Superficial Defects Research Articles

Pelvic and Perineal Reconstruction.

After studying this article, the participant should be able to: 1. Classify types of bony pelvic resections. 2. Outline reconstructive options for pelvic and perineal defects. 3. Identify advantages and drawbacks of various reconstructive techniques. 4. Recognize the functional benefits of bony and soft-tissue reconstruction. Defects of the pelvis and perineum arise from tumors, trauma, infection, congenital differences, and gender incongruence. Pelvic resections can result in bony instability and soft-tissue deficiency. The goals of reconstruction are maintenance of spinopelvic continuity, elimination of dead space, resurfacing of cutaneous defects, and prevention of hernias. Perineal reconstruction has important functional considerations. Abdominoperineal resection and pelvic exenteration defects benefit from flap reconstruction to decrease pelvic wound complications. Vulvovaginal reconstruction is performed with flaps from the perineum, thigh, or abdomen. Scrotal and superficial penile defects are most commonly reconstructed with scrotal flaps and skin grafts. Total penile reconstruction most commonly uses a radial forearm free flap.

Investigating Flow-Induced Corrosion of Magnesium in Ophthalmological Milieu.

Although the impact of local fluid dynamics in the biodegradation of magnesium is well known, currently no studies in the literature address the degradation effects of ocular vitreous on bioresorbable devices made of magnesium, which could be developed as drug delivery carriers. The aim of this study was to investigate the flow-induced corrosion mechanism of magnesium in an ophthalmological environment for future applications in ophthalmic drug delivery. To achieve this, experimental and computational methods were combined. Specifically, a CFD model was employed to design experimental conditions that replicate the ocular flow-induced shear stress (FISS) on manufactured magnesium samples. Pure Mg samples were tested in a bioreactor system capable of imposing the ocular CFD calculated values of FISS on the Mg samples' surface by varying the pump flow rate. Optimal flow rates for a range of different FISS values specific to the ophthalmological fluid dynamics affecting the device were indeed determined before running the experiments. After conducting customized corrosion tests, morphological observations and profilometric maps of the eroded surfaces of Mg samples were obtained using scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). These maps were then post-processed for the parametric evaluation of corrosion rates. Pre-existing localized superficial defects did affect the final corrosion pattern. SEM images and CLSM data confirmed a uniform corrosion mechanism, with corrosion rates of 1.9, 2.7, and 3.4 μm/day under different shear stress conditions (0, 0.01, and 0.032 Pa, respectively). More generally, uniform corrosion on pure Mg samples increased with higher FISS values, and at higher shear stress values (FISS = 0.032 Pa), a notable washing-out effect of the corrosion products was observed. The removal of corrosion products at higher shear stresses suggests that the dynamic ocular environment, influenced by saccadic movements, plays a significant role in the corrosion mechanism of pure magnesium. The corrosion rates determined in this study, in conjunction with clinical drug release requirements, are crucial for designing potential drug-release devices for ocular applications.

From Angiosomal to Bi-Angiosomal and Extra-Angiosomal Pedicled Perforator Flaps: Optimizing the Use of Local Tissues in Abdominal Wall Reconstruction.

The use of free-style and propeller perforator-based flaps has been popularized for the reconstruction of moderate size defects in the trunk and extremities, while their application in the field of abdominal reconstruction is seldom reported. The purpose of this report is to describe the authors experience with the use of pedicled perforator-based flaps in abdominal wall reconstruction, presenting the innovative concept of transition from angiosomal to bi-angiosomal and extra-angiosomal perforator flaps and showing applications of the different flap designs according to the multiple clinical scenarios. A total of 15 patients underwent abdominal wall reconstruction with angiosomal, bi-angiosomal, and extra-angiosomal pedicled perforator-based flaps harvested from the surrounding abdominal subunits for superficial or full thickness defects of the abdominal wall of moderate and large dimensions. The defects were consequent to soft-tissue sarcomas (STS) and non-melanoma skin cancer (NMSC) resection in 11 and 4 cases, respectively. Operative data, post-operative course, and complications were recorded. Moreover, at 12 months follow-up, patients were asked to rate the esthetic and functional outcomes of the reconstructive procedure on a 5-point Likert scale. Ten angiosomal perforator flaps (4 DIEP, 4 SCIP, 1 SEAP, and 1 LICAP flaps) and 5 bi-angiosomal and extra-angiosomal conjoined perforator flaps including different vascular territories (3 bilateral DIEP, 1 bilateral SEAP, and 1 ipsilateral DIEP-SEAP flap) were successfully transferred in 15 patients. In two patients, microsurgical anastomoses were performed to guarantee proper vascularization of the additional cutaneous territory. Mean age was 59.3 years. Defect sizes ranged from 98 to 408 cm2 (mean size was 194.7 cm2). Mean operative time was 280 min. Flap surface ranged from 108 to 336 cm2 (mean surface was 209.3 cm2). No major complications were registered. One bi-angiosomal bilateral DIEP flap suffered from partial necrosis and required an additional flap reconstruction. All patients underwent a 12-month follow-up except one, who did not show for clinical follow-up but responded at the Likert scale at clinical follow-up at 9 months. Overall patients' satisfaction was high, with mean esthetic and functional ratings of 4.27 and 3.87. The use of local tissues is an under-utilized solution in the field of abdominal wall reconstruction. Angiosomal, bi-angiosomal, and extra-angiosomal perforator flaps proved to be a reliable option to provide the transfer of a significant amount of tissue and offer like with like reconstruction while maximizing flap survival.

An in situ forming cartilage matrix mimetic hydrogel scavenges ROS and ameliorates osteoarthritis after superficial cartilage injury

Superficial cartilage defects represent the most prevalent type of cartilage injury encountered in clinical settings, posing significant treatment challenges. Here, we fabricated a cartilage extracellular matrix mimic hydrogel (GHC, consisting of Gelatin, Hyaluronic acid, and Chondroitin sulfate) to avoid the exacerbation of cartilage deterioration, which is often driven by the accumulation of reactive oxygen species (ROS) and a pro-inflammatory microenvironment. The GHC hydrogel exhibited multifunctional properties, including in situ formation, tissue adhesiveness, anti-ROS capabilities, and the promotion of chondrogenesis. The enhancement of tissue adhesion was achieved by chemically modifying hyaluronic acid and chondroitin sulfate with o-nitrobenzene, enabling a covalent connection to the cartilage surface upon light irradiation. In vitro characterization revealed that GHC hydrogel facilitated chondrocyte adhesion, migration, and differentiation into cartilage. Additionally, GHC hydrogels demonstrated the ability to scavenge ROS in vitro and inhibit the production of inflammatory factors by chondrocytes. In the animal model of superficial cartilage injury, the hydrogel effectively promoted cartilage ECM regeneration and facilitated the interface integration between the host tissue and the material. These findings suggest that the multifunctional GHC hydrogels hold considerable promise as a strategy for cartilage defect repair. Statement of significanceSuperficial cartilage defects represent the most prevalent type of cartilage injury encountered in the clinic. Previous cartilage tissue engineering materials are only suitable for full-thickness cartilage defects or osteochondral defects. Here, we developed a multifunctional GHC hydrogel composed of gelatin, hyaluronic acid, and chondroitin sulfate, which are natural cartilage extracellular matrix components. The drug-free and cell-free hydrogel not only avoids immune rejection and drug toxicity, but also shows good mechanical properties and biocompatibility. More importantly, the GHC hydrogel could adhere tightly to the superficial cartilage defects and promote cartilage regeneration while protecting against oxidation. This natural ingredients and multifunctional hydrogel is a potential material for repairing superficial cartilage defects.

Complications of chest wall around malignant tumors: differences based on reconstruction strategy

BackgroundMalignant chest wall tumors need to be excised with wide resection to ensure tumor free margins, and the reconstruction method should be selected according to the depth and dimensions of the tumor. Vascularized tissue is needed to cover the superficial soft tissue defect or bone tissue defect. This study evaluated differences in complications according to reconstruction strategy.MethodsForty-five patients with 52 operations for resection of malignant tumors in the chest wall were retrospectively reviewed. Patients were categorized as having superficial tumors, comprising Group A with simple closure for small soft tissue defects and Group B with flap coverage for wide soft tissue defects, or deep tumors, comprising Group C with full-thickness resection with or without mesh reconstruction and Group D with full-thickness resection covered by flap with or without polymethyl methacrylate. Complications were evaluated for the 52 operations based on reconstruction strategy then risk factors for surgical and respiratory complications were elucidated.ResultsTotal local recurrence-free survival rates in 45 patients who received first operation were 83.9% at 5 years and 70.6% at 10 years. The surgical complication rate was 11.5% (6/52), occurring only in cases with deep tumors, predominantly from Group D. Operations needing chest wall reconstruction (p = 0.0016) and flap transfer (p = 0.0112) were significantly associated with the incidence of complications. Operations involving complications showed significantly larger tumors, wider areas of bony chest wall resection and greater volumes of bleeding (p < 0.005). Flap transfer was the only significant predictor identified from multivariate analysis (OR: 10.8, 95%CI: 1.05–111; p = 0.0456). The respiratory complication rate was 13.5% (7/52), occurring with superficial and deep tumors, particularly Groups B and D. Flap transfer was significantly associated with the incidence of respiratory complications (p < 0.0005). Cases in the group with respiratory complications were older, more frequently had a history of smoking, had lower FEV1.0% and had a wider area of skin resected compared to cases in the group without respiratory complications (p < 0.05). Preoperative FEV1.0% was the only significant predictor identified from multivariate analysis (OR: 0.814, 95%CI: 0.693–0.957; p = 0.0126).ConclusionsSurgical complications were more frequent in Group D and after operations involving flap transfer. Severe preoperative FEV1.0% was associated with respiratory complications even in cases of superficial tumors with flap transfer.

Exploring deep fully convolutional neural networks for surface defect detection in complex geometries

In this paper, we propose a machine learning approach for detecting superficial defects in metal surfaces using point cloud data. We compare the performance of two popular deep learning architectures, multilayer perceptron networks (MLPs) and fully convolutional networks (FCNs), with varying feature sets. Our results show that FCNs (F1=0.94) outperformed MLPs (F1=0.52) in terms of precision, recall, and F1-score. We found that transfer learning with pre-trained models can improve performance when the amount of available data is limited. Our study highlights the importance of considering the amount and quality of training data in developing machine learning models for defect detection in industrial settings with 3D images.

Bilateral Superior Gluteal Artery Perforator (SGAP) Flap: Modified Concept in Perineal Reconstruction.

Background/Objectives: Perineal reconstruction after abdominoperineal excision often requires complex closures and is fraught with wound healing complications. Flap-based approaches introduce non-irradiated vascularized tissue to the area of resection to fill a large soft-tissue defect and dead space, reduce the risk of infection, and facilitate wound healing. Employing perforator flaps with their beneficial donor site properties, the authors have developed a concept of bilateral superior gluteal artery perforator (SGAP) flaps to restore extensive perineal defects. Methods: This retrospective case series was conducted between September 2015 and December 2019. We included three patients who received bilateral SGAP flap reconstruction after oncological resection. One deepithelialized SGAP flap was used for obliteration of dead space, combined with the contralateral SGAP flap for superficial defect reconstruction and wound closure. Results: Within this patient population, two male and one female patient, with a median age of 62 years (range, 52-76 years), were included. Six pedicled SGAP flaps were performed with average flap dimensions of 9 × 20 cm (range 7-9 × 19 × 21). No flap loss or no local recurrence were documented. In one case, partial tip necrosis with prolonged serous drainage was observed, which was managed by surgical debridement. No further complications were detected. Conclusions: The combination of two SGAP flaps provides maximal soft tissue for defect reconstruction and obliteration of dead space, while maintaining a very inconspicuous donor site, even with bilateral harvesting. Given these advantages, the authors recommend this promising approach for successful reconstruction of perineal defects.

Superficial Defect Detection for Concrete Bridges Using YOLOv8 with Attention Mechanism and Deformation Convolution

The accuracy of detecting superficial bridge defects using the deep neural network approach decreases significantly under light variation and weak texture conditions. To address these issues, an enhanced intelligent detection method based on the YOLOv8 deep neural network is proposed in this study. Firstly, multi-branch coordinate attention (MBCA) is proposed to improve the accuracy of coordinate positioning by introducing a global perception module in coordinate attention mechanism. Furthermore, a deformable convolution based on MBCA is developed to improve the adaptability for complex feature shapes. Lastly, the deformable convolutional network attention YOLO (DCNA-YOLO) detection algorithm is formed by replacing the deep C2F structure in the YOLOv8 architecture with a deformable convolution. A supervised dataset consisting of 4794 bridge surface damage images is employed to verify the proposed method, and the results show that it achieves improvements of 2.0% and 3.4% in mAP and R. Meanwhile, the model complexity decreases by 1.2G, increasing the detection speed by 3.5/f·s−1.

Inspection of Semi-Elliptical Defects in a Steel Pipe Using the Metal Magnetic Memory Method

Ferromagnetic pipes are widely used for fluid transportation in various industries. The failure of these ferromagnetic pipes due to surface defects can generate industrial accidents, economic losses, and environmental pollution. Non-destructive testing techniques are required to detect these surface defects. An alternative is the metal magnetic memory (MMM) method, which can be employed to detect surface flaws in ferromagnetic structures. Based on this method, we present an analysis of experimental results of the magnetic field variations around five different surface semi-elliptical defects of an ASTM A36 steel pipe. A measurement system of MMM signals is implemented with a rotatory mechanism, a magnetoresistive sensor, a data processing unit, and a control digital unit. The MMM method does not require expensive equipment or special treatment of the ferromagnetic structures. In order to research a potential relationship between the defect sample size and the measured MMM signals, variable defect dimensions are experimentally considered. According to these results, the shape and magnitude of the normal and tangential MMM signals are altered by the superficial semi-elliptical defects. In particular, the maximum and mean tangential components and the maximum and minimum normal components are related to the defect dimensions. The proposed measurement system can be used to study the behavior of magnetic field variations around surface defects of ferromagnetic pipes. This system can be adapted to measure the position and damage level of small defects on the surface of ferromagnetic pipes.

Improving the Transparency of a MgAl2O4 Spinel Damaged by Sandblasting through a SiO2-ZrO2 Coating

Transparent materials in contact with harmful environments such as sandstorms are exposed to surface damage. Transparent MgAl2O4 spinel used as protective window, lens or laser exit port, among others, is one of the materials affected by natural aggressions. The impact of sand particles can cause significant defects on the exposed surface, thus affecting its optical and mechanical behavior. The aim of this work is to improve the surface state of a spinel damaged surface by the deposition of a thin layer of SiO2-ZrO2. For this purpose, spinel samples obtained from different commercial powders sintered by Spark Plasma Sintering were sandblasted and further coated with a SiO2-ZrO2 thin layer. The coating was successfully synthesized by the sol/gel method, deposited on the sandblasted samples and then treated at 900 °C, reaching a final thickness of 250 nm. The results indicated that sandblasting significantly affects the surface of the spinel samples as well as the optical transmission, confirmed by UV-visible spectroscopy and profilometry tests. However, the deposition of a SiO2-ZrO2 coating modifies the UV-visible response. Thus, the optical transmission of the S25CRX12 sample presents the best transmission values of 81%, followed by the S25CRX14 sample then the S30CR sample at 550 nm wavelength. An important difference was observed between sandblasted samples and coated samples at low and high wavelengths. At low wavelengths (around 200 nm), sandblasting tends to improve significantly the transmission of spinel samples, which exhibit a low transmission in the pristine state. This phenomenon can be attributed to the healing of small superficial defects responsible for the degradation of transmission such as pores or flaws. When the initial transmission at 200 nm is high, the sandblasting worsens the transmission. Sandblasting reduces slightly the transmission values for long wavelengths due to the formation of large superficial defects like chipping by creation and propagation of lateral cracks. The coating of the sandblasted samples exhibits some healing of defects induced by sandblasting. The deposition of the SiO2-ZrO2 layer induces a clear increase in the optical transmission values, sometimes exceeding the initial values of the transmission in the pristine state.

Refining animal welfare of wild boar (Sus scrofa) corral-style traps through behavioral and pathological investigations.

Wild boar trapping has been used as a management tool to control wild boar populations. However, it is increasingly criticized due to animal welfare concerns. While cortisol levels have been used to assess trap-related stress in wild boar, data on trap-related injuries and behavioral data are scarce. We aimed to evaluate three different corral-style traps for wild boar according to available mammal trapping standards to investigate and refine animal welfare in wild boar trapping. We examined 138 wild boars captured and killed by head shot in 27 capture events. Traps were closed by remote control only if the complete group were trapped. The behavior of the animals in the trap and during culling was recorded on video. All wild boars were examined and a pathological and radiological examination of the heads for trap- and shot-related injuries followed. Trap-related injuries occurred in 33% of the animals with superficial mild skin defects to skull fractures. One out of three traps met all the set requirements. A wire-meshed trapping system failed all. After installing an incomplete barrier in the center of the trap to slow down trapped animals, the fracture rate in one trap type was significantly reduced by 29% (p < 0.05). Our data showed that the type of trap (p = 0.007) and the number of animals trapped at once (p = 0.002) had a significant influence on the number of escape attempts. Trapping larger groups reduced the escape attempts. We emphasize the importance of an accurate pathological examination to evaluate animal welfare in traps and call for adjusting the injury categories listed in the standards and make a proposal for wild boar live trapping.

Sulphide stress corrosion in SAE 1070 steel wire used in the tensile armour of flexible pipelines: Effect of induced superficial defects

This research aims to investigate and quantify potential damage resulting from induced superficial defects on the surface of wires use on tensile armor of flexible pipes. Different values of kt factors and H2S concentration in aggressive gas mixtures with CO2, were analysed to determine the operational conditions that do not result in rupture of the tensile reinforcement during service, under the conditions studied. The tests were based on NACE TM0316 standard, using a 4-point bend test. Two superficial notches were created, which generated known stress concentration factor Kt values of 1.5 and 2.0, and three gaseous concentrations (220, 700, and 1100 ppm of H2S in CO2) were used. After bending tests, the samples were evaluated by metallographic and fractographic analysis, weight loss and liquid penetrant inspection. The results were then analysed using analysis of variance (ANOVA). Only the samples exposed to 220 ppm of H2S in CO2 did not rupture at both Kt values. However, for the Kt value of 2.0, cracks were observed in the longitudinal direction of the wires, originating from the machined notch. Additionally, the samples exposed to 700 ppm and 1100 ppm of H2S had a significantly higher damage score (approximately 15x) than the samples exposed to 220 ppm, regardless of the Kt value.

RESIN INFILTRATION OF HYPOMINERALIZED ENAMEL DEFECTS WITH COMPOSITE RESIN COMBINED RESTORATION: CASE REPORT

The purpose of these case reports is the aesthetic treatment of enamel defects using the resin infiltration method and conservative approach. The treatment of three patients who came to our clinic complaining of an opaque enamel lesion in the upper anterior region is described. During oral examination, it was determined that the teeth were healthy but there were superficial and deep developmental defects. Before starting the restorative procedures, it was planned to treat the teeth using the resin infiltration method. The Icon infiltration technique, which has microinvasion technology, was applied in accordance with the manufacturer's instructions. Follow-up examinations were performed at 2, 6, 8 months and 1 year in 3 cases. The most aesthetic results can be achieved in a short time by using the resin infiltration method and minimally invasive approaches. The micro abrasive technique is effective in superficial defects, but is insufficient in more advanced deep enamel defects. A combination of resin infiltration technique, composite resin restoration and bleaching procedures to treat increased opacity, discoloration and defects in the anterior teeth can result in a homogeneous and aesthetic appearance of the teeth.

Limonia acidissima fruit juice mediated eco-friendly synthesis of pervoskite ZnSnO3 nanoparticles: Applications to photocatalytic, electrochemical, antioxidant and antibacterial activities

In anticipation toa growing desire for start-ups to be both green and sustainable, there has been an increase in research focus on the effective removal and degradation of toxic wastewater effluents. A viable and sustainable wastewater treatment method is the use of light to degrade organic contaminants. Photocatalysis holds great potential for addressing environmental, energy, and health challenges, offering sustainable solutions for a wide range of applications with significant societal and economic benefits. In this paper, a multicomponent heterostructure photocatalyst ZnSnO3 was designed and prepared via a simple environmentally responsible path, which included the use of limonia acidissima natural fruit juice as a capping and reducing agent. The ZnSnO3 nanoparticles that were generated were examined using XRD, FT-IR, UV-DRS, SEM-EDAX, TEM, PL and BET investigations. The structure and crystallographic parameters were examined using XRD analysis, and found that the crystallite had orthorhombic geometry. The functional groups were investigated using FTIR spectroscopy. The band gaps (3.59 & 3.69 eV) were estimated using a Tauc plot employing the data of UV-DRS. According to SEM and TEM studies, the morphologies are irregular in shape and have particles that are about 14 nm in size. EDAX analysis was used to determine the elemental composition of the examined ZnSnO3 nanostructures, which demonstrated their purity. Using PL spectroscopy, superficial defects were investigated. The synthesized NPs were used as photocatalysts to degradethe methylene blue dye. Electrochemical measurement of K3[Fe(CN)6] revealed a good sensory activity with a detection limit of 38 μL. K3[Fe(CN)6] is used to detect ferrous ions in biological specimens. Furthermore, it also shows the superior anti-bacterial activity against gram-positive bacteria such as Staphylococcus aureus, and gram-negative bacteria Pseudomonas fluorescens. To the best of our literature survey, it’s the first report for the synthesis of ZnSnO3 nanostructures using the natural reducing agent limonia acidissima natural fruit juice for dye degradation, electrochemical, anti-oxidant, and anti-bacterial applications.

Effects of removing superficial layer of cartilage on the surface morphology and mechanical behavior of cartilage

Superficial cartilage defect is an important factor that causes osteoarthritis. Therefore, it is very important to investigate the influence of superficial cartilage defects on its surface morphology and mechanical properties. In this study, the knee joint cartilage samples of adult pig were prepared, which were treated by enzymolysis with chymotrypsin and physical removal with electric friction pen, respectively. Normal cartilage and surface treated cartilage were divided into five groups: control group (normal cartilage group), chymotrypsin immersion group, chymotrypsin wiping group, removal 10% group with electric friction pen, and removal 20% group with electric friction pen. The surface morphology and structure of five groups of samples were characterized by laser spectrum confocal microscopy and environmental field scanning electron microscopy, and the mechanical properties of each group of samples were evaluated by tensile tests. The results show that the surface arithmetic mean height and fracture strength of the control group were the smallest, and the fracture strain was the largest. The surface arithmetic mean height and fracture strength of the removal 20% group with electric friction pen were the largest, and the fracture strain was the smallest. The surface arithmetic mean height, fracture strength and fracture strain values of the other three groups were all between the above two groups, but the surface arithmetic mean height and fracture strength of the removal 10% group with electric friction pen, the chymotrypsin wiping group and the chymotrypsin soaking group decreased successively, and the fracture strain increased successively. In addition, we carried out a study on the elastic modulus of different groups, and the results showed that the elastic modulus of the control group was the smallest, and the elastic modulus of the removal 20% group with electric friction pen was the largest. The above study revealed that the defect of the superficial area of cartilage changed its surface morphology and structure, and reduced its mechanical properties. The research results are of great significance for the prevention and repair of cartilage injury.

Pannexin 3 deletion in mice results in knee osteoarthritis and intervertebral disc degeneration after forced treadmill running.

Pannexin 3 (Panx3) is a glycoprotein that forms mechanosensitive channels expressed in chondrocytes and annulus fibrosus cells of the intervertebral disc (IVD). Evidence suggests Panx3 plays contrasting roles in traumatic versus aging osteoarthritis (OA) and intervertebral disc degeneration (IDD). However, whether its deletion influences the response of joint tissue to forced useis unknown. The purpose of this study was to determine if Panx3 deletion in mice causes increased knee joint OA and IDD after forced treadmill running. Male and female wildtype (WT) and Panx3 knockout (KO) mice were randomized to either a no-exercise group (sedentary; SED) or daily forced treadmill running (forced exercise; FEX) from 24 to 30 weeks of age. Knee cartilage and IVD histopathology were evaluated by histology, while tibial secondary ossification centers were analyzed using microcomputed tomography (µCT). Both male and female Panx3 KO mice developed larger superficial defects of the tibial cartilage after forced treadmill running compared with SED WT mice. Additionally, Panx3 KO mice developed reduced bone volume, and female PANX3 KO mice had lengthening of the lateral tubercle at the intercondylar eminence. In the lower lumbar spine, both male and female Panx3 KO mice developed histopathological features of IDD after running compared to SED WT mice. These findings suggest that the combination of deleting Panx3 and forced treadmill running induces OA and causes histopathological changes associated with the degeneration of the IVDs in mice.

Devastating Mooren Ulcer Halt by Timely Aggressive Treatment - A Case Report

Introduction : Mooren ulcer is a progressive and painful peripheral ulcerative keratitis of unknown cause. Study aims to show effective aggressive treatment for Mooren ulcer.&#x0D; Case Illustration : A 43-year-old man was admitted with a marked clinical worsening of the white tissue covering the cornea, accompanied by pain, redness, and blurry vision of the left eye. Initial examination showed visual acuity of 6/21cc. Peripheral corneal ulcer was found from 6 to 2 clock hours with superficial vascularization and epithelial defect. Patient underwent ancillary examinations with unremarkable findings. Patient was diagnosed with Mooren Ulcer and treated with artificial tears and steroid topical. Patient had no significant improvement; therefore conjunctival resection with immunosuppressive therapy were performed. At follow up, no pain was reported, vision improved to 6/15cc, and the ocular surface inflammation resolved.&#x0D; Discussion : Mooren ulcer is usually misdiagnosed since the clinical signs are similar to other differential diagnoses. The examination must be performed carefully to rule out autoimmune and corneal infection. Treatment goals are to halt the destructive process and promote reepithelization. The stepwise aggressive approach of Mooren Ulcer treatments is crucial. It starts directly with topical steroid to control the progression of inflammation. However, when used alone, topical steroid usually cannot prevent the rapid progression so conjunctival resection is needed to remove the source of collagenase production by cutting the perilimbal blood vessels’ access to the area of the ulcer. Combination with an immunosuppressant will effectively maintain a stable condition.&#x0D; Conclusion : Early diagnosis and aggressive treatment for Mooren ulcer are needed to prevent the rapid progression.

Term Neonate Born With Right Upper Extremity Skin Necrosis at Birth: A Case Report.

Congenital skin and soft tissue necrosis is a rare condition associated with significant morbidity and mortality in neonates. The authors treated a neonate born with significant skin necrosis of the right forearm. The case report is followed by a literature review and discussion of previously published reports of neonatal skin necrosis. A term female neonate was admitted to our hospital at 24 h of age for skin necrosis of the right forearm with sloughing and edema below the right elbow and contractures of her fingers. Topical treatment with cleansing and antibiotic application was initiated. The LUNA florescent microangiography showed superficial perfusion defects in the arm and dorsum of the hand along with overt ischemia over the dorsal aspect of the forearm. She was treated with intravenous antibiotics following a sepsis evaluation. Subsequently, she developed hypotension treated with fluid boluses, dopamine, and stress dose steroids. Concerns of wound infection and sepsis led to debridement of the necrotic area within the first 24 h post-admission. Wet-to-dry dressing changes using Vashe wound solution were begun postoperatively.; followed by placement of Integra on postoperative day-of-life (DOL) 7; dressing takedown on DOL 12; and autografting of the right hand and forearm with disarticulation of the 4th distal interphalangeal joints and right 5th distal interphalangeal transection on DOL 24. Postoperative dressing care was continued during the remainder of the hospital stay, she remained stable without any further complications and was discharged home on DOL 34 with outpatient clinic follow-up.

Efficacy, Feasibility, and Safety of the X-Tack Endoscopic HeliX Tacking System: A Multicenter Experience.

The application of endoscopic suturing has revolutionized defect closures. Conventional over-the-scope suturing necessitates removal of the scope, placement of the device, and reinsertion. A single channel, single sequence, through-the-scope suturing device has been developed to improve this process. This study aims to describe the efficacy, feasibility, and safety of a through-the-scope suturing device for gastrointestinal defect closure. This was a retrospective multicenter study involving 9 centers of consecutive adult patients who underwent suturing using the X-Tack Endoscopic HeliX Tacking System (Apollo Endosurgery). The primary outcomes were technical success and long-term clinical success. Secondary outcomes included adverse events, recurrence, and reintervention rates. In all, 56 patients (mean age 53.8, 33 women) were included. Suturing indications included fistula repair (n=22), leak repair (n=7), polypectomy defect closure (n=12), peroral endoscopic myotomy (POEM) site closure (n=7), perforation repair (n=6), and ulcers (n=2). Patients were followed at a mean duration of 74 days. Overall technical and long-term clinical success rates were 92.9% and 75%, respectively. Both technical and clinical success rates were 100% for polypectomies, POEM-site closures, and ulcers. Success rates were lower for the repair of fistulas (95.5% technical, 54.5% clinical), leaks (57.1%, 28.6%), and perforations (100%, 66.7%). No immediate adverse events were noted. This novel, through-the-scope endoscopic suturing system, is a safe and feasible method to repair defects that are ≤3cm. The efficacy of this device may be better suited for superficial defects as opposed to full-thickness defects. Larger defects will need more sutures and probably a double closure technique to provide a reinforcement layer.

Optimization of the cosmetic appearance of skin scar after caesarean section - part II physiotherapy practice.

Scar formation is a natural part of the healing process after CS. This process, lasting up to two years, depends on the number of factors including type of incision, wound size, the person's age, body weight, health condition, and many others. Abnormal scarring should not be treated only as a cosmetic defect or superficial tissue defects. Functional and anatomical considerations must also be considered. Large varieties of non-invasive treatment modalities have been used to enhance wound healing and scar treatment. The article proposes a comprehensive approach to scar prevention and remodeling. The role of manual techniques, dry needling, cupping therapy, compression therapy, Kinesio taping, and physical agents is highlighted.