Lumbar perforator flap for closure of sacral tissue defect after lipomyelomeningocele

Complex sacral midline defects following spinal surgery have been traditionally closed with either muscle or musculocutaneous flaps. We present a case with a complicated sacral wound extending to the medulla spinalis after a lipomeningomyelocele excision in an ambulating adult. Wound was repaired with a lumbar perforator-based rotation flap. This well-vascularized flap is relatively easy to harvest, and results in minimal donor site morbidity, provides adequate dimensions, and permits primary closure of donor defect. In addition, the flap allows for anatomic muscle approximation without sacrificing the muscle functions, and provides reliable soft tissue coverage. Level of Evidence: Level V, therapeutic study.     

Effects of pirfenidone on experimental head injury in rats

Traumatic brain injury (TBI) continues to be a significant public healthcare concern. Neuroinflammation that occurs in the secondary phase of TBI leads to cognitive and physical dysfunction. A number of therapeutic modalities have been evaluated in an attempt to find a suitable treatment. The only drug approved for the treatment of idiopathic pulmonary fibrosis, pirfenidone, has been evaluated for its antifibrotic, anti-inflammatory, and anti-oxidant properties for various disorders, but this is the first study to examine its effects in an experimental TBI model. Twenty-four Wistar rats were randomly divided into three groups: control, trauma, and pirfenidone. The two latter groups underwent experimental diffuse cortical injury mimicking TBI. Neurological assessment was performed using the Garcia test, histological analysis was performed to examine neuroprotective and anti-inflammatory effects, and biochemical analyses of neuron-specific enolase (NSE), S-100B, caspase-3, and thiobarbituric acid reactive substances were performed. The pirfenidone group had a better Garcia test score (P=0.001), an increased anti-inflammatory effect (P<0.001), and an enhanced neuroprotective effect (P=0.007) along with decreased NSE, S100B, and TBARS levels compared to the trauma group. However, pirfenidone did not show a beneficial effect on caspase-3 levels. Pirfenidone may help decrease mortality and morbidity rates after TBI through its anti-inflammatory and antioxidant effects.     

Production of chlorine-containing functional group doped graphene powders using Yucel's method as anode materials for Li-ion batteries

In this study, the one-step electrochemical preparation of chlorine doped and chlorine-oxygen containing functional group doped graphene-based powders was carried out by Yucel''s method, with the resultant materials used as anode materials for lithium (Li)-ion batteries. Cl atoms and ClO_x (x = 2, 3 or 4) groups, confirmed by X-ray photoelectron spectroscopy analysis, were covalently doped into the graphene powder network to increase the defect density in the graphene framework and improve the electrochemical performance of Li-ion batteries. The microscopic properties of the Cl-doped graphene powder were investigated by scanning electron microscopy and transmission electron microscopy (TEM) analyses. TEM analysis showed that the one-layer thickness of the graphene was approximately 0.33 nm. Raman spectroscopy analysis was carried out to determine the defect density of the graphene structures. The G peak obtained in the Raman spectra is related to the formation of sp² hybridized carbons in the graphene-based powders. The 2D peak seen in the spectra shows that the synthesized graphene-based powders have optically transparent structures. In addition, the number of sp² hybridized carbon rings was calculated to be 22, 19, and 38 for the Cl-GP1, Cl-GP2, and Cl-GOP samples, respectively. As a result of the charge/discharge tests of the electrodes as anodes in Li-ion batteries, Cl-GP2 exhibits the best electrochemical performance of 493 mA h g⁻¹ at a charge/discharge current density of 50 mA g⁻¹.

In this study, the one-step electrochemical preparation of chlorine doped and chlorine-oxygen containing functional group doped graphene-based powders was carried out by Yucel''s method, with the resultant materials used as anode materials for lithium (Li)-ion batteries.     

Standalone epicardial left atrial appendage exclusion for thromboembolism prevention in atrial fibrillation

Open in a separate window OBJECTIVESMost strokes associated with atrial fibrillation (AF) result from left atrial appendage thrombi. Oral anticoagulation can reduce stroke risk but is limited by complication risk and non-compliance. Left atrial appendage exclusion (LAAE) is a new surgical option to reduce stroke risk in AF. The study objective was to evaluate the safety and feasibility of standalone thoracoscopic LAAE in high stroke risk AF patients.METHODSThis was a retrospective, multicentre study of high stroke risk AF patients who had oral anticoagulation contraindications and were not candidates for ablation nor other cardiac surgery. Standalone thoracoscopic LAAE was performed using 3 unilateral ports access and epicardial clip. Periprocedural adverse events, long-term observational clinical outcomes and stroke rate were evaluated.RESULTSProcedural success was 99.4% (174/175 patients). Pleural effusion occurred in 4 (2.3%) patients; other periprocedural complications were <1% each. One perioperative haemorrhagic stroke occurred (0.6%). No phrenic nerve palsy or cardiac tamponade occurred. Predicted annual ischaemic stroke rate of 4.8/100 patient-years (based on median CHA₂DS₂-VASc score of 4.0) was significantly higher than stroke risk observed in follow-up after LAAE. No ischaemic strokes occurred (median follow-up: 12.5 months), resulting in observed rate of 0 (95% CI 0–2.0)/100 patient-years (P < 0.001 versus predicted). Six all-cause (non-device-related) deaths occurred during follow-up.CONCLUSIONSStudy proved that a new surgical option, standalone thoracoscopic LAAE, is feasible and safe. With this method, long-term stroke rate may be reduced compared to predicted for high-risk AF population.     

Carcinoma of the fourth part of the duodenum: Report of a case

Primary carcinoma of the duodenum is rare, accounting for only 0.35% of all gastrointestinal carcinomas, and carcinoma of the fourth part of the duodenum constitutes approximately 10% of duodenal carcinomas. Since the predominant symptoms of tumors in this part of duodenum are related to upper intestinal obstruction, the diagnosis is usually made late. We report the case of a 66-year-old man who presented with anemia, weight loss, and upper intestinal obstruction, and was found to have advanced primary carcinoma of the fourth part of the duodenum by upper gastrointestinal series and computed tomography (CT). A review of the literature indicates that survival, which is related to nodal status, the grade of the tumor, and surgical results, seems to be longer in patients with carcinoma in this part of the duodenum compared to those with carcinomas in other parts of the duodenum. Moreover, segmentary resection has been reported to achieve a favorable outcome.     

Hybrid Repair of an Acute Type B Dissection with Subclavian‐to‐Subclavian Bypass and Stent‐Grafting

Abstract Hybrid repair of an acute type B aortic dissection with endovascular stenting and aortic arch debranching is an acceptable treatment in complicated type B dissection. We present the case of a 71‐year‐old man presenting with acute type B aortic dissection and concomitant aneurysm of the distal aortic arch, who underwent an uneventful hybrid procedure, which involved subclavian‐to‐subclavian bypass before endovascular stent‐graft placement to the aortic arch. (J Card Surg 2010;25:336‐339)     

Migraine susceptibility is modulated by food triggers and analgesic overuse via sulfotransferase inhibition

Background/aimCertain constituents in migraine food triggers and non-steroidal anti-inflammatory drugs (NSAIDs) inhibit sulfotransferases (SULTs) that detoxify drugs/chemicals and play role in the metabolism of neurotransmitters. We aimed to dissect SULT1A1 modulation of CSD susceptibility and behavior in an in vivo experimental model using hesperidin, a SULT1A1 inhibitor found in citrus fruits (known migraine triggers) and mefenamic acid (SULT1A1 inhibitor), an NSAID to simulate medication overuse.MethodsHesperidin was used as SULT1A1 inhibitor found in citrus fruits, known migraine triggers and mefenamic acid (NSAID), another SULT1A1 inhibitor, was used to induce MO in rats. The groups were; 1) Hesperidin (ip) or its vehicle-DMSO (ip) 2) Chronic (4 weeks) mefenamic acid (ip) or its vehicle (ip) 3) Chronic mefenamic acid+hesperidin (ip) or DMSO (ip). CSD susceptibility was evaluated and behavioral testing was performed. SULT1A1 enzyme activity was measured in brain samples.ResultsSingle-dose of hesperidin neither changed CSD susceptibility nor resulted in any behavioral change. Chronic mefenamic acid exposure resulted in increased CSD susceptibility, mechanical-thermal hypersensitivity, increased head shake, grooming and freezing and decreased locomotion. Single dose hesperidin administration after chronic mefenamic acid exposure resulted in increased CSD susceptibility and mechanical-thermal hypersensitivity, increased freezing and decreased locomotion. SULT1A1 enzyme activity was lower in mefenamic acid and mefenamic acid+hesperidin groups compared to their vehicles.ConclusionMefenamic acid and hesperidin have synergistic effect in modulating CSD susceptibility and pain behavior. Sulfotransferase inhibition may be the common mechanism by which food triggers and NSAIDs modulate migraine susceptibility. Further investigations regarding human provocation studies using hesperidin in migraine patients with medication overuse are needed.     

Three-year randomized clinical evaluation of a low-shrinkage silorane-based resin composite in non-carious cervical lesions

Objective

The clinical suitability of low-shrinkage resin composites for class V cavities has not been investigated in vivo. The purpose of this double-blind randomized clinical trial was to compare the clinical performances of low-shrinkage resin composite Filtek silorane and nanoceramic resin composite Ceram X mono in non-carious cervical lesions (NCCLs) over 36 months.

Materials and methods

Two calibrated operators restored 144 NCCLs in 24 patients by using Filtek silorane with silorane system adhesive (FS/SSA) and Ceram X mono with Clearfil SE (CXM/CSE) or XP bond (CXM/XPB). Then, two blinded, calibrated evaluators assessed the restorations at the baseline and 6, 12, 24, and 36 months thereafter by using the modified US Public Health Service criteria. Data were analyzed with the Freidman and Wilcoxon signed-rank tests at a significance level of 5 % (P?<?0.05).

Results

No restoration was associated with postoperative sensitivity or secondary caries. Further, no group showed significant changes until 12 months. The retention rates of the FS/SSA (97.5 %), CXM/CSE (97.5 %), and CXM/XPB (92.31 %) restorations did not differ significantly (P?>?0.05). Six (4 CXM/XPB, 1 FS/SSA, and 1 CXM/CSE) of the 121 restorations evaluated at 36 months were completely lost. However, no significant intergroup differences were observed in the other evaluation criteria.

Conclusion

The 3-year clinical performances of the restorative materials in NCCLs were not significantly different.

Clinical relevance

Filtek silorane is suitable for restoring NCCLs.