable strain environment for fracture healing in the 2-ring group.

Optimized Method for High‐Quality RNA Extraction from Formalin‐Fixed Paraffin‐Embedded Tissues

AbstractRNA extraction from formalin‐fixed paraffin‐embedded tissues (FFPE) presents a notable challenge. Extracting RNA from FFPE tissues has been challenging due to RNA degradation and chemical bonding between RNA and proteins during the fixation process. This results in reduced concentration and quality of the extracted RNA from FFPE tissues, impacting subsequent downstream analyses. In this study, we present an optimized approach involves replacing the tissue temperature‐digestion step with tissue crushing and homogenization. RNA extraction was performed on 100 FFPE tissue blocks obtained from the archive of Pathology Department of Shiraz University of Medical Sciences. After deparafinization of the tissues, RNA was extracted using this modified method, and the results compared to those of a standard extraction procedure and commercial kits used for FFPE tissue. Then gel electrophoresis and Real time PCR were done to check the quality and integrity of the extracted RNA. The results show that the concentration of RNA obtained from this method was significantly (P value &lt;0.0001) higher than the other methods. In conclusion, we have successfully introduced a modified method that enables the extraction of high‐quality and intact RNA from FFPE tissue. This method stands as a reliable option for molecular biology studies necessitating precise RNA extraction.

Retrospective cross-sectional study to evaluate outcome of Loco-regional flaps in head and neck reconstruction in Sudanese patients

Introduction: Soft tissue of Head and neck region poses both aesthetic and functional aspects must be retorted simultaneously, as any defect will be easy recognizable and will affect quality of patient’s life. Reconstruction by local- regional flap still the most popular approach used and outcome also better than other options. Objectives: To assess the outcome of Loco-regional flaps in head and neck reconstruction in Sudanese patients. Patients and Methods: Retrospective cross-Sectional, Multicenteric study (Soba University Hospital, Khartoum North teaching hospital and associated specialized hospital) – Khartoum – Sudan, 84 patients underwent head/neck reconstruction during the period from 2017 up to 2021were included. Results: Out of eighty four patients 47.6% were female, and 52.4% were male. The etiology of head and neck defects in majority (69%) was neoplastic, and in 11.9% was trauma. According to site of defect, in 23.8% of patients was Cheek unit, 21.4% was nasal site, and 16.7% was neck site. Surgery in 85.7% of patients were primary, while in 14.3 was delayed. Fasciocutaneous flaps were used in 64.3%, followed by Myocutaneous flap in 28.6%; Functional outcome was excellent in 61.9%, adequate in 35.7%, and was inadequate in only 2.4%. Majority of patients 66.2% didn’t develop any complications. Conclusion: Loco-regional flaps are ideally useful in covering head and neck defects. It has an acceptable aesthetic and functional outcome in majority of cases. It can be considered as a reliable option for reconstruction especially in resource constrained centers.

Comparison of Reconstruction of Maxilloalveolar Resections in Head and Neck Cancers with Chimeric Anterolateral Thigh Flap (ALT) versus Standard ALT Flap

Abstract Background Oral malignancy that presents at a locally advanced stage needs complex surgical resections in which the maxillary cavity is usually left open. The constant maxillary secretions lead to problems like poor healing, fistula formation, and flap necrosis, causing longer hospital stays, delayed adjuvant therapy, and additional surgeries. Several methods have been tried to ameliorate this, each faced with its own difficulties. This study describes the use of chimeric free anterolateral thigh (ALT) with vastus lateralis (VL) muscle to tackle this problem. Methodology With the aim to assess the advantage of reconstruction of maxillo-alveolar resections using chimeric ALT + VL, we analyzed data from 20 cases reconstructed with chimeric free ALT + VL over a year. We compared them with twenty matched controls reconstructed with standard ALT. Analysis was done with respect to intraoperative ease, adequacy of maxillary sinus fill, postoperative secretions, length of hospital stay, duration to adjuvant therapy, and postoperative complications tabulated using the modified Clavien-Dindo classification. Results It was found that chimeric ALT + VL gave greater freedom of movement to plug the maxillary cavity easily. The chimeric arm patients had fewer complications and a shorter mean hospital stay. Most of them received adjuvant therapy within their optimal time window. Conclusion Chimeric ALT with vastus lateralis muscle is a reliable option for reconstructing complex defects, especially with dead space cavities like the maxillary sinus. Effective plugging of the maxillary sinus during the primary surgery results in better patient outcomes and must be done routinely.