Volume Deficiency Research Articles

Comparison of dronedarone vs. flecainide in the maintenance of sinus rhythm, following electrocardioversion in adults with persistent atrial fibrillation: a systematic review and meta-analysis.

To compare flecainide and dronedarone for sinus rhythm (SR) maintenance following electrocardioversion of persistent atrial fibrillation (AF), in patients with minimal or no structural heart disease. A systematic search of publications using EMBASE, CENTRAL, CINAHL, and MEDLINE (1989-2019), identified a total of 595 articles. No limitations were applied. Nine articles met the inclusion criteria [five randomized controlled trials (RCTs) and four cohort studies], encompassing 1349 persistent AF candidates. Two retrospective studies compared flecainide with dronedarone, indicating a 6% reduced risk of AF recurrence with flecainide; however, results were not statistically significant [risk ratio (RR) 0.94, 95% confidence interval (CI) 0.71-1.24; P = 0.66]. One RCT compared dronedarone to placebo, demonstrating a 28% reduced risk of AF recurrence at 6 months (RR 0.72, 95% CI 0.58-0.90; P = 0.004). Two RCTs compare flecainide to placebo, when a 16% decreased risk of AF recurrence at 6-12 months was indicated; however, these results were not statistically significant (RR 0.84, 95% CI 0.66-1.07; P = 0.16). Within a 6- to 12-month follow-up period, a combined recurrence rate of AF was examined, in which flecainide and dronedarone maintained SR in 50% and 42%, respectively. Four articles satisfied quality appraisal, one of which focused on flecainide data. Dronedarone and flecainide displayed similar efficacy in maintaining SR in patients following electrocardioversion for persistent AF. The SR maintenance was numerically but not statistically significant in the flecainide group. Side effects uncovered similar pro-arrhythmic activity. However, in light of the deficiency of volume and quality of available evidence, the writer acknowledges the requirement for future research.

Demystifying Shrinkage Porosity in Ductile Iron Castings

Shrinkage porosity or volume deficiency in ductile iron castings manifests itself in many different physical shapes and sizes. The terminology used to describe the various forms of shrinkage confuses operating personnel when they try to solve the problems. There is also confusion as to the use of thermal analysis events in estimating the carbon equivalent. Irons with wide range of chemistry may solidify as eutectic. To maximize the potential of ductile iron and to produce castings with consistent high quality, it is essential to understand the fundamental nature of ductile iron solidification and use appropriate process controls. In this paper, an attempt is made to interpret various kinds of shrinkage porosity occurrences and make sense of process variables that may be contributing to them.

Fat Grafting in Patients With Extensive Unilateral Facial Deficiency: Three-Dimensional Computer-Assisted Planning, Implementation, and Outcome Assessment.

Autologous fat injection is a widely used, simple, and less invasive technique to correct volume deficiency. This study developed a treatment method by using a 3-dimensional (3D) simulation to plan and implement fat injection in patients with an extensive facial deficiency and then validated the accuracy of the method and treatment outcomes. Seven patients with a large unilateral facial deficiency receiving autologous fat grafts between 2015 and 2017 were recruited. One patient received repeated treatment. Furthermore, 3D surgical simulation was used to measure the difference between the mirrored image and lesion side. An extra 20% to 30% of fat graft was added. A color map was provided, and contour lines 2 mm deep marked the location of the fat injection. Outcome assessments were then performed, and a 3D symmetry index was defined using the contour lines on the facial surface. No significant difference was noted between the predicted volume and postoperative fat graft retention (35.7 ± 7.4 and 31.6 ± 9.7 mL, respectively; P = 0.176). A comparison of preoperative (79.5% ± 4.3%) and postoperative (89.0% ± 3.3%) 3D symmetry indexes indicated significantly improved facial symmetry (P = 0.018). Patient-reported outcomes of satisfaction on FACE-Q questionnaires yielded an average score of 62.73, higher than the control score (59.83). By using the proposed method, we could predict the required fat graft volume; moreover, the contoured map aided accurate surgical implementation. Thus, this method is useful for planning and guiding fat grafting treatment in patients with major unilateral facial deficiency.

One- Week Prophylaxis with Enoxaparin after Hospital Discharge Is Effective in Preventing Venous Thromboembolism in Living Liver Donors- Single Institution Retrospective Analysis

Background: Living donor liver transplant (LDLT) has expanded organ availability to patients with advanced liver failure. While this procedure decreased morbidity and mortality in recipients, it could pose a risk to the donors. Deep vein thrombosis and pulmonary embolism are known postoperative complications associated with morbidity and mortality in living liver donors. At our institution thrombophilia screening starts during donor selection process with antiphospholipid antibody panel and screening coagulation tests for all candidates. This is followed by hematology evaluation to determine the need for inherited thrombophilia screening and accordingly, hypercoagulability risk. Additionally, the institution strategy for venous thromboembolism (VTE) prevention in liver donors involves prophylactic subcutaneous heparin within 24 hours of the surgery and maintained until discharge followed by enoxaparin for 7 days after discharge. We conducted this retrospective analysis to evaluate the efficacy of these measures in reducing the rate of VTE in this population. Methods: Retrospective electronic medical chart review to analyze data on living liver donors in our institution between January 2000 and February 2019. Inclusion criteria: all adult living liver donors who underwent partial right hepatectomy and followed for at least 6 weeks after surgery. The primary endpoint is the rate of VTE within 6 weeks of liver donation in patients who received post-discharge enoxaparin for one week in comparison to donors who did not receive enoxaparin. Secondary endpoints: re-admission rate and bleeding events. All continuous data was presented using means, medians and standard deviation, while categorical data were presented using counts and percentages. Results: At our institution 112 liver donors underwent right hepatectomy. Baseline characteristics (Table-1): The average age was 34 years, 58% were females and 86% were white. 10% of donors reported family history of DVT/PE. 90% of donors were screened for antiphospholipid antibody syndrome, with one case with positive titers. 34% of donors were screened for protein C (PC), Protein S (PS) and Antithrombin deficiency (AT-III). There were no cases of PC or AT-III deficiency, but one case of mild PS deficiency was identified. 38% cases were screened for factor V Leiden and prothrombin mutations, with 3 donors carrying heterozygous factor V Leiden mutation and one with heterozygous prothrombin mutation. All donors received prophylactic heparin during their stay in the hospital. A total of 15 donors had coagulation factors checked before and after the surgery. Post operatively, there was significant transient deficiency in PC, PS and AT-III, as well as significant increase in factor VIII level. This imbalance peaked within one week of surgery, with PC mean activity of 48%, PS mean activity of 48%, AT-III mean activity of 53% and FVIII of 290%. Factor activities started to recover by third week of surgery and returned to baseline within 8 weeks (figure 1). A total of 100 patients received one week of prophylaxis with Enoxaparin after being discharged from the hospital (Table-2). There was no VTE incidents in this group. 14/100 were readmitted to the hospital within 6 weeks of initial hospital admission; none due to bleeding. A total of 12 patients did not receive any pharmacological preventive measures upon discharge; due to in-hospital bleeding in 3 cases, prior to starting this strategy in 4 cases, unknown reason in 5 cases. VTE events and subsequent readmissions occurred in 2/12 (16.7%) (figure 2). Odds ratio could not be performed due to the very small number of patients in the comparison group (Table-2). Conclusion: Partial hepatectomy for liver donation is associated with significant remote hypercoagulable state due to the sudden loss in liver volume and concomitant transient deficiency of PC, PS and AT-III as well as increasing Factor VIII activity. This thrombophilia peaks within one week after the surgery and starts to recover by the third week. Clinicians should consider performing baseline thrombophilia screening and subsequently exclude potential donors with preexisting hypercoagulable state. Extending pharmacological VTE prevention with enoxaparin for 7 days after hospital discharge has been successful in reducing the VTE risk without increasing risk of bleeding or readmission rate in our patient population. Disclosures Kuriakose: Alexion: Consultancy, Honoraria, Speakers Bureau; Bayer: Consultancy.

Sub-SMAS Transposition of the Buccal Fat Pad.

Regardless of the technique chosen to treat the aging midface, the isolated lateral approach facelift has a limited impact on the midface volume deficit. In an effort to overcome this limitation, modern facial rejuvenation procedures incorporate an additional modality for replenishing the midface volume. Some of the author's facelift patients present with bulging buccal fat pads despite volume deficiency in the inframalar region. The author's technique is designed to utilize the buccal fat pad to replenish the inframalar volume deficit. The author sought to present the fat pad transposition surgical technique along with objective outcome data. This study was a retrospective review of nonconsecutive cases where the sub-superficial-musculo-aponeurotic-system transposition of the buccal fat pad was performed. A total of 22 patients underwent the fat pad transposition technique by the author (O.B.) between July 2013 and December 2017. Patient data were obtained from patient records, 3-dimensional models, magnetic resonance images, and standardized photography. Preoperative differences in midface volume were assessed utilizing curvilinear surface measurements on 3-dimensional models and the Allergan midface volume deficit scale on standardized photography. The average midface volume deficit score significantly improved, and the average midfacial curvilinear surface measurement significantly increased after surgery. Magnetic resonance imaging confirmed a stable position of the buccal fat pad after surgery. The sub-superficial-musculo-aponeurotic-system transposition of the buccal fat pad is an effective technique that can be safely employed for autologous inframalar augmentation in patients with a favorable facial morphology.

Risk factors in bone augmentation procedures.

Bone augmentation is an extremely common procedure in implant dentistry today because of significant advancements with reactive biomaterials, a better understanding of the mechanism of action that is found with growth factors contained in platelets, and improvements in surgical techniques. The expectation is for the surgeon to place the dental implant in the position that best serves the requirements of the prosthetic restorations. With the increasing demands that patients have for ideal prosthetic results, surgeons are expected to predictably augment both hard and soft tissues to provide the anticipated esthetic and functional outcomes. Bone grafting can be performed before, during, and after the implant placement; however, these augmentation procedures come with increased cost, the risk of complications such as infection or failure, and lengthening of the total treatment time. In addition, a plethora of grafting materials are available commercially, where they are often inadequately studied, or there is minimal information regarding their predictability or long-term success, or ability to support dental implants. It is clear that although the surgical field has seen major progress since early implant surgical techniques in the 1980s, major challenges still exist with hard tissue augmentation procedures. This review will discuss these challenges that are increased and often specific to bone graft healing, and which are becoming more common as implant site development often requires bone augmentation to improve volume or contour deficiencies. The risk factors that patients may present with that will affect outcomes with bone augmentation procedures are identified, and recommendations for the prevention of complications or managing complications once they have occurred are provided.

In vitro evaluation of functionalized decellularized muscle scaffold for in situ skeletal muscle regeneration

Current treatment options for repairing volumetric muscle loss injury involve the use of existing host tissue like muscular flaps or grafts. However, host muscle tissue may not be available and donor site morbidity, such as functional loss and volume deficiency, is often present. In this study, we developed a biofunctionalized muscle-derived decellularized extracellular matrix scaffolding system to utilize endogenous stem/progenitor cells for in situ muscle tissue regeneration. We optimized the decellularization process to enhance cellular infiltration and fabricated an insulin-like growth factor-binding protein 3 (IGFBP-3)-conjugated scaffold for controlled delivery of IGF-I. We then tested in vitro characterization including IGF-I release kinetics and cellular infiltration. In addition, we have analyzed the bioactivities of skeletal muscle cells (C2C12) to assess the indirect effect of released IGF-1 from the scaffold. The IGFBP-3 conjugated scaffolds demonstrated showed sustained release of IGF-1 and 1% SDS decellularized scaffold with IGF-1 showed higher cellular infiltration compared to control scaffolds (no conjugation). In indirect bioactivity assay, IGF-1 conjugated scaffold showed 2.1-fold increased cell activity compared to control (fresh media). Our results indicate that IGFBP-3/IGF-I conjugated scaffold has the potential to be used for in situ muscle tissue regeneration.

Highly Accurate Water Level Measurement System Using a Microcontroller and an Ultrasonic Sensor

In many conditions, the conventional liquid data monitoring based on an ultrasonic sensor provides the unreliable readings due to the dynamically changed water level. In addition, in some conditions, it needs not only measuring water level but also needs to measure the volume and control water surplus or deficiency. To solve these issues, this paper proposes an accurate non-contact water measurement system based on a microcontroller and an ultrasonic sensor to measure the level and volume of liquids in small tanks without any contact. The proposed system also provides automatically controlling the water level with an alarm system to provide early warning of water surplus or deficiency. Microcontroller PIC16F877A is used to drive the sensor circuit and measure the time change of the reflected echoes from the water surface received by the ultrasonic (PING) sensor that correspond to the changes in the water level. The experimental results illustrate the effectiveness of the proposed system to measure the level and volume of water over 30 cm range with small error rates (SSE = 0.033 cm, RMSE = 0.034 cm and MAE = 0.029 cm for level measurement and SSE = 0.025 liter, RMSE = 0.026 liter and MAE = 0.021 liter for volume measurement) and excellent correlation coefficients (SCC = 0.9997 and KCC = 0.9951), thus provide accurate results for continuous measurement of the water level and volume in industrial applications.

Pediatric heart failure therapy: why β1-receptor blocker, tissue ACE-I and mineralocorticoid-receptor-blocker?

Pediatric heart failure (HF) treatment lagged behind the knowledge of pharmacological research and evidence-based clinical experience in adults. Considering the lack of prospective, double blind randomized studies in children, the review is focused on the preferred indication of specific β1-adrenoreceptor blockers (ARB), mineralocorticoid antagonists and tissue angiotensin-converting enzyme inhibitors (ACE-I). Our recommendations are based on the specificity in children, the effectiveness and the side-effect profile of HF-drugs, the receptor-physiological knowledge and the negative results of the few pediatric HF studies with an "evidence study label". In the interest of our pediatric patients, effective HF treatment has not longer to be postponed by balancing between evidence-based versus pathophysiology-based approach. At our institution, bisoprolol, lisinopril and spironolactone (BLS) are used treating HF in patients with left-right shunt lesions, reduced ejection fraction as well as during the inter-stage after HLHS-Hybrid approach. Chronic use of diuretics and fluid restriction is avoided, if always possible; intravascular volume deficiency stimulates further the neurohumoral axis. Pediatric HF needs to be treated with a strategy respecting the variable pathophysiology and the differences of receptor physiology between children and adult patients. The personalized treatment can be easily proofed by the surrogate parameters as heart rate, breath pattern, weight gain and image-derived parameters as well as biomarkers. Effective HF-therapy is also the basis for novel regenerative strategies in particular for young children with "end-stage" HF avoiding cardiac transplant or death.

The use of Medpor implants for midface contouring in cleft patients

Three-dimensional midfacial deficiency in cleft patients is common and is frequently connected to impairment of the aesthetic facial appearance. Different approaches to augment relevant facial regions are available. Alloplastic facial implants have been established as a viable alternative to autologous tissue augmentation in various circumstances. However, in cleft patients, the application of facial implants has rarely been reported. This retrospective study aimed to evaluate the use of Medpor implants for midfacial contouring in cleft patients. Fifty-one patients with orofacial clefts were assessed with regard to defined parameters. A range of Paranasal, Malar and Nasal Dorsum Medpor implants had been used. Unilateral cleft lip and palate (UCLP) represented the most common indication, followed by bilateral cleft lip and palate (BCLP). Bilateral implant insertion was performed as a general rule with few exceptions. Insertion of implants was frequently combined with other cleft-related surgical procedures. Even after orthognathic surgery, midfacial augmentation was implemented to specifically address residual volume deficiency, particularly in the malar region. The complication rate amounted to 4.9% (6/122 implants). Based on our findings, Medpor implants are reliable and long-term stable materials to successfully augment paranasal, subnasal and malar areas as well as a solid nasal dorsum material with few complications in cleft patients.

Experimental effect of different dilutions of blood with human plasma protein fraction and large dose factor one on blood coagulation and chemistry in vitro

Background and Aims:Human plasma protein fraction 5% (PPF5%) is an albumin-based colloid used to expand the plasma volume during volume deficiency. The current basic medical experimental study assessed in vitro coagulation of PPF5% solution and its effects on blood coagulation and chemistry.Methods:The study involved 20 volunteers, and each volunteer donated 20–50 ml of fresh blood. Three dilutions of blood with PPF5% dilutions were prepared (30, 50, and 70%). The fibrinogen dose required to correct coagulation in the 50% diluted samples was assessed (two doses used). The thromboelastogram (TEG) measured the haemostatic parameters (fibrinogen level, initiation of coagulation [R time], kinetics [K], acceleration of coagulation [α angle], maximum amplitude [MA] and coagulation index [CI]), and the ABL gas analyser measured the blood chemistry changes.Results:All dilutions showed significant TEG and blood chemistry changes when compared to controls. The two doses of fibrinogen corrected the clot formation speed with no significant difference in speed between the two doses. Acidosis measured by the strong ion gap (SID) and pH were significant for all dilutions when compared with the baseline. The 30% dilution remained within the lower normal acceptable value while 50% dilution was beyond the critical normal values.Conclusion:In vitro PPF5% to replace blood loss up to 50% dilution did not have significant coagulation and blood chemistry effects while coagulopathy should be expected in extreme dilutions (70%). Fibrinogen in a dose equivalent to 4 gm/70 kg adult improved clot strength at 50% dilution.

Severe multiple trauma: analysis of multistage tactic of treatment

Introduction. The main directions of intensive care in the acute polytrauma period are based on the principles of Damage control surgery, Damage control resusсitation, Damage control orthopedics. The purpose of work was to analyze the results of the diagnosis, treatment, surgical correction stages, deadlines final stabilization of bone fragments. Materials and methods. A retrospective study was carried out on history of 32 patients suffering from polytrauma which was accompanied by massive blood loss (30-40% deficiency of blood volume) and was characterized by combination of injuries. Clinical and laboratory parameters, stages according to Damage сontrol (DC) tactic, results of treatment were analyzed. Results. The results of diagnosis and treatment were analyzed in 20 (62.5%) males and 12 (37.5%) women, whose average age was 35.22 ± 12.7 years. The severity of injuries graded by the ISS scale was 26.84 ± 4.1. The level of consciousness by the GCS was 13,5 ± 0,5 points. In assessing the severity scale for patients with APACHE II was 14,97 ± 2,78 points. The degree of blood loss in the surveyed group corresponded to the III class according to the classification of the American college of surgeons and amounted to 35.21 ± 4.52% of the blood volume. Hemodynamic signs of hypovolemia were registered in all patients, and 25% needed vasopressor support. A total of 140 operations were performed in several stages. Оn the first day were performed 114 operations in order to stop the bleeding and temporary immobilization of the limbs. On the 2-14 days were performed 26 operations due to deferred indicators. Conclusion. this question need to further study of intensive care and development of criteria for the sequence and timing of multistage surgical correction in order to optimize treatment and reduce complications.

Microtia Reconstruction in Hemifacial Microsomia Patients: Three Framework Coverage Techniques

Microtia with hemifacial microsomia is difficult to treat because of skin volume deficiency. To provide further information for coverage techniques in microtia reconstruction, the authors have reviewed and analyzed patients who underwent surgery at their center. A total 52 patients with microtia with hemifacial microsomia who underwent reconstruction between 2006 and 2016 were involved. Patients were reviewed retrospectively by examining medical records and photographic data. All reconstructed cases were followed for 6 months to 10 years (median, 33 months). The average (median) surgeon's satisfaction score was 8.2 (median, 9) for the embedded and elevation technique (n = 23); 7.89 (median, 8) for the temporoparietal fascia flap technique (n = 10); and 6.30 (median, 7) for the subfascial expansion technique (n = 19). The median score difference between the embedding and subfascial expansion techniques was statistically significant (p = 0.03). Major factors that deteriorated aesthetic outcomes were large reconstructed ears (11 cases), cartilage framework resorption (11 cases), mismatched skin color (eight cases), different axis (seven cases), and different shapes (five cases). Mismatched skin color was significant in cases treated with the fascia flap technique (p < 0.0001), whereas cartilage framework resorption was significant in cases treated with the tissue expansion technique (p = 0.004). To obtain better aesthetic outcomes, the embedding technique should be used when the patient shows a mild to moderate degree of low hairline and usable remnant vestiges. In cases showing severe degrees of associated anomalies, the temporoparietal fascia flap technique should be used. Therapeutic, III.

Novel Forehead Augmentation Strategy: Forehead Depression Categorization and Calcium-Hydroxyapatite Filler Delivery after Tumescent Injection

The minimally invasive delivery of soft-tissue calcium hydroxyapatite fillers can ameliorate the appearance of forehead depressions and wrinkles. Forehead augmentations using fillers lead to fewer adverse events and to a faster recovery time than those using surgical procedures. However, many physicians avoid using them due to the risk of pain, intravascular injections, and embolisms that can cause skin necrosis and blindness. Strategy to address these issues includes pain reduction through tumescent solution before filler injection considering the vascular pathway. In addition, the strategy is also safer from embolism. The author presents a forehead augmentation technique involving the injection of a tumescent solution for tissue hydrodissection. Not only does this create a pocket of space (TS) for filler placement, it also allows the physician to detect bleeding and prevent vessel compromise It is better to minimize the number of entry-points where no vessel exists. By minimizing the number of entry-points and physical proximity to vessels and nerves during injection, this technique reduces the risks of embolization and bleeding. For optimal, patient-customized results, the author also classifies forehead depressions in 5 different categories, depending on the severity, shape, contour, slope, and quantity of volume deficiency observed. The author treated 218 patients using the author's forehead augmentations (using one central entry-site after TS test injection). The method was easy to perform and safe from adverse effects such as vascular problem, irregularity, infection, and prolonged swelling. Using this simple technique, I demonstrate how calcium hydroxyapatite fillers can be injected with little force or dilution, thus preserving its original properties while increasing procedural safety, minimizing pain, restoring convexity, and creating ideal curvatures.

Phi, Fat, and the Mathematics of a Beautiful Midface.

The Golden ratio, or Phi, has been used to explain the substrates of two-dimensional beauty utilizing the faces of models. A "Phi point" has been identified at the apex of the cheek mound that can be targeted in filler injections. The authors report herein how they have applied this algorithm for surgical shaping of the "beautiful" cheek as a routine part of their lower blepharoplasty procedure. The authors present their technique and results with patients undergoing lower blepharoplasty along with the adjunct of liposculpture to areas of volume deficiency in the midface with a particular goal of enhancing the Phi point. This study was retrospective, consecutive, nonrandomized, interventional case series. The authors reviewed the medical records of 113 consecutive patients who underwent lower blepharoplasty with autologous fat transfer to the Phi point. The aesthetic outcome, patient satisfaction, and complication/revisions were evaluated. One hundred two out of 113 patients achieved excellent lower lid position and cheek enhancement as assessed by both patient and surgeon. In these 102 patients, there was significant improvement in lower lid appearance, contour, transition to the cheek, and cheek projection as observed by the surgeon. Three patients required revision to achieve sufficient volume. Eight patients were satisfied with the outcome, nevertheless, requested additional filler injection to optimize. Lower blepharoplasty combined with autologous fat transfer to reshape the Phi point is a safe and reliable technique and another step further in our quest for recreating the beautiful face.

Multidisciplinary treatment: association among orthodontics, implantodontia and prosthetics. Case report

Deficiencies in the alveolar ridge, dental migration and malocclusion are conditions that may hamper restorative treatment and thus must be resolved by taking a multidisciplinary approach. This clinical case report is associated with orthodontics, implantology and prostheses for rehabilitation. A 34-year-old male patient presented himself in a private practice complaining of aesthetics and discomfort when chewing. At the clinical examination, teeth numbers 11, 12, 21, 22 and 25 were absent, with a removable partial denture replacing them. Due to the prolonged use of this prosthesis, wear of the artificial teeth and the extrusion of the anterior inferior teeth were present. A depression was also present in the vestibular region of the upper incisors, which did not provide adequate lip support. The tomographic examination revealed that despite the deficiency of the vestibular-lingual bone volume, the remnant in this region allowed for the implantation of implants. Orthodontic treatment was performed for the intrusion of the inferior elements and the alignment of the arches, with the goal of providing more spaces for rehabilitation. Afterward, the patient underwent surgery to install implants in the 11, 21 and 25 regions, concomitantly with bone regeneration in the vestibular region of the upper incisors. During this time, the patient used a new removable partial denture. After eight months, the prosthetic phase was started. Ten years after the end of treatment, the patient is satisfied with the results and performs maintenance every six months.KeywordsTooth movement techniques; Dental implants; Bone transplantation; Dental prosthesis.

Structural and histological differences between connective tissue grafts harvested from the lateral palatal mucosa or from the tuberosity area.

The study aims to understand the differences in the structural composition of soft tissue autografts harvested from the lateral palate or the tuberosity. Patients were randomly allocated to receive autografts harvested either from palatal or tuberosity sites to augment horizontal volume deficiencies around single-tooth implants. Tissue biopsies were analyzed for histological and histo-morphometric analysis. Picro-sirius red stain was used to evaluate collagen 1 and 3. Also, immuno-histochemical analysis was performed against MMP1, MMP2, cytokeratin-10, cytokeratin-13, and lysine hydroxylase-2. Twenty specimens were harvested from 9 subjects in the lateral palate group (PG) and 11 subjects in the tuberosity group (TG). The percentage of lamina propria represented 51.08% in the PG group and 72.79% in the TG group, while the area of submucosa was minimal in the TG group representing 4.89% of the total sample vs 25.75% in the PG. The total area of COL-1 and 3 in the TG was 1.19 ± 0.57 and 0.72 ± 0.44mm2, respectively, while in the PG, the corresponding values were 1.4 ± 0.7 and 1.04 ± 0.5mm2. The immuno-histochemical analysis generally showed a higher expression of LLH-2, MMP2, CYT-10, and CYT-13 in the TG when compared with the PG. Tuberosity grafts had a greater percentage of lamina propria and lower percentage of submucosa. The collagen content in the lamina propria was similar for both groups while the immuno-histochemical profile showed differences in the antibody expression of the epithelial cells. Tuberosity grafts had more lamina propria and less submocusa, which may be beneficial for volume augmentation.

Influence of season and climatic variables on testicular cytology, semen quality and melatonin concentrations in crossbred bucks reared under subtropical climate.

Seasonality in reproduction and effects of climatic variables on testicular cytology and semen quality in bucks reared under subtropical climatic conditions were not well understood. In the present study, using testicular cytology, semen evaluation and melatonin concentrations assessed over a period of 1year, we report that bucks reared under subtropical climatic conditions did not show seasonality in reproduction. Climatic variables including temperature, relative humidity, temperature-humidity index (THI), sunshine hours and day length were recorded daily during the whole period of experimentation (one complete year). Ejaculates were collected from crossbred (Alpine X Beetal) males (n = 6) biweekly using artificial vagina, and semen quality (volume, mass activity, sperm concentration, motility, viability, membrane integrity and protamine deficiency) was assessed. To understand the seasonal influence at testicular level, using fine needle aspiration biopsy method, testicular cells were aspirated and different types of cells and testicular cytology indices were quantified. Blood was collected biweekly for estimation of melatonin concentrations. Mass activity was higher (P < 0.05) during rainy season while individual sperm motility and sperm concentration were higher (P < 0.05) during rainy and autumn seasons as compared to other seasons. Sperm functional parameters did not show any differences during different seasons. Sertoli cell count, spermatogenic cell count and testicular indices did not differ among the seasons. Melatonin concentrations also did not differ significantly among the four seasons studied. Among the climatic parameters, THI had significant (P < 0.05) influence on sperm quality. The proportion of Sertoli cell in the testicular cytology had a significant and positive relationship with RH, THI and day length. It was concluded that seasonal variations are less evident in terms of spermatogenesis and semen quality in Alpine X Beetal crossbred bucks reared under subtropical climatic conditions.

Autologous Fat Grafting in the Treatment of Cleft Lip Volume Asymmetry.

The goal of cleft lip repair is a symmetrical balanced lip with minimal scar. Fat grafting is an established procedure in cosmetic and reconstructive surgery for restoration or correction of contour deformity, volume loss, and improved tissue characteristics. In this study, we evaluated the use of fat grafting in correction of cleft lip volume asymmetry. We performed a retrospective analysis of our series of patients who underwent fat grafting using the Coleman technique for cleft lip volume asymmetry. Sex, age at primary repair, age at fat grafting, perioperative data, and preoperative and postoperative photographs were reviewed. A total of 52 children underwent fat grafting as secondary revision for both unilateral and bilateral cleft lip repair. Fat was hand suctioned from the abdominal or buttock region with a mean yield of 3.0 mL (range, 2.0-5.0 mL). An average total volume of 3.0 mL (range, 2.0-4.5 mL) of fat was injected via an intraoral incision into the philtrum, vermillion, and volume deficiencies in the vertical component of the lip for volume restoration. No complications were noted with fat harvest or with fat grafting. Mean follow-up was 48 months. Postoperative assessment revealed improved volume symmetry in all patients, and all patients or families were pleased with the results. Fat grafting via an intraoral incision is a minimally invasive, safe, and reliable secondary procedure to improve volume asymmetries after cleft lip repairs.

Definitions of groove and hollowness of the infraorbital region and clinical treatment using soft-tissue filler.

Clarification is needed regarding the definitions and classification of groove and hollowness of the infraorbital region depending on the cause, anatomical characteristics, and appearance. Grooves in the infraorbital region can be classified as nasojugal grooves (or folds), tear trough deformities, and palpebromalar grooves; these can be differentiated based on anatomical characteristics. They are caused by the herniation of intraorbital fat, atrophy of the skin and subcutaneous fat, contraction of the orbital part of the orbicularis oculi muscle or squinting, and malar bone resorption. Safe and successful treatment requires an optimal choice of filler and treatment method. The choice between a cannula and needle depends on various factors; a needle is better for injections into a subdermal area in a relatively safe plane, while a cannula is recommended for avoiding vascular compromise when injecting filler into a deep fat layer and releasing fibrotic ligamentous structures. The injection of a soft-tissue filler into the subcutaneous fat tissue is recommended for treating mild indentations around the orbital rim and nasojugal region. Reducing the tethering effect of ligamentous structures by undermining using a cannula prior to the filler injection is recommended for treating relatively deep and fine indentations. The treatment of mild prolapse of the intraorbital septal fat or broad flattening of the infraorbital region can be improved by restoring the volume deficiency using a relatively firm filler.