Sample records for include channel incision

  1. Drainage basins and channel incision on Mars (United States)

    Aharonson, Oded; Zuber, Maria T.; Rothman, Daniel H.; Schorghofer, Norbert; Whipple, Kelin X.


    Measurements acquired by the Mars Orbiter Laser Altimeter on board the Mars Global Surveyor indicate that large drainage systems on Mars have geomorphic characteristics inconsistent with prolonged erosion by surface runoff. We find the topography has not evolved to an expected equilibrium terrain form, even in areas where runoff incision has been previously interpreted. By analogy with terrestrial examples, groundwater sapping may have played an important role in the incision. Longitudinally flat floor segments may provide a direct indication of lithologic layers in the bedrock, altering subsurface hydrology. However, it is unlikely that floor levels are entirely due to inherited structures due to their planar cross-cutting relations. These conclusions are based on previously unavailable observations, including extensive piece-wise linear longitudinal profiles, frequent knickpoints, hanging valleys, and small basin concavity exponents.

  2. Autogenic entrenchment patterns and terraces due to coupling with lateral erosion in incising alluvial channels (United States)

    Malatesta, Luca C.; Prancevic, Jeffrey P.; Avouac, Jean-Philippe


    The abandonment of terraces in incising alluvial rivers can be used to infer tectonic and climatic histories. A river incising into alluvium erodes both vertically and laterally as it abandons fill-cut terraces. We argue that the input of sediment from the valley walls during entrenchment can alter the incision dynamics of a stream by promoting vertical incision over lateral erosion. Using a numerical model, we investigate how valley wall feedbacks may affect incision rates and terrace abandonment as the channel becomes progressively more entrenched in its valley. We postulate that erosion of taller valley walls delivers large pulses of sediment to the incising channel, potentially overwhelming the local sediment transport capacity. Based on field observations, we propose that these pulses of sediment can form talus piles that shield the valley wall from subsequent erosion and potentially force progressive channel narrowing. Our model shows that this positive feedback mechanism can enhance vertical incision relative to 1-D predictions that ignore lateral erosion. We find that incision is most significantly enhanced when sediment transport rates are low relative to the typical volume of material collapsed from the valley walls. The model also shows a systematic erosion of the youngest terraces when river incision slows down. The autogenic entrenchment due to lateral feedbacks with valley walls should be taken into account in the interpretation of complex-response terraces.

  3. Incision of the Jezero Crater Outflow Channel by Fluvial Sediment Transport (United States)

    Holo, S.; Kite, E. S.


    Jezero crater, the top candidate landing site for the Mars 2020 rover, once possessed a lake that over-spilled and eroded a large outflow channel into the Eastern rim. The Western deltaic sediments that would be the primary science target of the rover record a history of lake level, which is modulated by the inflow and outflow channels. While formative discharges for the Western delta exist ( 500 m3/s), little work has been done to see if these flows are the same responsible for outflow channel incision. Other models of the Jezero outflow channel incision assume that a single rapid flood (incision timescales of weeks), with unknown initial hydraulic head and no discharge into the lake (e.g. from the inflow channels or the subsurface), incised an open channel with discharge modulated by flow over a weir. We present an alternate model where, due to an instability at the threshold of sediment motion, the incision of the outflow channel occurs in concert with lake filling. In particular, we assume a simplified lake-channel-valley system geometry and that the channel is hydraulically connected to the filling/draining crater lake. Bed load sediment transport and water discharge through the channel are quantified using the Meyer-Peter and Mueller relation and Manning's law respectively. Mass is conserved for both water and sediment as the lake level rises/falls and the channel incises. This model does not resolve backwater effects or concavity in the alluvial system, but it does capture the non-linear feedbacks between lake draining, erosion rate, channel flow rate, and slope relaxation. We identify controls on incision of the outflow channel and estimate the time scale of outflow channel formation through a simple dynamical model. We find that the observed 300m of channel erosion can be reproduced in decades to centuries of progressive bed load as the delta forming flows fill the lake. This corresponds to time scales on the order of or smaller than the time scale

  4. Disturbance, stream incision, and channel evolution: The roles of excess transport capacity and boundary materials in controlling channel response (United States)

    Simon, Andrew; Rinaldi, Massimo


    Channel incision is part of denudation, drainage-network development, and landscape evolution. Rejuvenation of fluvial networks by channel incision often leads to further network development and an increase in drainage density as gullies migrate into previously non-incised surfaces. Large, anthropogenic disturbances, similar to large or catastrophic "natural" events, greatly compress time scales for incision and related processes by creating enormous imbalances between upstream sediment delivery and available transporting power. Field examples of channel responses to antrhopogenic and "natural" disturbances are presented for fluvial systems in the mid continent and Pacific Northwest, USA, and central Italy. Responses to different types of disturbances are shown to result in similar spatial and temporal trends of incision for vastly different fluvial systems. Similar disturbances are shown to result in varying relative magnitudes of vertical and lateral (widening) processes, and different channel morphologies as a function of the type of boundary sediments comprising the bed and banks. This apparent contradiction is explained through an analysis of temporal adjustments to flow energy, shear stress, and stream power with time. Numerical simulations of sand-bed channels of varying bank resistance and disturbed by reducing the upstream sediment supply by half, show identical adjustments in flow energy and the rate of energy dissipation. The processes that dominate adjustment and the ultimate stable geometries, however, are vastly different, depending on the cohesion of the channel banks and the supply of hydraulically-controlled sediment (sand) provided by bank erosion. The non-linear asymptotic nature of fluvial adjustment to incision caused by channelization or other causes is borne out in similar temporal trends of sediment loads from disturbed systems. The sediments emanating from incised channels can represent a large proportion of the total sediment yield from a

  5. Climatic controls on mechanical rock strength and channel incision due to bedrock weathering, Kohala Peninsula, Hawaii (United States)

    Murphy, B. P.; Johnson, J. P.; Gasparini, N. M.; Sklar, L. S.


    Orographic precipitation gradients are prevalent in mountainous terrains, and climate-dependent bedrock weathering may play an important role in the incision of bedrock channels and the evolution of landscapes. Kohala Peninsula on the big island of Hawaii presents a unique natural setting for exploring climate sensitivity of landscape erosion, with over an order of magnitude variation in mean annual precipitation, a landscape composed entirely of weatherable basalt, and systematic variations in fluvial incision and resulting topography across the climate gradient. We hypothesize that increases in local mean annual precipitation will promote long-term channel incision rates due to increases in bedrock weathering, but measurements of rock strength within bedrock channels will be greatly influenced by the efficient removal of weathered rock by fluvial erosion. Mechanical properties of bedrock were measured at a total of 13 sites across two watersheds that vary in local mean annual precipitation from 0.27 - 2.25 m/yr. In situ strength measurements were collected using a Schmidt hammer with a pseudo-random sampling method along transects parallel to stream direction and just above the channel thalweg. Tensile strength and elastic moduli were also measured in the laboratory on cores collected from a subset of the same transects. Long-term channel incision rates were independently constrained from the local valley relief and the ages of mapped basalt units that form the relatively unmodified volcanic shield of Kohala. When strength data comes from sites of low long-term incision, we find strong power-law relationships between both rock strength measurements and local mean annual precipitation. However, for sites with high precipitation rate and variable erosion rates, we find significant variability in the rock strength. We interpret this to reflect the removal of weathered rock by erosion. In order to interpret the influence of climate in our dataset, we made a

  6. A field guide for the assessment of erosion, sediment transport, and deposition in incised channels of the southwestern United States (United States)

    Parker, John T.C.


    Deeply incised channels, commonly called arroyos, are a typical feature of the dry alluvium-filled valleys of the southwestern United States. Unlike many geological processes that operate over millions of years, the formation of many miles of arroyos is one that took place in a little more than a century. Most arroyos in the region began to form in the late 19th century. Because dry landscapes change so quickly, they present society with special problems. Rapid expansion of channels by headcut migration, deepening, and widening causes loss of productive agricultural and commercial lands and threatens infrastructure such as roads, bridges, and buildings. High rates of sedimentation shorten the life of reservoirs, clog culverts, and fill stream channels to the extent that they can no longer contain streamflow within their banks. This report presents an explanation of erosional and depositional processes in desert landscapes, especially those characterized by incised channels, for the use of those who use, manage, and live on such lands. The basic principles of erosion, sediment transport, and deposition are presented including the formation of sediment, the forces that erode and transport it, the forces that resist its erosion and transport, and the conditions that cause it to be deposited. The peculiarities of sedimentation processes in the Southwest include the infrequent and variable precipitation, the geological setting, and the sparseness of vegetation. A classification system for incised channels that is intended for users who do not necessarily have a background in fluvial hydrology has been developed and is presented in this report. The classification system is intended to enable a user to classify a reach of channel quickly on the basis of field observations. The system is based on the shape and condition of channels and on the sedimentation processes that are predominantly responsible for those conditions. Because those processes are controlled by

  7. Drainage development and incision rates in an Upper Pleistocene Basalt-Limestone Boundary Channel: The Sa'ar Stream, Golan Heights, Israel (United States)

    Shtober-Zisu, N.; Inbar, M.; Mor, D.; Jicha, B. R.; Singer, B. S.


    Long-term fluvial incision processes and corresponding geomorphic evolution are difficult to quantify, especially in complex systems affected by lithological and tectonic factors. Volcanic landscapes offer the most appropriate environment for the study of landscape evolution, as there is a clear starting time of formation and the lithology is homogenous. In the present study we aim to: (1) analyse the interplay of construction and incision processes throughout eruptive activity; (2) study fluvial erosion processes; (3) analyse sedimentary and volcanic lithological responses to channel erosion; and (4) calculate the incision rates in young basaltic bedrock. We have integrated existing and new 40Ar/39Ar ages of lava flows with estimates of channel geometry and tectonic activity, and considered process geomorphology concepts, to fully understand evolution of a bedrock channel incised at the boundary between basalts and sedimentary rocks with coeval active volcanic processes forcing drainage evolution. Our findings indicate that the Sa'ar basin evolution is controlled by: (1) rock strength of the mixed lithology; (2) alternating cycles of volcanic activity followed by erosion and incision; and (3) the Plio-Pleistocene uplift of Mt. Hermon. The carbonate slopes composing the southern flank of Mt. Hermon are moderate (18-26%) while the basalt slopes deriving from the Golan Heights are much steeper (26-51%). The highly erodible sedimentary rocks at Mt. Hermon's piedmont accelerated river incision, shaping a 650 m wide by 100 m deep canyon. Inside the canyon, the steep channel slope (8.6%) enables downstream movement of large boulders, including autochthonous mega-blocks (D90 size > 2.5 m); 24 knickpoints were identified using DS plots, developed within a knick zone over a distance of 6 km. The brittle and porous structure of the rubbly and blocky interflow layers (clinkers), interbedded between two massive basalt flows, enhances erosion and accelerates scouring of the

  8. Rapid channel incision of the lower Pearl River (China since the 1990s as a consequence of sediment depletion

    Directory of Open Access Journals (Sweden)

    X. X. Lu


    Full Text Available This paper reported a dramatic channel incision (>10 m in the deepest cut during the past 10 y or so in the lower Pearl River, the second largest river in terms of water discharge in China. The channel incision had caused changes both in the channel geometry as well as in the river hydraulics. Also, the water exchange between the two major tributaries of the Pearl River, the Xijiang and Beijiang, had been significantly changed due to the channel incision. The rapid channel incision was principally the result of extensive sand mining in the lower Pearl River and the delta region due to the booming economy in the Pearl Delta region. Slight increase of water discharge and significant decrease of sediment load since the early 1990s in both the Xijiang and Beijiang also likely contributed to the observed dramatic river bed downcutting to some extent. This has important implications for river management, as the large Chinese rivers have seen a dramatic depletion of sediment fluxes due to the combined effects of declining rainfall, dam constructions, water diversion, reforestation and afforestation, and sediment mining over the recent decades.

  9. Incised channel fills containing conifers indicate that seasonally dry vegetation dominated Pennsylvanian tropical lowlands (United States)

    Falcon-Lang, H. J.; Nelson, W.J.; Elrick, S.; Looy, C.V.; Ames, P.R.; DiMichele, W.A.


    The idea that the Pennsylvanian tropical lowlands were temporally dominated by rainforest (i.e., the Coal Forest) is deeply ingrained in the literature. Here we challenge two centuries of research by suggesting that this concept is based on a taphonomic artifact, and that seasonally dry vegetation dominated instead. This controversial finding arises from the discovery of a new middle Pennsylvanian (Moscovian) fossil plant assemblage in southeast Illinois, United States. The assemblage, which contains xerophytic walchian conifers, occurs in channels incised into a calcic Vertisol below the Baker Coal. These plants grew on seasonally dry tropical lowlands inferred to have developed during a glacial phase. This xerophytic flora differs markedly from that of the typical clubmoss-dominated Coal Forest developed during deglaciation events. Although preserved only very rarely, we argue that such xerophytic floras were temporally as dominant, and perhaps more dominant, than the iconic Coal Forests, which are overrepresented in the fossil record due to taphonomic megabias. These findings require the iconography of Pennsylvanian tropical lowlands to be redrawn. ?? 2009 Geological Society of America.

  10. Climate-modulated channel incision and rupture history of the San Andreas Fault in the Carrizo Plain. (United States)

    Grant Ludwig, Lisa; Akçiz, Sinan O; Noriega, Gabriela R; Zielke, Olaf; Arrowsmith, J Ramón


    The spatial and temporal distribution of fault slip is a critical parameter in earthquake source models. Previous geomorphic and geologic studies of channel offset along the Carrizo section of the south central San Andreas Fault assumed that channels form more frequently than earthquakes occur and suggested that repeated large-slip earthquakes similar to the 1857 Fort Tejon earthquake illustrate typical fault behavior. We found that offset channels in the Carrizo Plain incised less frequently than they were offset by earthquakes. Channels have been offset by successive earthquakes with variable slip since ~1400. This nonuniform slip history reveals a more complex rupture history than previously assumed for the structurally simplest section of the San Andreas Fault.

  11. A Hot Knife Through Ice-Cream: Earthflow Response to Channel Incision (Or Channel Response to Earthflows?), Eel River Canyon, California (United States)

    Mackey, B. H.; Roering, J. J.; McKean, J. A.


    Abundant glacier-like earthflow features are recognized as a primary erosional process in the highly erodable Franciscan Melange of the Eel River Basin, CA. Despite their prominence in this "melting ice-cream" topography, many questions regarding their effects on the long term sediment flux from this rapidly eroding basin remain unresolved. For example, does an earthflow's basal shear zone propagate vertically downwards with vertical river incision? What controls the upslope and lateral extent of individual earthflows? How does the erosive power of a river influence the rate of earthflow movement, or conversely do earthflow toe deposits regulate the rate of river incision? Here we present preliminary findings derived from study of 200km2 of lidar data (1m resolution) covering hillslopes adjacent to 30km of the Eel River. Lidar allows detailed analysis of the interaction between earthflows and the drainage network, and we document how inferred changes in local base level are propagated throughout adjacent hillslopes via earthflow movement. The most active earthflows (determined by field surveying and analysis of aerial photos rectified using lidar- generated digital topography) coincide with locally steep sections of channel, while downstream of the most active flows we frequently observe less-active or dormant earthflows. This observation supports the idea that the locations of the most active earthflows coincide with headward propagating knickpoints in the channel. The rate of earthflow movement appears to slow when an earthflow exhausts the upslope area of easily mobilized sediment. Earthflow toes can protrude directly into the channel, causing the channel to narrow and steepen, and even undercut the opposite bank. Large resistant boulders (>2m diameter) transported by the earthflow accumulate in the streambed and appear to both act as a check on further channel incision and earthflow movement. In contrast, areas adjacent to active earthflows exhibit smooth

  12. Bank-toe processes in incised channels: the role of apparent cohesion in the entrainment of failed bank materials (United States)

    Wood, Anna L.; Simon, Andrew; Downs, Peter W.; Thorne, Colin R.


    Numerous processes may instigate bank retreat and the consequent collection of failed cohesive materials at the bank toe. Cohesion between the failed material and the substrate can provide additional strength to resist direct fluvial entrainment. Failed, cohesive material can act as a form of natural bank-toe protection by consuming and diverting flow energy that may otherwise be used to further scour the basal zone of incising channels.Investigations in Goodwin Creek, Mississippi, have revealed the existence of apparent cohesion between failed, cohesive blocks and their underlying surface. The method used to assess this cohesion involved a pulley system mounted on a tripod and supporting a load cell. Mean and maximum apparent-cohesion values of 1·08 kPa and 2·65 kPa, respectively, were measured in this way, identifying a source that bonds blocks to the underlying surface. Cohesion values and types vary spatially and temporally. Tensiometric tests beneath blocks suggest that cohesion resulting from matric suction alone may be as much as 3·5 kPa in summer and 1·8 kPa in winter.Apparent cohesion is believed to have been sufficient to help prevent removal of the largest blocks by a peak flow of 66·4m3/s on 23 September 1997. Maximum excess shear stress required to entrain a D75 block can be augmented by as much as 97% by the presence of apparent cohesion at the block-substrate interface when compared with a condition with zero apparent cohesion at the block underside. Given these findings, it is no longer sufficient to estimate block entrainment in the basal area from block size or bed roughness alone, as in a Shields-type approach.

  13. The fourth incision: a cosmetic autopsy incision technique. (United States)

    Patowary, Amarjyoti


    Autopsy procedure includes thorough external examination as well as internal examination including opening of all the body cavities for proper visualization of all the visceral organs. As such, there remains incision marks with stitches which harts the sentiment of the already traumatized relatives of the deceased. Moreover, it looks odd especially in cases of otherwise healthy dead bodies. So, autopsy incisions should be such that, we can get maximum possible visualization of the body cavities, particularly the thorax and abdomen, and at the same time the incision as well as the stitch marks are also hidden. This article is aimed to describe few modifications in the autopsy incisions for opening the thorax and abdomen and also proper visualization of the neck structures during autopsy where the incisions and the stitches are kept hidden.

  14. One- and two-incision anterior cruciate ligament reconstruction: a biomechanical comparison including the effect of simulated closed-chain exercise. (United States)

    Dalldorf, P G; Alexander, J; Lintner, D M


    The purpose of this study was to evaluate the effect of simulated closed-chain exercise on anterior translation in the anterior cruciate ligament (ACL) reconstructed knee comparing patellar tendon grafts secured with endoscopic and two-incision techniques. ACL reconstructions, were performed on five matched pairs of fresh frozen cadaver lower extremities. One of each pair had endoscopic (inside-out) placement of the femoral interference screw and other had outside-in femoral screw placement. A model for closed-chain exercise was developed to simulate half squat exercises using a custom apparatus on the Material Testing machine with a 356 N (80 lb) axial load and 40 N (9 lb) static hamstring force. Knee motion from near full extension to 60 degrees flexion was achieved by varying the quadricep force. One thousand squats were performed, and KT-1000 arthometry was done before and after cycling each specimen. The femur-graft-tibia constructs were then stressed to failure. Closed-chain cycling resulted in no significant change in anterior translation in either group. The mean maximum load to failure of the femur-graft-tibia construct was 340.4N in the one-incision group and 434.2 N in the two-incision group. P=.048 was considered statistically significant. Anterior translation did not increase after 1,000 simulated half knee bends in either the one- or two-incision groups. Shallow knee bends are an important part of aggressive rehabilitation programs, and our data support the position that these closed-chain exercises do not deleteriously affect the graft. Though the maximum strength to failure differed significantly between the one- and two-incision groups, both techniques offered sufficient strength to withstand an aggressive simulated rehabilitation protocol.

  15. Alopecia Following Bicoronal Incisions. (United States)

    Kadakia, Sameep; Badhey, Arvind; Ashai, Sara; Lee, Thomas S; Ducic, Yadranko


    Multiple techniques may be used to perform bicoronal incisions, and alopecia is a known postoperative complication of this procedure. To date, no large studies exist comparing alopecia outcomes among bicoronal incision techniques with and without the use of Raney clips. To determine (1) whether postoperative alopecia is more common when bicoronal incisions are performed with monopolar cautery, Colorado microdissection tip cautery, or traditional cold steel and (2) whether this outcome is affected by the use of Raney clips. This retrospective study of postoperative alopecia included 505 patients undergoing bicoronal incisions in a single head and neck surgery practice from 1997 to 2015 with a minimum follow-up of 1 year. Patients with preexisting baldness as well as patients not following up for the minimum period were excluded. All data analysis took place between 1997 and 2015. Maximum alopecia width was measured in the postoperative period and compared among the technique groups both with and without Raney clip use. Raney clip duration as a product of surgery length was also compared. A total of 505 patients (301 male, 204 female) ranging in age from 3 to 97 years were included in the study (median age, 53.9 years). Of these, 236 underwent bicoronal incisions to approach the skull base, 78 to treat chronic frontal sinusitis unresponsive to endoscopic management or frontal sinus mucocele, 143 for trauma, and 48 for craniofacial surgery. For 173 patients, the cold steel technique was used for both skin and subcutaneous incision, 102 of whom needed Raney clips. For 161 patients, cold steel technique was used for skin incisions and monopolar cautery for subcutaneous incision; 81 of these patients required Raney clips. For 171 patients, Colorado tip microdissection cautery was used for both skin and subcutaneous incision, with Raney clips used in 66 of these patients. Incisions made with cold steel for both skin and subcutaneous tissue, regardless of Raney clip use

  16. Enhanced UWB Radio Channel Model for Short-Range Communication Scenarios Including User Dynamics

    DEFF Research Database (Denmark)

    Kovacs, Istvan Zsolt; Nguyen, Tuan Hung; Eggers, Patrick Claus F.


    channel model represents an enhancement of the existing IEEE 802.15.3a/4a PAN channel model, where antenna and user-proximity effects are not included. Our investigations showed that significant variations of the received wideband power and time-delay signal clustering are possible due the human body...

  17. The DNA Repair Repertoire of Mycobacterium smegmatis FenA Includes the Incision of DNA 5' Flaps and the Removal of 5' Adenylylated Products of Aborted Nick Ligation. (United States)

    Uson, Maria Loressa; Ghosh, Shreya; Shuman, Stewart


    We characterize Mycobacterium smegmatis FenA as a manganese-dependent 5'-flap endonuclease homologous to the 5'-exonuclease of DNA polymerase I. FenA incises a nicked 5' flap between the first and second nucleotides of the duplex segment to yield a 1-nucleotide gapped DNA, which is then further resected in dinucleotide steps. Initial FenA cleavage at a Y-flap or nick occurs between the first and second nucleotides of the duplex. However, when the template 3' single strand is eliminated to create a 5'-tailed duplex, FenA incision shifts to between the second and third nucleotides. A double-flap substrate with a mobile junction (mimicking limited strand displacement synthesis during gap repair) is preferentially incised as the 1-nucleotide 3'-flap isomer, with the scissile phosphodiester shifted by one nucleotide versus a static double flap. FenA efficiently removes the 5' App(dN) terminus of an aborted nick ligation reaction intermediate, thereby highlighting FenA as an agent of repair of such lesions, which are formed under a variety of circumstances by bacterial NAD + -dependent DNA ligases and especially by mycobacterial DNA ligases D and C. IMPORTANCE Structure-specific DNA endonucleases are implicated in bacterial DNA replication, repair, and recombination, yet there is scant knowledge of the roster and catalytic repertoire of such nucleases in Mycobacteria This study identifies M. smegmatis FenA as a stand-alone endonuclease homologous to the 5'-exonuclease domain of mycobacterial DNA polymerase 1. FenA incises 5' flaps, 5' nicks, and 5' App(dN) intermediates of aborted nick ligation. The isolated N-terminal domain of M. smegmatis Pol1 is also shown to be a flap endonuclease. Copyright © 2017 American Society for Microbiology.

  18. Double-gate junctionless transistor model including short-channel effects

    International Nuclear Information System (INIS)

    Paz, B C; Pavanello, M A; Ávila-Herrera, F; Cerdeira, A


    This work presents a physically based model for double-gate junctionless transistors (JLTs), continuous in all operation regimes. To describe short-channel transistors, short-channel effects (SCEs), such as increase of the channel potential due to drain bias, carrier velocity saturation and mobility degradation due to vertical and longitudinal electric fields, are included in a previous model developed for long-channel double-gate JLTs. To validate the model, an analysis is made by using three-dimensional numerical simulations performed in a Sentaurus Device Simulator from Synopsys. Different doping concentrations, channel widths and channel lengths are considered in this work. Besides that, the series resistance influence is numerically included and validated for a wide range of source and drain extensions. In order to check if the SCEs are appropriately described, besides drain current, transconductance and output conductance characteristics, the following parameters are analyzed to demonstrate the good agreement between model and simulation and the SCEs occurrence in this technology: threshold voltage (V TH ), subthreshold slope (S) and drain induced barrier lowering. (paper)

  19. A self-regulating model of bedrock river channel geometry (United States)

    Stark, C. P.


    The evolution of many mountain landscapes is controlled by the incision of bedrock river channels. While the rate of incision is set by channel shape through its mediation of flow, the channel shape is itself set by the history of bedrock erosion. This feedback between channel geometry and incision determines the speed of landscape response to tectonic or climatic forcing. Here, a model for the dynamics of bedrock channel shape is derived from geometric arguments, a normal flow approximation for channel flow, and a threshold bed shear stress assumption for bedrock abrasion. The model dynamics describe the competing effects of channel widening, tilting, bending, and variable flow depth. Transient solutions suggest that channels may take ~1-10 ky to adapt to changes in discharge, implying that channel disequilibrium is commonplace. If so, landscape evolution models will need to include bedrock channel dynamics if they are to probe the effects of climate change.

  20. Spatial Correlation of PAN UWB-MIMO Channel Including User Dynamics

    DEFF Research Database (Denmark)

    Wang, Yu; Kovacs, Istvan Zsolt; Pedersen, Gert Frølund

    . It is found the channel shows spatial correlated wideband power, and spatial uncorrelated complex channel coefficients at different frequencies and delays with respect to a correlation coefficient threshold of 0.7. The Kronecker model is proved not suitable for the investigated scenarios. The MIMO UWB channel...... achieves an ergodic capacity close to i.i.d. Rayleigh channel capacity. However the outage capacity degrades due to the wideband power fluctuation / shadowing introduced by user’s body....

  1. The properties of batrachotoxin-modified cardiac Na channels, including state-dependent block by tetrodotoxin. (United States)

    Huang, L Y; Yatani, A; Brown, A M


    Batrachotoxin (BTX) modification and tetrodotoxin (TTX) block of BTX-modified Na channels were studied in single cardiac cells of neonatal rats using the whole-cell patch-clamp recording technique. The properties of BTX-modified Na channels in heart are qualitatively similar to those in nerve. However, quantitative differences do exist between the modified channels of these two tissues. In the heart, the shift of the conductance-voltage curve for the modified channel was less pronounced, the maximal activation rate constant, (tau m)max, of modified channels was considerably slower, and the slow inactivation of the BTX-modified cardiac Na channels was only partially abolished. TTX blocked BTX-modified mammalian cardiac Na channels and the block decreased over the potential range of -80 to -40 mV. The apparent dissociation constant of TTX changed from 0.23 microM at -50 mV to 0.69 microM at 0 mV. No further reduction of block was observed at potentials greater than -40 mV. This is the potential range over which gating from closed to open states occurred. These results were explained by assuming that TTX has a higher affinity for closed BTX-modified channels than for open modified channels. Hence, the TTX-binding rate constants are considered to be state dependent rather than voltage dependent. This differs from the voltage dependence of TTX block reported for BTX-modified Na channels from membrane vesicles incorporated into lipid bilayers and from amphibian node of Ranvier.

  2. Single-incision total laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Sinha Rakesh


    Full Text Available Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. We perform single-incision total laparoscopic hysterectomy using three ports in the single transumbilical incision.

  3. Sparse Channel Estimation Including the Impact of the Transceiver Filters with Application to OFDM

    DEFF Research Database (Denmark)

    Barbu, Oana-Elena; Pedersen, Niels Lovmand; Manchón, Carles Navarro


    Traditionally, the dictionary matrices used in sparse wireless channel estimation have been based on the discrete Fourier transform, following the assumption that the channel frequency response (CFR) can be approximated as a linear combination of a small number of multipath components, each one......) and receive (demodulation) filters. Hence, the assumption of the CFR being sparse in the canonical Fourier dictionary may no longer hold. In this work, we derive a signal model and subsequently a novel dictionary matrix for sparse estimation that account for the impact of transceiver filters. Numerical...... results obtained in an OFDM transmission scenario demonstrate the superior accuracy of a sparse estimator that uses our proposed dictionary rather than the classical Fourier dictionary, and its robustness against a mismatch in the assumed transmit filter characteristics....

  4. Heat transfer including radiation and slag particles evolution in MHD channel-I

    Energy Technology Data Exchange (ETDEWEB)

    Im, K H; Ahluwalia, R K


    Accurate estimates of convective and radiative heat transfer in the magnetohydrodynamic channel are provided. Calculations performed for a base load-size channel indicate that heat transfer by gas radiation almost equals that by convection for smooth walls, and amounts to 70% as much as the convective heat transfer for rough walls. Carbon dioxide, water vapor, and potassium atoms are the principal participating gases. The evolution of slag particles by homogeneous nucleation and condensation is also investigated. The particle-size spectrum so computed is later utilized to analyze the radiation enhancement by slag particles in the MHD diffuser. The impact of the slag particle spectrum on the selection of a workable and design of an efficient seed collection system is discussed.

  5. Ballistic electron channels including weakly protected topological states in delaminated bilayer graphene (United States)

    Lane, T. L. M.; Andelković, M.; Wallbank, J. R.; Covaci, L.; Peeters, F. M.; Fal'ko, V. I.


    We show that delaminations in bilayer graphene (BLG) with electrostatically induced interlayer symmetry can provide one with ballistic channels for electrons with energies inside the electrostatically induced BLG gap. These channels are formed by a combination of valley-polarized evanescent states propagating along the delamination edges (which persist in the presence of a strong magnetic field) and standing waves bouncing between them inside the delaminated region (in a strong magnetic field, these transform into Landau levels in the monolayers). For inverted stackings in BLGs on the left and right of the delamination (AB-2ML-BA or BA-2ML-AB, where 2ML indicates two decoupled monolayers of graphene), the lowest-energy ballistic channels are gapless, have linear dispersion, and appear to be weakly topologically protected. When BLG stackings on both sides of the delamination are the same (AB-2ML-AB or BA-2ML-BA), the lowest-energy ballistic channels are gapped, with a gap ɛg scaling as ɛg∝W-1 with delamination width and ɛg∝δ-1 with the on-layer energy difference in the delaminated part of the structure. Depending on the width, delaminations may also support several "higher-energy" waveguide modes. Our results are based on both the analytical study of the wave matching of Dirac states and tight-binding model calculations, and we analyze in detail the dependence of the delamination spectrum on the electrostatic conditions in the structure, such as the vertical displacement field.

  6. Stratigraphic architecture of back-filled incised-valley systems: Pennsylvanian-Permian lower Cutler beds, Utah, USA (United States)

    Wakefield, Oliver J. W.; Mountney, Nigel P.


    The Pennsylvanian to Permian lower Cutler beds collectively form the lowermost stratigraphic unit of the Cutler Group in the Paradox Basin, southeast Utah. The lower Cutler beds represent a tripartite succession comprising lithofacies assemblages of aeolian, fluvial and shallow-marine origin, in near equal proportion. The succession results from a series of transgressive-regressive cycles, driven by repeated episodes of climatic variation and linked changes in relative sea-level. Relative sea-level changes created a number of incised-valleys, each forming through fluvial incision during lowered base-level. Aeolian dominance during periods of relative sea-level lowstand aids incised-valley identification as the erosive bounding surface juxtaposes incised-valley infill against stacked aeolian faces. Relative sea-level rises resulted in back-flooding of the incised-valleys and their infill via shallow-marine and estuarine processes. Back-flooded valleys generated marine embayments within which additional local accommodation was exploited. Back-filling is characterised by a distinctive suite of lithofacies arranged into a lowermost, basal fill of fluvial channel and floodplain architectural elements, passing upwards into barform elements with indicators of tidal influence, including inclined heterolithic strata and reactivation surfaces. The incised-valley fills are capped by laterally extensive and continuous marine limestone elements that record the drowning of the valleys and, ultimately, flooding and accumulation across surrounding interfluves (transgressive surface). Limestone elements are characterised by an open-marine fauna and represent the preserved expression of maximum transgression.

  7. The mandibular incisive foramen.


    Serman, N J


    An anatomical variant in the region of the mental foramen is discussed. In these cases the inferior alveolar nerve divides into its two terminal branches only after it has exited through the mental foramen. The incisive nerve thus commences outside the mandible, and has a short extra-osseous course before it enters the mandible through a separate foramen on the same horizontal plane. For the distance between these two foramina there is no nerve supply within the mandible. The groove between t...

  8. Surface potential based modeling of charge, current, and capacitances in DGTFET including mobile channel charge and ambipolar behaviour (United States)

    Jain, Prateek; Yadav, Chandan; Agarwal, Amit; Chauhan, Yogesh Singh


    We present a surface potential based analytical model for double gate tunnel field effect transistor (DGTFET) for the current, terminal charges, and terminal capacitances. The model accounts for the effect of the mobile charge in the channel and captures the device physics in depletion as well as in the strong inversion regime. The narrowing of the tunnel barrier in the presence of mobile charges in the channel is incorporated via modeling of the inverse decay length, which is constant under channel depletion condition and bias dependent under inversion condition. To capture the ambipolar current behavior in the model, tunneling at the drain junction is also included. The proposed model is validated against TCAD simulation data and it shows close match with the simulation data.

  9. The inverted Batman incision: a new incision in transcolumellar incision for open rhinoplasty. (United States)

    Nakanishi, Yuji; Nagasao, Tomohisa; Shimizu, Yusuke; Miyamoto, Junpei; Fukuta, Keizo; Kishi, Kazuo


    Columellar and nostril shapes often present irregularity after transcolumellar incision for open rhinoplasty, because of the contracture of the incised wound. The present study introduces a new technique to prevent this complication, and verifies its efficacy in improving cosmetic appearance. In our new method, a zig-zag incision with three small triangular flaps is made on the columella and in the pericolumellar regions of the bilateral nostril rims. Since the shape of the incision resembles the contour of an inverted "batman", we term our new method the "Inverted Batman" incision. To verify the effectiveness of the Inverted Batman incision, aesthetic evaluation was conducted for 21 patients operated on using the conventional transcolumellar incision (Conventional Group) and 19 patients operated on using the Inverted Batman incision (Inverted Batman Group). The evaluation was performed by three plastic surgeons, using a four-grade scale to assess three separate items: symmetry of bilateral soft triangles, symmetry of bilateral margins of the columella, and evenness of the columellar surface. The scores of the two groups for these three items were compared using a non-parametric test (Mann-Whitney U-test). With all three items, the Inverted Batman group patients present higher scores than Conventional Group patients. The Inverted Batman incision is effective in preserving the correct anatomical structure of the columella, soft triangle, and nostril rims. Hence, we recommend the Inverted Batman incision as a useful technique for open rhinoplasty.

  10. Laboratory Experiments on Meandering Meltwater Channels (United States)

    Fernandez, R.; Berens, J.; Parker, G.; Stark, C. P.


    Meandering channels of all scales and flowing over a wide variety of media have common planform patterns. Although the analogy in planform suggests there is a common underlying framework, the constitutive relations driving planform evolution through vertical incision/deposition and lateral migration differ from medium to medium. The driving processes in alluvial and mixed bedrock-alluvial meandering channels have been studied substantially over the last decades. However, this is not the case for meandering channels in other media such as ice or soluble rock. Here we present results from experiments conducted at the Ven Te Chow Hydrosystems Laboratory of the University of Illinois at Urbana-Champaign on meltwater meandering channels. A rivulet is carved into an ice block and water is allowed to flow at a constant discharge. Planform evolution is analyzed with time lapse imaging and complemented with rubber molds of the channel once the experiment is over. These molds give us the full 3D structure of the meandering, including incisional overhang. Vertical incision rates are measured throughout the run by taking elevations along the channel, and these measurements are complemented with analysis from the molds. We show examples of meandering of intense amplitude with deep overhangs. Features resembling scroll bars document cyclically punctuated melting. We report on lateral migration rates, incision rates, sinuosity, channel depths, channel widths, reach averaged velocities, bend wavelengths and amplitudes and compare them to values reported in the literature for alluvial rivers.

  11. Meta-analysis of the effectiveness of surgical scalpel or diathermy in making abdominal skin incisions.

    LENUS (Irish Health Repository)

    Ahmad, Nasir Zaheer


    BACKGROUND: Surgical scalpels are traditionally used to make skin incisions. Diathermy incisions on contrary are less popular among the surgeons. The aim of this meta-analysis was to compare the effectiveness of both techniques and address the common fallacies about diathermy incisions. METHODS: A literature search of MEDLINE and Cochrane databases was done, using the keywords diathermy, cold scalpel, and incisions. Eleven clinical trials comparing both methods of making skin incisions were selected for meta-analysis. The end points compared included postoperative wound infection, pain in first 24 hours after surgery, time taken to complete the incisions, and incision-related blood loss. RESULTS: Postoperative wound infection rate was comparable in both techniques (P = 0.147, odds ratio = 1.257 and 95% CI = 0.923-1.711). Postoperative pain was significantly less with diathermy incisions in first 24 hours (P = 0.031, weighted mean difference = 0.852 and 95% CI = 0.076-1.628). Similarly, the time taken to complete the incision and incision-related blood loss was significantly less with diathermy incisions (95% CI = 0.245-0.502 and 0.548-1.020, respectively). CONCLUSION: Diathermy incisions are equally prone to get wound infection, as do the incisions made with scalpel. Furthermore, lower incidence of early postoperative pain, swiftness of the technique, and a reduced blood loss are the encouraging facts supporting routine use of diathermy for abdominal skin incisions after taking careful precautions.

  12. Two Late Pleistocene climate-driven incision/aggradation rhythms in the middle Dnieper River basin, west-central Russian Plain (United States)

    Panin, Andrei; Adamiec, Grzegorz; Buylaert, Jan-Pieter; Matlakhova, Ekaterina; Moska, Piotr; Novenko, Elena


    In valleys of the River Seim and its tributaries in the middle Dnieper basin (west-central Russian Plain), two low terraces (T1, 10-16 m, and T0, 5-7 m above the river) and a floodplain (2-4 m) with characteristic large and small palaeochannels exist. A range of field and laboratory techniques was applied and ∼30 new numerical ages (OSL and 14C dates) were obtained to establish a chronology of incision and aggradation events that resulted in the current valley morphology. Two full incision/aggradation rhythms and one additional aggradation phase from the previous rhythm were recognized in the Late Pleistocene - Holocene climate cycle. The following events were detected. (1) Late MIS 5 - early MIS 4: aggradation of Terrace T1 following the deep incision at the end of MIS 6. (2) Late MIS 4 (40-30 ka): incision into Terrace T1 below the present-day river, formation of the main scarp in the bottom of the valley between Terrace T1 and Terrace T0/Floodplain levels. (3) MIS 2: aggradation of Terrace T0, lateral migrations of a shallow braided channel located few meters above the present-day river since ∼25 ka through the LGM. (4) 18-13 ka: incision into Terrace T0 below the modern river. Multiple-thread channels concentrated in a single flow that at some places formed large meanders. In the period 15-13 ka, high floods that rose above the present-day floods left large levees and overbank loams on Terrace T0. (5) Younger Dryas - Holocene transition: aggradation up to the modern channel level, transformation of large Late Glacial to small Holocene meanders. The established incision/aggradation rhythms are believed to be manifested over the Central Russian Plain outside the influence of ice sheets in the north and base level changes in the south. The two-phase deepening of the valley occurred in the last quarter of the last glacial epoch but can not be attributed directly to the glacial-interglacial transition. Both the detected incision events correspond to relatively

  13. Mini transverse versus longitudinal incision in carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Korkmaz, M.; Cepoglu, M.C.


    Objective: To evaluate the effectiveness of mini-transverse compared with mini-longitudinal incision for carpal tunnel release (CTR) with reference to postoperative functional capacity, symptom severity and complication rate. Study Design: Analytical study. Place and Duration of Study: Cumhuriyet University Medical Faculty, Department of Orthopaedics, Tokat State Hospital, Department of Orthopaedics and Medical Park Tokat Hospital, Department of Neurosurgery, from January 2007 to January 2009. Methodology: This study included 93 hands of 79 patients with carpal tunnel syndrome (CTS), which were operated between 2007 and 2009. Patients were divided according to incision types into Group-1 (undergoing mini-longitudinal incision) and Group-2 (undergoing mini-transverse incision). Patients were evaluated initially and at 3 weeks after treatment according to symptom severity and functional status of Boston Questionnaire (BQ). Demographic and clinical data were analyzed and compared statistically between two groups. Results: Statistically significant differences were observed in BQ symptom and functional scores between the pre- and postoperative period (p < 0.0001). BQ symptom and functional scores at postoperative period were better in Group-1 than Group-2 (p = 0.044 and p = 0.023 respectively). The scar hypersensitivity (p = 0.258) and tenderness (p = 1.00) associated with the incision sites were not statistically different. Conclusion: Longitudinal incision is more effective on symptom and functional conditions than transverse incision. However, there was less scar formation with transverse incision. (author)

  14. Performance Analysis of a Six-Port Receiver in a WCDMA Communication System including a Multipath Fading Channel

    Directory of Open Access Journals (Sweden)

    A. O. Olopade


    Full Text Available Third generation communication systems require receivers with wide bandwidth of operation to support high transmission rates and are also reconfigurable to support various communication standards with different frequency bands. An ideal software defined radio (SDR will be the absolute answer to this requirement but it is not achievable with the current level of technology. This paper proposes the use of a six-port receiver (SPR front-end (FE in a WCDMA communication system. A WCDMA end-to-end physical layer MATLAB demo which includes a multipath channel distortion block is used to determine the viability of the six-port based receiver. The WCDMA signal after passing through a multipath channel is received using a constructed SPR FE. The baseband signal is then calibrated and corrected in MATLAB. The six-port receiver performance is measured in terms of bit error rate (BER. The signal-to-noise ratio (SNR of the transmitted IQ data is varied and the BER profile of the communication system is plotted. The effect of the multipath fading on the receiver performance and the accuracy of the calibration algorithm are obtained by comparing two different measured BER curves for different calibration techniques to the simulated BER curve of an ideal receiver.

  15. Morphodynamic Model of Submarine Canyon Incision by Sandblasting (United States)

    Zhang, L.; Parker, G.; Izumi, N.; Cartigny, M.; Li, T.; Wang, G.


    Submarine canyons are carved by turbidity currents under the deep sea. As opposed to subaerial canyons, the relevant processes are not easy to observe directly. Turbidity currents are bottom-hugging sediment gravity flows of that can incise or deposit on the seafloor to create submarine canyons or fans. The triggers of turbidity currents can be storms, edge waves, internal waves, canyon wall sapping, delta failure, breaching and hyperpycnal flows. The formation and evolution mechanisms of submarine canyons are similar to those of subaerial canyons, but have substantial differences. For example, sandblasting, rather than wear due to colliding gravel clasts is more likely to be the mechanism of bedrock incision. Submarine canyons incise downward, and often develop meander bends and levees within the canyon, so defining "fairways". Here we propose a simple model for canyon incision. The starting point of our model is the Macro Roughness Saltation Abrasion Alluviation model of Zhang et al. [2015], designed for bedrock incision by gravel clasts in mixed bedrock-alluvial rivers. We adapt this formulation to consider sandblasting as a means of wear. We use a layer-averaged model for turbidity current dynamics. The current contains a mixture of mud, which helps drive the flow but which does not cause incision, and sand, which is the agent of incision. We show that the model can successfully model channel downcutting, and indeed illustrate the early formation of net incisional cyclic steps, i.e. upstream-migrating undulations on the bed associated with transcritical (in the Froude sense) flow. These steps can be expected to abet the process of incision.

  16. Functional and aesthetic results of various lip-splitting incisions: A clinical analysis of 60 cases. (United States)

    Rapidis, A D; Valsamis, S; Anterriotis, D A; Skouteris, C A


    This study retrospectively evaluated the functional and aesthetic results of various types of lip-splitting incisions in a group of patients in whom this approach was used to treat intraoral tumors. Between 1992 and 1998, 87 consecutive patients were subjected to either mandibulotomy or mandibulectomy using a lip-splitting incision. During this period, 4 types of incisions were sequentially used: straight midline incision, lateral lip-splitting incision, midline splitting with extension around the contour of the chin, and the chevron chin-contour incision. Sixty patients with a follow-up of at least 6 months were included in the study. The patients were asked to answer a questionnaire regarding the degree of satisfaction with the cosmetic result of the procedure and were clinically assessed for sensory and functional impairment resulting from the incision. The remaining 27 patients were lost to follow-up or had died of their disease. The lateral lip-splitting incision caused the fewest postoperative problems in patients subjected to either mandibulotomy or mandibulectomy. The best overall results were achieved by the chevron-chin contour incision. The incision that followed the contour of the chin and the straight midline incision showed less satisfactory results. The chevron chin-contour incision, along with meticulous soft tissue closure, produces the best aesthetic and functional results. Copyright 2001 American Association of Oral and Maxillofacial Surgeons

  17. Comprehensive capacitance-voltage analysis including quantum effects for high-k interfaces on germanium and other alternative channel materials (United States)

    Anwar, Sarkar R. M.

    High mobility alternative channel materials to silicon are critical to the continued scaling of metal oxide semiconductor (MOS) devices. However, before they can be incorporated into advanced devices, some major issues need to be solved. The high mobility materials suffer from lower allowable thermal budgets compared to Si (before desorption and defect formation becomes an issue) and the absence of a good quality native oxide has further increased the interest in the use of high-k dielectrics. However, the high interface state density and high electric fields at these semiconductor/high-k interfaces can significantly impact the capacitance-voltage (C-V) profile, and current C-V modeling software cannot account for these effects. This in turn affects the parameters extracted from the C-V data of the high mobility semiconductor/high-k interface, which are crucial to fully understand the interface properties and expedite process development. To address this issue, we developed a model which takes into account quantum corrections which can be applied to a number of these alternative channel materials including SixGe1-x, Ge, InGaAs, and GaAs. The C-V simulation using this QM correction model is orders of magnitude faster compared to a full band Schrodinger-Poisson solver. The simulated C-V is directly benchmarked to a self consistent Schrodinger-Poisson solution for each bulk semiconductor material, and from the benchmarking process the QM correction parameters are extracted. The full program, C-V Alternative Channel Extraction (CV ACE), incorporates a quantum mechanical correction model, along with the interface state density model, and can extract device parameters such as equivalent oxide thickness (EOT), doping density and flat band voltage (Vfb) as well as the interface state density profile using multiple measurements performed at different frequencies and temperatures, simultaneously. The program was used to analyze experimentally measured C-V profiles and the

  18. Incision rate changes in the upper Var River catchment, southern French Alps: from observations to models. (United States)

    Petit, Carole; Rolland, Yann; Goren, Liran; Bourlès, Didier; Braucher, Régis; Saillard, Marianne; Cassol, Davide


    Cosmic Ray Exposure (CRE) dating on river polished surfaces from gorges located in the Var River catchment (Southern French Alps) reveals high incision rate pulses (>10 mm.yr-1) related with climate changes, and in particular with glacial-interglacial transitions. In addition, they show that the onset of the last deglaciation in this area occurred shortly after the Last Glacial Maximum (LGM), i.e. 16-19 ka ago. Extrapolating these results to longer time scales suggests that the post 140 ka history of this landscape was dominated by fluvial incision. Inverse models based on the stream power law are then used to determine uplift rate variations in several small tributaries of this catchment with respect to the main channel. These inverse models show that all tributaries have consistent incision rate histories with alternating high and low values, and a comparison with global temperature curves shows that these variations significantly correlate with quaternary climate changes. We suggest that during warm periods, a wave of regressive erosion propagates in the main channel, while its tributaries deeply incise their substratum to catch up with the falling base-level. We then perform forward models of river incision and simulate the incision of the main channel system over a time span of 600 ka. This model allows us to extract time and space incision rate variations along the Tinée River channel (the largest tributary of the Var River). With a background of a few mm.yr-1, incision rate can increase up to more than 10 mm.yr-1 during short episodes, in agreement with CRE dating. The part of the channel located between 12 and 20 km downstream from the source has undergone several periods of rapid incision rates, which could explain the steep hillslopes and the triggering of a landslide 10 kyr ago.

  19. Vertical compared with transverse incisions in abdominal surgery

    DEFF Research Database (Denmark)

    Grantcharov, T P; Rosenberg, J


    . SETTING: Teaching hospital, Denmark. SUBJECTS: Patients undergoing open abdominal operations. INTERVENTIONS: For some of the variables (burst abdomen and incisional hernia) it was considered adequate to include retrospective studies. Studies were identified through Medline, Cochrane library, Embase...... with fewer complications (pain, burst abdomen, and pulmonary morbidity) and there is lower incidence of late incisional hernia after transverse compared with vertical laparotomy. A midline incision is still the incision of choice in conditions that require rapid intra-abdominal entry (such as trauma...

  20. Geologic constraints on bedrock river incision using the stream power law (United States)

    Stock, Jonathan D.; Montgomery, David R.


    Denudation rate in unextended terranes is limited by the rate of bedrock channel incision, often modeled as work rate on the channel bed by water and sediment, or stream power. The latter can be generalized as KAmSn, where K represents the channel bed's resistance to lowering (whose variation with lithology is unknown), A is drainage area (a surrogate for discharge), S is local slope, and m and n are exponents whose values are debated. We address these uncertainties by simulating the lowering of ancient river profiles using the finite difference method. We vary m, n, and K to match the evolved profile as closely as possible to the corresponding modern river profile over a time period constrained by the age of the mapped paleoprofiles. We find at least two end-member incision laws, KA0.3-0.5S1 for Australian rivers with stable base levels and KfA0.1-0.2Sn for rivers in Kauai subject to abrupt base level change. The long-term lowering rate on the latter expression is a function of the frequency and magnitude of knickpoint erosion, characterized by Kf. Incision patterns from Japan and California could follow either expression. If they follow the first expression with m = 0.4, K varies from 10-7-10-6 m0.2/yr for granite and metamorphic rocks to 10-5-10-4 m0.2/yr for volcaniclastic rocks and 10-4-10-2 m0.2/yr for mudstones. This potentially large variation in K with lithology could drive strong variability in the rate of long-term landscape change, including denudation rate and sediment yield.

  1. Single incision pediatric endoscopic surgery: advantages of relatively large incision

    International Nuclear Information System (INIS)

    Yilmaz, E.; Afsarlar, E.; Karaman, I.


    To describe Single Incision Pediatric Endoscopic Surgery (SIPES) performed on children with various diagnoses, emphasizing its advantages. Study Design: An observational case series. Place and Duration of Study: Department of Pediatric Surgery, Dr. Sami Ulus Maternity and Child Health Hospital, Ankara, Turkey, from January 2011 to November 2014. Methodology: A review of patient charts was conducted in which SIPES was preferred as the surgical procedure. Patient demographics, operative details, operative time, clinical outcomes, postoperative pain and cosmesis were analyzed. Results: SIPES was performed on 45 patients (21 girls, 24 boys). Thirty-three appendectomies, 5 varicocelectomies, 3 oophorectomies, 2 ovarian and one paratubal cyst excision, and one fallopian tube excision were performed. All except one procedures were performed through our standard 2cm umbilical vertical or smile incision. In 18 cases, abdominal irrigation/aspiration was easily performed through the existing larger incision, as is done with open surgical technique. None of the patients had early postoperative shoulder/back pain since complete disinflation of CO/sub 2/ could be ensured. All of the patients/parents were satisfied with the cosmesis. Conclusion: SIPES has the advantages of limiting the surgical scar to within the umbilicus and providing easy disinflation of CO/sub 2/, allowing intraabdominal cleaning and extraction of large volume tissue samples through a single large umbilical incision. (author)

  2. Recent, climate-driven river incision rate fluctuations in the Mercantour crystalline massif, southern French Alps (United States)

    Petit, C.; Goren, L.; Rolland, Y.; Bourlès, D.; Braucher, R.; Saillard, M.; Cassol, D.


    We present a new geomorphological analysis of the Tinée River tributaries in the southern French Alps based on numerical inverse and forward modelling of their longitudinal profiles. We model their relative uplift history with respect to the main channel, hence the incision rate history of this channel. Inverse models show that all tributaries have consistent incision rate histories with alternating high and low values. A comparison with global temperature curves shows that these variations correlate with quaternary climate changes. We suggest that during warm periods, a wave of regressive erosion propagates in the Tinée River, while its tributaries deeply incise their substratum to catch up with the falling base-level. We also show that the post 140 ka history of this landscape evolution is dominated by fluvial incision. We then perform forward models of river incision and simulate the incision of the Tinée River system over a time span of 600 ka. This model allows us to extract time and space incision rate variations of the Tinée River. With a background of a few mm.yr-1, incision rate can increase up to more than 1 cm yr-1 during short periods of time due to climatic oscillations. This result is compatible with published cosmogenic nuclide based dating, which evidenced incision rates from 0.2 to 24 mm yr-1. The part of the channel located between 12 and 20 km downstream from the source has undergone several periods of rapid incision rates, which could explain the steep hillslopes and the triggering of a landslide ∼10 ka ago.

  3. Incision for pleural tissue biopsy (image) (United States)

    ... open pleural biopsy, a small piece of the pleural tissue is removed through a surgical incision in the chest. After the sample is obtained, a chest tube is placed and the incision is closed with ...

  4. Rectus abdominis atrophy after ventral abdominal incisions: midline versus chevron. (United States)

    Vigneswaran, Y; Poli, E; Talamonti, M S; Haggerty, S P; Linn, J G; Ujiki, M B


    Although many outcomes have been compared between a midline and chevron incision, this is the first study to examine rectus abdominis atrophy after these two types of incisions. Patients undergoing open pancreaticobiliary surgery between 2007 and 2011 at our single institution were included in this study. Rectus abdominis muscle thickness was measured on both preoperative and follow-up computed tomography (CT) scans to calculate percent atrophy of the muscle after surgery. At average follow-up of 24.5 and 19.0 months, respectively, rectus abdominis atrophy was 18.9% greater in the chevron (n = 30) than in the midline (n = 180) group (21.8 vs. 2.9%, p 20% atrophy at follow-up compared with 10% with a midline incision [odds ratio (OR) 9.0, p atrophy of the rectus abdominis compared with midline incisions. The long-term effects of transecting the rectus abdominis and disrupting its innervation creates challenging abdominal wall pathology. Atrophy of the abdominal wall can not be readily fixed with an operation, and this significant side effect of a transverse incision should be factored into the surgeon's decision-making process when choosing a transverse over a midline incision.

  5. Visual CRO display of pulse height distribution including discriminator setting for a single channel X-ray analyser

    International Nuclear Information System (INIS)

    Shaw, S.E.


    An outline for a simple pulse spectroscope which attaches to a standard laboratory CRO is presented. The peak amplitude voltage of each pulse from the linear amplifier of a single channel X-ray analyser is stored for the duration of one oscilloscope trace. For each amplifier pulse, input from the discriminator is tested and if these is coincidence of pulses the oscilloscope beam is blanked for approximately the first 2 cm of its traverse across the screen. Repetition of pulses forms a pulse height distribution with a rectangular dark area marking the position of the discriminator window. (author)

  6. Kinetic structure of large-conductance Ca2+-activated K+ channels suggests that the gating includes transitions through intermediate or secondary states. A mechanism for flickers. (United States)

    Rothberg, B S; Magleby, K L


    Mechanisms for the Ca2+-dependent gating of single large-conductance Ca2+-activated K+ channels from cultured rat skeletal muscle were developed using two-dimensional analysis of single-channel currents recorded with the patch clamp technique. To extract and display the essential kinetic information, the kinetic structure, from the single channel currents, adjacent open and closed intervals were binned as pairs and plotted as two-dimensional dwell-time distributions, and the excesses and deficits of the interval pairs over that expected for independent pairing were plotted as dependency plots. The basic features of the kinetic structure were generally the same among single large-conductance Ca2+-activated K+ channels, but channel-specific differences were readily apparent, suggesting heterogeneities in the gating. Simple gating schemes drawn from the Monod- Wyman-Changeux (MWC) model for allosteric proteins could approximate the basic features of the Ca2+ dependence of the kinetic structure. However, consistent differences between the observed and predicted dependency plots suggested that additional brief lifetime closed states not included in MWC-type models were involved in the gating. Adding these additional brief closed states to the MWC-type models, either beyond the activation pathway (secondary closed states) or within the activation pathway (intermediate closed states), improved the description of the Ca2+ dependence of the kinetic structure. Secondary closed states are consistent with the closing of secondary gates or channel block. Intermediate closed states are consistent with mechanisms in which the channel activates by passing through a series of intermediate conformations between the more stable open and closed states. It is the added secondary or intermediate closed states that give rise to the majority of the brief closings (flickers) in the gating.

  7. A neural network potential energy surface for the F + CH4reaction including multiple channels based on coupled cluster theory. (United States)

    Chen, Jun; Xu, Xin; Liu, Shu; Zhang, Dong H


    We report here a new global and full dimensional potential energy surface (PES) for the F + CH4 reaction. This PES was constructed by using neural networks (NN) fitting to about 99 000 ab initio energies computed at the UCCSD(T)-F12a/aug-cc-pVTZ level of theory, and the correction terms considering the influence of a larger basis set as well as spin-orbit couplings were further implemented with a hierarchial scheme. This PES, covering both the abstraction and substitution channels, has an overall fitting error of 8.24 meV in total, and 4.87 meV for energies within 2.5 eV using a segmented NN fitting method, and is more accurate than the previous PESs.

  8. Mixed-scale channel networks including Kingfisher-beak-shaped 3D microfunnels for efficient single particle entrapment (United States)

    Lee, Yunjeong; Lim, Yeongjin; Shin, Heungjoo


    Reproducible research results for nanofluidics and their applications require viable fabrication technologies to produce nanochannels integrated with microchannels that can guide fluid flow and analytes into/out of the nanochannels. We present the simple fabrication of mixed-scale polydimethylsiloxane (PDMS) channel networks consisting of nanochannels and microchannels via a single molding process using a monolithic mixed-scale carbon mold. The monolithic carbon mold is fabricated by pyrolyzing a polymer mold patterned by photolithography. During pyrolysis, the polymer mold shrinks by ~90%, which enables nanosized carbon molds to be produced without a complex nanofabrication process. Because of the good adhesion between the polymer mold and the Si substrate, non-uniform volume reduction occurs during pyrolysis resulting in the formation of curved carbon mold side walls. These curved side walls and the relatively low surface energy of the mold provide efficient demolding of the PDMS channel networks. In addition, the trigonal prismatic shape of the polymer is converted into to a Kingfisher-beak-shaped carbon structure due to the non-uniform volume reduction. The transformation of this mold architecture produces a PDMS Kingfisher-beak-shaped 3D microfunnel that connects the microchannel and the nanochannel smoothly. The smooth reduction in the cross-sectional area of the 3D microfunnels enables efficient single microparticle trapping at the nanochannel entrance; this is beneficial for studies of cell transfection.Reproducible research results for nanofluidics and their applications require viable fabrication technologies to produce nanochannels integrated with microchannels that can guide fluid flow and analytes into/out of the nanochannels. We present the simple fabrication of mixed-scale polydimethylsiloxane (PDMS) channel networks consisting of nanochannels and microchannels via a single molding process using a monolithic mixed-scale carbon mold. The monolithic

  9. Small incision removal of nylon foil orbital implants. (United States)

    Liu, Catherine Y; Vemuri, Swapna; Tao, Jeremiah P


    To describe a small incision technique for the removal of a nylon foil orbital wall implant. The authors retrospectively reviewed the charts of 9 patients who underwent a minimally invasive anterior orbitotomy for nylon foil explantation. Indications for removal and surgical technique, including size of orbitotomy incision and extent of orbital dissection, were recorded. Motility, globe position, strabismus pre- and post procedure, and complications were also assessed. Photographs, videos, and postoperative imaging were included, when available. The indications for removal were adjacent sinusitis (4 cases), undesirable implant position (3), orbital abscess (1), and adjacent orbital emphysema (1). The removal technique was associated with no changes in motility, globe position, or strabismus postprocedure. The average incision size was 1.1 cm, and the procedure was rapid, usually seconds once the anterior aspect of the implant was exposed and grasped with a hemostat. The dissection in all cases was to the anterior aspect of the implant without a need for deep orbital manipulation. The authors demonstrate through video that the implant folds to exit through a small incision. No adverse events were noted. Nasal endoscopy and radiography demonstrated a fibrous capsule that maintained orbital structure and support. Thin nylon foil implant can be explanted safely and efficiently through a very small incision. The orbit maintains structure and configuration postexplantation in this series.

  10. Three versus four radial keratotomy incisions. (United States)

    Melles, G R; Go, A T; Beekhuis, W H; van Rij, G; Binder, P S


    Radial keratotomy (RK) is currently performed with four or eight semi-radial incisions. To evaluate the effect of a theoretically more stable three-incision RK pattern, centripetal incisions were made in 16 human donor eyes (eight pairs), using a double-edged diamond blade set to 90% of central pachymetry and a 3.5 mm optical clear zone. Intraocular pressure was maintained at 15 mm Hg during surgery and while keratometry readings were made. One randomly selected eye of each pair had three radial incisions made at 12, 4 and 8 o'clock; the other eye had four radial incisions at 12, 3, 6, and 9 o'clock. Corneal flattening was 6.08 diopters (D) with four incisions and 4.84 D with three incisions (P less than .05). Astigmatism increased 0.44 D and 0.69 D, respectively (P greater than .1). Histologically measured mean incision depth (77.4%) did not differ significantly between the groups (P greater than .1). This study shows that 80% of the effect of a four-incision RK pattern can be obtained with a theoretically more stable three-incision pattern.

  11. Single-incision laparoscopic bariatric surgery

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    Huang Chih-Kun


    Full Text Available Background: Bariatric surgery has been established as the best option of treatment for morbid obesity. In recent years single-incision laparoscopic surgery (SILS has emerged as another modality of carrying out the bariatric procedures. While SILS represents an advance, its application in morbid obesity at present is limited. In this article, we review the technique and results of SILS in bariatric surgery. Methods: The PubMed database was searched and totally 11 series reporting SILS in bariatric surgery were identified and analyzed. The case reports were excluded. Since 2008, 114 morbidly obese patients receiving SILS bariatric surgeries were reported. Results: The procedures performed included SILS gastric banding, sleeve gastrectomy and gastric bypass. No mortality was reported in the literatures. Sixteen patients (14.05% needed an additional incision for a liver retractor, a trocar or for conversion. Only one complication of wound infection was reported in these series. All the surgeons reported that the patients were highly satisfied with the scar. Conclusion: Because of abundant visceral and subcutaneous fat and multiple comorbidities in morbid obesity, it is more challenging for surgeons to perform the procedures with SILS. It is clear that extensive development of new instruments and technical aspects of these procedures as well as randomized studies to compare them with traditional laparoscopy are essential before these procedures can be utilized in day-to-day clinical practice.

  12. Modified tubularized incised plate urethroplasty

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    Shivaji Mane


    Full Text Available Aim: To share our experience of doing tubularized incised plate urethroplasty with modifications. Materials and Methods: This is a single surgeon personal series from 2004 to 2009. One hundred patients of distal hypospadias were subjected for Snodgrass urethroplasty with preputioplasty. The age range was 1 to 5 year with mean age of 2.7 years. Selection criteria were good urethral plate, without chordee and torsion needing complete degloving. Main technical modification from original Snodgrass procedure was spongioplasty, preputioplasty, and dorsal slit when inability to retract prepuce during surgery. Results: Average follow-up period is 23 months. Seven (7% patients developed fistula and one patient had complete preputial dehiscence. Phimosis developed in three (3% patients and required circumcision. Dorsal slit was required in seven patients. One patient developed meatal stenosis in postoperative period. All other patients are passing single urinary stream and have cosmesis that is acceptable. Conclusions: Modified tubularized incised plate urethroplasty with preputioplasty effectively gives cosmetically normal looking penis with low complications.

  13. Signatures of Late Pleistocene fluvial incision in an Alpine landscape (United States)

    Leith, Kerry; Fox, Matthew; Moore, Jeffrey R.


    Uncertainty regarding the relative efficacy of fluvial and glacial erosion has hindered attempts to quantitatively analyse the Pleistocene evolution of alpine landscapes. Here we show that the morphology of major tributaries of the Rhone River, Switzerland, is consistent with that predicted for a landscape shaped primarily by multiple phases of fluvial incision following a period of intense glacial erosion after the mid-Pleistocene transition (∼0.7 Ma). This is despite major ice sheets reoccupying the region during cold intervals since the mid-Pleistocene. We use high-resolution LiDAR data to identify a series of convex reaches within the long-profiles of 18 tributary channels. We propose these reaches represent knickpoints, which developed as regional uplift raised tributary bedrock channels above the local fluvial baselevel during glacial intervals, and migrated upstream as the fluvial system was re-established during interglacial periods. Using a combination of integral long-profile analysis and stream-power modelling, we find that the locations of ∼80% of knickpoints in our study region are consistent with that predicted for a fluvial origin, while the mean residual error over ∼100 km of modelled channels is just 26.3 m. Breaks in cross-valley profiles project toward the elevation of former end-of-interglacial channel elevations, supporting our model results. Calculated long-term uplift rates are within ∼15% of present-day measurements, while modelled rates of bedrock incision range from ∼1 mm/yr for low gradient reaches between knickpoints to ∼6-10 mm/yr close to retreating knickpoints, typical of observed rates in alpine settings. Together, our results reveal approximately 800 m of regional uplift, river incision, and hillslope erosion in the lower half of each tributary catchment since 0.7 Ma.

  14. Better outcome from arthroscopic partial meniscectomy than skin incisions only?

    DEFF Research Database (Denmark)

    Roos, Ewa M; Hare, Kristoffer Borbjerg; Nielsen, Sabrina Mai


    . In total, nine participants experienced 11 adverse events; six in the surgery group and three in the skin-incisions-only group. CONCLUSION: We found greater improvement from arthroscopic partial meniscectomy compared with skin incisions only at 2 years, with the statistical uncertainty of the between......-group difference including what could be considered clinically relevant. Because of the study being underpowered, nearly half in the sham group being non-blinded and one-third crossing over to surgery, the results cannot be generalised to the greater patient population. TRIAL REGISTRATION NUMBER: NCT01264991....

  15. Small incision transcutaneous levator aponeurotic repair for blepharoptosis. (United States)

    Baroody, Michael; Holds, John B; Sakamoto, Douglas K; Vick, Valerie L; Hartstein, Morris E


    Patients presenting with blepharoptosis due to disinsertion or thinning of the levator aponeurosis require surgical repair. A minimally invasive approach directed specifically at the levator aponeurotic anatomic defect may provide benefits to the patient. Proposed advantages of a small eyelid incision (8-13 mm) include less local anesthetic and tissue distortion, less ecchymosis and edema, decreased operative times, a shortened recovery period, and improved surgical results. We describe our results with the use of a small incision ptosis repair in select patients. A retrospective chart review between January 2000 and September 2001 included 91 patients and 118 eyelids with blepharoptosis due to aponeurotic disinsertion, corrected by a minimally invasive approach. The small incision technique comprised levator aponeurotic resection and advancement. Pre- and postoperative upper eyelid marginal reflex distances (MRD1), eyelid contour, need for reoperation, and complications (overcorrection, undercorrection, hematoma, and infection) were recorded. The average preoperative MRD1 measured 0.5 +/- 1.1 mm, with a range of -2.0 to 2.5 mm. The average postoperative MRD1 measured 2.6 +/- 0.8 mm, with a range of 1 to 5.5 mm (P < 0.0001). Of the 118 eyelids corrected by a small incision technique, there were 4 overcorrections, 3 undercorrections, 1 failure, 1 postoperative ptosis procedure of the contralateral upper eyelid secondary to Hering's law ptosis, and 4 patients requesting surgical treatment of dermatochalasis. No symptomatic dry eye, exposure keratopathy, or other complication resulted in association with the overcorrections. No contour abnormalities, infections, hematomas, or other complications were noted. Our experience suggests that utilization of a small skin incision is safe, precise, and efficient and allows for more rapid recovery from surgery. The authors note a decreased incidence of reoperation and postoperative complaints compared with historical larger-incision

  16. Single-incision sling operations for urinary incontinence in women. (United States)

    Nambiar, Arjun; Cody, June D; Jeffery, Stephen T


    Urinary incontinence has been shown to affect up to 50% of women. Studies in the United States have shown that up to 80% of these women have an element of stress urinary incontinence. Colposuspension and now mid-urethral slings have been shown to be effective in treating patients with stress incontinence. However, associated adverse events include bladder and bowel injury, groin pain and haematoma formation. This has led to the development of third-generation single-incision slings, also referred to as mini-slings.It should be noted that TVT-Secur (Gynecare, Bridgewater, NJ, USA) is one type of single-incision sling; it has been withdrawn from the market because of poor results. However, it is one of the most widely studied single-incision slings and was used in several of the trials included in this review. Despite its withdrawal from clinical use, it was decided that data pertaining to this sling should be included in the first iteration of this review, so that level 1a data are available in the literature to confirm its lack of efficacy. To assess the effectiveness of mini-sling procedures in women with urodynamic clinical stress or mixed urinary incontinence in terms of improved continence status, quality of life or adverse events. We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in process; we handsearched journals and conference proceedings (searched 6 February 2013) and searched (searched 20 September 2012), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (searched 20 September 2012) and the reference lists of relevant articles. Randomised or quasi-randomised controlled trials in women with urodynamic stress incontinence, symptoms of stress incontinence or stress-predominant mixed urinary incontinence, in which at least one trial arm involves one of the

  17. Charybdotoxin is a new member of the K sup + channel toxin family that includes dendrotoxin I and mast cell degranulating peptide

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    Schweitz, H.; Bidard, J.N.; Lazdunski, M. (Universite de Nice (France)); Maes, P. (Institut Pasteur de Lille (France))


    A polypeptide was identified in the venom of the scorpion Leiurus quinquestriatus hebraeus by its potency to inhibit the high affinity binding of the radiolabeled snake venom toxin dendrotoxin I ({sup 125}I-DTX{sub I}) to its receptor site. It has been purified, and its properties investigated by different techniques were found to be similar to those of MCD and DTX{sub I}, two polypeptide toxins active on a voltage-dependent K{sup +} channel. However, its amino acid sequence was determined, and it was shown that this toxin is in fact charybdotoxin (ChTX), a toxin classically used as a specific tool to block one class of Ca{sup 2+}-activated K{sup +} channels. ChTX, DTX{sub I}, and MCD are potent convulsants and are highly toxic when injected intracerebroventricularly in mice. Their toxicities correlate well with their affinities for their receptors in rat brain. These three structurally different toxins release ({sup 3}H)GABA from preloaded synaptosomes, the efficiency order being DTX{sub I} > ChTX > MCD. Both binding and cross-linking experiments of ChTX to rat brain membranes and to the purified MCD/DTX{sub I} binding protein have shown that the {alpha}-subunit of the MCD/DTX{sub I}-sensitive K{sup +} channel protein also contains the ChTX binding sites. Binding sites for DTX{sub I}, MCD, and ChTX are in negative allosteric interaction. The results show that charybdotoxin belongs to the family of toxins which already includes the dendrotoxins and MCD, which are blockers of voltage-sensitive K{sup +} channels. ChTX is clearly not selective for Ca{sup 2+}-activated K{sup +} channel.

  18. Long-Term Incisal Relationships After Palatoplasty in Patients With Isolated Cleft Palate. (United States)

    Odom, Elizabeth B; Woo, Albert S; Mendonca, Derick A; Huebener, Donald V; Nissen, Richard J; Skolnick, Gary B; Patel, Kamlesh B


    Various palatoplasty techniques have limited incisions in the hard palate due to concerns that these incisions may limit maxillary growth. There is little convincing long-term evidence to support this. Our purpose is to determine incisal relationships, an indicator for future orthognathic procedure, in patients after repair of an isolated cleft of the secondary palate. Our craniofacial database was used to identify patients aged 10 years or greater with an isolated cleft of the secondary palate who underwent palatoplasty between 1985 and 2002. Data collected included age at palatoplasty and follow-up, cleft type, associated syndrome, Robin sequence, surgeon, repair technique, number of operations, and occlusion. Incisal relationship was determined through clinical observation by a pediatric dentist and orthodontist. Seventy eligible patients operated on by 9 surgeons were identified. Class III incisal relationship was seen in 5 patients (7.1%). Palatoplasty techniques over the hard palate (63 of 70 patients) included 2-flap palatoplasty, VY-pushback, and Von Langenbeck repair. There was an association between class III incisal relationship and syndromic diagnosis (P cleft of the secondary palate, there was no association between class III incisal relationship and surgeon, age at repair, cleft type, palatoplasty technique, or number of operations. Increased likelihood of class III incisal relationship was associated primarily with syndromic diagnosis.

  19. A Single-Chip 64-Channel Ultrasound RX-Beamformer Including Analog Front-End and an LUT for Non-Uniform ADC-Sample-Clock Generation. (United States)

    Kim, Yoon-Jee; Cho, Sung-Eun; Um, Ji-Yong; Chae, Min-Kyun; Bang, Jihoon; Song, Jongkeun; Jeon, Taeho; Kim, Byungsub; Sim, Jae-Yoon; Park, Hong-June


    A 64-channel RX digital beamformer was implemented in a single chip for 3-D ultrasound medical imaging using 2-D phased-array transducers. The RX beamformer chip includes 64 analog front-end branches including 64 non-uniform sampling ADCs, a FIFO/Adder, and an on-chip look-up table (LUT). The LUT stores the information on the rising edge timing of the non-uniform ADC sampling clocks. To include the LUT inside the beamformer chip, the LUT size was reduced by around 240 times by approximating an ADC-sample-time profile w.r.t. focal points (FP) along a scanline (SL) for a channel into a piece-wise linear form. The maximum error between the approximated and accurate sample times of ADC is eight times the sample time resolution (Ts) that is 1/32 of the ultrasound signal period in this work. The non-uniform sampling reduces the FIFO size required for digital beamforming by around 20 times. By applying a 9-dot image from Field-II program and 2-D ultrasound phantom images to the fabricated RX beamformer chip, the original images were successfully reconstructed from the measured output. The chip in a 0.13-um CMOS occupies 30.25 [Formula: see text] and consumes 605 mW.


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    Galina G. Dimitrova


    Full Text Available Purpose: To evaluate the role of conjunctival incision in medial rectus muscle recessions as surgical treatment of choice in esotropia. Methods: The study included 200 patients (370 eyes, operated on for esotropia in the period of 2000-2014. 170 of them (340 eyes underwent bilateral medial rectus muscle recessions and 30- unilateral medial rectus muscle recession for various forms of alternating/alternated esotropia. We compared the effect (Δ/mm recession of fornix and limbal approach. Diagnostic, surgical and statistical methods were used. Results: Limbal incision was performed on 110 patients (55,3% and fornix approach was done in 89 cases (44,7%. The mean effect corrected prism diopters for each mm of recession (Δ/mm differed significantly in the two groups, being bigger in cases with fornix incision (p<0,001 . Conclusion: The type of conjunctival incision in medial rectus muscle recessions have an influence not only on the cosmetic appearance, but also on the functional result. This is especially true for large recessions.

  1. Influence of upper and temporal transconjunctival sclerocorneal incision on marginal reflex distance after cataract surgery. (United States)

    Tamaki, Rikiya; Gosho, Masahiko; Mizumoto, Kyoichi; Kato, Nahoko; Zako, Masahiro


    Ptosis incidence following cataract surgery is reduced with a recently developed phacoemulsification technique using a small incision. However, it remains uncertain whether an upper transconjunctival sclerocorneal incision can cause minor blepharoptosis. In the present prospective study, patients underwent cataract surgery with either an upper or temporal 2.4-mm transconjunctival sclerocorneal incision. We measured the marginal reflex distance 1 (MRD1) preoperatively and postoperatively, and compared these measurements between the two different incision types. Further we explored the risk factors of the postoperative MRD1 reduction. The study population included patients who underwent cataract surgery on both eyes at Aichi Medical University between October 2013 and September 2015. In each patient, one eye was operated using an upper 2.4-mm transconjunctival sclerocorneal incision, and the other with a temporal incision. We prespecified that an MRD1 difference of ≥0.5 mm between the pre- and post-surgical measurements indicated postoperative ptosis, which was a strict criterion. MRD1 was measured using digital photography, and we calculated the difference between the preoperative and postoperative MRD1 values. This change in MRD1 was compared between the groups with different incision locations. The change in MRD1 was analyzed by using the multivariate regression model including incision position (temporal or upper), preoperative MRD1, and preoperative distance between medial and lateral canthi. We assessed data from a total of 34 patients. The mean change in MRD1 from pre-operation to post-operation measurements was -0.26 ± 0.93 with the temporal incision and -0.24 ± 0.86 with the upper incision. The mean difference in the change in MRD1 between the different two incision types was -0.02, with a 95 % CI of -0.24 to 0.20, establishing equivalence between these incision types. The multivariate regression analysis showed that the preoperative MRD1 was

  2. Watershed-scale modeling of streamflow change in incised montane meadows (United States)

    Essaid, Hedeff I.; Hill, Barry R.


    Land use practices have caused stream channel incision and water table decline in many montane meadows of the Western United States. Incision changes the magnitude and timing of streamflow in water supply source watersheds, a concern to resource managers and downstream water users. The hydrology of montane meadows under natural and incised conditions was investigated using watershed simulation for a range of hydrologic conditions. The results illustrate the interdependence between: watershed and meadow hydrology; bedrock and meadow aquifers; and surface and groundwater flow through the meadow for the modeled scenarios. During the wet season, stream incision resulted in less overland flow and interflow and more meadow recharge causing a net decrease in streamflow and increase in groundwater storage relative to natural meadow conditions. During the dry season, incision resulted in less meadow evapotranspiration and more groundwater discharge to the stream causing a net increase in streamflow and a decrease in groundwater storage relative to natural meadow conditions. In general, for a given meadow setting, the magnitude of change in summer streamflow and long-term change in watershed groundwater storage due to incision will depend on the combined effect of: reduced evapotranspiration in the eroded meadow; induced groundwater recharge; replenishment of dry season groundwater storage depletion in meadow and bedrock aquifers by precipitation during wet years; and groundwater storage depletion that is not replenished by precipitation during wet years.

  3. Single Incision Laparoscopic Splenectomy: Our First Experiences

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    Umut Barbaros


    Full Text Available Objective: Most laparoscopic surgeons have attempted to reduce incisional morbidity and improve cosmetic outcomes by using less and smaller trocars. Single incision laparoscopic splenectomy is a new laparoscopic procedure. Herein we would like to present our experiences.Material and Methods: Between January 2009 and June 2009, data of the 7 patients who underwent single incision laparoscopic splenectomy were evaluated retrospectively.Results: There were 7 patients (5 females and 2 males with a mean age of 29.9 years. The most common splenectomy indication was idiopathic thrombocytopenic purpura. Single incision laparoscopic splenectomy was performed successfully in 6 patients. In one patient the operation was converted to an open procedure.Conclusion: With surgeons experienced in minimally invasive surgery, single incision laparoscopic splenectomy could be performed successfully. However, in order to demonstrate the differneces between standard laparoscopic splenectomy and SILS splenetomy, prospective randomized comparative studies are required.

  4. Mast Quadrant-assisted Minimally Invasive Modified Transforaminal Lumbar Interbody Fusion: Single Incision Versus Double Incision

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    Xin-Lei Xia


    Full Text Available Background: The concept of minimally invasive techniques is to make every effort to reduce tissue damage. Certainly, reducing skin incision is an important part of these techniques. This study aimed to investigate the clinical feasibility of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion (TLIF with a small single posterior median incision. Methods: During the period of March 2011 to March 2012, 34 patients with single-segment degenerative lumbar disease underwent the minimally invasive modified TLIF assisted by Mast Quadrant with a small single posterior median incision (single incision group. The cases in this group were compared to 37 patients with single-segment degenerative lumbar disease in the double incision group. The perioperative conditions of patients in these two groups were statistically analyzed and compared. The Oswestry Disability Index (ODI scores, Visual Analog Scale (VAS scores, and sacrospinalis muscle damage evaluation indicators before operation and 3, 12 months postoperation were compared. Results: A total of 31 and 35 cases in the single incision and double incision groups, respectively, completed at least 12 months of systemic follow-up. The differences in perioperative conditions between the two groups were not statistically significant. The incision length of the single incision group was significantly shorter than that of the double incision group (P < 0.01. The ODI and VAS scores of patients in both groups improved significantly at 3 and 12 months postoperation. However, these two indicators at 3 and 12 months postoperation and the sacrospinalis muscle damage evaluation indicators at 3 months postoperation did not differ significantly between the two groups (P ≥ 0.05. Conclusions: Mast Quadrant-assisted modified TLIF with a small single posterior median incision has excellent clinical feasibility compared to minimally invasive TLIF with a double paramedian incision.

  5. DNA Methylation Modulates Nociceptive Sensitization after Incision.

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    Yuan Sun

    Full Text Available DNA methylation is a key epigenetic mechanism controlling DNA accessibility and gene expression. Blockade of DNA methylation can significantly affect pain behaviors implicated in neuropathic and inflammatory pain. However, the role of DNA methylation with regard to postoperative pain has not yet been explored. In this study we sought to investigate the role of DNA methylation in modulating incisional pain and identify possible targets under DNA methylation and contributing to incisional pain. DNA methyltranferase (DNMT inhibitor 5-Aza-2'-deoxycytidine significantly reduced incision-induced mechanical allodynia and thermal sensitivity. Aza-2'-deoxycytidine also reduced hindpaw swelling after incision, suggesting an anti-inflammatory effect. Global DNA methylation and DNMT3b expression were increased in skin after incision, but none of DNMT1, DNMT3a or DNMT3b was altered in spinal cord or DRG. The expression of proopiomelanocortin Pomc encoding β-endorphin and Oprm1 encoding the mu-opioid receptor were upregulated peripherally after incision; moreover, Oprm1 expression was further increased under DNMT inhibitor treatment. Finally, local peripheral injection of the opioid receptor antagonist naloxone significantly exacerbated incision-induced mechanical hypersensitivity. These results suggest that DNA methylation is functionally relevant to incisional nociceptive sensitization, and that mu-opioid receptor signaling might be one methylation regulated pathway controlling sensitization after incision.

  6. Single scrotal incision orchiopexy - a systematic review

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    Hugo Fabiano Fernandes Novaes


    Full Text Available Objective To conduct a systematic review on single scrotal incision orchiopexy. Materials and Methods A search was performed using Pubmed, through which 16 articles were selected out of a total of 133. The following conditions were considered exclusion criteria: other surgical methods such as an inguinal procedure or a laparoscopic approach, retractile testes, or patients with previous testicular or inguinal surgery. Results A total of 1558 orchiopexy surgeries initiated with a transcrotal incision were analyzed. Patients' ages ranged between 5 months and 21 years. Thirteen studies used high scrotal incisions, and low scrotal incisions were performed in the remainder of the studies. In 55 cases (3.53%, there was a need for inguinal incision. Recurrence was observed in 9 cases, testicular atrophy in 3, testicular hypotrophy in 2, and surgical site infections in 13 cases. High efficacy rates were observed, varying between 88% and 100%. Conclusions Single scrotal incision orchiopexy proved to be an effective technique and is associated with low rates of complications.

  7. A small incision technique facilitates pterygium removal

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    Shu Zhang


    Full Text Available AIM: To verify the advantages of an improved protocol for pterygium surgery(small incision removalover a conventional protocol of this surgery.METHODS: Totally 40 primary pterygium cases were divided into two groups(n=20 eachaccording to the protocols: small incision removal versus conventional removal. In our small incision removal, group 1, the pterygium body was cut open with a small incision firstly, through which the conjunctiva was separated from the underlying degenerated Tenon's layer; while in the conventional protocol, group 2, the whole head of pterygium was taken down before the separation. Then the head of pterygium was torn down in our protocol using a forceps instead of cutting it down with a blade, which was facilitated by a special corneal epithelial flap formation method. Surgery time, pain score and corneal wound healing were measured to provide objective comparison of outcome between the two protocols. RESULTS: In the group using small incision removal, the average surgery time was 7.72min(or 48.9%shorter than that of the control group using conventional protocol(PPCONCLUSION: The small incision pterygium removal protocol was easier to perform and resulted in a better outcome than the conventional protocol.

  8. Abdominal incisions in General Surgery: a review | Ajao | Annals of ...

    African Journals Online (AJOL)

    There is this wrong notion that the only standard abdominal incision is the midline incision. Cases have been seen in which an abdominal incision extends from the xyphoid process to the symphysis pubis just to remove a perforated appendix! It is also not unusual to see a groin incision together with a lower abdominal ...

  9. Cyclic steps incised on experimental bedrock (United States)

    Yokokawa, M.; Kyogoku, A.; Kotera, A.; Izumi, N.


    the step shape has been predicted by the mathematical model (Izumi et al., 2012). Among three cases of sediment supply: 1 g/sec, 3 g/sec, and 6 g/sec with fixed water discharge (52 g/sec), the erosion rate was maximized in the cases of the sediment supply of 3 g/sec both in the cement-sand-water ratios of 2:150:50 and 3:150:50. The erosion rate is higher in the case of the moderate amount of sediment supply rather than in the case of the largest amount of sediment supply in which the alluvial cover effect inhibited erosion. This result is consistent with that observed in previous studies (Sklar & Dietrich, 2004; Johnson & Whipple, 2010). References Izumi, N., Yokokawa, M. & Parker G. 2012. Cyclic step morphology formed on bedrock. Annual Journal of Hydraulic Engineering 68(4) : I_955-I_960. Johnson, J.P.L. & Whipple, K.X. 2010. Evaluating the controls of shear stress, sediment supply, alluvial cover, and channel morphology on experimental bedrock incision rate. Journal of Geophysical Research 115, F02018, doi:10.1029/2009JF001335. Sklar, L.S. & Dietrich, W.E. 2004. A mechanistic model for river incision into bedrock by sultating bedload. Water Resources Re-search 40, W06301, doi:10.1029/2003WR002496.

  10. Techniques for creating inconspicuous face-lift scars: avoiding visible incisions and loss of temporal hair. (United States)

    Kridel, Russell W H; Liu, Edmund S


    Patients seeking rhytidectomy desire an improved neckline, jawline, and midface, but rarely at the price of signs that betray a face-lift, namely, visible incisions. We describe our face-lift incisional planning and the rationale behind specific surgical maneuvers for preventing unwanted sequelae. The telltale signs of poorly placed incisions include temporal hair loss, conspicuous scars, an unnatural appearance to the tragus, and a posterior hairline distorsion. Special considerations are given to the male patient and to the salvage of readily visible incision lines from previous surgery.

  11. Laparoscopic cholecystectomy with two mini cosmetic incisions. (United States)

    Tavassoli, Alireza; Noorshafiee, Sajad


    Minimally invasive surgery gained popularity between general surgeons especially laparoscopic four-port cholecystectomy. By introducing different methods such as NOTES and SILS, the costs elevated with its cosmetics. We aim to study a new technique of laparoscopic cholecystectomy by two incisions with best cosmetics, and same quality and lower cost as conventional four-port laparoscopic cholecystectomy and make a comparison between them. In a double-blind clinical trial from December 2012 to September 2014, patients with cholelithiasis who presented to general surgery clinic and candidate for laparoscopic cholecystectomy were studied. Half of patients underwent double-incision laparoscopic cholecystectomy and other half underwent conventional four-port laparoscopic cholecystectomy. The mean age and BMI were higher in double-incision and four-port group, respectively, but not statistically different. Also male to female ratio was 6:1 in double-incision group and 9:1 in four-port group, and they were not statistically different. The mean operation time was about 2 min more in double-incision group, but it is trivial to consider a significant difference at level of 5%. The mean pain score (0-10) was significantly lower in double incision group in comparison with four-port group (p < 0.0001). Patients in double incision group reported higher satisfaction and were sooner in return to work than in four-port group (p < 0.0001). It seems that DILS for uncomplicated cholelithiasis is safe. By reducing port number, we succeed in reducing the pain and need for analgesics, reducing hospital staying and sooner return to work. By taking into account using conventional CLS instrument and lowering the hospital charges, it could be a good alternative to SILS.

  12. De Qeurvian Tenosynovitis: Clinical Outcomes of Surgical Treatment with Longitudinal and Transverse Incision

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    Arefah Dehghani Tafti


    Full Text Available AbstractObjectives: De Quervain disease is a mechanical tenosynovitis due to inadequacy volume between abductor pollicis longus, extensor pollicis brevis and their tunnel. Treatment methods include immobilization, steroid injections, and operation. For the first time Fritz De Quervain described surgical treatment of this disease. Since then, various ways of treatment have been reported. The purpose of this study is to compare the clinical outcomes of a longitudinal incision with a transverse incision in De Quervain disease.Methods: This was a randomized controlled clinical trial conducted in three hospitals in Iran, Yazd from March 2003 to September 2008. One hundred-twenty patients with De Quervain disease who did not respond to conservative treatment were operated with two different incisions. The patients were followed for three months to compare the surgical outcomes.Results: During a three month follow-up, a significant difference was shown between the two methods (p=0.03. Results of surgical treatment with longitudinal incision were excellent (only 5 hypertrophic scars, but there were 13 postoperative complaints with transverse incision.Conclusion: According to our findings, longitudinal incision in surgical treatment of De Quervain disease is better than transverse incision.

  13. Comparison of surgically induced astigmatism in various incisions in manual small incision cataract surgery

    Directory of Open Access Journals (Sweden)

    Nidhi Jauhari


    Full Text Available AIM:To determine the surgically induced astigmatism (SIA in Straight, Frown and Inverted V shape (Chevron incisions in manual small incision cataract surgery (SICS.METHODS:A prospective cross sectional study was done on a total of 75 patients aged 40y and above with senile cataract. The patients were randomly divided into three groups (25 each. Each group received a particular type of incision (Straight, Frown or Inverted V shape incisions. Manual SICS with intraocular lens (IOL implantation was performed. The patients were compared 4wk post operatively for uncorrected visual acuity (UCVA, best corrected visual acuity (BCVA and SIA. All calculations were performed using the SIA calculator version 2.1, a free software program. The study was analyzed using SPSS version 15.0 statistical analysis software.RESULTS:The study found that 89.5% of patients in Straight incision group, 94.2% in Frown incision group and 95.7% in Inverted V group attained BCVA post-operatively in the range of 6/6 to 6/18. Mean SIA was minimum (-0.88±0.61D×90 degrees with Inverted V incision which was statistically significant.CONCLUSION:Inverted V (Chevron incision gives minimal SIA.

  14. Single incision laparoscopic colorectal resection: Our experience

    Directory of Open Access Journals (Sweden)

    Chinnusamy Palanivelu


    Full Text Available Background: A prospective case series of single incision multiport laparoscopic colorectal resections for malignancy using conventional laparoscopic trocars and instruments is described. Materials and Methods: Eleven patients (seven men and four women with colonic or rectal pathology underwent single incision multiport laparoscopic colectomy/rectal resection from July till December 2010. Four trocars were placed in a single transumblical incision. The bowel was mobilized laparoscopically and vessels controlled intracorporeally with either intra or extracorporeal anastomosis. Results: Three patients had carcinoma in the caecum, one in the hepatic flexure, two in the rectosigmoid, one in the descending colon, two in the rectum and two had ulcerative pancolitis (one with high grade dysplasia and another with carcinoma rectum. There was no conversion to standard multiport laparoscopy or open surgery. The median age was 52 years (range 24-78 years. The average operating time was 130 min (range 90-210 min. The average incision length was 3.2 cm (2.5-4.0 cm. There were no postoperative complications. The average length of stay was 4.5 days (range 3-8 days. Histopathology showed adequate proximal and distal resection margins with an average lymph node yield of 25 nodes (range 16-30 nodes. Conclusion: Single incision multiport laparoscopic colorectal surgery for malignancy is feasible without extra cost or specialized ports/instrumentation. It does not compromise the oncological radicality of resection. Short-term results are encouraging. Long-term results are awaited.

  15. Type of incision does not predict abdominal wall outcome after emergency surgery for colonic anastomotic leakage

    DEFF Research Database (Denmark)

    Jensen, Kristian Kiim; Oma, Erling; Harling, Henrik


    PURPOSE: Most literature on abdominal incision is based on patients undergoing elective surgery. In a cohort of patients with anastomotic leakage after colonic cancer resection, we analyzed the association between type of incision, fascial dehiscence, and incisional hernia. METHODS: Data were...... extracted from the Danish Colorectal Cancer Group database and merged with information from the Danish National Patient Register. All patients with anastomotic leakage after colonic resection in Denmark from 2001 until 2008 were included and surgical records on re-operations were retrieved. The primary...... for anastomotic leakage were included with a median follow-up of 5.4 years. Incisional hernia occurred in 41 of 227 (15.3%) patients undergoing midline incision compared with 14 of 81 (14.7%) following transverse incision, P = 1.00. After adjusting for confounders, there was no association between the type...

  16. Comparison of primary total hip replacements performed with a standard incision or a mini-incision. (United States)

    Woolson, Steven T; Mow, Christopher S; Syquia, Jose Fernando; Lannin, John V; Schurman, David J


    Primary total hip replacement performed through an incision that is a minimally invasive technique. Proponents have claimed that mini-incision techniques reduce blood loss, transfusion requirements, postoperative pain, and the length of the hospital stay compared with standard techniques through a longer incision. However, we are aware of no well-designed comparison study that supports these claims. The purpose of the present study was to compare the short-term results of a mini-incision with a standard incision technique for total hip replacement. A consecutive series of patients who underwent 135 primary unilateral total hip replacements (fifty with use of a mini-incision [a standard incision) by three surgeons at one hospital were studied. Each surgeon selected patients to have a mini-incision procedure and performed a standard approach in the remaining patients. A posterior approach was used for all procedures. In-hospital data were collected retrospectively, and the initial postoperative radiographs were analyzed. Because of the selection process, the patients who had a mini-incision had both a significantly lower average body-mass index (p = 0.008) and a lower average score on the American Society of Anesthesiologists rating (p = 0.006), indicating that they were thinner and healthier than the patients who had a standard incision. With the numbers of patients available, no significant differences were found between the groups with respect to the average surgical time, intraoperative blood loss, in-hospital transfusion rate, length of hospital stay, or the patients' disposition after discharge. The mini-incision group was found to have a significantly higher risk of a wound complication (p = 0.02), a higher percentage of acetabular component malposition (p = 0.04), and poor fit and fill of femoral components inserted without cement (p = 0.0036). There was no evidence that the mini-incision technique resulted in less bleeding or less trauma to the soft tissues

  17. Small Incision Cataract Surgery (SICS with Clear Corneal Incision and SICS with Scleral Incision – A Comparative Study

    Directory of Open Access Journals (Sweden)

    Md Shafiqul Alam


    Full Text Available Background: Age related cataract is the leading cause of blindness and visual impairment throughout the world. With the advent of microsurgical facilities simple cataract extraction surgery has been replaced by small incision cataract surgery (SICS with posterior chamber intra ocular lens implant, which can be done either with clear corneal incision or scleral incision. Objective: To compare the post operative visual outcome in these two procedures of cataract surgery. Materials and method: This comparative study was carried out in the department of Ophthalmology, Delta Medical College & Hospital, Dhaka, Bangladesh, during the period of January 2010 to December 2012. Total 60 subjects indicated for age related cataract surgery irrespective of sex with the age range of 40-80 years with predefined inclusion and exclusion criteria were enrolled in the study. Subjects were randomly and equally distributed in 2 groups; Group A for SICS with clear corneal incision and group B for SICS with scleral incision. Post operative visual out come was evaluated by determining visual acuity and astigmatism in different occasions and was compared between groups. Statistical analysis was done by SPSS for windows version12. Results: The highest age incidence (43.3% was found between 61 to 70 years of age group. Among study subjects 40 were male and 20 were female. Preoperative visual acuity and astigmatism were evenly distributed between groups. Regarding postoperative unaided visual outcome, 6/12 or better visual acuity was found in 19.98% cases in group A and 39.6% cases in group B at 1st week. At 6th week 6/6 vision was found in 36.3% in Group A and 56.1% in Group B and 46.2% in group A and 66% in group B without and with correction respectively. With refractive correction, 6/6 vision was attained in 60% subjects of group A and 86.67% of group B at 8th week. Post operative visual acuity was statistically significant in all occasions. Postoperative astigmatism of

  18. Seismic evidence of glacial-age river incision into the Tahaa barrier reef, French Polynesia (United States)

    Toomey, Michael; Woodruff, Jonathan D.; Ashton, Andrew D.; Perron, J. Taylor


    Rivers have long been recognized for their ability to shape reef-bound volcanic islands. On the time-scale of glacial–interglacial sea-level cycles, fluvial incision of exposed barrier reef lagoons may compete with constructional coral growth to shape the coastal geomorphology of ocean islands. However, overprinting of Pleistocene landscapes by Holocene erosion or sedimentation has largely obscured the role lowstand river incision may have played in developing the deep lagoons typical of modern barrier reefs. Here we use high-resolution seismic imagery and core stratigraphy to examine how erosion and/or deposition by upland drainage networks has shaped coastal morphology on Tahaa, a barrier reef-bound island located along the Society Islands hotspot chain in French Polynesia. At Tahaa, we find that many channels, incised into the lagoon floor during Pleistocene sea-level lowstands, are located near the mouths of upstream terrestrial drainages. Steeper antecedent topography appears to have enhanced lowstand fluvial erosion along Tahaa's southwestern coast and maintained a deep pass. During highstands, upland drainages appear to contribute little sediment to refilling accommodation space in the lagoon. Rather, the flushing of fine carbonate sediment out of incised fluvial channels by storms and currents appears to have limited lagoonal infilling and further reinforced development of deep barrier reef lagoons during periods of highstand submersion.

  19. A 1-D morphodynamic model of postglacial valley incision (United States)

    Tunnicliffe, Jon F.; Church, Michael


    Chilliwack River is typical of many Cordilleran valley river systems that have undergone dramatic Holocene degradation of valley fills that built up over the course of Pleistocene glaciation. Downstream controls on base level, mainly blockage of valleys by glaciers, led to aggradation of significant glaciofluvial and glaciolacustrine valley fills and fan deposits, subsequently incised by fluvial action. Models of such large-scale, long-term degradation present a number of important challenges since the evolution of model parameters, such as the rate of bedload transport and grain size characteristics, are governed by the nature of the deposit. Sediment sampling in the Chilliwack Valley reveals a complex sequence of very coarse to fine textural modes. We present a 1-D numerical morphodynamic model for the river-floodplain system tailored to conditions in the valley. The model is adapted to dynamically adjust channel width to optimize sediment transporting capacity and to integrate relict valley fill material as the channel incises through valley deposits. Sensitivity to model parameters is studied using four principal criteria: profile concavity, rate of downstream grain size fining, bed surface sand content, and the timescale to equilibrium. Model results indicate that rates of abrasion and coarsening of the grain size distributions exert the strongest controls on all of the interrelated model performance criteria. While there are a number of difficulties in satisfying all model criteria simultaneously, results indicate that 1-D models of valley bottom sedimentary systems can provide a suitable framework for integrating results from sediment budget studies and chronologies of sediment evacuation established from dating.


    African Journals Online (AJOL)

    Objective To evaluate prospectively our experience using tubularized incised plate (TIP) urethroplasty in primary and repeat penile shaft hypospadias. Patients and Methods Thirty-two boys with penile shaft hypospadias were selected to undergo TIP procedure. Their age ranged from 22 months to 9 years. Twenty-two cases ...

  1. Single scrotal incision orchidopexy for palpable undescended

    International Nuclear Information System (INIS)

    Ahmad, A.; Safdar, C.A.; Yasir, U.; Rasool, N.; Kanwal, S.; Boota, M.; Rehman, J.U.


    To retrospectively asses the results of single scrotal incision orchidopexy (SSIO) performed at our centre with ligation of the patent processus vaginalis in children having palpable undescended testes (UDT). Study Design: Quasi-experimental with retrospective data. Place and Duration of Study: Department of Paediatric surgery Military Hospital Rawalpindi, from April 2007 to December 2011. Patients and Methods: After making a single transverse incision at superior scrotal border, the testis was identified; gubernaculums and the sac were dissected to the highest level and divided. The testis was placed into the scrotum and fixed to the scrotal fascia/skin. All patients were assessed at 2 weeks, 2 months and 6 months post operatively, and then yearly. Results: A total of 38 orchidopexies were performed in 33 patients. The patients age ranged from 14 months to 7 years (mean:2.1 years). Bilateral UDT were found in 5 patients (15.1%). Operative time ranged from 20 to 45 minutes (mean: 36 minutes). The single scrotal incision technique was successful in all 38 cases (100%). All testes were easily fixed in the scrotum. Two patients (5.2%) developed scrotal haematoma and one patient (2.6%) developed stitch abscess. All showed good an atomical and cosmetic results up to a minimum of six months of follow-up. Conclusion: Single scrotal incision orchidopexy for palpable undescended testis is a simple and safe technique. It has shown to consume shorter time and give good cosmetic results. (author)

  2. Effect of incision design on interproximal bone loss of teeth adjacent to single implants. A randomized controlled clinical trial comparing intrasulcular vs paramarginal incision. (United States)

    Girbés-Ballester, Paula; Viña-Almunia, Jose; Balaguer-Martí, Jose C; Peñarrocha-Diago, Miguel; Peñarrocha-Oltra, David


    To evaluate the effect of incision design in implant surgery on interproximal bone loss of posterior teeth adjacent to interdental single implants, comparing intrasulcular and paramarginal incision. A further aim was to assess the influence of the incision technique on peri-implant bone remodeling. A controlled randomized clinical trial was carried out in a University Clinic. All the patients received an interdental posterior single implant. The incision type was randomly divided into two groups: (a) intrasulcular or (b) paramarginal. Standardized periapical digital radiographs were made with the parallel technique and a silicone index individualized in each patient. Radiographs were made immediately after implant placement, at abutment connection, 6 and 12 months post-loading. Two radiographic reference points were detected at the interproximal aspect of the adjacent teeth: (A) the cementoenamel junction and (B) the most coronal aspect of the bone crest. The interproximal bone loss of the adjacent teeth was calculated as the difference from A to B between the different follow-up periods and baseline. Two different examiners evaluated the radiographic measurements twice. Sixty patients, each with one implant, were included, 30 in each group. A mean interproximal bone loss in teeth of 0.09 mm in the intrasulcular and 0.10 mm in the paramarginal group was found at 12 months post-loading. Mean peri-implant bone remodeling was 0.17 mm in the intrasulcular group and 0.15 mm in the paramarginal group. Differences between incision types were not statistically significant (p > .05). Both incision designs used to place interdental single implants resulted in minimum bone loss at the interproximal aspect of adjacent teeth. The incision design did not significantly influence the radiographically assessed interproximal bone loss nor peri-implant bone remodeling. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Radiological findings after endoscopic incision of ureterocele

    International Nuclear Information System (INIS)

    Cheon, Jung Eun; Kim, In One; Seok, Eul Hye; Cha, Joo Hee; Choi, Gook Myung; Kim, Woo Sun; Yeon, Kyung Mo; Kim, Kwang Myung; Choi, Hwang; Cheon, Jung Eun; Seok, Eul Hye; Cha, Joo Hee; Choi, Guk Myung


    Endoscopic incision of ureterocele is considered a simple and safe method for decompression of urinary tract obstruction above ureterocele. The purpose of this study was to evaluate the radiological findings after endoscopic incision of ureterocele. We retrospectively reviewed the radiological findings (ultrasonography (US), intravenous urography, and voiding cystourethrography(VCU)) in 16 patients with ureterocele who underwent endoscopic incision (mean age at surgery, 15 months; M:F 3:13; 18 ureteroceles). According to the postoperative results, treatment was classified as successful when medical treatment was still required, and second operation when additional surgical treatment was required. Postoperative US (n=10) showed that in all patients, urinary tract obstruction was relieved: the kidney parenchima was thicker and the ureterocele was smaller. Intravenous urography (n=8), demonstrated that in all patients, urinary tract obstruction and the excretory function of the kidney had improved. Postoperative VCU indicated that in 92% of patients (12 of 13), endoscopic incision of the ureterocele led to vesicoureteral reflux(VUR). Of these twelve, seven (58%) showed VUR of more than grade 3, while newly developed VUR was seen in five of eight patients (63%) who had preoperative VCU. Surgery was successful in four patients (25%), partially successful in three (19%), and a second operation-on account of recurrent urinary tract infection and VUR of more than grase 3 during the follow-up period-was required by nine (56%). Although endoscopic incision of a ureterocele is a useful way of relieving urinary tract obstruction, an ensuing complication may be VUR. Postoperative US and intravenous urography should be used to evaluate parenchymal change in the kidney and improvement of uronary tract obstructon, while to assess the extend of VUR during the follow-up period , postoperative VCU is required

  4. Archigregarines of the English Channel revisited: New molecular data on Selenidium species including early described and new species and the uncertainties of phylogenetic relationships.

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    Sonja Rueckert

    Full Text Available Gregarines represent an important transition step from free-living predatory (colpodellids s.l. and/or photosynthetic (Chromera and Vitrella apicomplexan lineages to the most important pathogens, obligate intracellular parasites of humans and domestic animals such as coccidians and haemosporidians (Plasmodium, Toxoplasma, Eimeria, Babesia, etc.. While dozens of genomes of other apicomplexan groups are available, gregarines are barely entering the molecular age. Among the gregarines, archigregarines possess a unique mixture of ancestral (myzocytosis and derived (lack of apicoplast, presence of subpellicular microtubules features.In this study we revisited five of the early-described species of the genus Selenidium including the type species Selenidium pendula, with special focus on surface ultrastructure and molecular data. We were also able to describe three new species within this genus. All species were characterized at morphological (light and scanning electron microscopy data and molecular (SSU rDNA sequence data levels. Gregarine specimens were isolated from polychaete hosts collected from the English Channel near the Station Biologique de Roscoff, France: Selenidium pendula from Scolelepis squamata, S. hollandei and S. sabellariae from Sabellaria alveolata, S. sabellae from Sabella pavonina, Selenidium fallax from Cirriformia tentaculata, S. spiralis sp. n. and S. antevariabilis sp. n. from Amphitritides gracilis, and S. opheliae sp. n. from Ophelia roscoffensis. Molecular phylogenetic analyses of these data showed archigregarines clustering into five separate clades and support previous doubts about their monophyly.Our phylogenies using the extended gregarine sampling show that the archigregarines are indeed not monophyletic with one strongly supported clade of Selenidium sequences around the type species S. pendula. We suggest the revision of the whole archigregarine taxonomy with only the species within this clade remaining in the genus


    Directory of Open Access Journals (Sweden)

    Shayana Bhumbla


    Full Text Available BACKGROUND Surgically-Induced Astigmatism (SIA is one of the commonest causes of poor postoperative vision even after uneventful cataract surgery. Recent advances have led to a newer concept of “refractive cataract surgery.” The aim of the study is to study the comparison of postop SIA in Manual Small Incision Cataract Surgery (MSICS with straight versus frown incision. MATERIALS AND METHODS 50 patients of cataract were divided into 2 groups (25 each - group A underwent MSICS with 6 mm straight incision, group B underwent MSICS with 6 mm frown incision. BCVA, keratometry readings were recorded with auto kerato-refractometer preop, at 1 week, 1 month, 3 months and SIA was calculated with SIA calculator version 2.1, a free software program. RESULTS Mean SIA in group A and B were - 1.14D versus 0.92D at 1 week; 1.26D versus 0.97D at 1 month; 1.29D versus 0.95D at 3 months. The difference was statistically significant at each follow up visit (p<0.05. CONCLUSION Frown incision gives lesser SIA than straight incision in MSICS.

  6. Excellent scalability including self-heating phenomena of vertical-channel field-effect-diode type capacitor-less one transistor dynamic random access memory cell (United States)

    Imamoto, Takuya; Endoh, Tetsuo


    The scalability study and the impact of the self-heating effect (SHE) on memory operation of the bulk vertical-channel field effect diode (FED) type capacitorless one transistor (1T) dynamic random access memory (DRAM) cell are investigated via device simulator for the first time. The vertical-channel FED type 1T-DRAM cell shows the excellent hold characteristics (100 ms at 358 K of ambient temperature) with large enough read current margin (1 µA/cell) even when silicon pillar diameter (D) is scaled down from 20 to 12 nm. It is also shown that by employing the vertical-channel FED type, maximum lattice temperature in the memory cell due to SHE (T_{\\text{L}}^{\\text{Max}}) can be suppressed to a negligible small value and only reach 300.6 from 300 K ambient temperature due to the low lateral electric field, while the vertical-channel bipolar junction transistor (BJT) type 1T-DRAM shows significant SHE (T_{\\text{L}}^{\\text{Max}} = 330.6 K). Moreover, this excellent thermal characteristic can be maintained even when D is scaled down from 20 to 12 nm.

  7. Advantages and Disadvantages of 1-Incision, 2-Incision, 3-Incision, and 4-Incision Laparoscopic Cholecystectomy: A Workflow Comparison Study. (United States)

    Bartnicka, Joanna; Zietkiewicz, Agnieszka A; Kowalski, Grzegorz J


    A comparison of 1-port, 2-port, 3-port, and 4-port laparoscopic cholecystectomy techniques from the point of view of workflow criteria was made to both identify specific workflow components that can cause surgical disturbances and indicate good and bad practices. As a case study, laparoscopic cholecystectomies, including manual tasks and interactions within teamwork members, were video-recorded and analyzed on the basis of specially encoded workflow information. The parameters for comparison were defined as follows: surgery time, tool and hand activeness, operator's passive work, collisions, and operator interventions. It was found that 1-port cholecystectomy is the worst technique because of nonergonomic body position, technical complexity, organizational anomalies, and operational dynamism. The differences between laparoscopic techniques are closely linked to the costs of the medical procedures. Hence, knowledge about the surgical workflow can be used for both planning surgical procedures and balancing the expenses associated with surgery.

  8. One-incision versus two-incision techniques for arthroscopically assisted anterior cruciate ligament reconstruction in adults. (United States)

    Rezende, Fernando C; Moraes, Vinícius Y; Franciozi, Carlos Es; Debieux, Pedro; Luzo, Marcus V; Belloti, João Carlos


    Anterior cruciate ligament (ACL) tears are serious knee injuries that are frequently treated surgically in the form of arthroscopically assisted reconstruction with grafts from the patella or hamstrings tendons. We reviewed the evidence for the choice of arthroscopically assisted ACL reconstruction technique in terms of whether it should involve one incision (femoral tunnel drilled from inside the knee joint under arthroscopic visualisation) or two incisions (femoral tunnel drilled from outside to inside the knee joint). To assess the effects (benefits and harms) of one-incision versus two-incision techniques for arthroscopically assisted ACL reconstruction in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Latin American and Caribbean Health Sciences (LILACS), the World Health Organization International Clinical Trials Registry Platform,, reference lists, and conference abstracts. The date of the search was 16 August 2017. Randomised and quasi-randomised controlled clinical trials evaluating one-incision versus two-incision techniques for arthroscopically assisted ACL reconstruction in adults. Two review authors independently searched and selected studies, and extracted data and assessed the risk of bias of the eligible studies. We undertook limited pooling of data using the fixed-effect model. We included five trials (four randomised and one quasi-randomised) evaluating a total of 320 participants who were mainly in their 20s. All participants underwent ACL reconstruction with patella tendon grafts. All five included trials were at a high risk of bias, particularly performance bias. Based on these limitations and the insufficiency of the available data resulting in imprecision of effect estimates, we judged the quality of the evidence as very low for all outcomes. This means that we are uncertain of the findings of the

  9. Analysis of single-incision versus dual-incision fasciotomy for tibial fractures with acute compartment syndrome. (United States)

    Bible, Jesse E; McClure, D Jake; Mir, Hassan R


    To analyze the rate of postoperative infection and nonunion after tibial fractures in patients treated for acute compartment syndrome (ACS) using (1) single-incision versus (2) dual-incision fasciotomy technique. Retrospective. Level I trauma center. Review of all adult tibial fractures operatively treated (n = 2756) over a 12-year period identified 175 patients with concurrent ACS requiring fasciotomy. Of 60 patients treated with intramedullary nails, 36 patients had single-incision fasciotomy and 24 had dual-incision fasciotomy. Of 81 patients treated with plate fixation, 59 patients had single-incision fasciotomy and 22 had dual-incision fasciotomy. Tibial fixation with fasciotomy for ACS. Occurrence of postoperative infection and nonunion. Both fasciotomy groups were similar across recorded patient and treatment characteristics. Need for skin graft was similar between fasciotomy groups. For patients treated with intramedullary nail (n = 60), 1 infection (2.8%) occurred in single-incision group versus 2 (8.3%) in dual-incision group (P = 0.558). Seven nonunions (19.4%) occurred in single-incision group versus 3 (12.5%) in dual-incision group (P = 0.726). For plate fixation patients (n = 81), 15 infections (25.4%) occurred with single-incision fasciotomy versus 5 infections (22.7%) with dual-incision fasciotomy (P = 1.000). Seven nonunions (11.9%) occurred with single-incision group versus 4 nonunions (18.2%) with dual-incision group (P = 0.479). This is the first study to compare a single-incision fasciotomy technique to a dual-incision technique in the setting of tibial fractures with ACS, with similar infection and nonunion rates with either technique. The choice of fasciotomy technique can be based on surgeon experience or patient condition as opposed to a suspected elevated infection or nonunion risk with either technique. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  10. Primary closure of equine laryngotomy incisions

    DEFF Research Database (Denmark)

    Lindegaard, C.; Karlsson, L.; Ekstrøm, Claus Thorn


    The objective was to report healing characteristics and complications after primary closure of equine laryngotomies and analyse factors potentially associated with complications. This retrospective case series of the medical records of horses (n = 180) undergoing laryngoplasty and laryngotomy...... after primary closure of equine laryngotomy incisions are infrequent and considered of minimal severity and can be performed safely when paying careful attention to the closure of the cricothyroid membrane....

  11. Right Kocher’s incision: a feasible and effective incision for right hemicolectomy: a retrospective study

    Directory of Open Access Journals (Sweden)

    Theodosopoulos Theodosios


    Full Text Available Abstract Background The choice of surgical incision is determined by access to the surgical field, particularly when an oncological resection is required. Special consideration is also given to other factors, such as postoperative pain and its sequelae, fewer complications in the early postoperative period and a lower occurrence of incisional hernias. The purpose of this study is to compare the right Kocher’s and the midline incision, for patients undergoing right hemicolectomy, by focusing on short- and longterm results. Methods Between 1995 and 2009, hospital records for 213 patients that had undergone a right hemicolectomy for a right- sided adenocarcinoma were retrospectively studied. 113 patients had been operated via a Kocher’s and 100 via a midline incision. Demographic details, operative data (explorative access to the peritoneal cavity, time of operation, recovery parameters (time with IV analgesic medication, time to first oral fluid intake, time to first solid meal, time to discharge, and oncological parameters (lymph node harvest, TNM stage and resection margins were analyzed. Postoperative complications were also recorded. The two groups were retrospectively well matched with respect to demographic parameters and oncological status of the tumor. Results The median length of the midline incision was slightly longer (12 vs. 10 cm, p  Conclusions The Kocher’s incision approach for right- sided colon cancer is technically feasible, safe and overall very well tolerated. It can achieve the same standards of tumor resection and surgical field accessibility as the midline approach, while reducing postoperative recovery.

  12. Single incision laparoscopic liver resection (SILL – a systematic review

    Directory of Open Access Journals (Sweden)

    Benzing, Christian


    Full Text Available Background: Today, minimally invasive liver resections for both benign and malignant tumors are routinely performed. Recently, some authors have described single incision laparoscopic liver resection (SILL procedures. Since SILL is a relatively young branch of laparoscopy, we performed a systematic review of the current literature to collect data on feasibility, perioperative results and oncological outcome.Methods: A literature research was performed on Medline for all studies that met the eligibility criteria. Titles and abstracts were screened by two authors independently. A study was included for review if consensus was obtained by discussion between the authors on the basis of predefined inclusion criteria. A thorough quality assessment of all included studies was performed. Data were analyzed and tabulated according to predefined outcome measures. Synthesis of the results was achieved by narrative review. Results: A total of 15 eligible studies were identified among which there was one prospective cohort study and one randomized controlled trial comparing SILL to multi incision laparoscopic liver resection (MILL. The rest were retrospective case series with a maximum of 24 patients. All studies demonstrated convincing results with regards to feasibility, morbidity and mortality. The rate of wound complications and incisional hernia was low. The cosmetic results were good.Conclusions: This is the first systematic review on SILL including prospective trials. The results of the existing studies reporting on SILL are favorable. However, a large body of scientific evidence on the field of SILL is missing, further randomized controlled studies are urgently needed.

  13. Oblique lateral incision and subpectoral dissection in modified Nuss procedure minimize future breast deformity. (United States)

    Kimura, Hiroaki; Yasuoka, Tomoyuki; Nagao, Munetomo; Kudoh, Shin; Kobayashi, Seiichiro


    We experienced the occurrence of breast deformity in some young female patients who underwent a modified Nuss procedure before breast development. We studied the causes of and preventive measures for this complication. We classified 13 prepubescent female patients who underwent our modified Nuss procedure into three groups according to the direction of the skin incision and the dissection layer for bar insertion. Four patients who underwent transverse lateral thoracic skin incision and bar insertion through a subpectoral dissection were assigned to the T/SP group, five who underwent oblique skin incision along the rib and bar insertion through a suprapectoral dissection were assigned to the O/IP group, and four who underwent oblique skin incision and subpectoral dissection were assigned to the O/SP group. Each patient in the T/SP group underwent the operation by a different surgeon, two of whom were the authors, including the first author; the first author performed all operations in the O/IP and O/SP groups. The first author evaluated the shape of the developed breasts using the frontal- and oblique-view photographs. We also investigated the location of the lateral border of the mammary gland in seven other adolescent and adult female patients using three-dimensional computed tomography images. Lateral depression of the breast occurred in four of eight breasts with a transverse incision, and flattening of the lowermost portion of the inframammary fold occurred in six of 10 breasts with suprapectoral dissection. None of the eight breasts with an oblique incision and subpectoral dissection exhibited deformities. The lateral border of the mammary gland was on the fifth rib in five patients and on the fifth intercostal space in two patients. An oblique lateral thoracic skin incision along the sixth rib and subpectoral dissection may reduce the occurrence of breast deformity. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons

  14. Regression analysis of controllable factors of surgical incision complications in closed calcaneal fractures

    Directory of Open Access Journals (Sweden)

    Kai Wu


    Full Text Available Background: In surgeries of closed calcaneal fractures, the lateral L-shaped incision is usually adopted. Undesirable post-operative healing of the incision is a common complication. In this retrospective study, controllable risk factors of incision complications after closed calcaneal fracture surgery through a lateral L-shaped incision are discussed and the effectiveness of clinical intervention is assessed. Materials and Methods: A review of medical records was conducted of 209 patients (239 calcaneal fractures surgically treated from June 2005 to October 2012. Univariate analyses were performed of seven controllable factors that might influence complications associated with the surgical incision. Binomial multiple logistic regression analysis was performed to determine factors of statistical significance. Results: Twenty-one fractures (8.79% involved surgical incision complications, including 8 (3.35% cases of wound dehiscence, 7 (2.93% of flap margin necrosis, 5 (2.09% of hematoma, and 1 (0.42% of osteomyelitis. Five factors were statistically significant : t0 he time from injury to surgery, operative duration, post-operative drainage, retraction of skin flap, bone grafting, and patients′ smoking habits. The results of multivariate analyses showed that surgeries performed within 7 days after fracture, operative time > 1.5 h, no drainage after surgery, static skin distraction, and patient smoking were risk factors for calcaneal incision complications. The post-operative duration of antibiotics and bone grafting made no significant difference. Conclusion: Complications after calcaneal surgeries may be reduced by postponing the surgery at least 7 days after fracture, shortening the time in surgery, implementing post-operative drainage, retracting skin flaps gently and for as short a time as possible, and prohibiting smoking.

  15. Two hundred seventy-five single-incision laparoscopic gastric band insertions: what have we learnt? (United States)

    Murgatroyd, Beth; Chakravartty, Saurav; Sarma, Diwakar R; Patel, Ameet G


    Single-incision surgery in the morbidly obese patient has not been widely adopted, but remains a popular choice amongst patients. In the bariatric patient, it presents its own surgical challenges with hepatomegaly and increased abdominal adiposity. Here, we present our experience of 275 single-incision laparoscopic gastric bands.Between June 2009 and April 2013, 275 obese patients underwent single-incision laparoscopic adjustable gastric banding through a single incision using a multichannel single port and via a pars flaccida approach. Prospective data collection was undertaken including operating time, additional ports and additional procedures undertaken.In this series, median operative time was 60 (range 34-170) min. An additional port was placed in 15 patients (5%), including two conversions to four-port technique (0.7%). Of these patients (n = 15), the majority were male (p rate of success for all BMIs. Following 275 single-incision band insertions additional port placements were more commonly required in male patients, BMI >45 and earlier in the learning curve.

  16. [Preliminary clinical experience of single incision laparoscopic colorectal surgery]. (United States)

    Wu, S D; Han, J Y


    Objective: To discuss the preliminary experience of single incision laparoscopic colorectal surgery. Methods: The clinical data and surgical outcomes of 104 selected patients who underwent single incision laparoscopic colorectal surgery in the 2 nd Department of General Surgery, Shengjing Hospital of China Medical University from January 2010 to September 2015 were retrospectively analyzed. There were 62 male and 42 female patients, aging from 21 to 87 years with a mean of (61±12) years. Eighty-five patients were diagnosed with malignancy while the rest 19 cases were benign diseases. All the procedures were performed by the same surgeon using the rigid laparoscopic instruments. Surgical and oncological outcomes were analyzed in 4 kinds of procedures which are over 5 cases respectively, including low anterior resection, abdominoperineal resection, radical right colon resection and radical sigmoidectomy. Results: Single incision laparoscopic colorectal surgery was performed in 104 selected patients and was successfully managed in 99 cases with a total conversion rate of 4.8%. Radical procedures for malignancy in cases with the number of patients more than 5 were performed for 74 cases. For low anterior resection, 35 cases with an average surgical time of (191±57) minutes, average estimated blood loss of (117±72) ml and average number of harvested lymph nodes of 14.6±1.1. For abdominoperineal resection, 9 cases with an average surgical time of (226±54) minutes, average estimated blood loss of (194±95) ml and average number of harvested lymph nodes of 14.1±1.5. For radical right colon resection, 16 cases with an average surgical time of (222±62) minutes, average estimated blood loss of (142±68) ml and average number of harvested lymph nodes of 15.4±2.4. For radical sigmoidectomy, 14 cases with an average surgical time of (159±32) minutes, average estimated blood loss of (94±33) ml and average number of harvested lymph nodes of 13.9±1.5. The overall

  17. Two Late Pleistocene climate-driven incision/aggradation rhythms in the middle Dnieper River basin, west-central Russian Plain

    DEFF Research Database (Denmark)

    Panin, Andrei; Adamiec, Grzegorz; Buylaert, Jan-Pieter


    Pleistocene - Holocene climate cycle. The following events were detected. (1) Late MIS 5 - early MIS 4: aggradation of Terrace T1 following the deep incision at the end of MIS 6. (2) Late MIS 4 (40-30 ka): incision into Terrace T1 below the present-day river, formation of the main scarp in the bottom...... in the last quarter of the last glacial epoch but can not be attributed directly to the glacial-interglacial transition. Both the detected incision events correspond to relatively warm climate phases - late MIS 3, post-LGM warming including the Bølling-Allerød interstadial. Anomalously large size...... of the preserved river palaeochannels prove that the post-LGM incision phase was induced by a climatically forced large increase of water runoff. Considerable increase of water discharges is considered the most probably cause for the late MIS 4 incision phase also. Therefore river incision seems to have been...

  18. The importance of channel non-uniformity in riverine ecosystems (United States)

    Pasternack, G. B.


    A key aspect of the hierarchical controls on riverine ecosystems that has been undervalued in both river science and restoration is the role of channel non-uniformity. As the water depth to bed grain size ratio decreases, channel non-uniformity takes over as a dominant control on hydraulic, geomorphic, and ecologic processes in rivers. As a case in point, the degree of channel degradation and habitat loss that ensues after dams are built may be directly related to maintenance of channel non-uniformity. The study reported here evaluated channel change at different spatial (submeter to km) and temporal (seasonal to interdecadal) scales in a regulated, but still dynamic, gravel-cobble river. The objectives were to (1) determine the cause of the persistence of riffles and pools even as the channel incised more than 10 m over 70 years and (2) evaluate the linkage between channel change and anadromous fish habitat in such a dynamic setting. The study area was the top 10.5 km of the Yuba River below Englebright Dam. Although this dam has blocked bedload transport into the reach for 65 years causing significant channel incision, a residual of 17.7 million m3 of sediment remains in the study reach due to historical hydraulic mining for gold. The approach used was to combine the knowledge gained at multiple scales using different methods, including historical aerial photo analysis, channel DEM analysis and differencing, 2D hydrodynamic modeling, hydraulic geometry analysis, fish observations, process-based hydrogeomorphic monitoring, and sediment transport experiments. These diverse methods revealed an array of mechanisms contributing to channel change and habitat rejuvenation, most notable including flow-convergence routing responsible for maintaining riffles and pools over a range of flows. Anadromous fish were observed to shift their pattern of habitat utilization in response to channel change in predictable ways. The primary lesson for river management is that more

  19. LHCb: Measurements of the relative branching fractions of the decay channel $B^{\\pm}\\to p \\bar{p} K^{\\pm}$ including charmonium contributions at LHCb

    CERN Multimedia

    Cardinale, Roberta


    The study of the $B^{\\pm}\\to p \\bar{p} K^{\\pm}$ decay channel at LHCb is of great interest since it gives the possibility to study different aspects of the Standard Model and possibly Beyond Standard Model physics. A measurement of the direct CP asymmetry can be performed. Moreover intermediate states such as charmonium and "charmonium-like" resonances in the $p \\bar{p}$ final state can be observed and studied along with their characteristics. A multivariate selection has been implemented to select the interesting events using kinematic and topological variables and the particle identification information using the Ring Imaging Cherenkov detectors. The selection has a high signal efficiency and high background rejection capability. The ratios of the branching fractions of the $B^{\\pm}\\to p \\bar{p} K^{\\pm}$ decay channel, of the charmless component with $M_{p \\bar{p}} < 2.85 \\,{\\rm GeV/}c^{2}$ and of the charmonium contribution $\\eta_{c}$, ${\\mathcal B} (B^{\\pm}\\to \\eta_{c} K^{\\pm})\\times {\\mathcal B} (\\eta...

  20. Small-incision lenticule extraction (SMILE)

    DEFF Research Database (Denmark)

    Hansen, Rasmus Søgaard; Lyhne, Niels; Grauslund, Jakob


    PURPOSE: To study the outcomes of small-incision lenticule extraction (SMILE) for treatment of myopia and myopic astigmatism. METHODS: Retrospective study of patients treated for myopia or myopic astigmatism with SMILE, using a VisuMax(®) femtosecond laser (Carl Zeiss Meditec, Jena, Germany...... surgery was 0.07 ± 0.03 (logMAR). However, 12 eyes (1.6 %) lost 2 or more lines of CDVA from before surgery to 3 months postoperatively. Simultaneous treatment of up to 3.00 D of astigmatism was not associated with less predictable refractive outcomes. CONCLUSIONS: In the short term, SMILE seemed...

  1. Two-Step Incision for Periarterial Sympathectomy of the Hand. (United States)

    Jeon, Seung Bae; Ahn, Hee Chang; Ahn, Yong Su; Choi, Matthew Seung Suk


    Surgical scars on the palmar surface of the hand may lead to functional and also aesthetic and psychological consequences. The objective of this study was to introduce a new incision technique for periarterial sympathectomy of the hand and to compare the results of the new two-step incision technique with those of a Koman incision by using an objective questionnaire. A total of 40 patients (17 men and 23 women) with intractable Raynaud's disease or syndrome underwent surgery in our hospital, conducted by a single surgeon, between January 2008 and January 2013. Patients who had undergone extended sympathectomy or vessel graft were excluded. Clinical evaluation of postoperative scars was performed in both groups one year after surgery using the patient and observer scar assessment scale (POSAS) and the Wake Forest University rating scale. The total patient score was 8.59 (range, 6-15) in the two-step incision group and 9.62 (range, 7-18) in the Koman incision group. A significant difference was found between the groups in the total PS score (P-value=0.034) but not in the total observer score. Our analysis found no significant difference in preoperative and postoperative Wake Forest University rating scale scores between the two-step and Koman incision groups. The time required for recovery prior to returning to work after surgery was shorter in the two-step incision group, with a mean of 29.48 days in the two-step incision group and 34.15 days in the Koman incision group (P=0.03). Compared to the Koman incision, the new two-step incision technique provides better aesthetic results, similar symptom improvement, and a reduction in the recovery time required before returning to work. Furthermore, this incision allows the surgeon to access a wide surgical field and a sufficient exposure of anatomical structures.

  2. Current Status of Single-incision Laparoscopic Surgery

    DEFF Research Database (Denmark)

    Ahmed, Irfan; Ciancio, Fabio; Ferrara, Vincenzo


    Recent advances in minimally invasive surgery have centered on reducing the number of incisions required, which has led to the development of the single-incision laparoscopic technique. A panel of European single-incision laparoscopy experts met to discuss the current status of, and the future ex...... to be published to confirm its value. An ideal training route for surgeons who are adopting the technique was agreed upon, as was the need for a single, large clinical registry of data....

  3. Two-Step Incision for Periarterial Sympathectomy of the Hand

    Directory of Open Access Journals (Sweden)

    Seung Bae Jeon


    Full Text Available BackgroundSurgical scars on the palmar surface of the hand may lead to functional and also aesthetic and psychological consequences. The objective of this study was to introduce a new incision technique for periarterial sympathectomy of the hand and to compare the results of the new two-step incision technique with those of a Koman incision by using an objective questionnaire.MethodsA total of 40 patients (17 men and 23 women with intractable Raynaud's disease or syndrome underwent surgery in our hospital, conducted by a single surgeon, between January 2008 and January 2013. Patients who had undergone extended sympathectomy or vessel graft were excluded. Clinical evaluation of postoperative scars was performed in both groups one year after surgery using the patient and observer scar assessment scale (POSAS and the Wake Forest University rating scale.ResultsThe total patient score was 8.59 (range, 6-15 in the two-step incision group and 9.62 (range, 7-18 in the Koman incision group. A significant difference was found between the groups in the total PS score (P-value=0.034 but not in the total observer score. Our analysis found no significant difference in preoperative and postoperative Wake Forest University rating scale scores between the two-step and Koman incision groups. The time required for recovery prior to returning to work after surgery was shorter in the two-step incision group, with a mean of 29.48 days in the two-step incision group and 34.15 days in the Koman incision group (P=0.03.ConclusionsCompared to the Koman incision, the new two-step incision technique provides better aesthetic results, similar symptom improvement, and a reduction in the recovery time required before returning to work. Furthermore, this incision allows the surgeon to access a wide surgical field and a sufficient exposure of anatomical structures.

  4. Incision of the heart during meat inspection of fattening pigs - A risk-profile approach. (United States)

    Leps, J; Fries, R


    Meat inspection in the EU is based on Regulation (EC) 854/2004. Accordingly a risk based meat inspection should be implemented. In this paper, the incision of the heart in pig meat inspection is discussed with respect to efficacy. The incision especially can reveal the presence of endocarditis. Here, Erysipelothrixrhusiopathiae (E. rhusiopathiae) and/or Streptococcussuis (S. suis) are of particular concern. Both agents are regarded to be zoonotic agents. There is some evidence for infection of humans via an alimentary pathway. Hence, the occurrence of E. rhusiopathiae and S. suis is a concern of public health (PH) as well as veterinary public health (VPH). However, other measures, including on-farm disease prevention and diagnosis, seem to be more important for food safety. It is concluded that the incision and inspection of the heart is not justifiable with respect to PH aspects.

  5. Cutting electrocautery versus scalpel for surgical incisions: a systematic review and meta-analysis. (United States)

    Ismail, Ammar; Abushouk, Abdelrahman Ibrahim; Elmaraezy, Ahmed; Menshawy, Amr; Menshawy, Esraa; Ismail, Mahmoud; Samir, Esraa; Khaled, Anas; Zakarya, Hagar; El-Tonoby, Abdelrahman; Ghanem, Esraa


    Although cutting electrocautery can be superior to the scalpel in reducing blood loss and incisional time, several reports associated electrocautery with higher rates of wound infection, impaired healing, and worse cosmesis. We performed this systematic review and meta-analysis to compare cutting electrocautery versus scalpel for surgical incisions. We conducted a computerized literature search of five electronic databases and included all published original studies comparing cutting electrocautery and scalpel surgical incisions. Relevant data were extracted from eligible studies and pooled as odds ratios (ORs) or standardized mean difference (SMD) values in a meta-analysis model, using RevMan and Comprehensive Meta-analysis software. Forty-one studies (36 randomized trials, four observational, and one quasirandom study) were included in the pooled analysis (6422 participants). Compared with the scalpel incision, cutting electrocautery resulted in significantly less blood loss (SMD = -1.16, 95% CI [-1.60 to -0.72]), shorter incisional (SMD = -0.63, 95% CI [-0.96 to -0.29]) and operative times (SMD = -0.59, 95% CI [-1.12 to -0.05]), and lower pain scores (SMD = -0.91, 95% CI [-1.27 to -0.55]) with no significant differences in terms of wound infection rates (OR = 0.92, 95% CI [0.74-1.15]) or overall subjective scar score (SMD = -0.49, 95% CI [-1.72 to 0.75]). Surgical incision using electrocautery can be quicker with less blood loss and postoperative pain scores than the scalpel incision. No statistically significant difference was found between both techniques in terms of postoperative wound complications, hospital stay duration, and wound cosmetic characteristics. Therefore, we recommend routine use of cutting electrocautery for surgical incisions. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Measurement of [Formula: see text] production with additional jet activity, including [Formula: see text] quark jets, in the dilepton decay channel using pp collisions at [Formula: see text]. (United States)

    Khachatryan, V; Sirunyan, A M; Tumasyan, A; Adam, W; Asilar, E; Bergauer, T; Brandstetter, J; Brondolin, E; Dragicevic, M; Erö, J; Friedl, M; Frühwirth, R; Ghete, V M; Hartl, C; Hörmann, N; Hrubec, J; Jeitler, M; Knünz, V; König, A; Krammer, M; Krätschmer, I; Liko, D; Matsushita, T; Mikulec, I; Rabady, D; Rahbaran, B; Rohringer, H; Schieck, J; Schöfbeck, R; Strauss, J; Treberer-Treberspurg, W; Waltenberger, W; Wulz, C-E; Mossolov, V; Shumeiko, N; Suarez Gonzalez, J; Alderweireldt, S; Cornelis, T; De Wolf, E A; Janssen, X; Knutsson, A; Lauwers, J; Luyckx, S; Van De Klundert, M; Van Haevermaet, H; Van Mechelen, P; Van Remortel, N; Van Spilbeeck, A; Abu Zeid, S; Blekman, F; D'Hondt, J; Daci, N; De Bruyn, I; Deroover, K; Heracleous, N; Keaveney, J; Lowette, S; Moreels, L; Olbrechts, A; Python, Q; Strom, D; Tavernier, S; Van Doninck, W; Van Mulders, P; Van Onsem, G P; Van Parijs, I; Barria, P; Brun, H; Caillol, C; Clerbaux, B; De Lentdecker, G; Fasanella, G; Favart, L; Grebenyuk, A; Karapostoli, G; Lenzi, T; Léonard, A; Maerschalk, T; Marinov, A; Perniè, L; Randle-Conde, A; Reis, T; Seva, T; Vander Velde, C; Yonamine, R; Vanlaer, P; Yonamine, R; Zenoni, F; Zhang, F; Adler, V; Beernaert, K; Benucci, L; Cimmino, A; Crucy, S; Dobur, D; Fagot, A; Garcia, G; Gul, M; Mccartin, J; Ocampo Rios, A A; Poyraz, D; Ryckbosch, D; Salva, S; Sigamani, M; Strobbe, N; Tytgat, M; Van Driessche, W; Yazgan, E; Zaganidis, N; Basegmez, S; Beluffi, C; Bondu, O; Brochet, S; Bruno, G; Caudron, A; Ceard, L; Da Silveira, G G; Delaere, C; Favart, D; Forthomme, L; Giammanco, A; Hollar, J; Jafari, A; Jez, P; Komm, M; Lemaitre, V; Mertens, A; Musich, M; Nuttens, C; Perrini, L; Pin, A; Piotrzkowski, K; Popov, A; Quertenmont, L; Selvaggi, M; Vidal Marono, M; Beliy, N; Hammad, G H; Júnior, W L Aldá; Alves, F L; Alves, G A; Brito, L; Correa Martins Junior, M; Hamer, M; Hensel, C; Mora Herrera, C; Moraes, A; Pol, M E; Rebello Teles, P; Belchior Batista Das Chagas, E; Carvalho, W; Chinellato, J; Custódio, A; Da Costa, E M; De Jesus Damiao, D; De Oliveira Martins, C; Fonseca De Souza, S; Huertas Guativa, L M; Malbouisson, H; Matos Figueiredo, D; Mundim, L; Nogima, H; Prado Da Silva, W L; Santoro, A; Sznajder, A; Tonelli Manganote, E J; Vilela Pereira, A; Ahuja, S; Bernardes, C A; De Souza Santos, A; Dogra, S; Fernandez Perez Tomei, T R; Gregores, E M; Mercadante, P G; Moon, C S; Novaes, S F; Padula, Sandra S; Romero Abad, D; Ruiz Vargas, J C; Aleksandrov, A; Hadjiiska, R; Iaydjiev, P; Rodozov, M; Stoykova, S; Sultanov, G; Vutova, M; Dimitrov, A; Glushkov, I; Litov, L; Pavlov, B; Petkov, P; Ahmad, M; Bian, J G; Chen, G M; Chen, H S; Chen, M; Cheng, T; Du, R; Jiang, C H; Plestina, R; Romeo, F; Shaheen, S M; Spiezia, A; Tao, J; Wang, C; Wang, Z; Zhang, H; Asawatangtrakuldee, C; Ban, Y; Li, Q; Liu, S; Mao, Y; Qian, S J; Wang, D; Xu, Z; Avila, C; Cabrera, A; Chaparro Sierra, L F; Florez, C; Gomez, J P; Gomez Moreno, B; Sanabria, J C; Godinovic, N; Lelas, D; Puljak, I; Ribeiro Cipriano, P M; Antunovic, Z; Kovac, M; Brigljevic, V; Kadija, K; Luetic, J; Micanovic, S; Sudic, L; Attikis, A; Mavromanolakis, G; Mousa, J; Nicolaou, C; Ptochos, F; Razis, P A; Rykaczewski, H; Bodlak, M; Finger, M; Finger, M; El Sawy, M; El-Khateeb, E; Elkafrawy, T; Mohamed, A; Salama, E; Calpas, B; Kadastik, M; Murumaa, M; Raidal, M; Tiko, A; Veelken, C; Eerola, P; Pekkanen, J; Voutilainen, M; Härkönen, J; Karimäki, V; Kinnunen, R; Lampén, T; Lassila-Perini, K; Lehti, S; Lindén, T; Luukka, P; Mäenpää, T; Peltola, T; Tuominen, E; Tuominiemi, J; Tuovinen, E; Wendland, L; Talvitie, J; Tuuva, T; Besancon, M; Couderc, F; Dejardin, M; Denegri, D; Fabbro, B; Faure, J L; Favaro, C; Ferri, F; Ganjour, S; Givernaud, A; Gras, P; Hamel de Monchenault, G; Jarry, P; Locci, E; Machet, M; Malcles, J; Rander, J; Rosowsky, A; Titov, M; Zghiche, A; Antropov, I; Baffioni, S; Beaudette, F; Busson, P; Cadamuro, L; Chapon, E; Charlot, C; Dahms, T; Davignon, O; Filipovic, N; Florent, A; Granier de Cassagnac, R; Lisniak, S; Mastrolorenzo, L; Miné, P; Naranjo, I N; Nguyen, M; Ochando, C; Ortona, G; Paganini, P; Pigard, P; Regnard, S; Salerno, R; Sauvan, J B; Sirois, Y; Strebler, T; Yilmaz, Y; Zabi, A; Agram, J-L; Andrea, J; Aubin, A; Bloch, D; Brom, J-M; Buttignol, M; Chabert, E C; Chanon, N; Collard, C; Conte, E; Coubez, X; Fontaine, J-C; Gelé, D; Goerlach, U; Goetzmann, C; Le Bihan, A-C; Merlin, J A; Skovpen, K; Van Hove, P; Gadrat, S; Beauceron, S; Bernet, C; Boudoul, G; Bouvier, E; Carrillo Montoya, C A; Chierici, R; Contardo, D; Courbon, B; Depasse, P; El Mamouni, H; Fan, J; Fay, J; Gascon, S; Gouzevitch, M; Ille, B; Lagarde, F; Laktineh, I B; Lethuillier, M; Mirabito, L; Pequegnot, A L; Perries, S; Ruiz Alvarez, J D; Sabes, D; Sgandurra, L; Sordini, V; Vander Donckt, M; Verdier, P; Viret, S; Toriashvili, T; Lomidze, D


    Jet multiplicity distributions in top quark pair ([Formula: see text]) events are measured in pp collisions at a centre-of-mass energy of 8 TeV with the CMS detector at the LHC using a data set corresponding to an integrated luminosity of 19.7[Formula: see text]. The measurement is performed in the dilepton decay channels ([Formula: see text], [Formula: see text], and [Formula: see text]). The absolute and normalized differential cross sections for [Formula: see text] production are measured as a function of the jet multiplicity in the event for different jet transverse momentum thresholds and the kinematic properties of the leading additional jets. The differential [Formula: see text] and [Formula: see text] cross sections are presented for the first time as a function of the kinematic properties of the leading additional [Formula: see text] jets. Furthermore, the fraction of events without additional jets above a threshold is measured as a function of the transverse momenta of the leading additional jets and the scalar sum of the transverse momenta of all additional jets. The data are compared and found to be consistent with predictions from several perturbative quantum chromodynamics event generators and a next-to-leading order calculation.

  7. Historical Channel Adjustment and Estimates of Selected Hydraulic Values in the Lower Sabine River and Lower Brazos River Basins, Texas and Louisiana (United States)

    Heitmuller, Franklin T.; Greene, Lauren E.


    The U.S. Geological Survey, in cooperation with the Texas Water Development Board, evaluated historical channel adjustment and estimated selected hydraulic values at U.S. Geological Survey streamflow-gaging stations in the lower Sabine River Basin in Texas and Louisiana and lower Brazos River Basin in Texas to support geomorphic assessments of the Texas Instream Flow Program. Channel attributes including cross-section geometry, slope, and planform change were evaluated to learn how each river's morphology changed over the years in response to natural and anthropogenic disturbances. Historical and contemporary cross-sectional channel geometries at several gaging stations on each river were compared, planform changes were assessed, and hydraulic values were estimated including mean flow velocity, bed shear stress, Froude numbers, and hydraulic depth. The primary sources of historical channel morphology information were U.S. Geological Survey hard-copy discharge-measurement field notes. Additional analyses were done using computations of selected flow hydraulics, comparisons of historical and contemporary aerial photographs, comparisons of historical and contemporary ground photographs, evaluations of how frequently stage-discharge rating curves were updated, reviews of stage-discharge relations for field measurements, and considerations of bridge and reservoir construction activities. Based on historical cross sections at three gaging stations downstream from Toledo Bend Reservoir, the lower Sabine River is relatively stable, but is subject to substantial temporary scour-and-fill processes during floods. Exceptions to this characterization of relative stability include an episode of channel aggradation at the Sabine River near Bon Wier, Texas, during the 1930s, and about 2 to 3 feet of channel incision at the Sabine River near Burkeville, Texas, since the late 1950s. The Brazos River, at gaging stations downstream from Waco, Texas, has adjusted to a combination of

  8. Hypospadias and concomitant undescended testis: Comparison of no skin incision with inguinal and scrotal skin incision orchiopexy. (United States)

    Sabetkish, Shabnam; Kajbafzadeh, Abdol-Mohammad; Sabetkish, Nastaran


    To present the feasibility of no skin incision orchiopexy in children with concomitant hypospadias and undescended testis (UDT) by a single subcoronal incision technique. To introduce the creation of subdartos muscle scrotal pouch with no scrotal skin incision. From one thousand and twenty-one children with hypospadias, 61 patients presented with concomitant palpable UDT and hypospadias. In group I (N = 34) single subcoronal incision with no scrotal skin incision was applied. In group II (N = 27), multi-incision technique was applied for classical orchiopexy and hypospadias surgery. For hypospadias reconstruction, all patients had classical subcoronal and para urethral plate incision with penile skin degloving according to the location of urethral meatus. Early and late complications, surgical time, hospital stay, and cosmetic results were recorded. Children with unilateral UDT and hypospadias had one incision in group I and three skin incisions in group II. Patients with bilateral UDT had one incision in group I and five skin incisions in group II. The operation time was significantly shorter in group I (93 ± 11 min) compared with group II (138 ± 17 min) (P = 0.03). Both groups were operated as day care basis; however, the hospital stay was slightly longer in group II (group I = 12 ± 2 h, vs group II = 16 ± 3 h) (P = 0.07). All testes were satisfactorily positioned into the bottom of the scrotum without development of any testicular atrophy. Single subcoronal penile skin incision is a feasible, safe, and cosmetically satisfactory technique in patients with hypospadias and concomitant UDT. Reduced postoperative pain, better objective cosmetic results, shorter operative time and comfortable post-operative period are the most significant advantages of this approach. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  9. Single-Incision Laparoscopic Surgery (SILS Assisted Sigma Resection Via Pfannenstiel Incision for Complicated Diverticulitis

    Directory of Open Access Journals (Sweden)

    Arne Dietrich


    Results: The operation time ranged from 89 to 280 min. There were no conversions, and no additional trocars were used. The postoperative hospital stay ranged from 5 to 14 days. All patients were discharged without any intraoperative or postoperative complications. Conclusions: SILS sigma or anterior rectum resection for complicated diverticulitis can be performed via a Pfannenstiel incision. This approach provides direct visualization and access into the pelvis as well as the option to benefit from open surgery devices. The Pfannenstiel incision may generally be recommended for the favorable cosmetic effect and the very low rate of incisional hernias, as reported in the literature. [Arch Clin Exp Surg 2014; 3(1.000: 10-15

  10. Diathermy versus Scalpel incision in elective midline laparotomy: A ...

    African Journals Online (AJOL)

    ... two groups with respect to the mean length of hospital stay (p = 0.834). Conclusion: We conclude that diathermy incision in elective midline laparotomy has significant advantages compared with the scalpel because of reduced incision time, less blood loss, reduced early postoperative pain and analgesic requirements.

  11. Temporal versus Superior Limbal Incision: Any difference in visual ...

    African Journals Online (AJOL)

    Dr. C. Pedro-Egbe

    Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. ABSTRACT. Aim: To compare the visual outcome of a superiorly placed limbal incision ..... Roman SJ, Auclin FX, Chong-Sit DA, Ullern MM. Surgically induced astigmatism with superior and temporal incisions in cases of ...

  12. Transurethral incision of urethral diverticulum in the female

    DEFF Research Database (Denmark)

    Miskowiak, J; Honnens de Lichtenberg, M


    A new technique of transurethral incision of urethral diverticulum was successfully used in two women. The method described is safe, simple and shortens operating time.......A new technique of transurethral incision of urethral diverticulum was successfully used in two women. The method described is safe, simple and shortens operating time....

  13. Temporal versus Superior Limbal Incision: Any difference in visual ...

    African Journals Online (AJOL)

    Aim: To compare the visual outcome of a superiorly placed limbal incision with a temporal limbal incision in extracapsular cataract surgery. The main outcome measures are visual acuity and the degree of stigmatism based on refraction. Method: A retrospective non randomized comparative study. Medical records of 40 ...

  14. First Canadian experience with robotic single-incision pyeloplasty: Comparison with multi-incision technique. (United States)

    Law, Jeffrey; Rowe, Neal; Archambault, Jason; Nastis, Sofia; Sener, Alp; Luke, Patrick P


    We compared the outcomes of single-incision, robot-assisted laparoscopic pyeloplasty vs. multiple-incision pyeloplasty using the da Vinci robotic system. We reviewed all consecutive robotic pyeloplasties by a single surgeon from January 2011 to August 2015. A total of 30 procedures were performed (16 single:14 multi-port). Two different single-port devices were compared: the GelPort (Applied Medical, Rancho Santa Margarita, CA) and the Intuitive single-site access port (Intuitive Surgical, Sunnyvale, CA). Patient demographics were similar between the two groups. Mean operating time was similar among the single and multi-port groups (225.2 min vs. 198.9 minutes [p=0.33]). There was no significant difference in length of hospital stay in either group (86.2 hr vs. 93.2 hr [p=0.76]). There was no difference in success rates or postoperative complications among groups. Single-port robotic pyeloplasty is non-inferior to multiple-incision robotic surgery in terms of operative times, hospitalization time, success rates, and complications. Verifying these results with larger cohorts is required prior to the wide adoption of this technique. Ongoing objective measurements of cosmesis and patient satisfaction are being evaluated.

  15. Vertical compared with transverse incisions in abdominal surgery

    DEFF Research Database (Denmark)

    Grantcharov, T P; Rosenberg, J


    OBJECTIVE: To reach an evidence-based consensus on the relative merits of vertical and transverse laparotomy incisions. DESIGN: Review of all published randomised controlled trials that compared the postoperative complications after the two main types of abdominal incisions, vertical and transverse...... postoperative pain and fewer pulmonary complications. Vertical laparotomy, however, is associated with shorter operating time and better possibilities for extension of the incision. The pooled odds ratio for burst abdomen in the vertical incision group was 2.86 (95% confidence interval 1.72 to 4.73, p = 0.......0001), and regarding late incisional hernia the pooled odds ratio was 1.68 (95% confidence interval 1.10 to 2.57. p = 0.02). CONCLUSIONS: Transverse incisions in abdominal surgery are based on better anatomical and physiological principles. They should be recommended, as the early postoperative period is associated...

  16. Incisive canal deflation for correct implant placement: case report. (United States)

    Spin-Neto, Rubens; Bedran, Telma Blanca Lombardo; de Paula, Wagner Nunes; de Freitas, Rubens Moreno; de Oliveira Ramalho, Lizeti Toledo; Marcantonio, Elcio


    This article is a case report of a patient in whom the prosthetic planning indicated the necessity of an incisive canal deflation for the correct installation of an implant that is to be osseointegrated. In the reopening phase after the bone graft installation, the incisive canal deflation (biopsy of its content) was done and titanium implants were installed with one of them invading the anatomical space occupied previously by the incisive canal. The biopsy analysis showed fragments of the incisive artery and nerve, which are responsible for the anterior upper-tooth pulp, the periodontium vascularization and the innervation. From the anastomosis present along with other structures allied with the absence of teeth in the region, there was no detriment to the patient caused by the deflation. Incisive canal deflation is a viable technique in implantology. It can permit ideal prosthetic planning with no detriment to the patient.

  17. Experimental evidence for climatically controlled changes between lateral erosion and incision of actively uplifting folds (United States)

    Bufe, Aaron; Paola, Chris; Burbank, Douglas; Thompson, Jessica


    The understanding of the incision and lateral erosion of rivers provides key data for the interpretation of landscapes as recorders of climatic and tectonic processes. We present results from six physical experiments on the erosion of a simple growing fold by antecedent streams. By varying uplift rates, sediment flux, and the width of alluvial fans upstream of the uplift, we produced a range of morphologies from narrow canyons through the fold to erosion of the entire uplift. The fraction of the uplift that was beveled by the river can be predicted by a dimensionless parameter linking the mobility of channels (strongly dependent on the sediment flux) and the rock-uplift rate. We apply these findings to a series of active folds in the foreland of the Tian Shan in NW China. Whereas the folds are incised today, they preserve uplifted, kilometer-wide beveled platforms. In the light of the experimental results, lateral migration rates required to explain such extensive beveling are similar to the lateral mobility of alluvial streams in areas much wetter than the presently arid northwestern Tarim Basin and suggest that major changes in water and sediment influxes are the probable cause of switches between lateral erosion and incision of active uplifts in the foreland of the Tian Shan. This finding is supported by the clustering of ages of fluvial terrace and alluvial fan deposition in that region.

  18. Influence of Incision Location on Transmitter Loss, Healing, Incision Lengths, Suture Retention, and Growth of Juvenile Chinook Salmon

    Energy Technology Data Exchange (ETDEWEB)

    Panther, Jennifer L.; Brown, Richard S.; Gaulke, Greggory L.; Woodley, Christa M.; Deters, Katherine A.


    In this study, conducted by Pacific Northwest National Laboratory for the U.S. Army Corps of Engineers, Portland District, we measured differences in survival and growth, incision openness, transmitter loss, wound healing, and erythema among abdominal incisions on the linea alba, lateral and parallel to the linea alba (muscle-cutting), and following the underlying muscle fibers (muscle-sparing). A total of 936 juvenile Chinook salmon were implanted with both Juvenile Salmon Acoustic Tracking System transmitters (0.43 g dry) and passive integrated transponder tags. Fish were held at 12°C (n = 468) or 20°C (n = 468) and examined once weekly over 98 days. We found survival and growth did not differ among incision groups or between temperature treatment groups. Incisions on the linea alba had less openness than muscle-cutting and muscle-sparing incisions during the first 14 days when fish were held at 12°C or 20°C. Transmitter loss was not different among incision locations by day 28 when fish were held at 12°C or 20°C. However, incisions on the linea alba had greater transmitter loss than muscle-cutting and muscle-sparing incisions by day 98 at 12°C. Results for wound closure and erythema differed among temperature groups. Results from our study will be used to improve fish-tagging procedures for future studies using acoustic or radio transmitters.

  19. Full-Thickness Retinochoroidal Incision in the Management of Central Retinal Vein Occlusion

    Directory of Open Access Journals (Sweden)

    San-Ni Chen


    Full Text Available Purpose. To evaluate the clinical outcomes in patients with central retinal vein occlusion (CRVO treated with full-thickness retinochoroidal incisions and to compare whether there is difference in treatment response in ischemic and nonischemic CRVO. Methods. Retrospective study of patients of CRVO receiving full-thickness retinochoroidal incisions in Changhua Christian Hospital. Fluorescein angiography (FA, slit-lamp biomicroscopy, indirect funduscopy, best corrected visual acuity, and central macular thickness (CMT measured by optical coherence tomography were performed pre- and postoperatively. Patients were divided into an ischemic and nonischemic group according to the findings of FA. Patients were followed up for at least 1 year. Results. Twenty-eight eyes (14 ischemic and 14 nonischemic CRVO were included. Functional retinochoroidal venous anastomosis (RCVA was achieved in 48 of the 65 retinochoroidal incisions (73.8%. Central macular thickness (CMT and retinal hemorrhage decreased significantly after the surgery. Significant visual gain was observed postoperatively in the nonischemic group, but not in the ischemic group. Postoperative complications included vitreous hemorrhage (17.8%, neovascular glaucoma (7.1%, and preretinal fibrovasular membrane (10.7%, all of which were in the ischemic group. Conclusions. RCVA formation induced by retinochoroidal incisions could improve venous flow, and decrease CMT and retinal hemorrhage. However, only eyes with nonischemic CRVO showed visual improvement.

  20. Assessment of corneal astigmatism following frown and straight incision forms in sutureless manual small incision cataract surgery

    Directory of Open Access Journals (Sweden)

    Amedo AO


    Full Text Available Angela Ofeibea Amedo, Kwadwo Amoah, Nana Yaa Koomson, David Ben Kumah, Eugene Appenteng Osae Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana Abstract: To investigate which of two tunnel incision forms (frown versus straight in sutureless manual small incision cataract surgery creates more corneal astigmatism. Sixty eyes of 60 patients who had consented to undergo cataract surgery and to partake in this study were followed from baseline through >12-week postoperative period. Values of preoperative and postoperative corneal astigmatism for the 60 eyes, measured with a Bausch and Lomb keratometer, were extracted from the patients’ cataract surgery records. Residual astigmatism was computed as the difference between preoperative and postoperative keratometry readings. Visual acuity was assessed during the preoperative period and at each postoperative visit with a Snellen chart at 6 m. Fifty eyes of 50 patients were successfully followed-up on. Overall, the mean residual astigmatism was 0.75±0.12 diopters. The differences in mean residual astigmatism between the two different incision groups were statistically significant (t [48]=6.33, P<0.05; frown incision group recorded 1.00±0.12 diopters, whereas the straight incision group recorded 0.50±0.12 diopters. No significant difference was observed between male and female groups (t [48]=0.24, P>0.05. Residual corneal astigmatism in the frown incision group was significantly higher than in the straight incision group. Fisher’s exact test did not reveal a significant association between incision forms and visual acuity during the entire postoperative period (P>0.05. Keywords: cataract, residual corneal astigmatism, frown incision, straight incision

  1. Intraoral removal of a thyroglossal duct cyst using a frenotomy incision. (United States)

    Kim, Jin Pyeong; Park, Jung Je; Lee, Eun Jae; Woo, Seung Hoon


    Thyroglossal duct cyst (TGDC) is one of the most common causes of anterior neck swelling close to the midline. Surgical removal of a TGDC is usually accomplished through an external neck incision, including the removal of the middle part of hyoid bone and a block of tissues extending to the foramen cecum. However, this procedure inevitably results in a neck scar. We report the case of a 20-year-old woman with TGDC. We implemented a modified approach to TGDC removal through a frenotomy incision of the mouth using an endoscope system. The patient received a modified approach to TGDC removal. The total operative time was 60 minutes. She remains free of disease 12 months after her surgery. We describe, in a single patient, a procedure in detail for endoscope-assisted transoral TGDC excision using an intraoral frenotomy incision. The advantage of this approach is the avoidance of a neck scar. Our experience with this patient indicates that resection of a TGDC appears to be feasible through a transoral endoscope-assisted approach using a frenotomy incision in the mouth. Further experience with this procedure is required.

  2. Carpal tunnel release using the radial sided approach compared with the two-incision approach. (United States)

    Calleja, Henry; Tsai, Tsu-Min; Kaufman, Christina


    We compared carpal tunnel release using a radial sided approach (RCTR) with a two-incision approach with regards to complications, grip strength, and functional outcomes. Retrospective chart review was done and data was collected pre-operatively, and post-operatively at six weeks and three months. A total of 32 and 26 patients were included in the two-incision and RCTR groups respectively. At six weeks, the RCTR group showed an increased grip strength (+32.24%) while the two-incision group was weaker (-6.75%). Both groups showed an increased strength at three months, RCTR at 98.4% while the two-incision group was significantly lower at 38.6% increase. Both techniques provided improvement in outcome scores, with no statistical difference. RCTR was associated with a significantly earlier return of grip strength and had better grip strength at six weeks and three months post-operatively. Both techniques provided symptom relief and good functional outcome.


    Kingston meadow, located in the Toiyabe Range, is one of many wet meadow complexes threatened by rapid channel incision in the mountain ranges of the central Great Basin. Channel incision can lower the baselevel for groundwater discharge and de-water meadow complexes resulting in...

  4. Tectonic Uplift and Fan Delta Incision along the Conway Coast, NZ (United States)

    Burtt, D. G.; Bassett, K. N.


    The Conway Coast features a unique confluence of fan deltas, terrace uplift, and transpressional faulting. Thrust faults have caused the uplift of the Hawkeswood Range which provides sediment sources for local Gilbert-type fan deltas uplifting to form terraces. Sediments are characterized by steeply dipping foreset beds, horizontal topset beds and tangential bottomset beds. These fan deltas tend to form on steep basin margins often associated with extensional faulting. However, the Conway coast is dominated by thrust faulting. The Rafa terrace, dated between 52.4±4.5 and 79.0±3.5 ka with Optically Stimulated Luminescence, is exposed in cliff faces on the beach. Local creek channels deposited the fan deltas and later incised older deposits to reveal a three-dimensional perspective of the fan delta. This perspective is vital to the recreation of the fan delta position and channel avulsion, leading to a better understanding of the role of uplift superimposed by sea level change in the formation of the terraces. Forty-three photographs were stitched together to form an extensive photomosaic. The types of sediments, significant structures and relationships between adjacent beds were noted and analyzed. Correlations between the sedimentary architecture and sea level change were made using a sea level curve of the South Pacific over the last 140 ka. The incision of mud by gravel producing large flame structures suggests that there was a drop in sea level and a subsequent progradation of the fan delta. Based on the sea level curve, this drop occurred between ~66-79 ka. Higher in the fan delta, a fining-upward sequence points to a rise in sea level. This correlates with a rise on the sea level curve between ~52-63 ka. Upsection there is another coarsening-upward sequence of 5-10 m thick beds suggesting a fall in sea level before the uplift and incision of the terrace and the subsequent formation of the Ngaroma terrace. Due to their lateral extent, the gravels seem to

  5. New constraints on the late Cenozoic incision history of the New River, Virginia (United States)

    Ward, Dylan J.; Spotila, James A.; Hancock, Gregory S.; Galbraith, John M.


    The New River crosses three physiogeologic provinces of the ancient, tectonically quiescent Appalachian orogen and is ideally situated to record variability in fluvial erosion rates over the late Cenozoic. Active erosion features on resistant bedrock that floors the river at prominent knickpoints demonstrate that the river is currently incising toward base level. However, thick sequences of alluvial fill and fluvial terraces cut into this fill record an incision history for the river that includes several periods of stalled downcutting and aggradation. We used cosmogenic 10Be exposure dating, aided by mapping and sedimentological examination of terrace deposits, to constrain the timing of events in this history. 10Be concentration depth profiles were used to help account for variables such as cosmogenic inheritance and terrace bioturbation. Fill-cut and strath terraces at elevations 10, 20, and 50 m above the modern river yield model cosmogenic exposure ages of 130, ˜600, and 600-950 ka, respectively, but uncertainties on these ages are not well constrained. These results provide the first direct constraint on the history of alluvial aggradation and incision events recorded by New River terrace deposits. The exposure ages yield a long-term average incision rate of 43 m/my, which is comparable to rates measured elsewhere in the Appalachians. During specific intervals over the last 1 Ma, however, the New River's incision rate reached ˜100 m/my. Modern erosion rates on bedrock at a prominent knickpoint are between ˜28 and ˜87 m/my, in good agreement with rates calculated between terrace abandonment events and significantly faster than ˜2 m/my rates of surface erosion from ancient terrace remnants. Fluctuations between aggradation and rapid incision operate on timescales of 10 4- 10 5 year, similar to those of late Cenozoic climate variations, though uncertainties in model ages preclude direct correlation of these fluctuations to specific climate change events

  6. European Hernia Society guidelines on the closure of abdominal wall incisions. (United States)

    Muysoms, F E; Antoniou, S A; Bury, K; Campanelli, G; Conze, J; Cuccurullo, D; de Beaux, A C; Deerenberg, E B; East, B; Fortelny, R H; Gillion, J-F; Henriksen, N A; Israelsson, L; Jairam, A; Jänes, A; Jeekel, J; López-Cano, M; Miserez, M; Morales-Conde, S; Sanders, D L; Simons, M P; Śmietański, M; Venclauskas, L; Berrevoet, F


    The material and the surgical technique used to close an abdominal wall incision are important determinants of the risk of developing an incisional hernia. Optimising closure of abdominal wall incisions holds a potential to prevent patients suffering from incisional hernias and for important costs savings in health care. The European Hernia Society formed a Guidelines Development Group to provide guidelines for all surgical specialists who perform abdominal incisions in adult patients on the materials and methods used to close the abdominal wall. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and methodological guidance was taken from Scottish Intercollegiate Guidelines Network (SIGN). The literature search included publications up to April 2014. The guidelines were written using the AGREE II instrument. An update of these guidelines is planned for 2017. For many of the Key Questions that were studied no high quality data was detected. Therefore, some strong recommendations could be made but, for many Key Questions only weak recommendations or no recommendation could be made due to lack of sufficient evidence. To decrease the incidence of incisional hernias it is strongly recommended to utilise a non-midline approach to a laparotomy whenever possible. For elective midline incisions, it is strongly recommended to perform a continuous suturing technique and to avoid the use of rapidly absorbable sutures. It is suggested using a slowly absorbable monofilament suture in a single layer aponeurotic closure technique without separate closure of the peritoneum. A small bites technique with a suture to wound length (SL/WL) ratio at least 4/1 is the current recommended method of fascial closure. Currently, no recommendations can be given on the optimal technique to close emergency laparotomy incisions. Prophylactic mesh augmentation appears effective and safe and can be suggested in high

  7. A skin abscess model for teaching incision and drainage procedures. (United States)

    Fitch, Michael T; Manthey, David E; McGinnis, Henderson D; Nicks, Bret A; Pariyadath, Manoj


    Skin and soft tissue infections are increasingly prevalent clinical problems, and it is important for health care practitioners to be well trained in how to treat skin abscesses. A realistic model of abscess incision and drainage will allow trainees to learn and practice this basic physician procedure. We developed a realistic model of skin abscess formation to demonstrate the technique of incision and drainage for educational purposes. The creation of this model is described in detail in this report. This model has been successfully used to develop and disseminate a multimedia video production for teaching this medical procedure. Clinical faculty and resident physicians find this model to be a realistic method for demonstrating abscess incision and drainage. This manuscript provides a detailed description of our model of abscess incision and drainage for medical education. Clinical educators can incorporate this model into skills labs or demonstrations for teaching this basic procedure.

  8. Channelling and channelling radiation

    International Nuclear Information System (INIS)

    Soerensen, A.H.; Uggerhoej, E.


    The study of channelling phenomena has developed rapidly since the early 1960s and today channelling has found many applications. The radiation emitted by channelled megaelectronvolt and gigaelectronvolt electrons and positrons has been investigated extensively and the possibility of, for example, constructing intense tunable X- and γ-ray sources is being explored. Multi-gigaelectronvolt radiation and pair-creation processes in single crystals show similarities with strong-field effects and are of particular interest because of high production rates that persist far beyond the channelling regime. (author)

  9. Diathermy versus scalpel incisions for open cholecystectomy comparative study

    International Nuclear Information System (INIS)

    Ali, M.A.; Niazi, W.A.K.


    The aim of the study was to make a comparison between skin incisions made with electrocautery versus scalpel in terms of their safety, efficacy and post-operative complications. Design: A randomized controlled study. Setting: The study was conducted in Combined Military Hospital (CMH) Kharian, Pakistan airforce (PAF) Hospital Sargodha. Duration of Study: May 2008 to August 2011. Patients and Methods: Ninety seven patients who underwent open cholecystectomy were randomly divided into two groups on the basis of the use of electrocautery versus steel scalpel for making skin incision and sub-cutaneous tissue dissection. Parameters recorded were, time taken from skin incision to full incising of the peritoneum, length of the wound, amount of blood loss during this step of surgery in each group. Post-operative pain scoring using visual analogue scale was done. Wound complications such as infection, haematoma/seroma and dehiscence were noted too. One month of follow up was recorded in each group. Subsequently a comparison of these findings was done. Results: Incision time (sec/cm/sub 2/) was longer in scalpel group than in diathermy group (p = 0.001), whereas, incision blood loss (ml/cm/sub 2/) was significantly less in diathermy group than in scalpel group (p = 0.03). There was no difference in post-operative pain perception as delineated by visual pain analogue scoring system between the two groups (p = 0.57). Post-operative wound complications and the final healing of wound at 01 month of follow-up were almost similar in both groups. Conclusion: Electrocautery may be used safely without any untoward complication in making skin incision and sub-cutaneous tissue dissection with an advantage of reduced incision time and and less blood loss. (author)

  10. River Incision and Knickpoints on the Flank of the Yellowstone Hotspot — Alpine Canyon of the Snake River, Wyoming (United States)

    Tuzlak, D.; Pederson, J. L.


    Understanding patterns of deformation and testing geophysical models in the dynamic region of the Yellowstone Hotspot requires Quaternary-scale records of incision and uplift, which are currently absent. This study examines fluvial terraces and longitudinal-profile metrics along Alpine Canyon of the Snake River, WY. Because the Snake is the only regional river crossing from the uplifting Yellowstone Plateau and flowing into the subsiding Eastern Snake River Plain, it provides an opportunity to investigate both ends of the phenomenon. Field observations through Alpine Canyon indicate that Pleistocene incision rates in this region are relatively high for the interior western U.S., that the river switches between bedrock and alluvial forms, and that incision/uplift is not uniform. Two endmembers of regional deformation may be tested: 1) the arch of high topography surrounding Yellowstone is uplifting and terraces converge downstream as incision rates decrease towards the Snake River Plain, or 2) baselevel fall originates at the subsiding Snake River Plain and terraces diverge as incision rates increase downstream. Datasets include surficial mapping, rock strength measurements, surveying of the longitudinal profile and terraces using RTK-GPS, optically stimulated luminescence dating of fluvial-terrace deposits, and investigation of drainages through ksn and χ analyses. Initial results indicate that there are four primary terrace deposits along the canyon, three of which are timed with glacial epochs. Considering the relative heights of terrace straths and preliminary ages, incision rates are indeed relatively high. There is a major knickzone covering the last 15 km of the canyon that is also reflected in tributary profiles and is consistent with a wave of incision propagating upstream, favoring the second endmember of active baselevel fall downstream.


    Directory of Open Access Journals (Sweden)

    Ljiljana Stošić Mihajlović


    Full Text Available Marketing channel is a set of entities and institutions, completion of distribution and marketing activities, attend the efficient and effective networking of producers and consumers. Marketing channels include the total flows of goods, money and information taking place between the institutions in the system of marketing, establishing a connection between them. The functions of the exchange, the physical supply and service activities, inherent in the system of marketing and trade. They represent paths which products and services are moving after the production, which will ultimately end up buying and eating by the user.

  12. Feasibility of Performing Total Skin-Sparing Mastectomy in Patients With Prior Circumareolar Mastopexy or Reduction Mammoplasty Incisions. (United States)

    Vaughn, Carolyn J; Peled, Anne Warren; Esserman, Laura J; Foster, Robert D


    Total skin-sparing mastectomy (TSSM) techniques with preservation of the nipple-areolar complex (NAC) skin are becoming increasingly popular due to improved cosmesis without compromise in oncologic safety. However, these techniques are not routinely offered to patients who have undergone previous breast surgery involving circumareolar incisions due to concern for NAC viability. We reviewed the outcomes of TSSM in 11 patients who underwent 21 TSSM procedures at our institution between 2008 and 2011. All patients had undergone previous breast surgery including reduction mammaplasty (7 breasts), mastopexy (4 breasts), augmentation (3 breasts), and combined mastopexy-augmentation (7 breasts). Incisions from previous breast surgery included circumareolar (11 cases) and Wise pattern (10 cases) incisions. All patients underwent TSSM through an inframammary incision followed by immediate tissue expander reconstruction and subsequent implant exchange. Patient demographics, previous breast surgery details, tumor and treatment characteristics, and postoperative complications were reviewed. Mean patient age was 43 years (range, 35-53 years) and mean body mass index was 24 kg/m (range, 19-32 kg/m). Mean follow-up was 10.2 months (range, 3-20 months).Indications for TSSM included prophylactic risk reduction in 10 cases, in situ cancer in 2 cases, and invasive cancer in 9 cases. Mean time from previous breast surgery to mastectomy was 6.9 years (range, 6 months-26 years). Major complications requiring operative reintervention included 1 (4.8%) case of cellulitis requiring expander removal and 2 (9.5%) cases of wound breakdown requiring operative closure. There were no complications involving the NAC. Total skin-sparing mastectomy with immediate reconstruction can safely be performed in patients who have undergone previous breast surgery involving circumareolar incisions. Our preferred technique in this group of patients is to perform TSSM through an inframammary incision with 2

  13. Comparison of two incision designs for surgical removal of impacted mandibular third molar: A randomized comparative clinical study

    Directory of Open Access Journals (Sweden)

    Adarsh Desai


    Full Text Available Objective: The objective of this study is to investigate the influence of flap design on visibility and accessibility during removal of impacted third molar and hematoma formation, wound gaping and healing of flap post-operatively. Study Design: The randomized prospective comparative study included 30 patients with impacted mandibular third molars. Two flap designs namely "envelope flap" (Koener′s incision and ′triangular flap′ (Ward′s incision were used. After 7 days, sutures were removed and status of wound, periodontal health, and progress of healing was assessed. Patients were followed through 15 days to judge the incidence of post-operative complications in both groups. Results: No statistical differences were noted between the groups in terms of visibility, accessibility, excessive bleeding during surgery, healing of flap, sensitivity of adjacent teeth, and dry socket. A statistically significant difference was observed in post-operative hematoma, wound gaping, and distal pocket in adjacent tooth, which was significant in Ward′s triangular incision group in comparison to Koeiner′s envelope incision group. Conclusion: The selection of the flap design is dependent on needs of the case and preference of the operating surgeon and does not seem to have a significant influence on the health of tissues. In order to avoid wide area of exposure of bone, the operating surgeon should clinically and radiographically assess the designing of incision and mucoperiosteal flap, the clinical relevance is still debatable.

  14. Reproductive Outcome of Transcervical Uterine Incision in Unicornuate Uterus. (United States)

    Xia, En-Lan; Li, Tin-Chiu; Choi, Sze-Ngar Sylvia; Zhou, Qiao-Yun


    The pregnancy outcome of the unicornuate uterus is associated with an increased risk of miscarriage, cervical incompetence, and a number of obstetric complications. However, at present, there is no accepted treatment method for women with unicornuate uterus, other than expectant measures. The aim of this study was to evaluate the reproductive outcome of transcervical uterine incision (TCUI) in patients with unicornuate uterus. Thirty-three patients with unicornuate uterus presented to our tertiary center for infertility or miscarriage. All 33 patients underwent TCUI and were followed up for 10-52 months. The pregnancy outcomes ( first-trimester miscarriage, second-trimester miscarriage, preterm, term, intrauterine death, ongoing pregnancy, and live birth) before and after TCUI were compared by t- test. Among 31 patients who attempted to conceive after TCUI, twenty conceived including one termination of pregnancy, one second-trimester miscarriage, one ectopic pregnancy, five preterm deliveries, 11 term delivery, and one ongoing pregnancy. There were 16 live births in total. There was significant reduction in the first-trimester miscarriage rate (t = 4.890; Puterus presenting with infertility or miscarriage.

  15. Small incision lenticule extraction (SMILE) monovision for presbyopia correction. (United States)

    Luft, Nikolaus; Siedlecki, Jakob; Sekundo, Walter; Wertheimer, Christian; Kreutzer, Thomas C; Mayer, Wolfgang J; Priglinger, Siegfried G; Dirisamer, Martin


    To evaluate the outcomes of myopic small incision lenticule extraction (SMILE) monovision in presbyopic patients. This study included 49 presbyopic patients older than 45 years seeking surgical correction of myopia or myopic astigmatism who underwent bilateral SMILE with planned monovision in the SMILE Eyes Clinic Linz, Austria. Target refraction was plano for dominant (distance) eyes and ranged between -1.25 and -0.50 D for nondominant (near) eyes. Best-corrected distance visual acuity, uncorrected distance visual acuity (UDVA), uncorrected near visual acuity, as well as spectacle dependence were assessed after a mean postoperative period of 7.2 ± 4.8 months. Mean age was 49 ± 3 years and female to male ratio was 30:19. Distance eyes achieved a spherical equivalent correction of ±0.50 D from target refraction in 80% of patients and 96% were within ±1.0 D. Binocular UDVA of 20/20 or better was achieved by 90% of patients and all patients achieved 20/25 or better. The proportion of patients with a binocular UDVA of 20/20 or better who could read J2 or better amounted to 84%. Complete spectacle independence was achieved by 84% of patients and independence from reading glasses was achieved in 92% of cases. No patient requested refractive enhancement or monovision reversal. This first evaluation of SMILE monovision endorses the approach as a safe and effective option for the correction of presbyopia in myopic patients seeking refractive surgery.

  16. Effects of two different incision phacoemulsification on corneal astigmatism

    Directory of Open Access Journals (Sweden)

    Lu Huo


    Full Text Available AIM:To compare the effect of different incision in corneal astigmatism after phacoemulsification. METHODS: Totally 88 cases(122 eyeswith pure cataract were randomly divided into two groups. Forty cases(60 eyeswere clarity corneal incision in group A, and 48 cases(62 eyeswere sclera tunnel incision in group B. Mean corneal astigmatism, surgically induced astigmatism(SIA, uncorrected visual acuity(UCVAand best correct vision acuity(BCVAwere observed in pre- and post-operation at 1d; 1wk; 1mo.RESULTS: The mean astigmatism had statistically significant difference between two groups at 1d; 1wk; 1mo after operation(PPP>0.05. UCVA≥0.5 and BCVA≥0.8 had statistically significant difference at 1d; 1wk(PP>0.05.CONCLUSION: Phacoemulsification with scleral tunnel incision remove combined intraocular lens(IOLimplantation has small changes to corneal astigmatism. By selecting personalized corneal incision according to the corneal topography might be more beneficial.

  17. External defibrillation failure due to antimicrobial incise drape. (United States)

    Barbara, David W; Dietz, Niki M; White, Roger D; Pochettino, Alberto; Nuttall, Gregory A


    Antimicrobial incise drapes adhere to a patient's skin during surgery in an attempt to reduce surgical infections. We describe a patient undergoing repeated aortic valve replacement who experienced sudden ventricular fibrillation before median sternotomy. External defibrillation was unsuccessful on multiple attempts using several defibrillators. On removal of the incise drape from the patient's chest, external defibrillation was immediately successful. Increased transthoracic impedance can be caused by multiple factors and may prevent defibrillation. To our knowledge, this is the first reported case of an antimicrobial incise drape preventing defibrillation. If external defibrillation, cardioversion, or pacing is indicated intraoperatively, we recommend prompt removal of the antimicrobial incise drapes before electrode placement if the drapes overlay the intended pad position. Since this case, our institutional practice has now changed to placement of 2 external adhesive defibrillator electrodes onto the patient's skin lateral to the surgical field before incise drape application to allow for defibrillation. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  18. Distinctive channel geometry and riparian vegetation: A geomorphic classification for arid ephemeral streams (United States)

    Sutfin, N.; Shaw, J. R.; Wohl, E. E.; Cooper, D.


    Interactions between hydrology, channel form, and riparian vegetation along arid ephemeral streams are not thoroughly understood and current stream classifications do not adequately represent variability in channel geometry and associated riparian communities. Relatively infrequent hydrologic disturbances in dryland environments are responsible for creation and maintenance of channel form that supports riparian communities. To investigate the influence of channel characteristics on riparian vegetation in the arid southwestern United States, we develop a geomorphic classification for arid ephemeral streams based on the degree of confinement and the composition of confining material that provide constraints on available moisture. Our conceptual model includes five stream types: 1) bedrock channels entirely confined by exposed bedrock and devoid of persistent alluvium; 2) bedrock with alluvium channels at least partially confined by bedrock but containing enough alluvium to create bedforms that persist through time; 3) incised alluvium channels bound only by unconsolidated alluvial material into which they are incised; 4) braided washes that exhibit multi-thread, braided characteristics regardless of the composition of confining material; and 5) piedmont headwater 0-2nd order streams (Strahler) confined only by unconsolidated alluvium and which initiate as secondary channels on piedmont surfaces. Eighty-six study reaches representing the five stream types were surveyed on the U.S. Army Yuma Proving Ground in the Sonoran Desert of southwestern Arizona. Non-parametric multivariate analysis of variance (PERMANOVA) indicates significant differences between the five stream types with regards to channel geometry (i.e., stream gradient, width-to-depth ratio, the ratio between valley width and channel width (Wv/Wc), shear stress, and unit stream power) and riparian vegetation (i.e., presence and canopy coverage by species, canopy stratum, and life form). Discriminant analysis

  19. Three-dimensional analysis of the occlusal plane related to the hamular-incisive-papilla occlusal plane in young adults. (United States)

    Fu, P-S; Hung, C-C; Hong, J-M; Wang, J-C


    The planes which serve as references for cranium and face in dental clinical application included the occlusal plane, Frankfort plane, Camper's plane and hamular-incisive-papilla (HIP) plane. The HIP occlusal plane is a horizontal plane passing through the bilateral hamular notches and the incisive papilla (Dent Surv. 1975;51:60). The aim of this study was to estimate the relationship between the various occlusal planes and the HIP plane in Taiwanese young adults with approximately optimal occlusion. Study casts of 100 young adults (50 men and 50 women) were selected in this study. All market points on the maxillary casts were measured by a three-dimensional precise measuring device. The angular relationship between the four various occlusal planes and the HIP plane were investigated. The vertical distances between the cusp tips and incisal edges of maxillary teeth to the HIP plane were measured. Data were performed by the Statistic analysis software programme (JMP 4.02). The Student's t-test and Pearson's correlation test were used to test the statistical significance (P occlusal plane defined as the incisal edge of maxillary central incisor to mesiobuccal cusp tips of maxillary second molars had the smallest included angle with the HIP plane (2.61 +/- 0.81 degrees). The incisal edge of maxillary right central incisal to mesiopalatal cusp tips of maxillary first molars had the largest included angle with the HIP plane (7.72 +/- 1.60 degrees). The curve is drawn through the buccal cusp tips of maxillary teeth had better parallelism with the HIP plane.

  20. Radiological assessment of 50 cases of incisive or maxillary neoplasia in the dog

    International Nuclear Information System (INIS)

    Frew, D.G.; Dobson, J.M.


    This paper reviews the radiological features of 50 canine incisive or maxillary tumours and discusses the value of radiological assessment in the diagnosis and staging of these tumours. The 50 tumours examined included 21 sarcomas, 15 carcinomas, three melanomas and an assortment of benign tumours of the oral cavity. There was not any site specificity for the different histological tumour types within the upper dental arcade, although fibrosarcomas had a tendency to be maxillary whereas the squamous cell carcinomas were equally distributed between the incisive and maxillary regions. Seventy-eight per cent of fibrosarcomas, 82 per cent of squamous cell carcinoma and all three melanomas examined showed radiological evidence of bone involvement. Radiographic changes were also seen in the benign tumours. The pattern of growth of tumours correlated with the radiological changes observed. Malignant tumours showed a tendency to irregular or aggressive bone loss whereas bone production predominated in the benign tumours

  1. An empirical conceptual gully evolution model for channelled sea cliffs (United States)

    Leyland, Julian; Darby, Stephen E.


    Incised coastal channels are a specific form of incised channel that are found in locations where stream channels flowing to cliffed coasts have the excess energy required to cut down through the cliff to reach the outlet water body. The southern coast of the Isle of Wight, southern England, comprises soft cliffs that vary in height between 15 and 100 m and which are retreating at rates ≤ 1.5 m a - 1 , due to a combination of wave erosion and landslides. In several locations, river channels have cut through the cliffs to create deeply (≤ 45 m) incised gullies, known locally as 'Chines'. The Chines are unusual in that their formation is associated with dynamic shoreline encroachment during a period of rising sea-level, whereas existing models of incised channel evolution emphasise the significance of base level lowering. This paper develops a conceptual model of Chine evolution by applying space for time substitution methods using empirical data gathered from Chine channel surveys and remotely sensed data. The model identifies a sequence of evolutionary stages, which are classified based on a suite of morphometric indices and associated processes. The extent to which individual Chines are in a state of growth or decay is estimated by determining the relative rates of shoreline retreat and knickpoint recession, the former via analysis of historical aerial images and the latter through the use of a stream power erosion model.

  2. Antarctic Subglacial Lake Drainage Via Canals Incised Into Sediment: Progress From Modelling And Observations (United States)

    Carter, S. P.; Fricker, H. A.; Siegfried, M. R.


    Traditional models for the subglacial drainage of ice-dammed lakes in temperate environments invoke a channel eroded into the deformable ice above the bed. In Antarctica, however, modelling studies imply that conditions are more favourable to the drainage of water through channels eroded into the underlying sediments or till, commonly referred to as "canals". We have developed a model for the discharge of "active" subglacial lakes in Antarctica employing drainage through canals and tested its predictions for ice surface drawdown and rate of outflow against satellite- and ground-based observations. Our modeled outflow from a lake begins as a distributed flow, which evolves to incise a channel into the sediment as outflow rates increase. With further erosion, the canal aperture increases and soon quickly become the dominant flow mechanism, pulling water away from the distributed system. Lower pressure within the canal allows the lake to drain to levels below that necessary to initiate outflow, but also allows the sediment to flow into the canal. This deformational closure of the canal typically, ends lake drainage before all water is evacuated. The observed ice speedups associated with lake drainage appear to correlate not with peak total outflow, but with the peak in distributed outflow that before an effective channel is incised. Peak channelized flow reduces water pressure leading to a net slowdown relative to a steady-state distributed drainage. Although sensitivity studies indicate that rate of channel grown and contraction are highly dependent on relatively unconstrained sediment properties (e.g. grain size, porosity), the total drawdown and peak outflow rates for nearly every active lake identified in Antarctica so far all fall within 2 orders of magnitude of one another. The small spread of observations compared to the parameter space of the sensitivity study may indicate either that there is a feedback mechanism for maintaining optimal sediment properties

  3. Lacrimal sac empyema incision and drainage followed by early external dacryocystorhinostomy. (United States)

    Eshraghi, Bahram; Hashemian, Hesam; Fard, Masoud Aghsaei; Safizadeh, Mona


    To evaluate the success of lacrimal sac empyema incision and drainage followed by early external dacryocystorhinostomy. Interventional consecutive case series conducted in Farabi Eye Hospital between August 2007 and November 2010. Patients with acute dacyocystitis and lacrimal sac empyema underwent incision and drainage, followed by early (less than 4 weeks) external DCR. Data collection included patient demographics, past medical history, procedure technique, culture results, and formation of a persistent cutaneous fistula. A total of 32 patients were included: 87.5% had a positive history of chronic epiphora before dacryocystitis. Of these 32 cases, 55.6% had positive culture. Staphylococcus aureus was the most common organism with 8 isolates (38%). The average number of days between empyema drainage and DCR was 11.44 days. All patients had complete resolution of dacryocystitis, with no recurrence during the follow-up period. Neither of 32 patients treated with early DCR after primary empyema drainage, developed a persistent lacrimal-cutaneous fistula. Incision and drainage of the lacrimal sac empyema followed by early external dacryocystorhinostomy can be an appropriate treatment strategy for acute dacryocystitis.

  4. Sharp compared with blunt fascial incision at cesarean delivery

    DEFF Research Database (Denmark)

    Aabakke, Anna J M; Hare, Kristine J; Krebs, Lone


    OBJECTIVE: To compare patient preference for either sharp incision with scissors or blunt manual cleavage of the fascia at cesarean delivery in a randomized controlled trial in which each woman was her own control. STUDY DESIGN: Women undergoing primary cesarean delivery (n=34) were randomized...... to side distribution of sharp or blunt incision of the fascia (sharp right and blunt left or blunt right and sharp left) and followed three months postoperatively. The primary outcome was patient preference for the right or left side of the scar 3 months postoperatively and modeled by polytomous logistic...... difference was found in patient preference with regard to sharp or blunt incision of the fascia, nor was there a significant difference in postoperative pain scores. CLINICAL TRIAL REGISTRATION:;NCT01297725....

  5. The problem of insufficient incisal display: a case presentation. (United States)

    Castillo, Rodrigo


    Enhancement of facial beauty is one of the primary elective goals of patients seeking dental care. Frequently, improvements in natural beauty can be expected to follow restoration of ideal relationships between the denture and the facial soft tissues. A very important feature in a youthful appearance is the incisal tooth display; the amount of maxillary incisal exposure gradually decreases with age, accompanied by a gradual increase in mandibular incisal exposure. However, this problem could be present in young people where the effects of age should not be apparent yet. There are some other factors that could accelerate this process. The present case illustrates the improvement and rejuvenation of an unesthetic young smile through restorative treatment.

  6. Giant Nasolabial Cyst Treated Using Neumann Incision: Case Report

    Directory of Open Access Journals (Sweden)

    Ordones, Alexandre Beraldo


    Full Text Available Introduction: A nasolabial cyst is an ectodermal development cyst. It presents as a fullness of canine fossa, nasal ala, or vestibule of the nose. It is rare and usually small. Treatment consists of complete surgical excision or transnasal endoscopic marsupialization. Objective: To describe a giant nasolabial cyst case treated using Neumann incision. Case Report: A 37-year-old man was referred to the otolaryngology department with nasal obstruction and nasal deformity. Computed tomography showed a nasal cystic lesion 4 × 4.5 × 5 cm wide. Surgical excision using Neumann incision was performed. Discussion: Neumann incision provides wide access to the nasal cavity and may be useful in nasolabial cyst treatment.

  7. Force modeling for incision surgery into tissue with haptic application (United States)

    Kim, Pyunghwa; Kim, Soomin; Choi, Seung-Hyun; Oh, Jong-Seok; Choi, Seung-Bok


    This paper presents a novel force modeling for an incision surgery into tissue and its haptic application for a surgeon. During the robot-assisted incision surgery, it is highly urgent to develop the haptic system for realizing sense of touch in the surgical area because surgeons cannot sense sensations. To achieve this goal, the force modeling related to reaction force of biological tissue is proposed in the perspective on energy. The force model describes reaction force focused on the elastic feature of tissue during the incision surgery. Furthermore, the force is realized using calculated information from the model by haptic device using magnetorheological fluid (MRF). The performance of realized force that is controlled by PID controller with open loop control is evaluated.

  8. An empirical-conceptual gully evolution model for channelled sea cliffs


    Leyland, Julian; Darby, Stephen E.


    Incised coastal channels are a specific form of incised channel that are found in locations where stream channels flowing to cliffed coasts have the excess energy required to cut down through the cliff to reach the outlet water body. The southern coast of the Isle of Wight, southern England, comprises soft cliffs that vary in height between 15 and 100 m and which are retreating at rates ? 1.5 m a? 1, due to a combination of wave erosion and landslides. In several locations, river channels hav...

  9. Minimizing surgical skin incision scars with a latex surgical glove. (United States)

    Han, So-Eun; Ryoo, Suk-Tae; Lim, So Young; Pyon, Jai-Kyung; Bang, Sa-Ik; Oh, Kap-Sung; Mun, Goo-Hyun


    The current trend in minimally invasive surgery is to make a small surgical incision. However, the excessive tensile stress applied by the retractors to the skin surrounding the incision often results in a long wound healing time and extensive scarring. To minimize these types of wound problems, the authors evaluated a simple and cost-effective method to minimize surgical incision scars based on the use of a latex surgical glove. The tunnel-shaped part of a powder-free latex surgical glove was applied to the incision and the dissection plane. It was fixed to the full layer of the dissection plane with sutures. The glove on the skin surface then was sealed with Ioban (3 M Health Care, St. Paul, MN, USA) to prevent movement. The operation proceeded as usual, with the retractor running through the tunnel of the latex glove. It was possible to complete the operation without any disturbance of the visual field by the surgical glove, and the glove was neither torn nor separated by the retractors. The retractors caused traction and friction during the operation, but the extent of damage to the postoperative skin incision margin was remarkably less than when the operation was performed without a glove. This simple and cost-effective method is based on the use of a latex surgical glove to protect the surgical skin incision site and improve the appearance of the postoperative scar. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

  10. Ultrasonic diagnosis and transurethral incision of ureterocele with hydronephrosis

    DEFF Research Database (Denmark)

    Waaddegaard, P; Miskowiak, J; Stage, P


    In a 65-year-old woman with right-sided loin pain, ultrasonography revealed a grossly dilated and obstructed right pyelogram due to a 50-mm ureterocele. After transurethral lateral incision of the ureterocele, there was complete recovery without vesicoureteric reflux. Ultrasonography is advantage......In a 65-year-old woman with right-sided loin pain, ultrasonography revealed a grossly dilated and obstructed right pyelogram due to a 50-mm ureterocele. After transurethral lateral incision of the ureterocele, there was complete recovery without vesicoureteric reflux. Ultrasonography...

  11. Channel response in a semiarid stream to removal of tamarisk and Russian olive (United States)

    Jaeger, Kristin L.; Wohl, Ellen


    We report observed short-term (3 years) channel adjustment in an incised, semiarid stream to the removal of invasive plants, tamarisk (Tamarix spp.) and Russian olive (Elaeagnus angustifolia) by (1) removing the above-ground portion of the plant (cut-stump method) and (2) removing the entire plant (whole-plant method). The stream flows through Canyon de Chelly National Monument in Arizona, USA., draining an ˜1500 km2 catchment. Average channel width is 13 m; average thalweg depth is 2-3 m, although channel banks exceed 8 m locally. Channels adjusted primarily through widening, with significantly larger changes occurring in whole-plant removal reaches; however, neither plant removal method elicited large-scale bank destabilization, and the channels remained entrenched. Particular site conditions limiting large-scale destabilization include the absence of sufficient streamflow magnitudes, the presence of clay layers at the bank toe, the remaining presence of native vegetation, and the entrenched morphology. Our findings serve as a cautionary note regarding the temporal and spatial variability in channel response to invasive plant removal and underscore the importance of considering site-specific conditions in future restoration projects that include invasive plant removal.

  12. Sutured clear corneal incision: wound apposition and permeability to bacterial-sized particles. (United States)

    May, William N; Castro-Combs, Juan; Kashiwabuchi, Renata T; Tattiyakul, Woranart; Qureshi-Said, Saima; Hirai, Flavio; Behrens, Ashley


    To determine the effects of single radial or horizontal suture placement in 2-step clear corneal incision (CCI) wound apposition and permeability to particles of India ink. Five fresh human globes were included. Two 25-gauge needles connected to a saline solution bag and to a digital manometer were inserted through the limbus, 120 degrees apart from each other. Four 2-step CCIs (2.75 mm wide and 3 mm length) were constructed in each cornea. Incisions were divided into 3 groups: single radial suture (SRS), single horizontal suture (SHS), and unsutured group. Optical coherence tomography (OCT) was performed before and after suture placement. With a preset 10 mm Hg intraocular pressure (IOP), India ink was applied to the incision site and a standardized sudden IOP fluctuation was induced. OCT and superficial images were recorded before and after suture placement. India ink inflow and internal and external CCI gapping were outlined and measured by planimeter. The area and linear distance of India ink inflow after pressure challenge in all study groups were higher when compared with pre-pressure measurements; however, this increase was significant in the SRS and SHS groups (P < 0.05). Additionally, SRS placement significantly increased inner wound gapping (P = 0.018), and SHS significantly widened outer wound gape (P = 0.02). Well-constructed unsutured 2-step CCI seems to be more efficient at preventing bacterial-sized particles inflow during sudden changes in IOP, and it seems to offer better wound apposition as assessed by OCT.

  13. Transecting versus avoiding incision of the anterior placenta previa during cesarean delivery. (United States)

    Verspyck, Eric; Douysset, Xavier; Roman, Horace; Marret, Stephane; Marpeau, Loïc


    To compare maternal outcomes after transection and after avoiding incision of the anterior placenta previa during cesarean delivery. In a retrospective study, records were reviewed for women who had anterior placenta previa and delivered by cesarean after 24 weeks of pregnancy at a tertiary center in Rouen, France. During period A (January 2000 to December 2006), the protocol was to systematically transect the placenta when it was unavoidable. During period B (January 2007 to December 2010), the technique was to avoid incision by circumventing the placenta and passing a hand around its margin. Logistic regression was used to identify independent risk factors associated with maternal transfusion of packed red blood cells. Eighty-four women were included (period A: n=43; period B: n=41). During period B, there was a reduction in frequency of intraoperative hemorrhage (>1000 mL) (P=0.02), intraoperative hemoglobin loss (P=0.005), and frequency of blood transfusion (P=0.02) as compared with period A. In multivariable analysis, period B was associated with a reduced risk of maternal transfusion (odds ratio 0.27; 95% confidence interval 0.09-0.82; P=0.02). Avoiding incision of the anterior placenta previa was found to reduce frequency of maternal blood transfusion during or after cesarean delivery. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  14. No-Drain Single Incision Liposuction Pull-Through Technique for Gynecomastia. (United States)

    Khalil, Ashraf A; Ibrahim, Amr; Afifi, Ahmed M


    Several different methods have been proposed for treatment of gynecomastia, depending on the amount of breast enlargement and skin redundancy. The liposuction pull-through technique has been proposed as an efficacious treatment for many gynecomastia cases. This work aims to study the outcome of this technique when applied as an outpatient procedure, without the use of drains and through a single incision. Fifty-two patients with bilateral gynecomastia without significant skin excess were included in this study. The liposuction pull-through technique was performed through a single incision just above the inframammary fold and without the use of drains. Patients were followed up for 6 months. The proposed technique was able to treat the gynecomastia in all patients, with a revision rate of 1.9% to remove residual glandular tissues. There were no seromas, hematomas, nipple distortion, permanent affection of nipple sensation or wound healing problems. The liposuction pull-through technique is an effective treatment for gynecomastia without significant skin redundancy. It combines the benefits of the direct excision of glandular tissues, with the minimally invasive nature of liposuction. Performing the procedure through a single incision without the use of drains and without general anesthesia is a safe alternative. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

  15. Single-incision versus conventional laparoscopic appendectomy in 688 patients: a retrospective comparative analysis (United States)

    Liang, Hung-Hua; Hung, Chin-Sheng; Wang, Weu; Tam, Ka-Wai; Chang, Chun-Chao; Liu, Hui-Hsiung; Yen, Ko-Li; Wei, Po-Li


    Background Laparoscopic surgery has become the standard for treating appendicitis. The cosmetic benefits of using single-incision laparoscopy are well known, but its duration, complications and time to recovery have not been well documented. We compared 2 laparoscopic approaches for treating appendicitis and evaluated postoperative pain, complications and time to full recovery. Methods We retrospectively reviewed the cases of consecutive patients with appendicitis and compared those who underwent conventional laparoscopic appendectomy (CLA) performed using 3 incisions and those who underwent single-incision laparoscopic appendectomy (SILA). During SILA, the single port was prepared to increase visibility of the operative site. Results Our analysis included 688 consecutive patients: 618 who underwent CLA and 70 who underwent SILA. Postsurgical complications occurred more frequently in the CLA than the SILA group (18.1% v. 7.1%, p = 0.018). Patients who underwent SILA returned to oral feeding sooner than those who underwent CLA (median 12 h v. 22 h, p cosmetic advantages, SILA led to rapid recovery and no increase in postsurgical pain or complications. PMID:24869622

  16. Different air-water spray regulations affect the healing of Er,Cr:YSGG laser incisions. (United States)

    Sperandio, Felipe Fornias; Meneguzzo, Daiane T; Ferreira, Leila S; da Ana, Patrícia A; Azevedo, Luciane H; de Sousa, Suzana C O M


    Surgeries performed with high-intensity laser devices may be improved with accurate protocols, including the air-water spray regulation. Thus, this study sought to investigate the healing process of wounds made on the dorsum of rat tongues using an Er,Cr:YSGG laser device with different air-water spray regulations. The incisions were made on the dorsum of Wistar rat tongues using an Er,Cr:YSGG laser with three different air-water spray regulations (100/0%, 50/50%, 11/7%). Scalpel incisions functioned as controls. The sacrifices occurred between 0 and 14 days after surgery. Morphological, histological, and immunohistochemical (fibronectin and type III collagen) analysis of the wounds were performed. The air-water spray regulation influenced wound healing and the inflammatory response, especially in the earlier stages. Incisions performed using the 100/0% air/water spray regulation had the worst results, expressing a greater amount of fibronectin and type III collagen. The 50/50% air/water spray regulation brought in a non-clear surgical field and poor laser interaction with the tissue. The 11/7% air/water spray regulation showed the best clinical results and less pronounced histological events. According to the results encountered, the air-water spray should be regulated to improve surgery.

  17. [The cervical dermatoglyphic character of 229 Chinese patients and its application in incision design for the cervical lymph nodes dissection]. (United States)

    Shi, Qian; Chen, Xiaohong


    To summarize the cervical dermatoglyphics distribution in 229 participants, and to design dermatoglyphic incision for cervical lymph nodes dissection, including II , III, IV or/and V regions, in accordance with the requirement for cosmetology. To keep the patient's head right forward when the number and locations of the dermatoglyphy were collected by macroscopic observation. Upper Cricoid-Region is defined as the region above the cricoids, and Cricoids-Collarbone-Region is referred to the region below the cricoids. The relationship among the distribution of cervical dermatoglyph, patients' age, gender, and body mass index were analyzed. According to the distribution of cervical dermatoglyph, when performing the regional cervical lymph nodes dissection in patients with laryngocarcinoma and thyroid cancer, cervical dermatoglyphy incision or parallel dermatoglyphy incision were designed, and the operation time, operative complications, and cosmetology effects after surgery were observed. Distribution of cervical dermatoglyphics was statistically correlated to the age, gender, and body mass index (P < 0.05) of patients. The follow-up time were 12 months to 49 months, 19 months on average. Average operating time of unilateral lymph nodes dissection was (46 +/- 12) minutes. Patients undergone the designs of cervical dermatoglyphy incision or parallel dermatoglyphy incision, suffered neither skinflap necrosis nor accessory nerve injury. One patient had lymphatic fistula after surgery, and relieved by conservative treatment. One with T3 N2 M0 laryngocarcinoma got V region lymph nodes recurrence 6-months after surgery. The cervical lymph nodes dissection with dermatoglyphy design is safe with prominent cosmetology effects. It will take a little longer time to perform the neck dissection with the dermatoglyphy incision in the beginning.

  18. [Surgical treatment for incisions fat colliquation or infections at early stage after operation of lumbar disc herniation]. (United States)

    Guan, Ting-Jin; Zheng, Liang-Guo; Sun, Peng; Li, Xing-Xue


    To explore the reason, key diagnosic point and therapeutic method of the incisions fat colliquation or infections at early stage after operation of lumbar disc herniation. From July 2007 to May 2012, clinical data of 11 patients with incision fat liquefaction or early infection after lumbar discectomy were retrospectively analyzed. There were 5 males and 6 females with an average age of 43.1 years, and the mean time of incisions fat colliquation or infection was 5 days and a half after operation. The main clinical features included local wound pain aggravating, fervescence, fresh seepage in the wound, and blood inflammatory index increased, etc. The wound could heal at the first treatment stage or not was an evaluation standard of curative effect. All patients were followed up with an average period of 21 months. The wounds of 10 cases healed at the first stage without recurrence and complications. In 1 case infected by staphylococcus aureus, distal part of the wound present local red, swelling and with wave motion at 2 months after operation, staphylococcus aureus infection was confirmed after puncture and bacterial culture, and 1 thrum was found after local incision. The wound healed after change dressings for 1 week, without recurrence after followed up for 13 months. Preventing the risk factors before operation, minimizing invasive technique during operation reasonable antibiotics application for the lumbar operation reguiring placement objects, and correctly handling with wound after operation could prevent and reduce the incidence of incisions fat liquefaction or infection after operation of lumbar disc herniation. For incision fat liquefaction or infection, early diagnosis, debridement, VSD negative pressure irrigation and drainage, to choosing sensitive antibiotics according to the results of drug sensitivity, may contribute to wound early healing and decrease complication.

  19. Incised plate urethroplasty in perineal and perineo-scrotal ...

    African Journals Online (AJOL)

    Objective: The ideal replacement of the urethra is the urethra itself. However, when the urethra is not available, flaps or tubes are used as substitutes in hypospadias repair. The urethral plate, when preserved, is an excellent tool for tubularization and urethral reconstruction. Tubularized incise plate (TIP) repair has become ...

  20. Versatility of tubularized incised plate urethroplasty in the ...

    African Journals Online (AJOL)

    Background: The outcomes of urethroplasty in the management of different types of hypospadias have continued to improve since the introduction of the tubularized incised plate (TIP) urethroplasty (Snodgrass method). The aim of this study was to evaluate the feasibility and applicability of TIP urethroplasty in the ...

  1. Feasibility of a tubularised incised-plate urethroplasty with double ...

    African Journals Online (AJOL)

    Background: Reoperation for failed hypospadias has been considered to be seriously problematic. The dense fibrotic tissue causes difficulties in wound healing and increases the rate of complications. The tubularised incised-plate urethroplasty (TIPU) method has become a preferred method for all varieties of hypospadias ...

  2. Tubularized Incised Plate (TIP) Urethroplasty: Extended Use in ...

    African Journals Online (AJOL)

    Objective: Recently, tubularized incised plate (TIP) urethroplasty (Snodgrass repair) has gained popularity for the primary repair of distal and proximal hypospadias. This study was carried out to evaluate TIP urethroplasty in the repair of failed and complicated hypospadias cases. Patients and Methods: This study was ...

  3. Combined use of Mathieu and incised plate technique (Snodgrass ...

    African Journals Online (AJOL)

    Objectives: To evaluate the results and complications after combined use of Mathieu and incised plate technique for management of distal hypospadias in older children. Patients and methods: A total of 33 patients with primary distal penile hypospadias were operated upon using the Mathieu technique combined with deep ...

  4. Tubularized incised plate urethroplasty repair in adult hypospadias ...

    African Journals Online (AJOL)

    Objective: Most studies published in the literature report on the results of tubularized incised plate urethroplasty (TIPU) for hypospadias repair in children. Hence, the objective of this study was to evaluate the results of TIPU repair in adults. Patients and methods: The records of 60 adult patients with primary hypospadias ...

  5. Incised plate urethroplasty in perineal and perineo-scrotal ...

    African Journals Online (AJOL)

    A. Bhat

    Abstract. Objective: The ideal replacement of the urethra is the urethra itself. However, when the urethra is not available, flaps or tubes are used as substitutes in hypospadias repair. The urethral plate, when preserved, is an excellent tool for tubularization and urethral reconstruction. Tubularized incise plate (TIP) repair.

  6. Tubularized incised plate technique for recurrent hypospadias: a ...

    African Journals Online (AJOL)

    Annals of Pediatric Surgery 2012, 8:80–85. Keywords: recurrent hypospadias, salvage hypospadias, tubularized incised plate. aDepartment of Surgery, Division of Pediatric and Plastic Surgery, Faculty of. Medicine, Suez Canal University, Ismailia and bDepartment of Surgery, Faculty of. Medicine, Menoufia University ...

  7. a comparative study between manual small incision cataract surgery ...

    African Journals Online (AJOL)

    ... October 2012 to October 2014 for cataract surgery were followed up for 6 weeks after surgery. They were divided into two groups based on the type of surgical procedure opted by the patients. Group A consisted of 50 patients who underwent Manual Small Incision Cataract. Surgery with rigid Polymethyl Methacrylate IOL ...

  8. Anastomosis Procedure through an Inguinal Hernia Incision in ...

    African Journals Online (AJOL)

    was laparoscopically transected by a stapler. A 4 cm skin incision was then made in the left inguinal region and carried down to the peritoneum through the hernia sac [Figure 1]. Bowel resection was performed extracorporeally, and an anvil was placed at the proximal end of the colon, over a purse-string suture. [Figure 2].

  9. rubularised Incised Plate Hypospadias Urethroplasty In A Regional ...

    African Journals Online (AJOL)

    1t the Coast Province General Hospital in Mombasa. Xenya and in some private hospitals, nearby. junction. Artificial erection test is done to check for residual chordee20. Residual penile curvature is corrected by dorsal tunica albuginea plication8. - The glans wings are mobilized laterally. A midline relaxing incision is made ...

  10. Treatment of pharyngocutaneous fistula acquired from incisions and ...

    African Journals Online (AJOL)

    Treatment of pharyngocutaneous fistula acquired from incisions and drainage of deep neck space abscess in a patient with occult third branchial anomaly. ... We did surgical exploration to excise and close the fistula but only succeeded at the second attempt. Conclusion: We conclude that branchial apparatus anomaly ...

  11. Single-incision laparoscopic surgery for pyloric stenosis. (United States)

    Kozlov, Yury; Novogilov, Vladimir; Podkamenev, Alexey; Rasputin, Andrey; Weber, Irina; Solovjev, Alexey; Yurkov, Pavel


    Laparoscopy is the most common procedure for correction of congenital pyloric stenosis. The standard laparoscopic approach is based on the three-port technique. In contrast to the standard laparoscopic technique, the single-incision laparoscopic surgery (SILS) requires only one incision. We report on our experience with this surgical approach. Between September 2009 and August 2010 a total of 24 children underwent a laparoscopic pyloromyotomy, 12 in SILS technique. The single incision was carried through the center of the umbilicus. The working instruments were introduced in a two-dimensional direction into the peritoneal cavity via the same umbilical incision. The two groups were compared for patients' demographics, operative report and early postoperative outcomes. All SILS procedures were performed successfully with no conversion rate. There were no differences in the preoperative parameters between the two groups regarding age before surgery and body weight at operation. Operative time and time of full enteral intake was similar to comparable procedures with usage of a standard laparoscopic approach. There were no operative or postoperative complications. The early experience described in this study confirms that SILS can be applied for treatment of pyloric stenosis with outcomes similar to the standard laparoscopic surgery.

  12. Better outcome from arthroscopic partial meniscectomy than skin incisions only?

    DEFF Research Database (Denmark)

    Roos, Ewa M; Hare, Kristoffer Borbjerg; Nielsen, Sabrina Mai


    OBJECTIVE: Compare arthroscopic partial meniscectomy to a true sham intervention. METHODS: Sham-controlled superiority trial performed in three county hospitals in Denmark comparing arthroscopic partial meniscectomy to skin incisions only in patients aged 35-55 years with persistent knee pain and...

  13. Feasibility of reduced port surgery applying Higuchi's transverse incision

    Directory of Open Access Journals (Sweden)

    Kazu Ueda


    Conclusion: We reported novel forms of reduced port surgery applying Higuchi's transverse incision. It was suggested that these procedures are relatively simple, but ensure the same safety and efficacy as conventional methods. We intend to increase the number of cases and examine safety, efficacy, and patient satisfaction for these procedures.

  14. Short communication Combined use of Mathieu and incised plate ...

    African Journals Online (AJOL)

    Objectives: To evaluate the results and complications after combined use of Mathieu and incised plate technique for management of distal hypospadias in older children. Patients and methods: A total of 33 patients with primary distal penile hypospadias were operated upon using the Mathieu technique combined with deep ...

  15. Topical‑intracameral anesthesia in manual small incision cataract ...

    African Journals Online (AJOL)

    Background: Cataract remains a leading cause of blindness worldwide. Manual small incision cataract surgery (MSICS) is currently practiced as the technique of choice in Sub‑Saharan Africa to reduce the backlog of cataract blindness. Optimal pain control during surgery remains a challenge to cataract surgeons. Aim: To ...

  16. Visual Outcome after Small Incision Cataract Surgery in ...

    African Journals Online (AJOL)

    Objective: The aim of this study was to determine the visual outcome of patients who had manual small incision cataract surgery in a high volume secondary eye hospital in southwestern Nigeria, and to identify reasons for poor outcome. Methodology: This is an observational descriptive, longitudinal study of consecutive ...

  17. Ankle fusion using a 2-incision, 3-screw technique

    NARCIS (Netherlands)

    Hendrickx, R. P. M.; Kerkhoffs, G. M. M. J.; Stufkens, S. A. S.; van Dijk, C. N.; Marti, R. K.


    Reliable fusion and optimal correction of the alignment of the ankle joint using a 2-incision, 3-screw technique. Symptomatic osteoarthritis of the ankle joint after insufficient other treatment, severe deformity of the osteoarthritic ankle joint, or salvation procedure after failed arthroplasty.

  18. Polydioxanone versus polypropylene closure for midline abdominal incisions

    International Nuclear Information System (INIS)

    Naz, S.; Jamali, M.A.


    Background: Midline laparotomy is the most common technique of abdominal incisions because it is simple, provides adequate exposure to all four quadrants, and is rapid to open. A major problem after midline laparotomy remains the adequate technique of abdominal fascia closure. This study was conducted to see the role of Polydioxanone and Prolene for midline abdominal closure in terms of postoperative wound infection and wound pain. Methods: This study was carried out at surgical unit II, Federal Government Services Hospital Islamabad. Patients were equally divided in two groups, i.e., A and B. Groups A and B patients undergone midline abdominal closure with Polydioxanone number 1 and Polypropylene number 1 sutures respectively. Results: Total 620 patients were included in this study. Post-operative wound pain score according to Visual analogue scale (VAS) was compared in terms of no pain (0), mild pain (1-3), moderate pain (4-6), severe pain (7-9). In group A (Polydioxanone), the frequency and percentages of no, mild, moderate and severe pain were 101 (32.6%), 95 (30.6%), 81 (26.1%) and 33 (10.6%) respectively, where as in group B (polypropylene) it was 82 (26.5%), 43 (13.9%), 59 (19%) and 126 (40.6%) respectively. Similarly, the frequency and percentages of post-operative wound infection in group A (Polydioxanone) and group B (polypropylene) was 105 (33.9%) and 208 (67.1%) respectively. Conclusion: Polydioxanone results in less wound pain and wound infection when compared to Polypropylene. (author)

  19. Lithologic and hydrologic controls of mixed alluvial-bedrock channels in flood-prone fluvial systems: bankfull and macrochannels in the Llano River watershed, central Texas, USA (United States)

    Heitmuller, Frank T.; Hudson, Paul F.; Asquith, William H.


    The rural and unregulated Llano River watershed located in central Texas, USA, has a highly variable flow regime and a wide range of instantaneous peak flows. Abrupt transitions in surface lithology exist along the main-stem channel course. Both of these characteristics afford an opportunity to examine hydrologic, lithologic, and sedimentary controls on downstream changes in channel morphology. Field surveys of channel topography and boundary composition are coupled with sediment analyses, hydraulic computations, flood-frequency analyses, and geographic information system mapping to discern controls on channel geometry (profile, pattern, and shape) and dimensions along the mixed alluvial-bedrock Llano River and key tributaries. Four categories of channel classification in a downstream direction include: (i) uppermost ephemeral reaches, (ii) straight or sinuous gravel-bed channels in Cretaceous carbonate sedimentary zones, (iii) straight or sinuous gravel-bed or bedrock channels in Paleozoic sedimentary zones, and (iv) straight, braided, or multithread mixed alluvial–bedrock channels with sandy beds in Precambrian igneous and metamorphic zones. Principal findings include: (i) a nearly linear channel profile attributed to resistant bedrock incision checkpoints; (ii) statistically significant correlations of both alluvial sinuosity and valley confinement to relatively high f (mean depth) hydraulic geometry values; (iii) relatively high b (width) hydraulic geometry values in partly confined settings with sinuous channels upstream from a prominent incision checkpoint; (iv) different functional flow categories including frequently occurring events (high f values (most ≤ 0.45) that develop at sites with unit stream power values in excess of 200 watts per square meter (W/m2); and (vi) downstream convergence of hydraulic geometry exponents for bankfull and macrochannels, explained by co-increases of flood magnitude and noncohesive sandy sediments that collectively

  20. Endoscopic mucosal incision by diode laser for early cancer treatment in the alimentary tract: effect of submucosal indocyanine green solution injection (United States)

    Hayashi, Takuya; Arai, Tsunenori; Nakamura, Naoko; Tajiri, Hisao; Miura, Soichiro; Kikuchi, Makoto


    Mucosal incision technique by diode laser ablation was studied to ensure the operation of endoscopic mucosal resection (EMR), which is gold standard method for early gastric cancer with little/no risk of lymphnode metastasis. Our method was designed to facilitate grasping a large lesion by hitching the snaring wire on the incised mucosal groove around the lesion. We employed local submucosal injection of indocyanine green (ICG) solution. ICG solution was used to prevent direct laser light penetration to the muscularis propriae owing to strong absorption of 805nm light (absorption coefficent at 805 nm is about 200cm-1). We used diode laser radiation with an output of 25W by contact (0.1, 0.5, 1.0 kg/cm2) and non-contact irradiation methods. In the preliminary experiment with resected porcine stomach, muscularis propriae was intact by the 60s non-contact irradiation or the 8s contact irradiation with contact pressure of 1kg/cm2. In the endoscopic experiment we used 3 dogs. Using conical contact probe, we successfully demonstrated 3cm diameter circular incision with sharp groove in 10 minutes. We could place the snaring wire on the incised groove. Histology of the endoscopically incised canine stomach revealed that the submucosal layer welled up to 6mm in thickness and the bottom of the incision groove reached 1.9mm at deepest below the mucosal muscle. The thickness of the coagulation layer around the incised groove was up to 1.8mm. No damage was seen a the muscularis propriae. We demonstrate easy as well as sure snaring by using our laser incision technique. We think our technique may be available to enhance the efficacy of EMR for early gastric cancer including the lesion over 2cm in diameter.

  1. Incisional hernia after upper abdominal surgery: A randomised controlled trial of midline versus transverse incision

    NARCIS (Netherlands)

    J.A. Halm (Jens); H. Lip (Harm); P.I.M. Schmitz (Paul); J. Jeekel (Hans)


    textabstractObjectives: To determine whether a transverse incision is an alternative to a midline incision in terms of incisional hernia incidence, surgical site infection, postoperative pain, hospital stay and cosmetics in cholecystectomy. Summary background data: Incisional hernias after midline

  2. Longitudinal profile of channels cut by springs


    Devauchelle , O.; PETROFF , A. P.; LOBKOVSKY , A. E.; Rothman , D. H.


    International audience; We propose a simple theory for the longitudinal profile of channels incised by groundwater flow. The aquifer surrounding the stream is represented in two dimensions through Darcy's law and the Dupuit approximation. The model is based on the assumption that, everywhere in the stream, the shear stress exerted on the sediment by the flow is close to the minimal intensity required to displace a sand grain. Because of the coupling of the stream discharge with the water tabl...

  3. Closed-incision negative-pressure therapy in high-risk general surgery patients following laparotomy: a retrospective study. (United States)

    Zaidi, A; El-Masry, S


    Surgical site infection (SSI) and wound dehiscence are dreaded complications following laparotomy in general surgical patients, and can potentially occur more often in various comorbid states. Negative-pressure wound therapy (NPWT) has a positive effect of on open and complicated wounds and so has been used for at-risk surgical incisions with the aim of redistributing lateral tension and holding incision edges together. The aim of the present study was to compare the rate of wound complications following laparotomy in high-risk general surgical patients with a clean incision treated with closed-incision negative-pressure therapy (ciNPT) with those receiving conventional care. A retrospective review was performed of the hospital medical records of patients who underwent laparotomy between 1 October 2010 and 31 March 2012. Records of 69 patients who received ciNPT and 112 who were managed by adherent gauze dressings were included in the final analysis. Two (2.9%) patients in the ciNPT group and 23 (20.5%) in the non-NPWT group developed a wound complication following laparotomy (P surgery patients considered to have risk of developing wound complications following laparotomy. © 2016 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.

  4. River channel sensitivity to change in the context of human activities and natural factors: an 80-year record of channel morphodynamics on the lower Santa Clara River, Ventura County, California (United States)

    Downs, P. W.; Dusterhoff, S. R.; Sears, W. A.


    -2005), with downstream reaches losing their responsiveness to flood events over time, in contrast to the middle reaches. The channel bed has incised on average 0.7 m from 1949-2005, again with a strong contrast between the downstream reaches (average incision 2.4 m) and middle reaches (no incision). Overall, catchment historical disturbances to the LSCR consist of numerous ‘pulse’ disturbances related to sediment delivery during clustered flood events, and following wildfire and earthquakes, at least five human-caused ‘press’ disturbances and two human ‘pulse’ disturbances. The end product includes several ‘natural’ reaches that are highly responsive but resilient to flood events, and numerous disequilibrium lower reaches disconnected from this floodplain and with high potential sensitivity held in check by force. Long-term approaches to hazard management should consider vulnerability modification approaches.

  5. Geomorphic Response of a Low-Gradient Channel to Modern, Progressive Base-Level Lowering: Nahal HaArava, the Dead Sea (United States)

    Dente, Elad; Lensky, Nadav G.; Morin, Efrat; Grodek, Tamir; Sheffer, Nathan A.; Enzel, Yehouda


    The geomorphic response of channels to base-level fall is an important factor in landscape evolution. To better understand the complex interactions between the factors controlling channel evolution in an emerging continental shelf setting, we use an extensive data set (high-resolution digital elevation models, aerial photographs, and Landsat imagery) of a newly incising, perennial segment of Nahal (Wadi) HaArava, Israel. This channel responds to the rapid and progressive lowering of its base-level, the Dead Sea (>30 m in 35 years; 0.5-1.3 m yr-1). Progressively evolving longitudinal profiles, channel width, sinuosity, and knickpoint retreat during the last few decades were documented or reconstructed. The results indicate that even under fast base-level fall, rapid delta progradation on top of the shelf and shelf edge can moderate channel mouth slopes and, therefore, largely inhibit channel incision and knickpoint propagation. This channel elongation stage ends when the delta reaches an extended accommodation within the receiving basin and fails to keep the channel mouth slopes as low as the channel bed slopes. Then, processes of incision, narrowing, and meandering begin to shape the channel and expand upstream. When the down-cutting channel encounters a more resistant stratum within the channel substrate, these processes are restricted to a downstream reach by formation of a retreating vertical knickpoint. When the knickpoint and the channel incise to a level below this stratum, a spatially continuous, diffusion-like evolution characterizes the channel's response and source-to-sink transport can be implemented. These results emphasize the mouth slope and channel substrate resistance as the governing factors over long-term channel evolution, whereas flash floods have only local and short-lived impacts in a confined, continuously incising channel. The documented channel response applies to eustatic base-level fall under steepening basin bathymetry, rapid delta

  6. Sorting Out Effects of Active Stream Restoration: Channel Morphology, Channel Change Processes and Potential Controls (United States)

    McDowell, P. F.


    In many active restoration projects, instream structures or modifications are designed to produce specific change in channel form, such as reduced W:D or increased pool depth, yet there is little monitoring to evaluate effectiveness. Active restoration often takes place within a context of other land management changes that can have an effect on channel form. Thus, the effects of active restoration are difficult to separate from the effects of other management actions. We measured morphologic response to restoration designs on sections of the Middle Fork John Day River, a gravel-cobble bed river under a cattle grazing regime in the Blue Mountain of Oregon. Since 2000, restoration actions have included elimination of cattle grazing in the riparian zone (passive restoration), riparian planting of woody vegetation, instream log structures for fish habitat and pool maintenance, and elimination of a major flow diversion. We listed the hypothetical effects of each of these management changes, showing overlap among effects of active and passive restoration. Repeat cross-section and longitudinal profile surveys over eight years, and repeat aerial imagery, documented changes in channel width, depth and bed morphology, and processes of change (bank erosion or aggradation, point bar erosion or aggradation, bed incision or aggradation), in two restored reaches and two adjacent control (unrestored) reaches. Morphologic changes were modest. Bankfull cross-section area, width, and W:D all decreased slightly in both restored reaches. Control reaches were unchanged or increased slightly. Processes of change were markedly different among the four reaches, with different reaches dominated by different processes. One restored reach was dominated by slight bed aggradation, increased pool depth and deep pools/km, while the other restored reach was dominated by bank erosion, bar aggradation and slight bed incision, along with increased deep pools/km. The longitudinal profile showed


    DEFF Research Database (Denmark)


    the communication channel. The method further includes determining a sequence of second coefficient estimates of the communication channel based on a decomposition of the first coefficient estimates in a dictionary matrix and a sparse vector of the second coefficient estimates, the dictionary matrix including...

  8. Incision of Licus Vallis, Mars, From Multiple Lake Overflow Floods (United States)

    Goudge, Timothy A.; Fassett, Caleb I.


    Licus Vallis is a large valley (>350 km long, >2 km wide, and >150 m deep) that heads at the outlet breach of an 30 km diameter impact crater. We present observations of the geomorphology and topography of this paleolake outlet valley and associated tributary valleys to constrain the history of incision of the Licus Vallis system. Licus Vallis has an abrupt increase in gradient by a factor of approximately 4 along its longitudinal profile, and a knickpoint that drops 200 m over a reach of 2 km approximately 12 km downstream from the valley head. We also describe a set of paired terraces within Licus Vallis, which are continuous for tens of kilometers and define an interior valley >2 km in width. We interpret the geomorphology of Licus Vallis as recording at least two discrete, major episodes of valley incision, both driven by lake overflow floods. The main portion of Licus Vallis formed by overflow flooding from a large ( 103-104 km2) lake contained in an intercrater basin. Subsequently, overflow flooding from a lake within the 30 km diameter impact crater reactivated Licus Vallis, forming a major knickpoint at the valley head and establishing the upstream section of the valley at a lower slope. Farther down the valley, this flood event incised an interior valley bounded by paired terraces. Regional tributary valleys that feed Licus Vallis also have prominent knickpoints, which have retreated farthest for downstream valleys. We conclude that these knickpoints record successive waves of incision that swept up Licus Vallis during lake overflow flooding, with erosion in the main trunk of the valley (from overflow floods) significantly outpacing erosion in the tributary valleys (from regional surface runoff). These observations of Licus Vallis illustrate how lake overflow floods may have provided an important control on the pace of landscape evolution on Mars.

  9. Robot-assisted submandibular gland excision via modified facelift incision


    Jung, Seung Wook; Kim, Young Kwan; Cha, Yong Hoon; Koh, Yoon Woo; Nam, Woong


    Background The conventional transcervical resection for submandibular gland disease has some risks and an unsatisfactory cosmetic result. Recently, robot-assisted surgery has been developed as a plausible substitute for conventional surgery which provides an excellent cosmetic outcome. Case presentation The authors performed robot-assisted sialadenectomy via modified facelift incision using the da Vinci Xi surgical system (Intuitive Surgical Inc., CA, USA) with two endowrist arms (monopolar c...

  10. Rehabilitation of anterior teeth with customised incisal guide table. (United States)

    Mall, Priyanka; Singh, Kamleshwar; Rao, Jitendra; Kumar, Lakshya


    Restoration of anterior guidance is a major challenge to the clinician in planning of all restorative treatments. An accurate anterior guidance is important for proper function, aesthetics, comfort and phonetics. This article describes anterior rehabilitation of a patient who met with a road traffic accident and lost his anterior teeth. Anterior guidance developed in the provisional restorations was accurately recorded in the customised incisal guide table and permanent restorations were fabricated accordingly.

  11. Rehabilitation of anterior teeth with customised incisal guide table


    Mall, Priyanka; Singh, Kamleshwar; Rao, Jitendra; Kumar, Lakshya


    Restoration of anterior guidance is a major challenge to the clinician in planning of all restorative treatments. An accurate anterior guidance is important for proper function, aesthetics, comfort and phonetics. This article describes anterior rehabilitation of a patient who met with a road traffic accident and lost his anterior teeth. Anterior guidance developed in the provisional restorations was accurately recorded in the customised incisal guide table and permanent restorations were fabr...

  12. Rehabilitation of anterior teeth with customised incisal guide table (United States)

    Mall, Priyanka; Singh, Kamleshwar; Rao, Jitendra; Kumar, Lakshya


    Restoration of anterior guidance is a major challenge to the clinician in planning of all restorative treatments. An accurate anterior guidance is important for proper function, aesthetics, comfort and phonetics. This article describes anterior rehabilitation of a patient who met with a road traffic accident and lost his anterior teeth. Anterior guidance developed in the provisional restorations was accurately recorded in the customised incisal guide table and permanent restorations were fabricated accordingly. PMID:23709546

  13. Mini incision open pyeloplasty - Improvement in patient outcome

    Directory of Open Access Journals (Sweden)

    Vishwajeet Singh


    Full Text Available ABSTRACT Purpose: To assess the subjective and objective outcomes of mini-incision dismembered Anderson-Hynes pyeloplasty in the treatment of primary ureteropelvic junction obstruction (UPJO. Materials and Methods: Between January 2008 to January 2013, Anderson-Hynes pyeloplasty was performed in 71 patients diagnosed with primary UPJO. Small subcostal muscle splitting incision was used in all cases. Sixteen patients with renal calculi underwent concomitant pyelolithotomy. Subjective outcome was assessed using visual pain analogue score (VAS. For objective assessment, the improvement in differential renal function (DRF and radio-tracer wash out time (T1/2 on Tc-99m DTPA scan and decrease in hydronephrosis (HDN on renal ultrasound (USG and urography (IVU were assessed. Results: Mean incision length was 5.2 cm. The average operating time and postoperative hospital stay was 63 (52-124 minutes and 2.5 (2–6 days respectively. Concomitant renal calculi were successfully removed in all the patients. Overall complication rates were 8.4% and overall success rate was 98.6% at median follow-up of 16 months. There was significant improvement in pain score (p=0.0001 and significant decrease in HDN after the procedure. While preoperative mean T1/2 was 26.7±6.4 minutes, postoperative half-time decreased to 7.8±4.2 minutes at 6 months and to 6.7±3.3 minutes at 1 year. Mean pre-operative DRF was 26.45% and it was 31.38% and 33.19% at 6 months and 1 year respectively. Conclusions: Mini-incision pyeloplasty is a safe and effective technique with combined advantage of high success rates of standard open pyeloplasty with decreased morbidity of laparoscopic approach. Excellent functional and objective outcomes can be achieved without extra technical difficulty.

  14. Single incision laparoscopic hepatectomy: Advances in laparoscopic liver surgery. (United States)

    Tayar, Claude; Claude, Tayar; Subar, Daren; Daren, Subar; Salloum, Chady; Chady, Salloum; Malek, Alexandre; Alexandre, Malek; Laurent, Alexis; Alexis, Laurent; Azoulay, Daniel; Daniel, Azoulay


    Laparoscopic liver surgery is now an established practice in many institutions. It is a safe and feasible approach in experienced hands. Single incision laparoscopic surgery (SILS) has been performed for cholecystectomies, nephrectomies, splenectomies and obesity surgery. However, the use of SILS in liver surgery has been rarely reported. We report our initial experience in seven patients on single incision laparoscopic hepatectomy (SILH). From October 2010 to September 2012, seven patients underwent single-incision laparoscopic liver surgery. The abdomen was approached through a 25 mm periumbilical incision. No supplemental ports were required. The liver was transected using a combination of LigaSure™ (Covidien-Valleylab. Boulder. USA), Harmonic Scalpel and Ligaclips (Ethicon Endo-Surgery, Inc.). Liver resection was successfully completed for the seven patients. The procedures consisted of two partial resections of segment three, two partial resections of segment five and three partial resections of segment six. The mean operative time was 98.3 min (range: 60-150 min) and the mean estimated blood loss was 57 ml (range: 25-150 ml). The postoperative courses were uneventful and the mean hospital stay was 5.1 days (range: 1-13 days). Pathology identified three benign and four malignant liver tumours with clear margins. SILH is a technically feasible and safe approach for wedge resections of the liver without oncological compromise and with favourable cosmetic results. This surgical technique requires relatively advanced laparoscopic skills. Further studies are needed to determine the potential advantages of this technique, apart from the better cosmetic result, compared to the conventional laparoscopic approach.

  15. Incisive papilla and positions of maxillary anterior teeth among ...

    African Journals Online (AJOL)

    Results: One hundred and twelve maxillary casts generated from participants aged 18-35 years (mean age 22.39±2.00 years), with well aligned arches were studied. The maxillary central incisor exhibited a mean of 14.93±1.52mm from the posterior limit of the incisive papilla while the inter-canine line scored a mean of ...

  16. Single incision laparoscopic hepatectomy: Advances in laparoscopic liver surgery

    Directory of Open Access Journals (Sweden)

    Tayar Claude


    Full Text Available Background: Laparoscopic liver surgery is now an established practice in many institutions. It is a safe and feasible approach in experienced hands. Single incision laparoscopic surgery (SILS has been performed for cholecystectomies, nephrectomies, splenectomies and obesity surgery. However, the use of SILS in liver surgery has been rarely reported. We report our initial experience in seven patients on single incision laparoscopic hepatectomy (SILH. Patients and Methods: From October 2010 to September 2012, seven patients underwent single-incision laparoscopic liver surgery. The abdomen was approached through a 25 mm periumbilical incision. No supplemental ports were required. The liver was transected using a combination of LigaSure TM (Covidien-Valleylab. Boulder. USA, Harmonic Scalpel and Ligaclips (Ethicon Endo-Surgery, Inc.. Results: Liver resection was successfully completed for the seven patients. The procedures consisted of two partial resections of segment three, two partial resections of segment five and three partial resections of segment six. The mean operative time was 98.3 min (range: 60-150 min and the mean estimated blood loss was 57 ml (range: 25-150 ml. The postoperative courses were uneventful and the mean hospital stay was 5.1 days (range: 1-13 days. Pathology identified three benign and four malignant liver tumours with clear margins. Conclusion: SILH is a technically feasible and safe approach for wedge resections of the liver without oncological compromise and with favourable cosmetic results. This surgical technique requires relatively advanced laparoscopic skills. Further studies are needed to determine the potential advantages of this technique, apart from the better cosmetic result, compared to the conventional laparoscopic approach.

  17. Endoscope-assisted transoral thyroidectomy using a frenotomy incision. (United States)

    Woo, Seung Hoon


    Natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) has generated excitement among surgeons as potentially scar-free surgery. We developed this technique while taking into consideration that it could also be applied to transoral thyroid surgery. We report the case of a 35-year-old woman with a 0.5×0.5-cm papillary thyroid microcarcinoma. We implemented a modified approach for the removal of the thyroid by using a frenotomy incision of the mouth, accompanied by an endoscope system. A modified approach for the removal of the thyroid was used on the patient. The total operating time was 120 minutes, and there were no specific complications. The patient continues to be free of any diseases 12 months after the excision. Thyroidectomy can be performed by a transoral endoscope-assisted approach through a frenotomy incision of the mouth. We describe the detailed procedures for an endoscope-assisted transoral thyroidectomy using a frenotomy incision.

  18. Large-scale single incised valley from a small catchment basin on the western Adriatic margin (central Mediterranean Sea) (United States)

    Maselli, Vittorio; Trincardi, Fabio


    The Manfredonia Incised Valley (MIV) is a huge erosional feature buried below the Apulian shelf, on the western side of the Adriatic margin. The incision extends more than 60 km eastward, from the Tavoliere Plain to the outer shelf, not reaching the shelf edge. High-resolution chirp sonar profiles allow reconstruction of the morphology of the incision and its correlation at regional scale. The MIV records a single episode of incision, induced by the last glacial-interglacial sea level fall that forced the rivers draining the Tavoliere Plain to advance basinward, reaching their maximum extent at the peak of the Last Glacial Maximum. The valley was filled during a relatively short interval of about 10,000 yr during the Late Pleistocene-Holocene sea level rise and almost leveled-off at the time of maximum marine ingression, possibly recording the short-term climatic fluctuations that occurred. The accommodation space generated by the lowstand incision was exploited during the following interval of sea level rise by very high rates of sediment supply that allowed the preservation of up to 45 m of valley fill. High-resolution chirp sonar profiles highlight stratal geometries that are consistent with a typical transgressive valley fill of an estuary environment, including bay-head deltas, central basin and distal barrier-island deposits, organized in a backstepping configuration. The highest complexity of the valley fill is reached in the shallowest and most proximal area, where a kilometric prograding wedge formed during a period dominated by riverine input, possibly connected to high precipitation rates. Based on the depth of the valley margins during this interval, the fill was likely isochronous with the formation of sapropel S1 in the Mediterranean region and may have recorded significant fluctuations within the hydrological cycle.

  19. In vivo architectural analysis of clear corneal incisions using anterior segment optical coherence tomography. (United States)

    Dupont-Monod, Sylvère; Labbé, Antoine; Fayol, Nicolas; Chassignol, Alexis; Bourges, Jean-Louis; Baudouin, Christophe


    To use anterior segment optical coherence tomography (AS-OCT) to analyze the in vivo architecture of clear corneal incisions after phacoemulsification using different techniques. Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital, Paris, France. This prospective observational study analyzed clear corneal incisions used in phacoemulsification. All wounds were evaluated 1 day and 8 days postoperatively by AS-OCT (Visante). Incision architecture and pachymetry at the wound level were analyzed. Thirty-five clear corneal incisions were analyzed. Six eyes had 2.75 mm coaxial phacoemulsification, 19 had 2.20 mm microincision coaxial phacoemulsification, and 10 had 1.30 mm bimanual microincision phacoemulsification. The 1.30 mm incision had a straight-line configuration. The 2.20 mm and 2.75 mm incisions had an arcuate configuration. The angles of incidence of 1.30 mm incisions were greater than those of 2.20 mm incisions (P<.001). All incisions had slight corneal edema limited to the incision area. The edema was slightly greater around 1.30 mm incisions (mean pachymetry 1143 microm +/- 140 [SD]) than around 2.20 mm incisions (mean 1012 +/- 101 microm) (P = .001). Bimanual procedures had satisfactory endothelial apposition in the enlarged areas, where stromal edema was less than that surrounding the unenlarged 1.30 mm incisions. The 3 phacoemulsification techniques induced gaping of the endothelial edge, minor inadequate endothelial apposition, and mild stromal edema in the area of the clear corneal incisions. Bimanual microincision sleeveless phacoemulsification may alter the wound slightly more than coaxial 2.75 mm and microcoaxial 2.20 mm sleeved-tip phacoemulsification.

  20. Transumbilical single incision laparoscopic cholecystectomy with conventional instruments: A continuing study

    Directory of Open Access Journals (Sweden)

    Rajeev Sinha


    Full Text Available Introduction: The feasibility of the single incision, multiport transumbilical approach(SILC for the treatment of symptomatic gallbladder calculus disease has been established. Aims: The study examines both short and long term morbidity of the SILC approach. Materials and Methods: All the 1338 patients were operated by the same surgeon through a transversely placed umbilical incision in the upper third of the umbilicus.Three conventional ports,10,5 and 5 mm were introduced through the same skin incision but through separate transfascial punctures.The instruments were those used for standard laparoscopic cholecystectomy(SLC.Patients with acute cholecystitis and calculous pancreatitis were included,while those with choledocholithiasis were excluded.Results were compared with those of SLC. Results: Forty patients had difficult gall bladders, 214 had acute cholecystitis, and 16 had calculous pancreatitis.The mean operating time was 24.7 mins as compared to 18.4 mins in SLC. Intracorporeal knotting was required in four patients. Conversion to SLC was required in 12 patients.Morrisons pouch drain was left in 3 patients.Injectable analgesics were required in 85% vs 90% (SILC vs SLC on day 1 and 25% vs 45% on day 2 and infection was seen in 6(0. 45% patients.Port site hernia was seen in 2 patients. The data was compared with that of SLC and significance calculated by the student ′t′ test. A p value less than 0.05 was considered as significant. Conclusions: Trans umbilical SILC gives comparable results to SLC, and is a superior alternative when cosmesis and postoperative pain are considered, but the operative time is significantly more.

  1. Early experience with single incision laparoscopic surgery: eliminating the scar from abdominal operations. (United States)

    Dutta, Sanjeev


    Single incision laproscopic surgery (SILS) involves performing abdominal operations with laparoscopic instruments placed through a single, small umbilical incision. The primary goal is to avoid visible scarring. This is the first report of SILS cholecystectomy in children and the first report in the literature of SILS splenectomy. A retrospective chart review was performed in 20 consecutive inpatient SILS procedures (13 males, 7 females; ages 2-17 years) from May to December 2008. Outcome measures included need for conversion, operative time, time to oral analgesia, length of hospitalization, cosmetic outcome, and complications. There were 4 total splenectomies, 3 cholecystectomies, 2 combined splenectomy/cholecystectomies, and 11 appendectomies performed. All procedures were completed successfully without need for conversion to standard laparoscopy or open surgery. Mean operative time was 90 minutes for splenectomy, 68 minutes for cholecystectomy, 165 minutes for combined splenectomy/cholecystectomy, and 33 minutes for appendectomy. Mean hospital stay was 1 day for appendectomy, 1 day for cholecystectomy, and 2.5 days for splenectomy. One splenectomy patient received 1 U packed red blood cell transfusion. All appendectomy patients were converted to oral analgesia within 24 hours and splenectomy patients within 48 hours. All families were very pleased with the cosmetic outcome. Single incision laparoscopic surgery is feasible for a variety of pediatric general surgical conditions, allowing for scarless abdominal operations. This early experience suggests that outcomes are comparable to standard laparoscopic surgery but with improved cosmesis, however, a larger series is necessary to confirm these findings and to determine if there are any benefits in pain or recovery. Surgeons performing SILS should have a firm foundation of advanced minimal access surgical skills and a cautious, gradated approach to attempting the various procedures. Technological refinements will

  2. Spatial variations in fluvial incision across the eastern margin of Tibet reveal locus of deformation in the deep crust (United States)

    Kirby, Eric


    The manifestation of coupling among climate, erosion and tectonics along steep topographic margins of orogenic plateaus is strongly dependent on the processes driving crustal thickening. Along the eastern margin of the Tibetan Plateau, a long-standing and vigorous debate persists over whether mountain building occurred largely along upper-crustal faults or was the consequence of distributed thickening in the lower crust. Here I revisit this debate and show how surface deformation recorded by geomorphology over millennial timescales (10^4-105 yr) can yield insight into the role the deep crust along plateau margins. In contrast to the intensively studied Longmen Shan, the topographic margin of the Tibetan Plateau north of the Sichuan Basin follows the north-south Min Shan and cuts orthogonally across the structural grain of the Mesozoic West Qinling orogen. The lack of a direct association of topography with upper crustal faults affords an opportunity to evaluate the patterns of differential rock uplift from geomorphology. First, I employ an empirical calibration of river profile steepness (channel gradient normalized for drainage basin area) and erosion rate from cosmogenic 10Be concentrations in modern sediment. Application to the channels draining the plateau margin reveals a locus of high (300-500 m/Myr) erosion rate coincident with the Min Shan. Second, I present new results of surveying and dating of fluvial terraces developed along the Bailong Jiang, one of the major rivers draining across the plateau margin. A preliminary chronology of terrace formation and abandonment based on radiocarbon and OSL dating of fluvial deposits reveals systematic spatial gradients in fluvial incision, with highest incision rates (1000-2000 m/Myr) localized along the axis of the Min Shan and decreasing toward both the foreland and the plateau. This locus of incision has apparently been sustained through multiple generations of terrace formation and abandonment since at least 80 ka

  3. Crayfish Use of Trash Versus Natural Cover in Incised, Sand-Bed Streams (United States)

    Adams, Susan B.


    Historic land use changes and subsequent river channelization created deeply incised, unstable stream channels largely devoid of natural cover throughout the Yazoo River basin, Mississippi, USA. Large trash (e.g., televisions, toilets, car parts) dumped in streams provided shelter for some aquatic fauna. To determine whether trash served as a surrogate for natural cover, I examined crayfish use of both cover types. I sampled crayfishes by kick-seining 2 × 1-m plots in three cover classes: trash, natural cover, and no cover. I captured 415 crayfishes from 136 of the 294 plots. Most crayfishes were in natural cover (253), followed by trash (154), and no-cover (8) plots. Trash use varied by crayfish genus and size. Frequencies of all size classes of Procambarus and of the smallest Cambarus were higher in natural cover than trash. Many of the smallest individuals were found in live root mats. As Cambarus and Orconectes grew, they shifted more toward trash, and the largest Orconectes size class was significantly more abundant than expected in trash. Trash served as "artificial reefs," providing cover for crayfishes and other fauna, but functioned differently than the remaining natural cover. The results confirmed that stream substrate did not provide adequate instream cover for crayfishes in the study area and suggested that high-quality natural cover for large crayfishes was in short supply, at least for some species. Land management that provides for abundant, ongoing input and retention of complex cover, such as trees and live roots, to stream channels should be beneficial for crayfish assemblages.

  4. Pressure Irrigation of Surgical Incisions and Traumatic Wounds. (United States)

    Fry, Donald E

    Pressure irrigation of surgical incisions and traumatic wounds is commonly used to prevent infections. Commercial pressure irrigation devices have proliferated rapidly, but scientific validation of clinical benefit or appropriate use remains uncertain. The published experimental and clinical investigations of pressure irrigation have been reviewed since the introduction of the Waterpik device in 1967 to identify the evidence for use to prevent soft tissue infections associated with injury wounds or surgical incisions. The published literature favors low pressure irrigation between 5-15 pounds/square inch (psi) for experimental removal of bacteria from contaminated tissues, with pressures higher being associated with soft tissue and bone injury. No experimental or clinical data have demonstrated improved benefit from pulsed over continuous lavage. Clinical studies have been very heterogeneous in patient populations and study design; meta-analysis was not feasible. High-risk abdominal operations may have lower surgical site infection rates with pressure irrigation. Pressure irrigation in fractures and joint replacement surgery has shown mixed results. The largest multi-center randomized trial showed no benefit of pulsed (8-10 psi) lavage over conventional continuous gravity irrigation of open fractures. Experimental studies have shown effective removal of bacteria and contamination, but with a potential risk of tissue injury or displacement of contamination deeper into the soft tissues. Rigorous clinical documentation has not validated the optimum flow or pressure characteristics of pressure lavage in clinical practice. There is need for randomized clinical trials to validate pressure lavage in the prevention of infections in soft tissue injuries or high-risk surgical incisions.

  5. Single transverse extended incision for radical neck dissection

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    José Francisco Sales Chagas

    Full Text Available ABSTRACT Objective: to assess the efficacy of the single transverse extended cervical incision in radical neck dissection. Method: we conducted a prospective study, from January 2008 to January 2009, with 18 patients undergoing surgical treatment of malignant tumors of the upper aero-digestive tract. The primary lesion was located in the oral cavity in eight cases, in the oropharynx in three, in the hypopharynx in three, in the larynx in two, in the maxillary sinus, and in one case, the primary injury was hidden. There were 29 neck dissections, eight bilateral and 10 unilateral (26 radical and three selective. Staging revealed nine patients with T4 tumor, one T3, six T2, one T1 and one Tx. Five patients were N0, nine N2b, one N2c and three N3. The average number of dissected lymph nodes was 34.25. We performed the neck dissection through a single incision located in the middle neck, coincident with the skinfold, with a length of about 2 to 3 cm behind the anterior edge of the trapezius muscle and 3 to 4 cm from the midline for the unilateral neck dissections. Results: as complications, there were myocutaneous flap necrosis in one patient with prior radiation therapy, one lymphatic fistula, one dehiscence of the tracheostomy, one cervical abscess, one salivary fistula and one suture dehiscence. Conclusions: the single extended incision provides adequate exposure of the neck structures, without compromising surgical time, even in bilateral dissections. It does not compromise the resection of all cervical lymph nodes; it has excellent aesthetic and functional results and is easily associated with other approaches to resection of the primary tumor.

  6. The extended minimal incision approach to midface rejuvenation. (United States)

    Pontius, Allison T; Williams, Edwin F


    Recent major advancements in comprehensive facial rejuvenation have focused on management of midfacial aging. Multiple techniques have been described to treat the aging midface; the mere nature of so many approaches is evidence that no one technique has prevailed. Although the nasolabial region remains a challenge to correct, the approach described herein provides comprehensive rejuvenation of the midface, lateral brow, and jawline. The technique is performed via a minimal incision brow-lift approach and has been performed (with minor modifications) by the senior author in more than 650 patients over the past 9 years. The technique has proven to be safe, reliable, and effective.

  7. A case of endophthalmitis associated with limbal relaxing incision

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    Aravind Haripriya


    Full Text Available Limbal relaxing incisions (LRIs are considered a relatively safe procedure with rapid stabilization and absence of infectious complications. Do we need to readdress this last impression? We report a case of nocardia endophthalmitis associated with an exudate at the site of an LRI in a patient who underwent routine cataract surgery. This case, to the best of our knowledge, is the first report of its kind, stressing the need for a cautious approach to the adoption of this method of astigmatic correction.

  8. Treatment of bilateral mammary ptosis and pectus excavatum through the same incision in one surgical stage

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    Fernando Passos Rocha

    Full Text Available CONTEXT: Congenital deformities of the anterior thoracic wall are characterized by unusual development of the costal cartilages. All these medical conditions are frequently associated with a variety of breast deformities. Several surgical techniques have been described for correcting them, going from sternochondroplasty to, nowadays, minimally invasive techniques and silicone prosthesis implantation. CASE REPORT: The present article reports the case of a young female patient who presented bilateral mammary ptosis and moderate pectus excavatum that caused a protrusion between the eighth and the tenth ribs and consequent esthetic disharmony. The proposed surgical treatment included not only subglandular breast implants of polyurethane, but also resection of part of the rib cartilage and a bone segment from the eighth, ninth and tenth ribs by means of a single submammary incision in order to make the scar minimally visible. Correction through a single incision benefited the patient and provided an excellent esthetic result. CONCLUSIONS: The techniques used to repair bilateral mammary ptosis and pectus excavatum by plastic and thoracic surgery teams, respectively, have been shown to be efficient for correcting both deformities. An excellent esthetic and functional result was obtained, with consequent reestablishment of the patient's self-esteem.

  9. Distal biceps tendon rupture reconstruction using muscle-splitting double-incision approach. (United States)

    Tarallo, Luigi; Mugnai, Raffaele; Zambianchi, Francesco; Adani, Roberto; Catani, Fabio


    To evaluate the clinical and functional results after repair of distal biceps tendon tears, following the Morrey's modified double-incision approach. We retrospectively reviewed 47 patients with distal rupture of biceps brachii treated between 2003 and 2012 in our Orthopedic Department with muscle-splitting double-incision technique. Outcome measures included the Mayo elbow performance, the DASH questionnaire, patient's satisfaction, elbow and forearm motion, grip strength and complications occurrence. At an average 18 mo follow-up (range, 7 mo-10 years) the average Mayo elbow performance and DASH score were respectively 97.2 and 4.8. The elbow flexion range was 94%, extension was -2°, supination was 93% and pronation 96% compared with the uninjured limb. The mean grip strength, expressed as percentage of respective contralateral limb, was 83%. The average patient satisfaction rating on a Likert scale (from 0 to 10) was 9.4. The following complications were observed: 3 cases of heterotopic ossification (6.4%), one (2.1%) re-rupture of the tendon at the site of reattachment and 2 cases (4.3%) of posterior interosseous nerve palsy. No complication required further surgical treatment. This technique allows an anatomic reattachment of distal biceps tendon at the radial tuberosity providing full functional recovery with low complication rate.

  10. 5-year results of the 1.5cm incision Achilles tendon repair. (United States)

    Ling, Samuel K K; Slocum, Amanda; Lui, T H


    To study a hypothesis that the cost-effective 1.5cm medial incision Achilles tendon repair technique will provide good functional outcomes which are maintained for over 5 years. Prospective study of 12 consecutive cases with a minimal 5-year follow-up were recruited from April 2008 to November 2010. Cases whom were mentally incompetent or those which required concomitant procedures were excluded. Outcomes measures included the numeric pain rating scale, motor power strength, range of motion, functional scoring using the AOFAS hindfoot score and patient's self-assessment using the Foot and Ankle Outcome Score (FAOS). No re-ruptures or sural nerve injured were identified after a minimal 5-year follow-up. Pain was minimal at 0.5/10, calf power was 5/5 and ankle range was good (plantarflexion: 38°/dorsiflexion: 21°). The AOFAS hindfoot score was 97.4 and all 5 sub-categories of the Foot and Ankle Outcome Score (FAOS) were good. The 1.5cm medial incision repair of the Achilles tendon is an economically sound surgical technique, with minimal complications, which gives good medium length functional outcomes. IV. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Simplified bone-anchored hearing aid insertion using a linear incision without soft tissue reduction. (United States)

    Husseman, J; Szudek, J; Monksfield, P; Power, D; O'Leary, S; Briggs, R


    Numerous techniques have been described to manage the skin and other soft tissues during bone-anchored hearing aid insertion. Previously, generally accepted techniques have sometimes led to distressing alopecia and soft tissue defects. Now, some surgeons are rejecting the originally described split skin flap in favour of a less invasive approach. To investigate bone-anchored hearing aid placement utilising a single, linear incision with either no or minimal underlying soft tissue reduction. Thirty-four adults were prospectively enrolled to undergo single-stage bone-anchored hearing aid placement with this modified technique. A small, linear incision was used at the standard position and carried down through the periosteum. Standard technique was then followed with placement of an extended length abutment. Patients were reviewed regularly to assess wound healing, including evaluation with Holgers' scale. Only 14.7 per cent of patients had a reaction score of 2 or higher. Most complications were limited to minor skin reactions that settled with silver nitrate cautery and/or antibiotics. None required revision surgery for tissue overgrowth, and there were no implant failures. Our results suggest this to be a simple and effective insertion technique with favourable cosmesis and patient satisfaction.

  12. Single Incision Laparoscopic Cholecystectomy vs Conventional Cholecystectomy in Developing Country

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    P B Thapa


    Full Text Available INTRODUCTION: Use of laparoscopic surgery has demanded principles of less trauma of access hence less scar and so probably less complications. Hence conventional laparoscopic surgeries were tried with natural orifice transluminal surgery (NOTES and then single incision laparoscopic surgery (SILS. With refinement in instruments and surgeons skills SILS have bridged up between conventional and NOTES in order to quench the desire of less or no scar at all. METHODS: Comparative case control study between conventional laparoscopic cholecystectomy and SILS in public teaching hospital. RESULTS: Total 20 patients underwent SILS cholecystectomy and 20 underwent conventional cholecystectomy and found that no difference between both in terms of post operative pain score, hospital stay and post operative wound infection except significant difference in mean operative time and patient's level of satisfaction was less in patient with SILC if were subjected to pay for instruments in order to maintain cosmesis. CONCLUSIONS: Though SILS have gained rapid acceptance in surgical fraternity, large number of randomized controlled trials are necessary to show its benefit over conventional laparoscopic cholecystectomy. Keywords: cholecystectomy, conventional, laparoscopy, single incision, surgery

  13. Single-incision laparoscopic surgery for diverticulitis in overweight patients. (United States)

    Rink, Andreas D; Vestweber, Boris; Hahn, Jasmina; Alfes, Angelika; Paul, Claudia; Vestweber, Karl-Heinz


    Single-incision laparoscopic surgery (SILS) has been introduced as a new technique for the treatment of various colorectal diseases. Recurrent or complicated diverticulitis of the sigmoid colon is a frequent indication for minimally invasive sigmoid colectomy. The aim of this study was to investigate the impact of obesity on the outcome of SILS sigmoid colectomy. From September 2009 to October 2014, data from 377 patients who had intended SILS sigmoid colectomy for diverticulitis at our institution were collected in a prospective database. The patients were categorized in the following subgroups: group 1 (normal weight, body mass index (BMI)  35 kg/m(2)). The groups were equivalent for sex, age, status of diverticulitis, the presence of acute inflammation in the specimen, and the percentage of teaching operations, but the percentage of patients with accompanying diseases was significantly more frequent in groups 2, 3, and 4 (p = 0.04, 0.008, and 0.018, respectively). As compared to group 1, the conversion rate was significantly increased in groups 2 and 4 (2.3 vs. 9.3% (p = 0.013) and 2.3 vs. 12.5% (p = 0.017), respectively). The duration of surgery, hospitalization, and morbidity did not differ between the four groups. Up to a body mass index of 35 kg/m(2), increased body weight does not significantly reduce the feasibility and outcome of single-incision laparoscopic surgery for diverticulitis.

  14. Muscle sparing lateral thoracotomy: the standard incision for thoracic procedures

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    Mihai Dumitrescu


    Full Text Available Lateral thoracotomy is a versatile approach with many variations and is currently the most widely used incision in thoracic surgery. In the current article we are presenting the muscle-sparing lateral thoracotomy in the lateral decubitus position which we consider to be the “standard” for lateral thoracotomies. Indications, surgical technique and pitfalls are described alongside our experience with thoracic drainage. Although there is no consensus regarding the name of this incision, some authors call it “axillary thoracotomy” while others call it a “modified lateral thoracotomy”, they all agree on one aspect – the importance of muscle sparing – which makes it the go-to thoracotomy for both small and large procedures involving the lung. Lateral muscle sparing thoracotomy allows for good exposure of the pulmonary hilum, fissures, apex and diaphragm. The approach is easy and quick to perform while at the same time ensuring faster postoperative recovery by sparing the latissimus dorsi muscle, better cosmetics and lower postoperative pain score when compared to the posterolateral or classical lateral thoracotomies.

  15. Unilateral corneal ectasia following small-incision lenticule extraction. (United States)

    Sachdev, Gitansha; Sachdev, Mahipal S; Sachdev, Ritika; Gupta, Hemlata


    We describe a case of unilateral corneal ectasia in a 26-year-old man following small-incision lenticule extraction. The preoperative corneal topography was normal, with a minimum corneal thickness of 511 μm and 513 μm in the right eye and left eye, respectively. Lenticules of 85 μm and 82 μm were fashioned to offer a refractive correction of -3.75 -1.50 × 180 and -3.50 -1.50 × 165 in the right eye and left eye, respectively. Twelve months after small-incision lenticule extraction, the patient presented with early signs of ectasia in the left eye on corneal topography, which had worsened at the 18-month examination. Intrastromal corneal ring segment implantation with corneal collagen crosslinking was performed to arrest further progression and to improve uncorrected distance visual acuity. On the last examination, the corrected distance visual acuity was 20/20(-2). Dr. Mahipal S. Sachdev receives travel grants from Carl Zeiss Meditec AG. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  16. Endoscopy-assisted cerebral falx incision via unilateral

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    DONG Ji-rong


    Full Text Available 【Abstract】Objective: To investigate the clinical features and treatment strategy of dissymmetric bilateral frontal contusion, and to summarize our experience in treat-ing these patients by minimally invasive surgery. Methods: Over the past 3 years, we have treated a total of 31 patients with dissymmetric bilateral frontal contusion using endoscopy-assisted unilateral cerebral falx incision. Other 30 patients treated by routine bilateral approaches within the same period were taken as control. Results: Seventeen cases (54.8% in the unilateral operation group survived and were in good condition, 8 (25.8% had moderate disability, 4 (12.9% had severe disability, 1 (3.2% was in vegetative state, and 1 (3.2% died. Compared with the control group, the Glasgow Out-come Scale score was not significantly different in the uni-lateral operation group, but the operation time, blood trans-fusion volume, the length of hospital stay, the incidences of mental disorder and olfactory nerve injury were greatly reduced in the unilateral operation group. Conclusions: Endoscopy-assisted unilateral cerebral falx incision can shorten the operation time, reduce surgical trauma and complications in treatment of patients with dis-symmetric bilateral frontal contusion. It can obviously di-minish the chance of delayed intracerebral hematoma and subsequently minimize the incidences of subfalcial and centrencephalic herniation. Key words: Brain injuries; Intracranial hemorrage, traumatic; Endoscopy; Surgically procedures, minimally invasive

  17. Magnetic resonance imaging evaluation of incision healing after cesarean sections

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    Dicle, O.; Kuecuekler, C.; Pirnar, T.; Erata, Y.; Posaci, C.


    The purpose of this study was to examine the healing period of incision scar in myometrial wall and the normal pelvis after cesarean sections by means of MRI. In this study 17 voluntary women were examined after their first delivery with cesarean section in the early postpartum period (first 5 days), and following this, three more times in 3-month intervals. The MRI examinations were performed on a 1.0-T system (Magnetom, Siemens, Erlangen, Germany), and sagittal T1-weighted (550/17 TR/TE) and T2-weighted (2000/80 TR/TE) spin-echo (SE) images of the pelvis were obtained. During follow-up examinations incision scar tissues lost their signals within the first 3 months on both SE sequences, and little alteration was observed in the subsequent tests. Zonal anatomy of the uterus reappeared completely 6 months after cesarean sections. The time for the involution of the uterus was independent of the zonal anatomy recovery, and the maximum involution was inspected within the first 3 months. In conclusion, the maturation time of myometrial scar tissue in uncomplicated cesarean sections, which can be evaluated by the signal alterations in MRI, is approximately 3 months, whereas the complete involution and the recovery of the zonal anatomy need at least 6 months. (orig.). With 6 figs

  18. Magnetic resonance imaging evaluation of incision healing after cesarean sections

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    Dicle, O. [Department of Radiodiagnosis, Dokuz Eyluel University, Izmir (Turkey); Kuecuekler, C. [Department of Radiodiagnosis, Dokuz Eyluel University, Izmir (Turkey); Pirnar, T. [Department of Radiodiagnosis, Dokuz Eyluel University, Izmir (Turkey); Erata, Y. [Department of Gynecology and Obstetrics, Dokuz Eyluel University, Izmir (Turkey); Posaci, C. [Department of Gynecology and Obstetrics, Dokuz Eyluel University, Izmir (Turkey)


    The purpose of this study was to examine the healing period of incision scar in myometrial wall and the normal pelvis after cesarean sections by means of MRI. In this study 17 voluntary women were examined after their first delivery with cesarean section in the early postpartum period (first 5 days), and following this, three more times in 3-month intervals. The MRI examinations were performed on a 1.0-T system (Magnetom, Siemens, Erlangen, Germany), and sagittal T1-weighted (550/17 TR/TE) and T2-weighted (2000/80 TR/TE) spin-echo (SE) images of the pelvis were obtained. During follow-up examinations incision scar tissues lost their signals within the first 3 months on both SE sequences, and little alteration was observed in the subsequent tests. Zonal anatomy of the uterus reappeared completely 6 months after cesarean sections. The time for the involution of the uterus was independent of the zonal anatomy recovery, and the maximum involution was inspected within the first 3 months. In conclusion, the maturation time of myometrial scar tissue in uncomplicated cesarean sections, which can be evaluated by the signal alterations in MRI, is approximately 3 months, whereas the complete involution and the recovery of the zonal anatomy need at least 6 months. (orig.). With 6 figs.

  19. active tectonics, incision rate and sedimentation in the subandean belt inferred from the caracteristics of the Pilcomayo river (United States)

    Bécel, D.; Mugnier, J. L.; Granjeon, D.


    Simple rationales have generally been used to derive a resultant macroscopic relationship and to relate channel river properties, to the rate of fluvial incision into bedrock. The fluvial shear stress model seems a robust model for the active foothill environment. To use this model, we have therefore collected the parameters of the Pilcomayo river: a) granulometry from field work ; b) drainage area from DEM ; c) slope from 1/50000 topographic maps and GPS measurements ; d) width from field work and topographic maps ; e) water discharge from filled work and bibliography. A comparison between the calculated shear stress and the structure of the subandean zone shows that the shear stress increases at the hanging-wall of 3 thrust faults. These faults show field evidence of recent thrust activity, and we use the ratio of Shield stress through the tertiary sediments at the hanging-wall of these faults to estimate the ratio of activity of these faults. It is found that half of the motion occurs along the Aguarague structure. Considering a 10 mm/yr. mean shortening rate through the subandean belt, the maximum uplift rate is about 6 mm/yr. and the erodability coefficient of the Tertiary is about 40 mm/yr. The shield stress also abruptly increases at the transition between subandean zone and interandean zone, suggesting that this latter develops like a mid-crustal in sequence stack. In the Eastern cordillera, the long term incision is low (1200 m for 3 Ma, i.e. 0.4 mm/yr.) and river presently incises fluvial sediments (Puente Sucre) deposited after 100 000 yr. BP.

  20. Influence of upper and temporal transconjunctival sclerocorneal incision on marginal reflex distance after cataract surgery


    Tamaki, Rikiya; Gosho, Masahiko; Mizumoto, Kyoichi; Kato, Nahoko; Zako, Masahiro


    Background Ptosis incidence following cataract surgery is reduced with a recently developed phacoemulsification technique using a small incision. However, it remains uncertain whether an upper transconjunctival sclerocorneal incision can cause minor blepharoptosis. In the present prospective study, patients underwent cataract surgery with either an upper or temporal 2.4-mm transconjunctival sclerocorneal incision. We measured the marginal reflex distance 1 (MRD1) preoperatively and postoperat...

  1. Nature of the Lowstand Surface on the Gulf of Cádiz Shelf and the Guadiana Incised-Valley System: Preliminary Results from the LASEA 2013 Cruise (United States)

    Lobo, F.; Lebreiro, S.; Antón, L.; Delivet, S.; Espinosa, S.; Fernández-Puga, M. C.; García, M.; Ibáñez, J.; Luján, M.; Mendes, I.; Reguera, M. I.; Sevillano, P.; Sinde, C.; Van Rooij, D.; Zarandona, P.


    The LASEA 2013 cruise was executed in August 2013 in the northern margin of the Gulf of Cádiz, with the main goal of collecting data from the Guadiana River-influenced shelf, in order to: (1) study changes affecting the entire drainage basin; (2) correlate shelf unit sequences with the upper slope sedimentary record, composed dominantly of contourite deposits in specific stretches of the margin. As a first approach, attention is paid to the most obvious sedimentary manifestation of the influence of the river on the shelf domain, represented by the Guadiana incised-valley system. The database comprises both geophysical and sedimentological records. Geophysical data include multibeam bathymetry, TOPAS profiles and single-channel Sparker seismic profiles. Sedimentological data include sediment cores collected with gravity- and vibro-corer devices. The lowstand erosional surface was mapped across the shelf. The lowstand surface exhibits two clearly contrasting patterns. In the outer shelf the surface isrepresented by an erosional truncation that can be planar or irregular. The lowstand surface is much more difficult to follow in the inner shelf, due to the amalgamation of erosional surfaces and the frequent stacking of coarse-grained deposits. Incised valleys are recognized at shallow waters (20-30 m) the most significant of them is at least 1.5 km wide in the most proximal (recognized) section, decreasing seawards in width. The internal architecture of the valley exhibits the intercalation of laterally prograding sediment bodies and high-amplitude, subparallel configurations laterally related to valley margin prograding wedges. The internal facies architecture suggests a transition from relatively high-energy fluvial to proximal estuarine environment to a lower-energy estuarine depositional environment. Thus, the study of the valley extension into the shelf is expected to provide clues for the recent reorganization of the entire fluvial system, during the course of

  2. Carpal tunnel release with a new mini-incision approach versus a conventional approach, a retrospective cohort study. (United States)

    Bai, Jiangbo; Kong, Lingde; Zhao, Hongfang; Yu, Kunlun; Zhang, Bing; Zhang, Jichun; Tian, Dehu


    We have make use of a new method to perform carpal tunnel release (CTR) through a 1.5-2.0 cm long incision The aim of this study is to introduce this method and to compare the effectiveness and safety of this approach to the conventional one. We included consecutive patients diagnosed with primary carpal tunnel syndrome (CTS) who had CTR from January 2015 to September 2016. A total of 85 patients were included in our study. Among them, 42 patients with mini-incision approach were enrolled in group A, and the other 43 patients with conventional approach were enrolled in group B. Objective tests and subjective evaluations were performed to compare the outcomes of mini-incision approach with the conventional approach. Postoperative complications after the two approaches were also compared. At the 12-months follow-up, all patients in both groups got recovery. We found no significant differences between the two groups in postoperative pinch strength, grip strength, 2-point discrimination (2-PD), visual analogue scale (VAS) score, Levine score and the Disabilities of the Arm, Shoulder and Hand (DASH) score (P > 0.05). However, at the one-month follow-up, the percentage of patients with wound pain in group A was significantly lower than that in group B (0.05% vs. 0.23%, P = 0.03). At the 12 months follow-up, the number of patients with persistent wound pain and pillar pain in group B were 2 (4.7%) and 3 (7.0%) respectively, while no patients showed wound pain and pillar pain in group A. Patients with mini-incision approach have satisfactory surgical outcomes, low postoperative complications, and good appearance. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  3. Single-Incision Carpal Tunnel Release and Distal Radius Open Reduction and Internal Fixation: A Cadaveric Study. (United States)

    Gaspar, Michael P; Sessions, Blane A; Dudoussat, Bryan S; Kane, Patrick M


    The safety of surgical approaches for single- versus double-incision carpal tunnel release in association with distal radius open reduction and internal fixation remains controversial. The purpose of this study was to identify critical structures to determine if a single-incision extension of the standard flexor carpi radialis (FCR) approach can be performed safely. Nine cadaveric arms with were dissected under loupe magnification, utilizing a standard FCR approach. After the distal radius exposure was complete, the distal portion of the FCR incision was extended to allow release of the carpal tunnel. Dissection of critical structures was performed, including the recurrent thenar motor branch of the median nerve, the palmar cutaneous branch of the median nerve (PCBm), the palmar carpal and superficial palmar branches of the radial artery, and proximally the median nerve proper. The anatomic relationship of these structures relative to the surgical approach was recorded. Extension of the standard FCR approach as described in this study did not damage any critical structure in the specimens dissected. The PCBm was noted to arise from the radial side of the median nerve an average of 6.01cm proximal to the proximal edge of the transverse carpal ligament. The PCBm became enveloped in the layers of the antebrachial fascia and the transverse carpal ligament at the incision site, protecting it from injury. The recurrent motor branch of the median nerve, branches of the radial artery and the median nerve proper were not at risk during extension of the FCR approach to release the carpal tunnel. Extension of the standard FCR approach to include carpal tunnel release can be performed with minimal risk to the underlying structures. This exposure may offer benefits in both visualization and extent of carpal tunnel release.

  4. Safety of cesarean delivery through placental incision in patients with anterior placenta previa. (United States)

    Hong, Deok-Ho; Kim, Eugene; Kyeong, Kyu-Sang; Hong, Seung Hwa; Jeong, Eun-Hwan


    To demonstrate the safety of fetal delivery through placental incision in a placenta previa pregnancy. We examined the medical records of 80 women with singleton pregnancy diagnosed with placenta previa who underwent cesarean section between May 2010 and May 2015 at the Department of Obstetrics and Gynecology, Chungbuk National University Hospital. Among the women with placenta previa, those who did not have the placenta in the uterine incision site gave birth via conventional uterine incision, while those with anterior placenta previa or had placenta attached to the uterine incision site gave birth via uterine incision plus placental incision. We compared the postoperative hemoglobin level and duration of hospital stay for the mother and newborn of the two groups. There was no difference between the placental incision group and non-incision group in terms of preoperative and postoperative hemoglobin change, the amount of blood transfusions required by the mother, newborns with 1-min or 5-min Apgar scores below 7 points or showing signs of acidosis on umbilical cord blood gas analysis result of pH below 7.20. Moreover, neonatal hemoglobin levels did not differ between the two groups. Fetal delivery through placental incision during cesarean section for placenta previa pregnancy does not negatively influence the prognosis of the mother or the newborn, and therefore, is considered a safe surgical technique.

  5. Ion channeling

    International Nuclear Information System (INIS)

    Erramli, H.; Blondiaux, G.


    Channeling phenomenon was predicted, many years ago, by stark. The first channeling experiments were performed in 1963 by Davies and his coworkers. Parallely Robinson and Oen have investigated this process by simulating trajectories of ions in monocrystals. This technique has been combined with many methods like Rutherford Backscattering Spectrometry (R.B.S.), Particles Induced X-rays Emission (P.I.X.E) and online Nuclear Reaction (N.R.A.) to localize trace elements in the crystal or to determine crystalline quality. To use channeling for material characterization we need data about the stopping power of the incident particle in the channeled direction. The ratios of channeled to random stopping powers of silicon for irradiation in the direction have been investigated and compared to the available theoretical results. We describe few applications of ion channeling in the field of materials characterization. Special attention is given to ion channeling combined with Charged Particle Activation Analysis (C.P.A.A.) for studying the behaviour of oxygen atoms in Czochralski silicon lattices under the influence of internal gettering and in different gaseous atmospheres. Association between ion channeling and C.P.A.A was also utilised for studying the influence of the growing conditions on concentration and position of carbon atoms at trace levels in the MOVPE Ga sub (1-x) Al sub x lattice. 6 figs., 1 tab., 32 refs. (author)

  6. Advantages of the modified double ring areolar incision over the traditional areolar incision in multicentric breast fibroadenoma surgery. (United States)

    Zhang, Mingliang; Shen, Gongjin; Zhang, Song; Cui, Zhen; Qian, Jun


    This study was conducted to investigate the clinical advantages of modified double ring areola incision (MDRAI) compared to ordinary areola incision (OAI) in multicentric breast fibroadenoma in women. Sixty cases of multicentric benign breast tumor were recruited from the First Affiliated Hospital of Bengbu Medical College from January to December 2016. The cases were divided into two groups according to surgical approach: MDRAI (n = 20) and OAI (n = 40). The operation duration, intraoperative blood loss, drainage time, and postoperative recurrence rate in the first six months were compared. The mean age and tumor locations were not statistically different between the groups (P > 0.05). However, more lesions and larger tumor diameter were found in the MDRAI group than in the OAI group, with statistical difference (P  0.05). However, the intraoperative blood loss was statistically different between the two groups (P < 0.05). All 60 cases received six months of follow-up. Eight recurrent cases were found in the OAI group, but none in the MDRAI group. The recurrence rate was significantly different (χ 2  = 4.62, P < 0.05). Compared with OAI, MDRAI offers greater advantages in the aspects of blood loss and recurrence for the treatment of breast benign tumor, especially for multicentric larger lesions. © 2017 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

  7. Muon cooling channels

    CERN Document Server



    A procedure uses the equations that govern ionization cooling, and leads to the most important parameters of a muon cooling channel that achieves assumed performance parameters. First, purely transverse cooling is considered, followed by both transverse and longitudinal cooling in quadrupole and solenoid channels. Similarities and differences in the results are discussed in detail, and a common notation is developed. Procedure and notation are applied to a few published cooling channels. The parameters of the cooling channels are derived step by step, starting from assumed values of the initial, final and equilibrium emittances, both transverse and longitudinal, the length of the cooling channel, and the material properties of the absorber. The results obtained include cooling lengths and partition numbers, amplitude functions and limits on the dispersion at the absorber, length, aperture and spacing of the absorber, parameters of the RF system that achieve the longitudinal amplitude function and bucket area ...

  8. Calcium channel blocker poisoning

    Directory of Open Access Journals (Sweden)

    Miran Brvar


    Full Text Available Background: Calcium channel blockers act at L-type calcium channels in cardiac and vascular smooth muscles by preventing calcium influx into cells with resultant decrease in vascular tone and cardiac inotropy, chronotropy and dromotropy. Poisoning with calcium channel blockers results in reduced cardiac output, bradycardia, atrioventricular block, hypotension and shock. The findings of hypotension and bradycardia should suggest poisoning with calcium channel blockers.Conclusions: Treatment includes immediate gastric lavage and whole-bowel irrigation in case of ingestion of sustainedrelease products. All patients should receive an activated charcoal orally. Specific treatment includes calcium, glucagone and insulin, which proved especially useful in shocked patients. Supportive care including the use of catecholamines is not always effective. In the setting of failure of pharmacological therapy transvenous pacing, balloon pump and cardiopulmonary by-pass may be necessary.

  9. Mouse preferential incising force orientation changes during jaw closing muscle hyperalgesia and is sex dependent. (United States)

    Widmer, C G; Morris-Wiman, J


    Mouse incising is controlled by a central pattern generator and this activity can change in the presence of pain. The incising frequency and maximum force generation decreases with pain. In this study, we used repetitive acidic injections in the left masseter muscle of male and female mice to determine differences between baseline and jaw muscle pain conditions and the effect of sex on preferential incising direction. A within subject design was used to evaluate data previously acquired using multi-axis force data (X, Y and Z) from the 4th baseline recording day and day 7 post-injection (day of maximal pain response) for each mouse of each sex. A total of 34 female and male (age 3-9months) CD-1 mice were evaluated. After mathematically rotating the X and Y axes to align the Y axis to be parallel to the wire struts of the cage top, data were analyzed to determine incising direction preference during baseline (non-pain) and pain (day 7) conditions and between sex. Radar plots of X-Y, X-Z and Y-Z axes depicted the average direction of incising preference between baseline and pain conditions for each sex. Statistical differences among groups were tested using a mixed model ANOVA. Similar to previous findings, female mice had a more robust difference in incising direction preference when comparing male and female pain conditions and this was most evident in the X-Z axes. The incising frequencies most commonly affected were 5.3, 6.2 and 7.6Hz. Male mice varied little in their incising direction preference between the baseline and pain conditions. In addition, statistical comparison of ratios of the percent of time spent incising in the Z versus X axes for each incising frequency found that the incising preference was not different when comparing 5.3 and 7.6Hz frequencies. Finally, female mice used a novel approach to minimize pain while incising by rotating their head and body nearly 180 degrees while males did not use this strategy as frequently. The preferred incising

  10. Effects of post-treatment incubation on recombinogenesis in incision-proficient and incision-deficient strains of saccharomyces cerevisiae, 2

    International Nuclear Information System (INIS)

    Saeki, Tetsuya; Machida, Isamu


    After the photoaddition of mono- and bifunctional furocoumarins to G1 phase cells, most gene conversion and crossing-over occurred without post-irradiation incubation of these cells in incision-proficient strains. In contrast, incision-deficient cells showed marked induction of both recombinational events only after treated cells had been incubated for several hours before selection. These results indicate that when furocoumarins are photoadded to G1 cells, initiation of recombinational events occurs during the same G1 phase in the incision-proficient cells; whereas, it occurs only after post-irradiation DNA replication in incision-deficient cells. The action of the PSO2 gene product specific for the repair of DNA crosslinks in recombination induction is discussed and compared to the actions of the excision repair genes RAD1 and RAD2. (author)

  11. Climate-driven sediment aggradation and incision phases since the Late Pleistocene in the NW Himalaya, India (United States)

    Dey, Saptarshi; Thiede, Rasmus C.; Schildgen, Taylor F.; Wittmann, Hella; Bookhagen, Bodo; Scherler, Dirk; Jain, Vikrant; Strecker, Manfred R.


    Deciphering the response of sediment routing systems to climatic forcing is fundamental for understanding the impacts of climate change on landscape evolution and depositional systems. In the Sub-Himalaya, late Pleistocene to Holocene alluvial fills and fluvial terraces record periodic fluctuations of sediment supply and transport capacity on timescale of 103 to 105 years, most likely related to past climatic fluctuations. To evaluate the climatic control on sediment supply and transport capacity, we analyze remnant alluvial fans and terraces in the Kangra Basin of the northwestern Sub-Himalaya. Based on field observations and OSL and CRN-dating, we recognized two sedimentary cycles with major sediment aggradation and subsequent re-incision phases. The large one developed over the entire last glacial period with ˜200 m high alluvial fan (AF1) and the second one during the latest Pleistocene/Holocene with ˜50 m alluvial fan (AF2) and its re-incision . Surface-exposure dating of six terrace levels with in-situ cosmogenic nuclides (10Be) indicates the onset of channel abandonment and ensuing incision phases. Two terrace surfaces from the highest level (T1) sculpted into the oldest-preserved AF1 dates back to 48.9 ± 4.1 ka and 42.1 ± 2.7 ka (2σ error). T2 surfaces sculpted into the remnants of AF1 have exposure ages of 16.8 ± 2 ka and 14.1 ± 0.9 ka, while terraces sculpted into the late Pleistocene- Holocene fan (AF2) provide ages of 8.4± 0.8 ka, 6.6± 0.7 ka, 4.9± 0.4 ka and 3.1± 0.3 ka. Together with previously-published ages on the timing of aggradation, we find a correlation between variations in sediment transport with oxygen-isotope records from regions affected by Indian Summer Monsoon. During stronger monsoon phases and post-LGM glacial retreat manifested by increased sediment delivery (moraines and hillslope-derived) to the trunk streams, causing aggradation in the basin; whereas, weakened monsoon phases characterized by reduced sediment

  12. Is there an improvement of antibiotic use in China? Evidence from the usage analysis of combination antibiotic therapy for type I incisions in 244 hospitals. (United States)

    Zhou, Wen-Juan; Luo, Zhen-Ni; Tang, Chang-Min; Zou, Xiao-Xu; Zhao, Lu; Fang, Peng-Qian


    The improvement of antibiotic rational use in China was studied by usage analysis of combination antibiotic therapy for type I incisions in 244 hospitals. Five kinds of hospitals, including general hospital, maternity hospital, children's hospital, stomatological hospital and cancer hospital, from 30 provinces were surveyed. A systematic random sampling strategy was employed to select outpatient prescriptions and inpatient cases in 2011 and 2012. A total of 29 280 outpatient prescriptions and 73 200 inpatient cases from 244 hospitals in each year were analyzed. Data were collected with regards to the implementation of the national antibiotic stewardship program (NASP), the overall usage and the prophylactic use of antibiotic for type I incisions. Univariate analysis was used for microbiological diagnosis rate before antimicrobial therapy, prophylactic use of antibiotics for type I incision operation, and so on. For multivariate analysis, the use of antibiotics was dichotomized according to the guidelines, and entered as binary values into logistic regression analysis. The results were compared with the corresponding criteria given by the guidelines of this campaign. The antibiotic stewardship in China was effective in that more than 80% of each kind of hospitals achieved the criteria of recommended antibiotics varieties. Hospital type appeared to be a factor statistically associated with stewardship outcome. The prophylactic use of antibiotics on type I incision operations decreased by 16.22% (Pantibiotic therapy for type I incisions was also decreased. Region and bed size were the main determinants on surgical prophylaxis for type I incision. This national analysis of hospitals on antibiotic use and stewardship allows relevant comparisons for bench marking. More efforts addressing the root cause of antibiotics abuse would continue to improve the rational use of antibiotics in China.

  13. Single-incision laparoscopic splenectomy with innovative gastric traction suture

    Directory of Open Access Journals (Sweden)

    Srikanth G


    Full Text Available Laparoscopic splenectomy is now the gold standard for patients with idiopathic thrombocytopenic purpura (ITP undergoing splenectomy. There are a few reports in literature on single-incision laparoscopic (SIL splenectomy. Herein, we describe a patient undergoing SIL splenectomy for ITP without the use of a disposable port device. We report a 20-year-old female patient with steroid-refractory ITP having a platelet count of 14,000/cmm who underwent a SIL splenectomy. Dissection was facilitated by the use of a single articulating grasper and a gastric traction suture and splenic vessels were secured at the hilum with an endo-GIA stapler. She made an uneventful postoperative recovery and was discharged on the second postoperative day. She is doing well with no visible scar at 8-month follow-up.

  14. Median sternotomy - gold standard incision for cardiac surgeons

    Directory of Open Access Journals (Sweden)

    Radu Matache


    Full Text Available Sternotomy is the gold standard incision for cardiac surgeons but it is also used in thoracic surgery especially for mediastinal, tracheal and main stem bronchus surgery. The surgical technique is well established and identification of the correct anatomic landmarks, midline tissue preparation, osteotomy and bleeding control are important steps of the procedure. Correct sternal closure is vital for avoiding short- and long-term morbidity and mortality. The two sternal halves have to be well approximated to facilitate healing of the bone and to avoid instability, which is a risk factor for wound infection. New suture materials and techniques would be expected to be developed to further improve the patients evolution, in respect to both immediate postoperative period and long-term morbidity and mortality

  15. A case of bifocal endometriosis involving a pfannenstiel incision. (United States)

    Evsen, Mehmet Sidik; Sak, Muhammet Erdal; Yalinkaya, Ahmet; Firat, Ugur; Caca, Fatma Nur


    A 25-year-old woman was referred to our clinic for atypical cyclic pain and masses at both ends of a Pfannenstiel incision scar. Ultrasound of the anterior abdominal wall showed two masses. Both masses were hypoechoic, heterogeneous lesions located at opposite ends of the scar. The lesions were surgically excised with. Microscopic examination revealed endometrial gland structures with endometrial stroma in fibroadipose tissue in sections of both specimens indicative of endometriosis. Incisional endometriosis (IE) is a form of extrapelvic endometriosis especially in scars of obstetric or gynecologic surgery IE may be multifocal at surgical scars. We report the a case of bifocal incisional endometriosis in Pfannesteil scar. Whole scar evaluation should be done for incisional endometriosis and surgical excision should be performed for treatment.

  16. Bedrock river networks of the Sierra Nevada, USA record westward tilting, large-scale drainage area loss, and distinct patterns and causes of stream incision between the northern and southern Sierra (United States)

    Beeson, H. W.; McCoy, S. W.


    The timing, rates, and spatial patterns of elevation change in the Sierra Nevada, California, USA, has been the subject of vigorous debate with multiple lines of evidence supporting the contrasting hypotheses that (1) the Sierra has been topographically high throughout the Cenozoic and (2) that the range has experienced a pulse of late Cenozoic uplift. We combined 2-D landscape evolution modeling with topographic analysis of the Sierra Nevada to investigate whether river networks dissecting the range record a change in tectonic forcing during the late Cenozoic. Specifically, we quantify basin geometry, including its area-channel length scaling relationship, fluvial channel steepness, and the spatial distributions of knickzones. We show that, throughout the Sierra, short equilibrated reaches near the mountain front are consistent with an ongoing westward tilt. However, the disequilibrium forms of river profiles north of the Kaweah River reflect large-scale drainage area loss due to network beheading by the Sierra Frontal Fault and/or reestablishment of a fluvial network on an inclined planar surface. Despite these similarities along the length of the range, river network analysis reveals striking differences north and south of approximately 37° N. In the northern Sierra, topographic asymmetry of drainage divides and large differences in cross-divide steady-state elevation suggest mobile divides. Additionally, the broad distribution of normalized knickzone locations, variability in channel steepness and basin shape, and the prevalence of anomalous topology, narrow basins, unadjusted captured reaches, and wind gaps is consistent with large-scale drainage reorganization following incision into an inclined planar surface. In contrast, in the southern Sierra, drainage divides appear more stable and knickzone locations are tightly distributed. We suggest that, although the northern Sierra may currently be tilting westward, the presence of large knickzones and deeply

  17. European Hernia Society guidelines on the closure of abdominal wall incisions

    DEFF Research Database (Denmark)

    Muysoms, F E; Antoniou, S A; Bury, K


    BACKGROUND: The material and the surgical technique used to close an abdominal wall incision are important determinants of the risk of developing an incisional hernia. Optimising closure of abdominal wall incisions holds a potential to prevent patients suffering from incisional hernias and for im...

  18. Performance of fast-absorbable suture and histo-glue in closing incisions in Brown trout

    DEFF Research Database (Denmark)

    Jepsen, Niels; Larsen, Martin Hage; Aarestrup, Kim


    , growth, tag expulsion rate and incision healing was compared among three groups of dummy transmitter-tagged wild brown trout Salmo trutta where incisions were closed with two types of suture material (absorbable vs. fast absorbable) and Histo-glue. The tagged fish were kept in semi-natural ponds for 20...

  19. Midline versus transverse incision for cesarean delivery in low-income countries

    DEFF Research Database (Denmark)

    Maaløe, Nanna; Aabakke, Anna J M; Secher, Niels J


    While transverse incision is the recommended entry technique for cesarean delivery in high-income countries, it is our experience that midline incision is still used routinely in many low-income settings. Accordingly, international guidelines lack uniformity on this matter. Although evidence...

  20. Measurement of toverline{t} production with additional jet activity, including b quark jets, in the dilepton decay channel using pp collisions at √{s} = 8 {TeV} (United States)

    Khachatryan, V.; Sirunyan, A. M.; Tumasyan, A.; Adam, W.; Asilar, E.; Bergauer, T.; Brandstetter, J.; Brondolin, E.; Dragicevic, M.; Erö, J.; Friedl, M.; Frühwirth, R.; Ghete, V. M.; Hartl, C.; Hörmann, N.; Hrubec, J.; Jeitler, M.; Knünz, V.; König, A.; Krammer, M.; Krätschmer, I.; Liko, D.; Matsushita, T.; Mikulec, I.; Rabady, D.; Rahbaran, B.; Rohringer, H.; Schieck, J.; Schöfbeck, R.; Strauss, J.; Treberer-Treberspurg, W.; Waltenberger, W.; Wulz, C.-E.; Mossolov, V.; Shumeiko, N.; Suarez Gonzalez, J.; Alderweireldt, S.; Cornelis, T.; de Wolf, E. A.; Janssen, X.; Knutsson, A.; Lauwers, J.; Luyckx, S.; van de Klundert, M.; van Haevermaet, H.; van Mechelen, P.; van Remortel, N.; van Spilbeeck, A.; Abu Zeid, S.; Blekman, F.; D'Hondt, J.; Daci, N.; de Bruyn, I.; Deroover, K.; Heracleous, N.; Keaveney, J.; Lowette, S.; Moreels, L.; Olbrechts, A.; Python, Q.; Strom, D.; Tavernier, S.; van Doninck, W.; van Mulders, P.; van Onsem, G. P.; van Parijs, I.; Barria, P.; Brun, H.; Caillol, C.; Clerbaux, B.; de Lentdecker, G.; Fasanella, G.; Favart, L.; Grebenyuk, A.; Karapostoli, G.; Lenzi, T.; Léonard, A.; Maerschalk, T.; Marinov, A.; Perniè, L.; Randle-Conde, A.; Reis, T.; Seva, T.; Vander Velde, C.; Yonamine, R.; Vanlaer, P.; Yonamine, R.; Zenoni, F.; Zhang, F.; Adler, V.; Beernaert, K.; Benucci, L.; Cimmino, A.; Crucy, S.; Dobur, D.; Fagot, A.; Garcia, G.; Gul, M.; McCartin, J.; Ocampo Rios, A. A.; Poyraz, D.; Ryckbosch, D.; Salva, S.; Sigamani, M.; Strobbe, N.; Tytgat, M.; van Driessche, W.; Yazgan, E.; Zaganidis, N.; Basegmez, S.; Beluffi, C.; Bondu, O.; Brochet, S.; Bruno, G.; Caudron, A.; Ceard, L.; da Silveira, G. G.; Delaere, C.; Favart, D.; Forthomme, L.; Giammanco, A.; Hollar, J.; Jafari, A.; Jez, P.; Komm, M.; Lemaitre, V.; Mertens, A.; Musich, M.; Nuttens, C.; Perrini, L.; Pin, A.; Piotrzkowski, K.; Popov, A.; Quertenmont, L.; Selvaggi, M.; Vidal Marono, M.; Beliy, N.; Hammad, G. H.; Júnior, W. L. Aldá; Alves, F. L.; Alves, G. A.; Brito, L.; Correa Martins Junior, M.; Hamer, M.; Hensel, C.; Mora Herrera, C.; Moraes, A.; Pol, M. E.; Rebello Teles, P.; Belchior Batista Das Chagas, E.; Carvalho, W.; Chinellato, J.; Custódio, A.; da Costa, E. M.; de Jesus Damiao, D.; de Oliveira Martins, C.; Fonseca de Souza, S.; Huertas Guativa, L. M.; Malbouisson, H.; Matos Figueiredo, D.; Mundim, L.; Nogima, H.; Prado da Silva, W. L.; Santoro, A.; Sznajder, A.; Tonelli Manganote, E. J.; Vilela Pereira, A.; Ahuja, S.; Bernardes, C. A.; de Souza Santos, A.; Dogra, S.; Fernandez Perez Tomei, T. R.; Gregores, E. M.; Mercadante, P. G.; Moon, C. S.; Novaes, S. F.; Padula, Sandra S.; Romero Abad, D.; Ruiz Vargas, J. C.; Aleksandrov, A.; Hadjiiska, R.; Iaydjiev, P.; Rodozov, M.; Stoykova, S.; Sultanov, G.; Vutova, M.; Dimitrov, A.; Glushkov, I.; Litov, L.; Pavlov, B.; Petkov, P.; Ahmad, M.; Bian, J. G.; Chen, G. M.; Chen, H. S.; Chen, M.; Cheng, T.; Du, R.; Jiang, C. H.; Plestina, R.; Romeo, F.; Shaheen, S. M.; Spiezia, A.; Tao, J.; Wang, C.; Wang, Z.; Zhang, H.; Asawatangtrakuldee, C.; Ban, Y.; Li, Q.; Liu, S.; Mao, Y.; Qian, S. J.; Wang, D.; Xu, Z.; Avila, C.; Cabrera, A.; Chaparro Sierra, L. F.; Florez, C.; Gomez, J. P.; Gomez Moreno, B.; Sanabria, J. C.; Godinovic, N.; Lelas, D.; Puljak, I.; Ribeiro Cipriano, P. M.; Antunovic, Z.; Kovac, M.; Brigljevic, V.; Kadija, K.; Luetic, J.; Micanovic, S.; Sudic, L.; Attikis, A.; Mavromanolakis, G.; Mousa, J.; Nicolaou, C.; Ptochos, F.; Razis, P. A.; Rykaczewski, H.; Bodlak, M.; Finger, M.; Finger, M.; El Sawy, M.; El-Khateeb, E.; Elkafrawy, T.; Mohamed, A.; Salama, E.; Calpas, B.; Kadastik, M.; Murumaa, M.; Raidal, M.; Tiko, A.; Veelken, C.; Eerola, P.; Pekkanen, J.; Voutilainen, M.; Härkönen, J.; Karimäki, V.; Kinnunen, R.; Lampén, T.; Lassila-Perini, K.; Lehti, S.; Lindén, T.; Luukka, P.; Mäenpää, T.; Peltola, T.; Tuominen, E.; Tuominiemi, J.; Tuovinen, E.; Wendland, L.; Talvitie, J.; Tuuva, T.; Besancon, M.; Couderc, F.; Dejardin, M.; Denegri, D.; Fabbro, B.; Faure, J. L.; Favaro, C.; Ferri, F.; Ganjour, S.; Givernaud, A.; Gras, P.; Hamel de Monchenault, G.; Jarry, P.; Locci, E.; Machet, M.; Malcles, J.; Rander, J.; Rosowsky, A.; Titov, M.; Zghiche, A.; Antropov, I.; Baffioni, S.; Beaudette, F.; Busson, P.; Cadamuro, L.; Chapon, E.; Charlot, C.; Dahms, T.; Davignon, O.; Filipovic, N.; Florent, A.; Granier de Cassagnac, R.; Lisniak, S.; Mastrolorenzo, L.; Miné, P.; Naranjo, I. N.; Nguyen, M.; Ochando, C.; Ortona, G.; Paganini, P.; Pigard, P.; Regnard, S.; Salerno, R.; Sauvan, J. B.; Sirois, Y.; Strebler, T.; Yilmaz, Y.; Zabi, A.; Agram, J.-L.; Andrea, J.; Aubin, A.; Bloch, D.; Brom, J.-M.; Buttignol, M.; Chabert, E. C.; Chanon, N.; Collard, C.; Conte, E.; Coubez, X.; Fontaine, J.-C.; Gelé, D.; Goerlach, U.; Goetzmann, C.


    Jet multiplicity distributions in top quark pair ({t}{overline{t}}) events are measured in pp collisions at a centre-of-mass energy of 8 TeV with the CMS detector at the LHC using a data set corresponding to an integrated luminosity of 19.7 {fb}^ {-1}. The measurement is performed in the dilepton decay channels (e^+e^-, μ^+ μ^-, and e^{±} μ^{∓}). The absolute and normalized differential cross sections for {t}overline{t} production are measured as a function of the jet multiplicity in the event for different jet transverse momentum thresholds and the kinematic properties of the leading additional jets. The differential {t overline{t} b} and {t overline{t} b overline{b}} cross sections are presented for the first time as a function of the kinematic properties of the leading additional b jets. Furthermore, the fraction of events without additional jets above a threshold is measured as a function of the transverse momenta of the leading additional jets and the scalar sum of the transverse momenta of all additional jets. The data are compared and found to be consistent with predictions from several perturbative quantum chromodynamics event generators and a next-to-leading order calculation.

  1. Measurement of $\\mathrm{ t \\bar{t} } $ production with additional jet activity, including b quark jets, in the dilepton decay channel using pp collisions at $\\sqrt{s} =$ 8 TeV

    CERN Document Server

    Khachatryan, Vardan; Tumasyan, Armen; Adam, Wolfgang; Aşılar, Ece; Bergauer, Thomas; Brandstetter, Johannes; Brondolin, Erica; Dragicevic, Marko; Erö, Janos; Flechl, Martin; Friedl, Markus; Fruehwirth, Rudolf; Ghete, Vasile Mihai; Hartl, Christian; Hörmann, Natascha; Hrubec, Josef; Jeitler, Manfred; Knünz, Valentin; König, Axel; Krammer, Manfred; Krätschmer, Ilse; Liko, Dietrich; Matsushita, Takashi; Mikulec, Ivan; Rabady, Dinyar; Rahbaran, Babak; Rohringer, Herbert; Schieck, Jochen; Schöfbeck, Robert; Strauss, Josef; Treberer-Treberspurg, Wolfgang; Waltenberger, Wolfgang; Wulz, Claudia-Elisabeth; Mossolov, Vladimir; Shumeiko, Nikolai; Suarez Gonzalez, Juan; Alderweireldt, Sara; Cornelis, Tom; De Wolf, Eddi A; Janssen, Xavier; Knutsson, Albert; Lauwers, Jasper; Luyckx, Sten; Van De Klundert, Merijn; Van Haevermaet, Hans; Van Mechelen, Pierre; Van Remortel, Nick; Van Spilbeeck, Alex; Abu Zeid, Shimaa; Blekman, Freya; D'Hondt, Jorgen; Daci, Nadir; De Bruyn, Isabelle; Deroover, Kevin; Heracleous, Natalie; Keaveney, James; Lowette, Steven; Moreels, Lieselotte; Olbrechts, Annik; Python, Quentin; Strom, Derek; Tavernier, Stefaan; Van Doninck, Walter; Van Mulders, Petra; Van Onsem, Gerrit Patrick; Van Parijs, Isis; Barria, Patrizia; Brun, Hugues; Caillol, Cécile; Clerbaux, Barbara; De Lentdecker, Gilles; Fasanella, Giuseppe; Favart, Laurent; Grebenyuk, Anastasia; Karapostoli, Georgia; Lenzi, Thomas; Léonard, Alexandre; Maerschalk, Thierry; Marinov, Andrey; Perniè, Luca; Randle-conde, Aidan; Reis, Thomas; Seva, Tomislav; Vander Velde, Catherine; Vanlaer, Pascal; Yonamine, Ryo; Zenoni, Florian; Zhang, Fengwangdong; Beernaert, Kelly; Benucci, Leonardo; Cimmino, Anna; Crucy, Shannon; Dobur, Didar; Fagot, Alexis; Garcia, Guillaume; Gul, Muhammad; Mccartin, Joseph; Ocampo Rios, Alberto Andres; Poyraz, Deniz; Ryckbosch, Dirk; Salva Diblen, Sinem; Sigamani, Michael; Strobbe, Nadja; Tytgat, Michael; Van Driessche, Ward; Yazgan, Efe; Zaganidis, Nicolas; Basegmez, Suzan; Beluffi, Camille; Bondu, Olivier; Brochet, Sébastien; Bruno, Giacomo; Caudron, Adrien; Ceard, Ludivine; Da Silveira, Gustavo Gil; Delaere, Christophe; Favart, Denis; Forthomme, Laurent; Giammanco, Andrea; Hollar, Jonathan; Jafari, Abideh; Jez, Pavel; Komm, Matthias; Lemaitre, Vincent; Mertens, Alexandre; Musich, Marco; Nuttens, Claude; Perrini, Lucia; Pin, Arnaud; Piotrzkowski, Krzysztof; Popov, Andrey; Quertenmont, Loic; Selvaggi, Michele; Vidal Marono, Miguel; Beliy, Nikita; Hammad, Gregory Habib; Aldá Júnior, Walter Luiz; Alves, Fábio Lúcio; Alves, Gilvan; Brito, Lucas; Correa Martins Junior, Marcos; Hamer, Matthias; Hensel, Carsten; Mora Herrera, Clemencia; Moraes, Arthur; Pol, Maria Elena; Rebello Teles, Patricia; Belchior Batista Das Chagas, Ewerton; Carvalho, Wagner; Chinellato, Jose; Custódio, Analu; Melo Da Costa, Eliza; De Jesus Damiao, Dilson; De Oliveira Martins, Carley; Fonseca De Souza, Sandro; Huertas Guativa, Lina Milena; Malbouisson, Helena; Matos Figueiredo, Diego; Mundim, Luiz; Nogima, Helio; Prado Da Silva, Wanda Lucia; Santoro, Alberto; Sznajder, Andre; Tonelli Manganote, Edmilson José; Vilela Pereira, Antonio; Ahuja, Sudha; Bernardes, Cesar Augusto; De Souza Santos, Angelo; Dogra, Sunil; Tomei, Thiago; De Moraes Gregores, Eduardo; Mercadante, Pedro G; Moon, Chang-Seong; Novaes, Sergio F; Padula, Sandra; Romero Abad, David; Ruiz Vargas, José Cupertino; Aleksandrov, Aleksandar; Hadjiiska, Roumyana; Iaydjiev, Plamen; Rodozov, Mircho; Stoykova, Stefka; Sultanov, Georgi; Vutova, Mariana; Dimitrov, Anton; Glushkov, Ivan; Litov, Leander; Pavlov, Borislav; Petkov, Peicho; Ahmad, Muhammad; Bian, Jian-Guo; Chen, Guo-Ming; Chen, He-Sheng; Chen, Mingshui; Cheng, Tongguang; Du, Ran; Jiang, Chun-Hua; Plestina, Roko; Romeo, Francesco; Shaheen, Sarmad Masood; Spiezia, Aniello; Tao, Junquan; Wang, Chunjie; Wang, Zheng; Zhang, Huaqiao; Asawatangtrakuldee, Chayanit; Ban, Yong; Li, Qiang; Liu, Shuai; Mao, Yajun; Qian, Si-Jin; Wang, Dayong; Xu, Zijun; Avila, Carlos; Cabrera, Andrés; Chaparro Sierra, Luisa Fernanda; Florez, Carlos; Gomez, Juan Pablo; Gomez Moreno, Bernardo; Sanabria, Juan Carlos; Godinovic, Nikola; Lelas, Damir; Puljak, Ivica; Ribeiro Cipriano, Pedro M; Antunovic, Zeljko; Kovac, Marko; Brigljevic, Vuko; Kadija, Kreso; Luetic, Jelena; Micanovic, Sasa; Sudic, Lucija; Attikis, Alexandros; Mavromanolakis, Georgios; Mousa, Jehad; Nicolaou, Charalambos; Ptochos, Fotios; Razis, Panos A; Rykaczewski, Hans; Bodlak, Martin; Finger, Miroslav; Finger Jr, Michael; El Sawy, Mai; El-khateeb, Esraa; Elkafrawy, Tamer; Mohamed, Amr


    Jet multiplicity distributions in top quark pair ($ \\mathrm{ t \\bar{t} } $) events are measured in pp collisions at a centre-of-mass energy of 8 TeV with the CMS detector at the LHC using a data set corresponding to an integrated luminosity of 19.7 fb$^{-1}$. The measurement is performed in the dilepton decay channels ($ \\mathrm{ e^{+} e^{-} }$, $\\mu^{+} \\mu^{-} $, and $\\mathrm{ e^{\\pm} } \\mu^{\\mp} $). The absolute and normalized differential cross sections for $ \\mathrm{ t \\bar{t} } $ production are measured as a function of the jet multiplicity in the event for different jet transverse momentum thresholds and the kinematic properties of the leading additional jets. The differential $ \\mathrm{ t \\bar{t} b} $ and $ \\mathrm{ t \\bar{t} b \\bar{b} } $ cross sections are presented for the first time as a function of the kinematic properties of the leading additional b jets. Furthermore, the fraction of events without additional jets above a threshold is measured as a function of the transverse momenta of the leadi...

  2. Initiation age and incision rates of inner gorges: Do they record multiple glacial-interglacial cycles? (United States)

    Delunel, Romain; Casagrande, Jan; Schlunegger, Fritz; Akçar, Naki; Kubik, Peter W.


    Inner gorges represent some of the most conspicuous landforms in the European Alps. They form narrow and deep active-channel incisions that link hanging tributaries with trunk valleys in glacially-conditioned environments. Despite abundant research carried out on these objects, both their origin and evolution have remained unclear. In particular, the age of initiation, the rate of incision, and the respective contribution of fluvial and subglacial processes in the evolution of inner gorges have still been a matter of scientific debate. Indeed, answering these questions has been complicated by the lack of appropriate quantitative methods and/or suitable sampling strategies for studying inner gorges. Here, we report 10Be concentrations measured in alluvial sediments that have been collected along the main stream of a ~20-km2-catchment in the Swiss foreland (Central European Alps). This catchment hosts a ca. 100-m-deep and 2-km-long inner gorge that has been cut mainly in glacial till. Catchment wide denudation rates inferred from 10Be analyses (n = 15) vary from ~120 to 650 mm/ka and show a general downstream increasing trend. Additional field observations and GIS analyses reveal that the denudation rates within the catchment increase from the headwaters, characterized by relict glacial/periglacial landscapes, to the downstream end of the basin where the inner gorge has been formed. Using a 10Be-based sediment budget approach and the delineation of topographic domains from a 2-m-resolution LIDAR, we provide an estimate of erosion rates within the gorge that are higher than 2.5 m/ka and can reach up to ~ 7 m/ka. Combining these estimated erosion rates with the reconstruction of eroded volumes within the gorge, we obtain a rough initiation age in the early Holocene, in general agreement with previous studies reporting a postglacial origin for the inner gorges. Our results therefore appear contradictory with recent findings arguing for a gradual formation of inner

  3. Clinical research of limbal relaxing incision during implantable collamer lens surgery

    Directory of Open Access Journals (Sweden)

    Zhen Li


    Full Text Available AIM: To evaluate the efficacy and safety of limbal relaxing incision(LRIfor correcting corneal astigmatism during implantable collamer lens(ICLsurgery.METHODS: A total of 185 eyes of 105 patients with high myopia and corneal keratometric astigmatism were included in the study. ICL surgery with concomitant relaxing incision was performed in 105 eyes of 60 patients in LRIs group(Group A. Eighty eyes of 45 patients only underwent ICL surgery were in control group(Group B. All patients undergone ophthalmic examination that included uncorrected visual acuity(UCVA, best-corrected visual acuity(BCVA, Pentacam analysis system to observe the changes of corneal astigmatism before and 1wk, 1 and 3mo after surgery.RESULTS: Respectively comparing UCVA between two groups in 1 and 3mo postoperatively, the P values were considered statistically significant(PP values were considered no statistically significant(P>0.05. Preoperative corneal astigmatism was 1.52±0.55D in group A and 1.48±0.57D in group B, there was no statistically significant difference(P>0.05. One week postoperatively, the astigmatism was 0.55±0.41D in group A and 1.20±0.48D in group B. One month postoperatively, the astigmatism was 0.60±0.38D in group A and 0.93±0.47D. Three months postoperatively, the astigmatism was 0.51±0.32D in group A and 0.96±0.40D in group B. The difference between the two groups were statistically significant(PPPCONCLUSION: LRIs performed during ICL surgery appeared to be an effective and safer procedure to reduce pre-existing corneal astigmatism and improve UCVA as well as the visual quality.

  4. Single Incision Distal Biceps Repair With Hemi-Krackow Suture Technique (United States)

    Goljan, Peter; Patel, Nimit; Stull, Justin D.; Donnelly, Brandon P.; Culp, Randall W.


    Background: Many surgical methods exist for distal biceps repair. We present the technique and early outcomes of a series of distal biceps repairs completed with a novel suturing technique utilizing a hemi-Krackow locking stitch at the tendon-bone interface. Methods: A retrospective review was performed of patients who underwent primary distal biceps repair using a single anterior incision with 2 suture anchors utilizing a hemi-Krackow stitch. With both anchors, a locking stitch along the tendon edge was complimented by the other strand passing through the central aspect of the distal tendon and advanced to pull the tendon edge down to the bone with appropriate tension. Patients with revision surgery and the use of allograft were excluded. Clinical outcomes included elbow range of motion and grip strength. All patients completed a Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire and reported satisfaction level, pain level, and any postoperative complications. Results: Fourteen patients with an average age of 51.3 years (range, 27.8-66.4 years) were included in the study. The dominant arm was injured in 9 cases. At an average of 16.4 months’ follow-up (range, 6.8-34.3 months), all patients had elbow range of motion of 0° to >130°, and grip strength was 101.5% of the uninjured arm (range, 70.6%-121.4%). The Average QuickDASH score was 6.5 (range, 0-36.5). Conclusion: Single incision biceps repair with suture anchor fixation using our hemi-Krackow stitch provided a strong repair allowing easy tensioning of the biceps tendon to bone and showed satisfactory functional outcomes at early follow-up. No patients required revision surgery, and there was only 1 case of transient nerve complaints. PMID:27390570

  5. Transscleral tunnel incision related arterial hemorrhage in 23-gauge Vitrectomy: case report. (United States)

    Liu, Bingqian; Li, Yonghao; Li, Tao; Lin, Ying; Ma, Wei; Lu, Lin


    Transscleral tunnel incisions are commonly made to avoid postoperative leakage in small gauge sutureless vitrectomy. We present an unreported intraoperative complication, tunnel incision related arterial hemorrhage from sclerotomy, in 23-gauge (23G) vitrectomy. Two cases of intraocular arterial hemorrhage from superonasal sclerotomy were observed at the beginning of vitrectomy. The bleeding filled the vitreous cavity quickly and gushed out from the incision port after the involved supronasal cannula was removed. The active bleeding seemed not to stop spontaneously. We controlled the active bleeding by relocating the involved cannula, elevating the intraocular pressure and compressing the sclera wound. Post-operative intraocular hemorrhage from the sclerotomy was not found in any of the two cases. We suggest that the bleeding was from injured ciliary artery when the incision crossed 3 or 9 o'clock accidently. Surgeons might avoid this complication by locating the superior incisions away from the horizontal axis, and should be aware the proper management.

  6. Coherifying quantum channels (United States)

    Korzekwa, Kamil; Czachórski, Stanisław; Puchała, Zbigniew; Życzkowski, Karol


    Is it always possible to explain random stochastic transitions between states of a finite-dimensional system as arising from the deterministic quantum evolution of the system? If not, then what is the minimal amount of randomness required by quantum theory to explain a given stochastic process? Here, we address this problem by studying possible coherifications of a quantum channel Φ, i.e., we look for channels {{{Φ }}}{ \\mathcal C } that induce the same classical transitions T, but are ‘more coherent’. To quantify the coherence of a channel Φ we measure the coherence of the corresponding Jamiołkowski state J Φ. We show that the classical transition matrix T can be coherified to reversible unitary dynamics if and only if T is unistochastic. Otherwise the Jamiołkowski state {J}{{Φ }}{ \\mathcal C } of the optimally coherified channel is mixed, and the dynamics must necessarily be irreversible. To assess the extent to which an optimal process {{{Φ }}}{ \\mathcal C } is indeterministic we find explicit bounds on the entropy and purity of {J}{{Φ }}{ \\mathcal C }, and relate the latter to the unitarity of {{{Φ }}}{ \\mathcal C }. We also find optimal coherifications for several classes of channels, including all one-qubit channels. Finally, we provide a non-optimal coherification procedure that works for an arbitrary channel Φ and reduces its rank (the minimal number of required Kraus operators) from {d}2 to d.

  7. [Shift the skin paddle in an additional incision improves the result: Study of a series of 82 breast reconstructions by latissimus dorsi flap and prosthesis implantation at 10 years]. (United States)

    Chiriac, S; Dissaux, C; Bruant-Rodier, C; Djerada, Z; Bodin, F; François, C


    The position of the skin paddle on the breast area is a fundamental element for the breast reconstructions by latissimus dorsi flap and prosthesis implantation. Should, as Millard advocated, to recreate the initial defect and include it in the mastectomy scar or is it better in an additional incision as have others authors. This study compares the long-term morphological results of these two attitudes, with or without additional incision. Eighty-two breast reconstructions by latissimus dorsi flap and prosthesis implantation, with a mean follow-up of 9.5 years were scored from 1 to 5 by a panel of expert and non-expert. The patients scored also their own reconstruction. Various parameters of the reconstructed breast were thus evaluated. We compared the results, according to the positioning of the skin paddle: with additional incision (50 cases); without additional incision (32 cases). The characteristics of the mastectomy scar on the breast area, high or low, horizontal or oblique, defined 6 groups where the results of the 2 surgical options were compared. Only the reconstructions with additional incision get significantly higher results than those without additional incision (P<0.05). This involves the two panels, in the case of high mastectomy scars. In the others cases the additional incision is not essential. If the realization of an additional incision can be perceived like misfit on an area already "mutilated", we plead for this solution in selected cases. This provides a benefit stable in time, in terms of overall results, shape and even rendering scar. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  8. Morphological dynamics of an englacial channel (United States)

    Vatne, Geir; Irvine-Fynn, Tristram D. L.


    Despite an interest in the hydraulic functioning of supraglacial and englacial channels over the last 4 decades, the processes and forms of such ice-bounded streams have remained poorly documented. Recent glaciological research has demonstrated the potential significance of so-called "cut-and-closure" streams, where englacial or subglacial flow paths are created from the long-term incision of supraglacial channels. These flow paths are reported to exhibit step-pool morphology, comprising knickpoints and/or knickzones, exaggerated in dimensions in comparison to supraglacial channels. However, little is known of the development of such channels' morphology. Here, we examine the spatial organisation of step pools and the upstream migration of steps, many of which form knickzones, with repeated surveys over a 10-year period in an englacial conduit in cold-based Austre Brøggerbreen, Svalbard. The observations show upstream step recession to be the dominant process for channel evolution. This is paralleled by an increase in average step height and conduit gradient over time. Characteristic channel-reach types and step-riser forms are consistently observed in each of the morphological surveys reported. We suggest that the formation of steps has a hydrodynamic origin, where step-pool geometry is more efficient for energy dissipation than meanders. The englacial channel system is one in rapid transition towards a quasi-equilibrium form within a decadal timescale. The evolution and recession of knickzones reported here result in the formation of a 37 m deep moulin shaft, suggesting that over time an incising supraglacial channel may evolve towards an englacial channel form exhibiting a stable end-point characterised by a singular vertical descent, which potentially can reach the glacier bed. This challenges the prevailing notions that crevasses or hydrofractures are needed to form deep moulins. Our observations highlight the need to further examine the adjustment processes

  9. Single transverse extended incision for radical neck dissection. (United States)

    Chagas, José Francisco Sales; Pascoal, Maria Beatriz Nogueira; Aquino, José Luís Braga; Brandi, Luís Antônio; Previtale, Evandro Von Zuben; Trillo, Ana Sofia Pontes; Curioni, Otávio Alberto; Rapoport, Abrão; Dedivitis, Rogério Aparecido


    to assess the efficacy of the single transverse extended cervical incision in radical neck dissection. we conducted a prospective study, from January 2008 to January 2009, with 18 patients undergoing surgical treatment of malignant tumors of the upper aero-digestive tract. The primary lesion was located in the oral cavity in eight cases, in the oropharynx in three, in the hypopharynx in three, in the larynx in two, in the maxillary sinus, and in one case, the primary injury was hidden. There were 29 neck dissections, eight bilateral and 10 unilateral (26 radical and three selective). Staging revealed nine patients with T4 tumor, one T3, six T2, one T1 and one Tx. Five patients were N0, nine N2b, one N2c and three N3. The average number of dissected lymph nodes was 34.25. We performed the neck dissection through a single incision located in the middle neck, coincident with the skinfold, with a length of about 2 to 3 cm behind the anterior edge of the trapezius muscle and 3 to 4 cm from the midline for the unilateral neck dissections. as complications, there were myocutaneous flap necrosis in one patient with prior radiation therapy, one lymphatic fistula, one dehiscence of the tracheostomy, one cervical abscess, one salivary fistula and one suture dehiscence. the single extended incision provides adequate exposure of the neck structures, without compromising surgical time, even in bilateral dissections. It does not compromise the resection of all cervical lymph nodes; it has excellent aesthetic and functional results and is easily associated with other approaches to resection of the primary tumor. verificar a eficácia da incisão cervical única, transversa e estendida, para o esvaziamento cervical radical. estudo prospectivo, de janeiro de 2008 a janeiro de 2009, de 18 pacientes submetidos a tratamento cirúrgico de tumores malignos da via aero-digestiva superior. A lesão primária se situava na cavidade oral em oito casos, na orofaringe em três, no seio

  10. [The standard implantation of a total hip prosthesis via two incisions (the Yale Technique)]. (United States)

    Kipping, Robert


    Implantation of a total hip endoprosthesis with minimal trauma to the soft tissue. The need for visual aids (e.g., navigation or X-rays) during the procedure is frequently avoided. All kinds of coxarthrosis for every age group, for every variation of bone construction, and even in obese patients. Extremely dysplastic hip joints involving the development of a secondary socket and the necessity of reconstruction of the acetabular socket (e.g., in the Harris method). Using a fixed lateral position, a small entry incision is made between the tensor fasciae latae and the sartorius muscles and the prosthesis socket is put into place. Via a second dorsal incision, after stripping the exterior rotators, the prosthesis stem and ball are implanted and the two parts of the prosthesis are attached. Full weight bearing allowed immediately. A luxation prophylaxis, in the form of a self-developed hip bodice (the so-called Yale bandage), is used until the end of the 4th postoperative week. Discharge from hospital is possible after just a few days. Upon discharge, the patient is sent to a rehabilitation facility, either as a resident or as an outpatient, for approximately 3 weeks. Return to the workplace, with only light physical activity, is possible once the wound has healed completely; this could be as soon as 14 days after the operation. Checkups are made after 4 weeks, 6 months, 1 year and then every year; these checkups include a full examination, X-rays and laboratory tests. Full exposure to sport or heavy manual labor is usually approved after the 6-month checkup. Between October 2004 and April 2006, a total of 221 patients underwent surgery using this new technique (of these 15 patients underwent two-stage bilateral hip joint replacements). Patients were followed up for a minimum of 12 months and a maximum of 30 months. The Harris Hip Score improved from an average of 45.25 preoperatively to 96.4 postoperatively.

  11. Tubularized proximally-incised plate in distal/midshaft hypospadias repair

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    Antonio Marte


    Full Text Available The aim of this study was to verify the validity, feasibility, and the functional results, by uroflowmetry, of Tubularized proximallyincised plate technique in selected case of distal/midshaft hypospadias. Out of 120 patients scheduled to undergo TIP (or Snodgrass procedure, 23 were selected between January 2013 and January 2016 (19.1%. This case series comprised 16 patients with distal and 7 with midshaft hypospadias. Mean age at surgery was 2.9 years. The inclusion criteria were a deep and wide glandular groove and a proximal narrow urethral plate. The procedure was carried out as described by Snodgrass but the incision of the urethral plate, including the mucosal and submucosal tissue, was made only proximally, between the original meatus and the glandular groove in no case extending to the entire length of the plate. Postoperatively a foley catheter was left in place from 4 to 7 days. Uroflowmetry was performed when the patients age ranged from 2.5 to 5.7 years (mean age 3.11 years and mean follow-up 1.8 years, body surface 2. No patient presented fistulas nor perioperative complications. At uroflowmetry, eighteen patients presented values above the 25th percentile and 5 showed a borderline flow. All patients in this group remained stable without urinary symptoms. In selected cases, the tubularized proximally-incised plate yields satisfactory cosmetic and functional results for the treatment of midshaft proximal hypospadias. A long-term follow-up study is needed for further evaluation. Patient selection is crucial for the success of this technique.


    Directory of Open Access Journals (Sweden)

    M. Zakariya


    Full Text Available Introduction : Povidoe iodine often used in incision treatment. This study was aimed to explain the differences between honey and povidone iodine 10% on incision healing, were unknown. Method : This study used a true experiment design with 18 samples of 3 years old-male guinea pigs, divided into three groups. One-control group and 2 treatment groups. This classification was done randomize. The independent variable was used of honey and 10-% povidon iodin and the dependent variable was inflammation phase (squeezing, edema, plasma of incision and proliferation (granulation, incision edge unification, skin structure were assessed in the third and sixth days.  Data were collected by using observation of the signs both of inflammation and proliferation phase and analyzed using Chi Square with level of significance α ≤ 0.05. Result : Results showed that there was no significant difference in the third and sixth days inflammation. In contrast, a significant difference was obtained in the third and sixth days proliferation. Granulation (p< 0,05, incision edge unification (p< 0,05, establishment of skin structures (p< 0,05. Analysis : It can be concluded that the honey usage was proven to be more effective in accelerated incision healing, increasing proliferation and reduce any infection risks. Discussion : For future research there is neeed to conduct a microscopically observation of numerous changes in collagen, PMN-cell (neutrophile and MN-cell (lymphocyte and monocyte, inflammation and proliferation as well as incision healing process.

  13. Nuclear management in manual small incision cataract surgery by snare technique

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    Bhattacharya Debasish


    Full Text Available Manual small incision cataract surgery has evolved into a popular method of cataract surgery in India. However, in supra hard cataract, bringing out the whole nucleus through the sclerocorneal flap valve incision becomes difficult. A bigger incision required in such cataracts loses its value action, as the internal incision and corneal valve slips beyond the limbus into sclera. Struggling with the supra hard cataracts through a regular small incision. Phacofracture in the anterior chamber becomes a useful option in these cases. In the snare technique, a stainless steel wire loop when lassoed around the nucleus in the anterior chamber constricts from the equator, easily dividing the hardest of the nuclei into two halves. The wire loop constricts in a controlled way when the second cannula of snare is pulled. The divided halves can easily be brought out by serrated crocodile forceps. This nuclear management can be safely performed through a smaller sclerocorneal flap valve incision where the corneal valve action is retained within the limbus without sutures, and the endothelium or the incision is not disturbed. However, the technique requires space in the anterior chamber to maneuver the wire loop and anterior chamber depth more than 2.5 mm is recommended. Much evidence to this wonderful technique is not available in literature, as its popularity grew through live surgical workshops and small interactive conferences.

  14. How well do the rosgen classification and associated "natural channel design" methods integrate and quantify fluvial processes and channel response? (United States)

    Simon, A.; Doyle, M.; Kondolf, M.; Shields, F.D.; Rhoads, B.; Grant, G.; Fitzpatrick, F.; Juracek, K.; McPhillips, M.; MacBroom, J.


    Over the past 10 years the Rosgen classification system and its associated methods of "natural channel design" have become synonymous (to many without prior knowledge of the field) with the term "stream restoration" and the science of fluvial geomorphology. Since the mid 1990s, this classification approach has become widely, and perhaps dominantly adopted by governmental agencies, particularly those funding restoration projects. For example, in a request for proposals for the restoration of Trout Creek in Montana, the Natural Resources Conservation Service required "experience in the use and application of a stream classification system and its implementation." Similarly, classification systems have been used in evaluation guides for riparian areas and U.S. Forest Service management plans. Most notably, many highly trained geomorphologists and hydraulic engineers are often held suspect, or even thought incorrect, if their approach does not include reference to or application of a classification system. This, combined with the para-professional training provided by some involved in "natural channel design" empower individuals and groups with limited backgrounds in stream and watershed sciences to engineer wholesale re-patterning of stream reaches using 50-year old technology that was never intended for engineering design. At Level I, the Rosgen classification system consists of eight or nine major stream types, based on hydraulic-geometry relations and four other measures of channel shape to distinguish the dimensions of alluvial stream channels as a function of the bankfull stage. Six classes of the particle size of the boundary sediments are used to further sub-divide each of the major stream types, resulting in 48 or 54 stream types. Aside from the difficulty in identifying bankfull stage, particularly in incising channels, and the issue of sampling from two distinct populations (beds and banks) to classify the boundary sediments, the classification provides a

  15. Single-Incision Laparoscopic Sterilization of the Cheetah (Acinonyx jubatus). (United States)

    Hartman, Marthinus J; Monnet, Eric; Kirberger, Robert M; Schmidt-Küntzel, Anne; Schulman, Martin L; Stander, Jana A; Stegmann, George F; Schoeman, Johan P


    To describe laparoscopic ovariectomy and salpingectomy in the cheetah (Acinonyx jubatus) using single-incision laparoscopic surgery (SILS). Prospective cohort. Female cheetahs (Acinonyx jubatus) (n = 21). Cheetahs were randomly divided to receive either ovariectomy (n = 11) or salpingectomy (n = 10). The use and complications of a SILS port was evaluated in all of cheetahs. Surgery duration and insufflation volumes of carbon dioxide (CO2 ) were recorded and compared across procedures. Laparoscopic ovariectomy and salpingectomy were performed without complications using a SILS port. The poorly-developed mesosalpinx and ovarian bursa facilitated access to the uterine tube for salpingectomy in the cheetah. The median surgery duration for ovariectomy was 24 minutes (interquartile range 3) and for salpingectomy was 19.5 minutes (interquartile range 3) (P = .005). The median volume of CO2 used for ovariectomy was 11.25 L (interquartile range 3.08) and for salpingectomy was 4.90 L (interquartile range 2.52), (P = .001) CONCLUSIONS: Laparoscopic ovariectomy and salpingectomy can be performed in the cheetah using SILS without perioperative complications. Salpingectomy is faster than ovariectomy and requires less total CO2 for insufflation. © Copyright 2015 by The American College of Veterinary Surgeons.

  16. Surgical incision can alter capsaicin-induced central sensitization in rat brainstem nociceptive neurons. (United States)

    Lam, D K; Sessle, B J; Hu, J W


    Surgical trauma can affect spinal neuronal excitability, but there have been no studies of the effects of surgical cutaneous injury on central nociceptive processing of deep afferent inputs evoked by noxious stimuli such as capsaicin. Thus our aim was to test the effect of surgical cutaneous incision in influencing central sensitization induced by capsaicin injection into the temporomandibular joint (TMJ). The activity of single nociceptive neurons activated by noxious mechanical stimulation of the TMJ was recorded in the trigeminal subnucleus caudalis/upper cervical cord of halothane-anesthetized rats. The cutaneous mechanoreceptive field (RF), cutaneous mechanical activation threshold (MAT) and TMJ MAT of neurons before and after both surgical cutaneous incision alone and capsaicin injection were compared with results of incision and lidocaine pretreatment of the facial skin overlying the TMJ and capsaicin injection into the TMJ. Incision itself induced a barrage of neuronal spikes and excitability increases reflecting central sensitization (cutaneous RF expansion, cutaneous MAT reduction) in most neurons tested whereas lidocaine pretreatment significantly attenuated the barrage and central sensitization. Capsaicin injection into the TMJ induced cutaneous RF expansion, cutaneous MAT reduction and TMJ MAT reduction following lidocaine pretreatment of the cutaneous incision site whereas capsaicin injection following incision alone not only failed to induce further central sensitization but also decreased the existing incision-induced central sensitization (no cutaneous RF expansion, increased cutaneous MAT and TMJ MAT) in most neurons tested. These findings suggest that central sensitization induced by capsaicin alone or by cutaneous incision alone can readily occur in TMJ-responsive nociceptive neurons and that following incision-induced excitability increases, capsaicin may result in a temporary suppression of nociceptive neuronal changes reflecting central

  17. Towards achieving small-incision cataract surgery 99.8% of the time.

    Directory of Open Access Journals (Sweden)

    Thomas R


    Full Text Available A surgical approach designed to reliably attain the modern goal of small incision cataract surgery 99.8% of the time is described. Phacoemulsification as well as a manual small incision technique is utilised to achieve the desired outcome as often as possible and for all types of cataracts. The logic, and required surgical steps are described and illustrated. This surgical technique allows the advantages of small incision surgery to be reliably achieved. The method is flexible and allows decisions and steps to be modified depending on the skill and comfort zone of the individual surgeon.

  18. Intracellular ion channels and cancer

    Directory of Open Access Journals (Sweden)

    Luigi eLeanza


    Full Text Available Several types of channels play a role in the maintenance of ion homeostasis in subcellular organelles including endoplasmatic reticulum, nucleus, lysosome, endosome and mitochondria. Here we give a brief overview of the contribution of various mitochondrial and other organellar channels to cancer cell proliferation or death. Much attention is focused on channels involved in intracellular calcium signaling and on ion fluxes in the ATP-producing organelle mitochondria. Mitochondrial K+ channels (Ca2+-dependent BKCa and IKCa, ATP-dependent KATP, Kv1.3, two-pore TWIK-related Acid-Sensitive K+ channel-3 (TASK-3, Ca2+ uniporter MCU, Mg2+-permeable Mrs2, anion channels (voltage-dependent chloride channel VDAC, intracellular chloride channel CLIC and the Permeability Transition Pore (MPTP contribute importantly to the regulation of function in this organelle. Since mitochondria play a central role in apoptosis, modulation of their ion channels by pharmacological means may lead to death of cancer cells. The nuclear potassium channel Kv10.1 and the nuclear chloride channel CLIC4 as well as the endoplasmatic reticulum (ER-located inositol 1,4,5-trisphosphate (IP3 receptor, the ER-located Ca2+ depletion sensor STIM1 (stromal interaction molecule 1, a component of the store-operated Ca2+ channel and the ER-resident TRPM8 are also mentioned. Furthermore, pharmacological tools affecting organellar channels and modulating cancer cell survival are discussed. The channels described in this review are summarized on Figure 1. Overall, the view is emerging that intracellular ion channels may represent a promising target for cancer treatment.

  19. Temporal Dynamics of Gully Evolution in a Small, Ephemeral Channel in a Semiarid Watershed (United States)

    Nichols, Mary; Nearing, Mark


    Incised channels that terminate at a vertical-wall gully heads are common features in semiarid watersheds. The geomorphic evolution of such channels is often dominated by migration of the headwall. The evolution of a headwall in a low order channel on the USDA-ARS Walnut Gulch Experimental Watershed (WGEW) in southeastern Arizona has been monitored since 2004, and since 2012, time-lapse photography has been employed to observe the temporal dynamics at high resolution. A Canon A1300 off the shelf point and shoot digital camera mounted inside a weatherproof Pelican case has been taking 15 mp photographs since 2012. The camera power supply was modified to run from a 12V car battery that was charged with a 25 Watt solar panel through a solar controller. During the runoff season from July through September, images were collected every 30 seconds and the time step was increase to 30 minutes during winter months. The field of view covers the headcut and the immediate surroundings. Runoff events were distinct flash floods in response to high intensity rain. The temporal sequencing of the dominant processes of erosion including mass wasting, plunge pool erosion, and piping are described. In addition, we present a description of the time-lapse camera system with suggestions for future improvements.

  20. Morphology of the last subaerial unconformity on a shelf: insights into transgressive ravinement and incised valley occurrence in the Gulf of Cádiz (United States)

    Lobo, F. J.; García, M.; Luján, M.; Mendes, I.; Reguera, M. I.; Van Rooij, D.


    The main aim of this study is to explore the spatial patterns of the shelf-scale erosional unconformity related to the last glacial maximum (LGM), particularly in terms of the role of underlying geology and the presumed primary influence of sea-level changes. This involved a detailed mapping of the most recent and widespread erosional shelf surface in a sector of the northern margin of the Gulf of Cádiz (northeast Atlantic Ocean) located adjacent to a major fluvial source. A dense network of high-resolution seismic profiles collected in the 1990s and 2013 off the Guadiana River revealed two distinct geomorphological domains on the LGM shelf-scale subaerial surface. The outer domain exhibits a widespread occurrence of erosional truncations, with a rugged, erosional pattern over the most distal shelf setting that evolves landward into a planar unconformity. The inner domain is more extensive and is characterized by the common occurrence of highly reflective, localized mounded seismic facies that laterally evolve into an irregular surface and in places may develop a channelized morphology. Significant fluvial incision is limited to a major straight valley and a secondary distributary channel. A distinct partition of the lowstand surface is documented, and attributed to a well-marked lithological change. A coarse-grained inner shelf comprises underlying lithified coastal deposits, whereas a fine-grained outer shelf is regarded as the uppermost expression of regressive prodeltaic wedges. The influence of regional indurated surfaces is also expressed in (1) the pattern of erosion, this being more patchy on the inner shelf due to lateral changes of erodibility, whereas on the outer shelf it shows laterally continuous bands, owing to different modes of transgressive ravinement; (2) the spatial and temporal variability of fluvial incision. Inner shelf armoring by indurated deposits prevents reoccupation of previously incised valleys.

  1. Blepharoptosis repair through the small orbital septum incision and minimal dissection technique in patients with coexisting dermatochalasis. (United States)

    Jung, Younhea; La, Tae Yoon


    To describe a modified surgical technique for blepharoptosis repair through a small orbital septum incision and minimal dissection, along with the results obtained in patients with coexisting dermatochalasis. A retrospective chart review included 33 patients (52 eyelids) with blepharoptosis coexisting with dermatochalasis, surgically corrected through a small orbital septum incision and minimal dissection after redundant upper lid skin excision, by placing a single fixation suture between the levator aponeurosis and the tarsal plate. Outcome measures included the pre- and postoperative marginal reflex distances (MRD1), eyelid contour, post-operative complications, and need for reoperation. The pre- and postoperative MRD1 averaged 1.1 ± 0.8 mm and 2.8 ± 1.1 mm, respectively. Of the 33 patients, 9 patients (9 eyelids) underwent surgery on one eyelid for unilateral blepharoptosis and dermatochalasis (Group I), 5 patients (5 eyelids) underwent a simple skin excision blepharoplasty of the contralateral eyelid (Group II), and 19 patients (38 eyelids) underwent bilateral blepharoptosis and dermatochalasis repair (Group III). Of the 14 eyelids that underwent unilateral ptosis repair (Groups I and II), 12 eyelids (85.7%) showed less than a 1-mm difference from the contralateral eyelid. Of the 38 eyelids that underwent bilateral ptosis repair (Group III), 27 eyelids (71.1%), 5 eyelids (13.1%), and 6 eyelids (15.8%) had excellent, good, and poor outcomes, respectively. Overall, 44 eyelids (84.6%) out of a total of 52 eyelids had successful outcomes; the remaining 8 eyelids demonstrated unsatisfactory eyelid contour was corrected by an additional surgery. Blepharoptosis repair through a small orbital septum incision and minimal dissection can be considered an efficient technique in patients with ptosis and dermatochalasis.

  2. Phacoemulsification versus small incision cataract surgery in patients with uveitis

    Directory of Open Access Journals (Sweden)

    Rahul Bhargava


    Full Text Available AIM: To compare the safety and efficacy of phacoemulsification and small incision cataract surgery (SICS in patients with uveitic cataract.METHODS:In aprospective, randomized multi-centric study, consecutive patients with uveitic cataract were randomized to receive phacoemulsification or manual SICS by either of two surgeons well versed with both the techniques. A minimum inflammation free period of 3mo (defined as less than 5 cells per high power field in anterior chamber was a pre-requisite for eligibility for surgery. Superior scleral tunnel incisions were used for both techniques. Improvement in visual acuity post-operatively was the primary outcome measure and the rate of post-operative complications and surgical time were secondary outcome measures, respectively. Means of groups were compared using t-tests. One way analysis of variance (ANOVA was used when there were more than two groups. Chi-square tests were used for proportions. Kaplan Meyer survival analysis was done and means for survival time was estimated at 95% confidence interval (CI. A P value of <0.05 was considered statistically significant.RESULTS:One hundred and twenty-six of 139 patients (90.6% completed the 6-month follow-up. Seven patients were lost in follow up and another six excluded due to either follow-up less than six months (n=1 or inability implant an intraocular lens (IOL because of insufficient capsular support following posterior capsule rupture (n=5. There was significant improvement in vision after both the procedures (paired t-test; P<0.001. On first postoperative day, uncorrected distance visual acuity (UDVA was 20/63 or better in 31 (47% patients in Phaco group and 26 (43.3% patients in SICS group (P=0.384. The mean surgically induced astigmatism (SIA was 0.86±0.34 dioptres (D in the phacoemulsification group and 1.16±0.28 D in SICS group. The difference between the groups was significant (t-test, P=0.002. At 6mo, corrected distance visual acuity (CDVA

  3. Association between incision technique for hamstring tendon harvest in anterior cruciate ligament reconstruction and the risk of injury to the infra-patellar branch of the saphenous nerve: a meta-analysis. (United States)

    Grassi, Alberto; Perdisa, Francesco; Samuelsson, Kristian; Svantesson, Eleonor; Romagnoli, Matteo; Raggi, Federico; Gaziano, Teide; Mosca, Massimiliano; Ayeni, Olufemi; Zaffagnini, Stefano


    To determine how the incision technique for hamstring tendon (HT) harvest in anterior cruciate ligament (ACL) reconstruction affects the risk of injury to the IPBSN and clinical outcome. A systematic literature search of the MEDLINE/Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL) and EBSCOhost electronic databases and for unpublished studies was performed to identify comparative studies investigating injury to the IPBSN after HT ACL reconstruction by comparing at least two different incision techniques. Data were extracted for the number of patients with evidence of any neurologic deficit corresponding to injury to the IPBSN, area of sensory deficit, the Lysholm score and patient satisfaction. The mean difference (MD) in study outcome between incision groups was assessed. The relative risk (RR) and the number needed to treat (NNT) were calculated. The Chi-square and Higgins' I 2 tests were applied to test heterogeneity. Data were pooled using a Mantel-Haenszel random-effects model if the statistical heterogeneity was > 50% and a fixed-effects model if the statistical heterogeneity was < 50%. The risk of bias was evaluated according to the Cochrane Database questionnaire and the quality of evidence was graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. A total of eight studies (three randomized controlled trials (RCTs) and five comparative studies) were included, of which six compared vertical and oblique incisions, one horizontal and vertical incisions, and one compared all three techniques. HT harvest was performed through a vertical incision in 329 patients, through an oblique incision in 195 patients and through a horizontal incision in 151 patients. Considering the meta-analysis of the RCTs, the performance of a vertical incision significantly increased the risk of causing IPBSN deficiency compared with both oblique and horizontal incision [RR 1.65 (CI 1

  4. Diagnosis of incisive canal in patients referred to radiology department of dental faculty of Tabriz University of Medical Sciences using cone beam computed tomogtaphy

    Directory of Open Access Journals (Sweden)

    Mahdi Niknami


    Full Text Available Background and Aims: Considering importance of recognizing the position of incisive canal before inserting intraosseous implants and bone harvesting from the symphysis and to preventing from adverse effects after these surgeries, using appropriate imaging method is essential and necessary. Due to the high accuracy measurement and high quality of CBCT and also low received dose to patient ̦ the aim of this study was to evaluate and recognize the position of incisive canal using cone beam computed tomography (CBCT. Materials and Methods: In this study, good quality CBCT mandible image of 60 patients including 32 women and 28 men with average ages of 41.3±2.5 were observed for diagnosing and recognizing the position of mandibular incisive canal using three observers separately. Data were statistically analyzed using SPSS software (version 20.0 for Windows, Chicago, IL, USA and Chi-square and Fisher's exact tests. Results: Horizontal and vertical assessment was independent from the sex of patients. The incisive canal was recognizable in 89.8 percent of specimens. In vertical dimension, in 57.5 percent of specimens the canal was observed in the inferior one third and in 32.25 percent in the medial one third. In horizontal dimension, in 14.75 percent of specimens the canal was observed in the buccal one third, 52.75 percent in the medial one third and 22.25 percent in the lingual one third. Conclusion: The quality of CBCT imaging and its accuracy and resolution can play an important role in the differentiation and determination of the position of incisive canal.

  5. Ex vivo evaluation of femtosecond pulse laser incision of urinary tract tissue in a liquid environment: implications for endoscopic treatment of benign ureteral strictures. (United States)

    Liang, Jun-Hao; Kang, Jian; Pan, Yu-Long; Zhang, Liang; Qi, Jun


    The femtosecond (FS) pulse laser incises soft tissues with minimal peripheral damage and is a promising cutting tool for ureteroscopic endoureterotomy of benign ureteral strictures. To evaluate the feasibility of applying the FS laser to ureteroscopic endoureterotomy. A commercial Ti:Sapphire regenerative amplifier system (Coherent, RegA 9050, USA) was used in this study. Normal saline, 5% glucose solution, 4% mannitol solution, distilled water, and a 1% (v/v) suspension of whole blood with each of these solutions were tested for their attenuation rate (AR) of the FS laser's power. Bladder specimens from Sprague-Dawley (SD) rats were used as a surrogate model. The laser incised slots of 2 mm in length at bladder samples using three power grades (5×, 10×, and 20× the threshold power) combined with five effective pulse rates (40, 20, 10, 5, and 2.5 kHz), both in air and in normal saline. After samples were processed with standard hematoxylin-eosin staining procedures, the incision depth and collateral damage range were determined microscopically. The ARs of blood suspensions with each of the three isosmotic solutions were significantly higher than the other five solutions (P laser's cutting depth and the collateral damage were increased with the laser power or power density but the collateral damages were less than 100 µm. Microbubble formation was detected in the liquid environments tested and influenced the effective laser power. Endoscopic application of the FS laser is feasible. Microbubble formation with the laser incision, however, may influence cutting effects. Proposed methods to address these issues include increasing the irrigation rate, using distilled water as irrigation or using gas insufflation instead of irrigation. It is necessary to evaluate these methods, as well as the long-term biologic response to laser incision, on living animal models in endoscopic settings before use on humans. Copyright © 2011 Wiley-Liss, Inc.

  6. Early clinical outcomes after small incision lenticule extraction surgery (SMILE). (United States)

    Recchioni, Alberto; Hartwig, Andreas; Dermott, Jay; Vaswani, Sundeep; Bhatt, Jay; Morris, Robert; O'Donnell, Clare


    Dry eye is known to impact on clinical outcomes after laser vision correction and the use of a newer 'all femtosecond laser' surgical approach may be associated with less impact on the ocular surface post-operatively. The purpose of this study was to evaluate the early clinical outcomes and tear instability after the first small incision lenticule extraction (SMILE) cases undertaken by three surgeons at a single site in the UK. Retrospective audit. Seventy-one eyes of 37 patients underwent SMILE surgery using the Zeiss VisuMax laser system (Carl Zeiss Meditec, Germany). Uncorrected and corrected distance visual acuity, spherical equivalent refraction, fluorescein enhanced tear break up time, simulated keratometry and complications were evaluated pre- and post-operatively where applicable. The study population consisted of 21 males and 16 females. The mean±standard deviation age was 33±8years. The results showed that 100% of eyes achieved 20/40 or better and 88% achieved 20/20 or better uncorrected distance visual acuity. The spherical equivalent refraction after surgery was within ±0.50D in 82% of eyes at three months. There was no significant difference in tear break up time from pre-operative levels at three months. Complications were infrequent. This early data from surgeons' first SMILE procedures suggest SMILE provides good outcomes in terms of refractive predictability and visual acuity with minimal impact on the tear film. Longitudinal research will further improve our understanding of the longer-term impact of SMILE on clinical outcomes, ocular surface metrics and patient reported outcomes. Copyright © 2017. Published by Elsevier Ltd.

  7. Channel Power in Multi-Channel Environments

    NARCIS (Netherlands)

    M.G. Dekimpe (Marnik); B. Skiera (Bernd)


    textabstractIn the literature, little attention has been paid to instances where companies add an Internet channel to their direct channel portfolio. However, actively managing multiple sales channels requires knowing the customers’ channel preferences and the resulting channel power. Two key

  8. Office-based relaxing incision procedure for correction of astigmatism after deep anterior lamellar keratoplasty

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Javadi


    Conclusion: Office-based relaxing incision is a safe and effective procedure for the treatment of corneal graft astigmatism after DALK. This approach effectively decreases the need for the more costly alternative in the operating room.

  9. Relaxation incisions of venomous snake "Japanese mamushi" bites to the hand

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    Sugamata A


    Full Text Available Akira Sugamata, Naoki Yoshizawa, Takahiro OkadaDepartment of Plastic and Reconstructive Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, JapanAbstract: Gloydius blomhoffii, commonly known as Japanese mamushi, is a venomous viper species found widely in Japan. The most frequently bitten regions are the fingers and toes, and severe swelling causes compression of peripheral arteries and/or compartment syndrome of the extremities. We experienced four cases of mamushi bites to the hand, and undertook relaxation incision in the hands of three of these patients. As a result, the patients who underwent relaxation incision did not show any skin necrosis or permanent sensory disturbance in the affected fingers. Relaxation incision can be useful to not only decompress subcutaneous and compartment pressure of the hand, but also to wash out the venom from the bitten region by improving venous and lymphatic drainage.Keywords: mamushi, snakebite, viper, relaxation incision

  10. Induced astigmatism in a 6.0 mm no-stitch frown incision. (United States)

    Sinskey, R M; Stoppel, J O


    Fifty-five consecutive patients had cataract extraction with a 6 mm no-stitch frown incision and implantation of a 6 mm optic three-piece posterior chamber lens. Vector analysis calculations of diopters (D) of mean induced keratometric astigmatism for this incision were 0.70 D at one day, 0.76 D at one week, 0.50 D at one month, and 0.50 D at three months. The Naeser's polar value showed a mean with-the-rule astigmatism of +0.42 D at one day and -0.08 D against-the-rule astigmatism at three months. The results suggest that the 6.0 mm no-stitch frown incision induces a low postoperative astigmatism and provides a stable incision.

  11. Intraoperative ventricular puncture during supraorbital craniotomy via an eyebrow incision. Technical note.

    NARCIS (Netherlands)

    Menovsky, T.; Vries, J. de; Wurzer, J.A.; Grotenhuis, J.A.


    The authors determined the landmarks and coordinates for intraoperative ventricular puncture directly from the supraorbital craniotomy opening via an eyebrow incision. Fifty magnetic resonance (MR) imaging studies were obtained from patients with no pathological cerebral characteristics or

  12. Erbium: YAG Laser Incision of Urethral Strictures for Treatment of Urinary Incontinence after Prostate Cancer Surgery

    National Research Council Canada - National Science Library

    Fried, Nathaniel


    .... The purpose of this research project is to test a new laser, the Erbium:YAG laser, which is capable of precisely incising the urethral stricture with minimal peripheral damage to adjacent healthy tissue...

  13. Seismic Facies of Pleistocene–Holocene Channel-fill Deposits in Bawean Island and Adjacent Waters, Southeast Java Sea

    Directory of Open Access Journals (Sweden)

    Ali Albab


    Full Text Available The late Pleistocene-Holocene stratigraphic architecture of the Bawean Island and surrounding waters, southeast Java Sea has been analyzed by using sparker seismic profiles. Geological interpretation of these seismic profiles revealed the widespread distribution of paleochannels with different shape and size in the present-day Java Sea. Two channel types can be distinguished based on its morphology: U-shaped channels in the western part and V-shaped channels in the eastern part. The stratigraphic successions were grouped into two major seismic units separated by different seismic boundaries. Characters of marine and fluvial deposits were determined based on seismic boundaries and internal reflectors. Three seismic facies can be identified within late Pleistocene – Holocene incised channel fills associated with SB2. The internal structure of incised-channels consist of chaotic reflector at the bottom, covered by parallel–sub parallel and almost reflection-free indicating the homogenous sediment deposited during the succession.

  14. Influence of orographic precipitation on the incision within a mountain-piedmont system (United States)

    Zavala, Valeria; Carretier, Sébastien; Bonnet, Stephane


    The geomorphological evolution of a mountain-piedmont system depends both on tectonics and climate, as well as on couplings between the mountain and its piedmont. Although the interactions between climate and tectonics are a fundamental point for understanding the landscape evolution, the erosion of a mountain range and the sediment deposition at the mountain front, or piedmont, have been poorly studied as a coupled system. Here we focus on the conditions driving an incision within such a system. Classically, it is thought that incision results from a change in climate or uplift rates. However, it is not clear which are the specific conditions that favor the occurrence of river incision in the piedmont. In particular, studies have shown that the presence of a piedmont can modify the incision patterns, and even drive autogenic incision, without any change in external forcings. This is a crucial issue in order to interpret natural incisions in terms of uplift or climatic modifications. Such a problem is further complicated by the modification of local precipitations and temperatures during uplift, because the progressive effect of climate change may superimpose to uplift. In this work we explore the hypothesis that a mountain-piedmont coupled system may develop incision in its piedmont as a result of enhanced orographic precipitations during surface uplift. We use a landscape evolution model, Cidre, in order to explore the response of a mountain-piemont system in which the mountain is continuously uplifted but in which precipitation rates depend on elevations. Thus precipitation amounts change during the mountain uplift. We test different peaks and amplitudes of the orographic precipitation pattern, maintaining the other conditions constant. Preliminary results show that elevation-dependent precipitations drive temporary but pronounced incisions of the main rivers within the piedmont, contrary to experiments without orographic precipitations.

  15. Clear corneal incisions in bimanual microincision cataract surgery: long-term wound-healing architecture. (United States)

    Cavallini, Gian Maria; Campi, Luca; Torlai, Giulio; Forlini, Matteo; Fornasari, Elisa


    To evaluate bimanual microincision cataract surgery (MICS) clear corneal incision (CCI) architectural features over the long-term using anterior segment optical coherence tomography (AS-OCT). Case series. Institute of Ophthalmology, University of Modena, Modena, Italy. Patients who had uneventful bimanual MICS in the previous 2 to 16 months were examined using AS-OCT. Images were used to measure corneal thickness, incision length, incision angle, incidence of epithelial or endothelial gaping, misalignment, Descemet membrane detachment, and posterior wound retraction. Fifty-two eyes (33 patients) were enrolled. Mean incision length and incision angle were, respectively, 1427.91 μm and 31.19 degrees for the right hand, 1440.63 μm and 31.54 degrees for the left hand, 1474.13 μm and 31.27 degrees for temporal incisions, and 1394.41 μm and 31.46 degrees for nasal CCIs. Posterior wound retraction was the only architectural feature found. Its prevalence was 7.10% at 2 to 3 months, 31.8% at 4 to 11 months, and 33.3% at 12 months. Fifty-three percent of posterior wound retractions were in 1.8 mm CCIs and 47% in 1.4 mm CCIs. Bimanual MICS was not related to particular morphologic features of CCIs. The enlargement of 1 incision or construction of the incision with the dominant or the nondominant hand did not affect long-term wound architecture. Posterior wound retraction was the only architectural feature; however, its prevalence seems substantially lower than with other surgical techniques. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  16. Spontaneous alignment of crowded inferior incisives after the extractionof temporary canines


    Orellana Manrique, Tomás Oriel; Calderón Cortez, Iván; Orellana Manrique, Martín


    This investigation evaluated the behavior of permanent inferior incisives after the primary canine’s extractions. The study was carried out in the Pediatric Clinic of Dental Faculty of San Marcos University. The sample was conformed by 10 patients, male and female children, between 8 and 9 years of age, with good general health, having Class I malocclusion and severe crowding of the inferior incisives. It was taken Cephalometric and Panoramic radiographies, as well as models to make the ortho...

  17. Channel identification machines. (United States)

    Lazar, Aurel A; Slutskiy, Yevgeniy B


    We present a formal methodology for identifying a channel in a system consisting of a communication channel in cascade with an asynchronous sampler. The channel is modeled as a multidimensional filter, while models of asynchronous samplers are taken from neuroscience and communications and include integrate-and-fire neurons, asynchronous sigma/delta modulators and general oscillators in cascade with zero-crossing detectors. We devise channel identification algorithms that recover a projection of the filter(s) onto a space of input signals loss-free for both scalar and vector-valued test signals. The test signals are modeled as elements of a reproducing kernel Hilbert space (RKHS) with a Dirichlet kernel. Under appropriate limiting conditions on the bandwidth and the order of the test signal space, the filter projection converges to the impulse response of the filter. We show that our results hold for a wide class of RKHSs, including the space of finite-energy bandlimited signals. We also extend our channel identification results to noisy circuits.

  18. Channel Identification Machines

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    Aurel A. Lazar


    Full Text Available We present a formal methodology for identifying a channel in a system consisting of a communication channel in cascade with an asynchronous sampler. The channel is modeled as a multidimensional filter, while models of asynchronous samplers are taken from neuroscience and communications and include integrate-and-fire neurons, asynchronous sigma/delta modulators and general oscillators in cascade with zero-crossing detectors. We devise channel identification algorithms that recover a projection of the filter(s onto a space of input signals loss-free for both scalar and vector-valued test signals. The test signals are modeled as elements of a reproducing kernel Hilbert space (RKHS with a Dirichlet kernel. Under appropriate limiting conditions on the bandwidth and the order of the test signal space, the filter projection converges to the impulse response of the filter. We show that our results hold for a wide class of RKHSs, including the space of finite-energy bandlimited signals. We also extend our channel identification results to noisy circuits.

  19. Starburst Channels (United States)


    [figure removed for brevity, see original site] Figure 1 Translucent carbon dioxide ice covers the polar regions of Mars seasonally. It is warmed and sublimates (evaporates) from below, and escaping gas carves a numerous channel morphologies. In this example (figure 1) the channels form a 'starburst' pattern, radiating out into feathery extensions. The center of the pattern is being buried with dust and new darker dust fans ring the outer edges. This may be an example of an expanding morphology, where new channels are formed as the older ones fill and are no longer efficiently channeling the subliming gas out. Observation Geometry Image PSP_003443_0980 was taken by the High Resolution Imaging Science Experiment (HiRISE) camera onboard the Mars Reconnaissance Orbiter spacecraft on 21-Apr-2007. The complete image is centered at -81.8 degrees latitude, 76.2 degrees East longitude. The range to the target site was 247.1 km (154.4 miles). At this distance the image scale is 24.7 cm/pixel (with 1 x 1 binning) so objects 74 cm across are resolved. The image shown here has been map-projected to 25 cm/pixel. The image was taken at a local Mars time of 04:52 PM and the scene is illuminated from the west with a solar incidence angle of 71 degrees, thus the sun was about 19 degrees above the horizon. At a solar longitude of 223.4 degrees, the season on Mars is Northern Autumn.

  20. Evaluation of four suture materials for surgical incision closure in Siberian sturgeon (United States)

    Boone, S. Shaun; Hernandez, Sonia M.; Camus, Alvin C.; Peterson, Douglas C.; Jennings, Cecil A.; Shelton, James L.; Divers, Stephen J.


    The visual and microscopic tissue reactions to the absorbable monofilament Monocryl, absorbable monofilament triclosan-coated Monocryl-Plus, absorbable multifilament Vicryl, and nonabsorbable monofilament Prolene were evaluated for their use of surgical closure in Siberian Sturgeon Acipenser baerii. Postoperative assessments were conducted at 1, 2, 8, 12, and 26 and 55 weeks to visually evaluate the surgical incision for suture retention, incision healing, erythema, and swelling. Incisions were also assessed microscopically at 1, 2, and 8 weeks for necrosis, inflammation, hemorrhage, and fibroplasia. The results indicated that incisions closed with either Vicryl or Prolene suture materials were more likely to exhibit more erythema or incomplete healing compared with those closed with Monocryl or Monocryl-Plus. The surgical implantation of a transmitter in the coelomic cavity did not significantly affect the response variables among the four suture materials. Monocryl or Monocryl-Plus were equally effective and superior to other suture materials used for closing surgical incisions in Siberian Sturgeon or closely related species of sturgeon. Furthermore, Monocryl or Monocryl-Plus may decrease the risk of transmitter expulsion through the incision, as surgical wounds appear to heal faster and exhibit less erythema compared with those closed with Vicryl.

  1. In vitro conjunctival incision repair by temperature-controlled laser soldering (United States)

    Norman, Galia; Rabi, Yaron; Assia, Ehud; Katzir, Abraham


    The common method of closing conjunctival incisions is by suturing, which is associated with several disadvantages. It requires skill to apply and does not always provide a watertight closure, which is required in some operations (e.g., glaucoma filtration). The purpose of the present study was to evaluate laser soldering as an alternative method for closing conjunctival incisions. Conjunctival incisions of 20 ex vivo porcine eyes were laser soldered using a temperature-controlled fiberoptic laser system and an albumin mixed with indocyanine green as a solder. The control group consisted of five repaired incisions by a 10-0 nylon running suture. The leak pressure of the repaired incisions was measured. The mean leak pressure in the laser-soldered group was 132 mm Hg compared to 4 mm Hg in the sutured group. There was no statistically significant difference in both the incision's length and distance from the limbus between the groups, before and after the procedure, indicating that there was no severe thermal damage. These preliminary results clearly demonstrate that laser soldering may be a useful method for achieving an immediate watertight conjunctival wound closure. This procedure is faster and easier to apply than suturing.

  2. Beaver dams and channel sediment dynamics on Odell Creek, Centennial Valley, Montana, USA (United States)

    Levine, Rebekah; Meyer, Grant A.


    Beaver dams in streams are generally considered to increase bed elevation through in-channel sediment storage, thus, reintroductions of beaver are increasingly employed as a restoration tool to repair incised stream channels. Here we consider hydrologic and geomorphic characteristics of the study stream in relation to in-channel sediment storage promoted by beaver dams. We also document the persistence of sediment in the channel following breaching of dams. Nine reaches, containing 46 cross-sections, were investigated on Odell Creek at Red Rock Lakes National Wildlife Refuge, Centennial Valley, Montana. Odell Creek has a snowmelt-dominated hydrograph and peak flows between 2 and 10 m3 s- 1. Odell Creek flows down a fluvial fan with a decreasing gradient (0.018-0.004), but is confined between terraces along most of its length, and displays a mostly single-thread, variably sinuous channel. The study reaches represent the overall downstream decrease in gradient and sediment size, and include three stages of beaver damming: (1) active; (2) built and breached in the last decade; and (3) undammed. In-channel sediment characteristics and storage were investigated using pebble counts, fine-sediment depth measurements, sediment mapping and surveys of dam breaches. Upstream of dams, deposition of fine (≤ 2 mm) sediment is promoted by reduced water surface slope, shear stress and velocity, with volumes ranging from 48 to 182 m3. High flows, however, can readily transport suspended sediment over active dams. Variations in bed-sediment texture and channel morphology associated with active dams create substantial discontinuities in downstream trends and add to overall channel heterogeneity. Observations of abandoned dam sites and dam breaches revealed that most sediment stored above beaver dams is quickly evacuated following a breach. Nonetheless, dam remnants trap some sediment, promote meandering and facilitate floodplain development. Persistence of beaver dam sediment

  3. A randomized clinical trial of knotless barbed suture vs conventional suture for closure of the uterine incision at cesarean delivery. (United States)

    Peleg, David; Ahmad, Ronan Said; Warsof, Steven L; Marcus-Braun, Naama; Sciaky-Tamir, Yael; Ben Shachar, Inbar


    Knotless barbed sutures are monofilament sutures with barbs cut into them. These sutures self-anchor, maintaining tissue approximation without the need for surgical knots. The hypothesis of this study was that knotless barbed suture could be used on the myometrium to close the hysterotomy at cesarean delivery. The objective was to compare uterine closure time, need for additional sutures, and blood loss between this and a conventional suture. This was a prospective, unblinded, randomized controlled trial conducted at the Ziv Medical Center, Zefat, Israel. The primary outcome was the length of time needed to close the uterine incision, which was measured from the start of the first suture on the uterus until obtaining uterine hemostasis. To minimize provider bias, women were randomized by sealed envelopes that were opened in the operating room just prior to uterine closure with either a bidirectional knotless barbed suture or conventional suture. Secondary outcomes included the number of additional hemostatic sutures needed and blood loss during incision closure. Patients were enrolled from August 2016 until March 2017. One hundred two women were randomized. Fifty-one had uterine closure with knotless barbed suture and 51 with conventional suture. The groups were similar for demographics as well as number of previous cesarean deliveries. Uterine closure time using the knotless barbed suture was significantly shorter than the conventional suture by a mean of 1 minute 43 seconds (P barbed sutures were associated with a lower need for hemostatic sutures (median 0 vs 1, P barbed suture is a reasonable alternative to conventional sutures because it reduced the closure time of the uterine incision. There was also less need for additional hemostatic sutures and slightly reduced estimated blood loss. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Elective gastropexy with a reusable single-incision laparoscopic surgery port in dogs: 14 cases (2012-2013). (United States)

    Stiles, Mandy; Case, J Brad; Coisman, James


    OBJECTIVE To describe the technique, clinical findings, and short-term outcome in dogs undergoing laparoscopic-assisted incisional gastropexy with a reusable single-incision surgery port. DESIGN Retrospective case series. ANIMALS 14 client-owned dogs. PROCEDURES Medical records of dogs referred for elective laparoscopic gastropexy between June 2012 and August 2013 were reviewed. History, signalment, results of physical examination and preoperative laboratory testing, surgical procedure, duration of surgery, postoperative complications, duration of hospital stay, and short-term outcome were recorded. All patients underwent general anesthesia and were positioned in dorsal recumbency. After an initial limited laparoscopic exploration, single-incision laparoscopic-assisted gastropexy was performed extracorporeally in all dogs via a conical port placed in a right paramedian location. Concurrent procedures included laparoscopic ovariectomy (n = 4), gastric biopsy (2), and castration (7). Short-term outcome was evaluated. RESULTS Median duration of surgery was 76 minutes (range, 40 to 90 minutes). Intraoperative complications were minor and consisted of loss of pneumoperitoneum in 2 of 14 dogs. A postoperative surgical site infection occurred in 1 dog and resolved with standard treatment. Median duration of follow-up was 371 days (range, 2 weeks to 1.5 years). No dogs developed gastric dilation-volvulus during the follow-up period, and all owners were satisfied with the outcome. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that single-incision laparoscopic-assisted gastropexy with a reusable conical port was feasible and effective in appropriately selected cases. Investigation of the potential benefits of this reusable port versus single-use devices for elective gastropexy in dogs is warranted.

  5. The clinical research of off-pump coronary artery bypass grafting by small incision at the left chest. (United States)

    Xiao, L-B; Zhang, Y-H; Zhou, J-W; Yang, M; Ling, Y-P; Gao, Z-S; Wang, Y-S


    To explore the clinical value of off-pump coronary artery bypass grafting by small incision at the left chest, and develop a better surgical regimen for coronary heart disease patients. 201 coronary heart disease patients who need coronary artery bypass grafting were required and randomly divided into 2 groups including a control group and an observation group. There were 107 cases in the control group who received coronary bypass grafting by extracorporeal circulation; there were 103 cases in the observation group who received off-pump coronary bypass grafting by small incision at the left chest. The duration of the mechanism ventilation, length of stay in ICU, hospitalization time, postoperative drainage volume, and the occurrence rate of complications were recorded and compared. The duration of mechanism ventilation, length of stay in ICU, hospitalization time and postoperative drainage volume in the control group were (19.21 ± 1.33) hours, (5.08 ± 0.57) days, (21.20 ± 2.34) days and (997.68 ± 96.35) mL, which were (7.73 ± 0.74) hours, (2.83 ± 0.16) days, (15.67 ± 1.18) days and (901.53 ± 89.32) mL in the observation group respectively, with statistical difference between the two groups (pdisease, pulmonary infection, perioperative cardiac infarction and mortality did not display a significant difference between the two groups (p > 0.05). Off-pump coronary artery bypass grafting by small incision at the left chest is a surgical method with less injury and fast recovery, which can be used as the preferred therapeutical method for the coronary heart disease patients who need coronary artery bypass grafting.

  6. Channel morphology change of an allogenic river channel in a very arid environment due to human interventions (United States)

    Yu, Guo-An; Disse, Markus; Qing Huang, He; Liu, Xiaofang


    Hydrological and fluvial processes of many dryland rivers have already been strongly influenced by various human interventions such as land reclamation and flow regulation, as the result of the accelerated expansion of human activities from temperate and humid environments into arid environments. Gauged hydrological data, channel bed survey and satellite images were used to analyze the temporal change of channel morphology of the main stem Tarim River, an allogenic river channel flowing in a very arid environment in northwest China, responding to ever increasing human impacts in recent decades. Surveyed channel cross sectional profiles in the upper reaches have shown that the mean channel bed elevation was in a fluctuating and silting trend in the last three decades, and the aggradation majorly occurred after the flood season, whereas scouring (incision) mainly occurred during the main flood season. The mean channel width and braiding intensity of the upper braided reaches followed an obvious decreasing trend. The channel embankments and gradual reclamation (occupation) of previous river flood plains and convex banks to farmlands is the major cause for the channel narrowing. The mean channel width and sinuosity index of the middle meandering reach in recent decades showed a gentle decreasing and increasing trend, respectively. The sinuosity index also differed quite clearly between the current and old (abandoned) channels. The meandering intensities (mean sinuosity index over a certain channel reach) of current meandering channels were obviously lower than the old channels. Human activity has changed the fluvial processes of the Tarim River and has restrained, to some extent, the evolution of channel patterns (meander development and channel avulsion).

  7. Vascularized dorsal dartos flap to prevent fistula in tubularized incised plate urethroplasty for primary distal and mid shaft hypospadias

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    A. K. M. Zahid Hossain


    Full Text Available The aim of the present study was to evaluate the importance of neourethral covering using vascularized dorsal flap for preventing fistula in Tabularized incised plate (TIP urethroplasty. The study included 52 children (aged 2-10 years who had hypospadias repaired including 44  with distal and 8  with mid shaft hypospadias. In all children, a standard tabularized incised plate urethroplasty was followed by reconstruction of new surrounding urethral tissue. A longitudinal dartos flap was harvested from excessive dorsal preputial and penile hypospadiac skin and transposed to ventral side by a buttonhole maneuver. It was sutured to the glans wings and the neomeatus and to the corpora covernosa over the neo-urethra. Thus the new urethra was completely covered with well-vascularzed subcutaneous tissue. At a mean follow-up of 18 months, the result was successful with no fistula or urethral stenosis, except 2 of the mid penile hypospadias. All patients had good functional and cosmetic results with straight penis and vertical slit shaped meatus at the tip of the penis. The 2 patients developed tiny fistula, which were closed spontaneously after meatal dilatation. In conclusion, urethral covering should be part of TIP urethroplasty. A dorsal well-vascularized dartos flap, button holed ventrally is a good choice for preventing fistula for distal and mid shaft hypospadias. 

  8. Outcomes of Phacoemulsification Using Different Size of Clear Corneal Incision in Eyes with Previous Radial Keratotomy.

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    Jing Shang Zhang

    Full Text Available To evaluate visual outcomes and complications after phacoemulsification in eyes with cataract and previous radial keratotomy (RK cuts using different sizes of clear corneal incisions.The study was a retrospective study. Thirty eyes with cataract and previous RK underwent phacoemulsification and intraocular lens (IOL implantation. Among them 7 eyes had 8 RK cuts, 13 eyes had 12 RK cuts, and 10 eyes had 16 RK cuts. Phacoemulsification and IOL implantation were performed through a 2.0-3.2 mm clear corneal incision by a single surgeon. In the 8 RK cuts group, 3.2 mm clear corneal incisions were used in 4 eyes, and 3.0 mm clear corneal incisions were used in 3 eyes. In the 12 RK cuts group, 3.2 mm clear corneal incisions were used in 6 eyes, and 2.2 mm clear corneal incisions were used in 7 eyes. In the 16 RK cuts group, 3.2 mm clear corneal incisions were used in 5 eyes, and 2.0 mm clear corneal incisions were used in 5 eyes. Patients were followed up 1 day, 1 week, 1 month, 3 months, 6 months, 1 year, 2 years, and 3 years postoperatively and were examined for the dehiscence of RK cuts during or after the surgery, post-operative best-corrected visual acuity (BCVA, corneal astigmatism, corneal endothelial cell density and complications.Successful phacoemulsification with IOL implantation was performed in all eyes. No wound dehiscence was noted in any eyes with 8 or 12 RK cuts. Wound dehiscence was noted in 2 eyes with 16 RK cuts. The dehiscence of RK cuts was closed successfully by injecting an air bubble with or without viscoelastic agent into the anterior chamber at the end of surgery. During the follow-up, the cuts were well apposed in all eyes, and no new dehiscence of RK cuts was noted. At the last follow-up, mean BCVA (0.2 ± 0.18 logMAR was better than preoperative BCVA(0.45±0.19 logMAR (P < 0.001. There was no significant difference between the long-term preoperative and postoperative mean corneal astigmatism (P = 0.3. However, there was a

  9. Prospective randomized comparison of the safety, efficacy, and cosmetic outcome associated with mini-transverse and mini-longitudinal radical prostatectomy incisions

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    Bruce R Kava


    Conclusions : Seven-centimeter transverse and longitudinal mini-incisions offer alternatives to the standard ORP incision, and to minimally invasive approaches. Both incisions are safe, associated with little postoperative pain, and a short postoperative LOS. Both incisions provide highly satisfactory cosmesis for the patient.

  10. Ectasia following small-incision lenticule extraction (SMILE: a review of the literature

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    Moshirfar M


    Full Text Available Majid Moshirfar,1,2 Julio C Albarracin,3 Jordan D Desautels,1,4 Orry C Birdsong,1 Steven H Linn,1 Phillip C Hoopes Sr1 1HDR Research Center, Hoopes Vision, Draper, 2John A Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, 3Department of Ophthalmology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 4Department of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, RI, USA Purpose: Four cases of corneal ectasia after small-incision lenticule extraction (SMILE have been reported. In this review, we provide an overview of the published literature on corneal ectasia after SMILE and risk factors associated with this complication.Methods: Case reports were identified by a search of seven electronic databases for pertinent heading terms between 2011 and July 2017. We identified patient characteristics and surgical details including preoperative topography, central corneal thickness, and anterior keratometry (Km. Residual stromal bed (RSB values not reported were computed using VisuMax ReLEx SMILE software Version 2.10.10. Preoperative ectasia risk was measured using the Randleman Ectasia Risk Score System (ERSS. Percent tissue alteration was calculated for each patient as described by Santhiago et al.Results: Seven eyes of four patients developed corneal ectasia post SMILE. Two patients had abnormal topography in both eyes. One patient had abnormal topography in one eye. Only one patient was noted to have normal topography in both eyes and later developed ectasia in one eye in the absence of any known risk factors. The mean Randleman ectasia risk score was 4±3 (range: 1–8. The mean calculated percent tissue altered (PTA was 38%±6% (range: 30%–47%.Conclusion: A majority of reported ectasia cases occurred in patients with subclinical keratoconus. These conditions may be exacerbated by SMILE and should be

  11. Highly mutagenic exocyclic DNA adducts are substrates for the human nucleotide incision repair pathway.

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    Paulina Prorok

    Full Text Available BACKGROUND: Oxygen free radicals induce lipid peroxidation (LPO that damages and breaks polyunsaturated fatty acids in cell membranes. LPO-derived aldehydes and hydroxyalkenals react with DNA leading to the formation of etheno(ε-bases including 1,N(6-ethenoadenine (εA and 3,N(4-ethenocytosine (εC. The εA and εC residues are highly mutagenic in mammalian cells and eliminated in the base excision repair (BER pathway and/or by AlkB family proteins in the direct damage reversal process. BER initiated by DNA glycosylases is thought to be the major pathway for the removal of non-bulky endogenous base damage. Alternatively, in the nucleotide incision repair (NIR pathway, the apurinic/apyrimidinic (AP endonucleases can directly incise DNA duplex 5' to a damaged base in a DNA glycosylase-independent manner. METHODOLOGY/PRINCIPAL FINDINGS: Here we have characterized the substrate specificity of human major AP endonuclease 1, APE1, towards εA, εC, thymine glycol (Tg and 7,8-dihydro-8-oxoguanine (8oxoG residues when present in duplex DNA. APE1 cleaves oligonucleotide duplexes containing εA, εC and Tg, but not those containing 8oxoG. Activity depends strongly on sequence context. The apparent kinetic parameters of the reactions suggest that APE1 has a high affinity for DNA containing ε-bases but cleaves DNA duplexes at an extremely slow rate. Consistent with this observation, oligonucleotide duplexes containing an ε-base strongly inhibit AP site nicking activity of APE1 with IC(50 values in the range of 5-10 nM. MALDI-TOF MS analysis of the reaction products demonstrated that APE1-catalyzed cleavage of εA•T and εC•G duplexes generates, as expected, DNA fragments containing 5'-terminal ε-base residue. CONCLUSIONS/SIGNIFICANCE: The fact that ε-bases and Tg in duplex DNA are recognized and cleaved by APE1 in vitro, suggests that NIR may act as a backup pathway to BER to remove a large variety of genotoxic base lesions in human cells.

  12. A study of incisive canal using a cone beam computed tomography

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    Kim, Gyu Tae; Hwang, Eui Hwan; Lee, Sang Rae [Kyunghee University College of Medicine, Seoul (Korea, Republic of)


    To investigate the anatomical structure of the incisive canal radiographically by a cone beam computed tomography. 38 persons (male 26, female 12) were chosen to take images of maxillary anterior region in dental CT mode using a cone beam computed tomography. The tube voltage were 65, 67, and 70 kVp, the tube current was 7 mA, and the exposure time was 13.3 seconds. The FH plane of each person was parallel to the floor. The images were analysed on the CRT display. The mean length of incisive canal was 15.87 mm {+-} 2.92. The mean diameter at the side of palate and nasal fossa were 3.49 mm {+-} 0.76 and 3.89 mm {+-} 1.06, respectively. In the cross-sectional shape of incisive canal, 50% were round, 34.2% were ovoid, and 15.8% were lobulated. 87% of incisive canal at the side of nasal fossa have one canal, 10.4% have two canals, and 2.6% have three canals, but these canals were merged into one canal in the middle portion of palate. The mean angles of the long axis of incisive canal and central incisor to the FH plane were 110.3 {+-} 6.96 and 117.45 {+-} 7.41, respectively. The angles of the long axis of incisive canal and central incisor to the FH plane were least correlated (r 0.258). This experiment suggests that a cone beam computed radiography will be helpful in surgery or implantation on the maxillary incisive area.

  13. Neogene unroofing and incision of the Ethiopian Plateau constrained from apatite (U-Th)/He thermochronometry (United States)

    Gani, N. D.; Van Soest, M. C.; Gani, M. R.; Tadesse, K.; Neupane, P. C.; Falster, A.


    Ethiopian Plateau in East Africa, one of the large igneous provinces, has been deeply incised by the Blue Nile River. The plateau has experienced extensive volcanisms at ~30 Ma linked to outpouring of the Afar mantle plume that accumulated average 1 km thick flood basalt. This event, along with later repetitive volcanisms in the region, has complicated (e.g., partial resetting of mineral cooling ages, abnormal geothermal gradients) the application of thermochronological modeling to constrain the Cenozoic unroofing and incision history of the plateau. In this study, we used (U-Th)/He thermochronometry of apatite grains extracted from gneissic and granitic basement rocks and overlying sandstones in a 1.2 km vertical elevation profile within the Blue Nile Canyon to partition incision in geologic time. Our apatite cooling ages are comparatively older than that of previous thermochronological studies of the area. These cooling ages show wide range and random distribution with elevation but positively correlate with effective uranium (eU) concentration of apatite minerals. Thus we chose recently developed RDAAM (Radiation Damage Accumulation and Annealing model) inverse modeling in HeFTy that was demonstrated to be appropriate for regions with complex thermal history and variable eU concentration. Initial results of RDAAM model, guided by reasonable thermal history of the plateau, show gradual cooling and thus slow incision during Early Neogene after the rapid heating of the region linked to the accumulation of thick flood basalt around 30 Ma. Importantly, these simulations predict rapid cooling, thus fast incision, during Late Neogene. This incision history of the Ethiopian Plateau interpreted from apatite thermal modeling is consistent with the previous GIS-and-geochronology-based study that showed increased incision rates around 10 Ma and 6 Ma.

  14. Distinguishing between tectonic and lithologic controls on bedrock channel longitudinal profiles using cosmogenic 10Be erosion rates and channel steepness index (United States)

    Cyr, Andrew J.; Granger, Darryl E.; Olivetti, Valerio; Molin, Paola


    Knickpoints in fluvial channel longitudinal profiles and channel steepness index values derived from digital elevation data can be used to detect tectonic structures and infer spatial patterns of uplift. However, changes in lithologic resistance to channel incision can also influence the morphology of longitudinal profiles. We compare the spatial patterns of both channel steepness index and cosmogenic 10Be-determined erosion rates from four landscapes in Italy, where the geology and tectonics are well constrained, to four theoretical predictions of channel morphologies, which can be interpreted as the result of primarily tectonic or lithologic controls. These data indicate that longitudinal profile forms controlled by unsteady or nonuniform tectonics can be distinguished from those controlled by nonuniform lithologic resistance. In each landscape the distribution of channel steepness index and erosion rates is consistent with model predictions and demonstrates that cosmogenic nuclide methods can be applied to distinguish between these two controlling factors.

  15. Recent morphological changes in the Mekong and Bassac river channels, Mekong delta: The marked impact of river-bed mining and implications for delta destabilisation (United States)

    Brunier, Guillaume; Anthony, Edward J.; Goichot, Marc; Provansal, Mireille; Dussouillez, Philippe


    The Mekong delta, in Vietnam, is the world's third largest delta. Densely populated, the delta has been significantly armoured with engineering works and dykes to protect populations and infrastructure from storms, and shrimp farms from saltwater intrusion. Considerable development pressures in Vietnam and in the upstream countries have resulted in the construction of several dams in China and in important channel-bed aggregate extractions especially in Cambodia. The effects of these developments impact the delta dynamics in various ways. In this study, changes in the channel morphology of the Mekong proper and the Bassac, the two main distributaries in the 250 km-long deltaic reach from the Cambodian border to the coast, were analysed using channel depth data for 1998 and 2008. The channels display important and irregular bed changes over the 10-year comparison period, including significant incision and expansion and deepening of numerous pools. The mean depth of both channels increased by more than 1.3 m. Both channels also showed correlative significant bed material losses: respectively 90 million m3 in the Mekong and 110 million m3 in the Bassac over the 10-year period. These important losses over a relatively short period, and weak correlations between bed incision and hydraulic parameters suggest that the marked morphological changes are not in equilibrium with flow and sediment entrainment conditions, and are therefore not related to changes in river hydrology. We claim that aggregate extraction, currently practised on a very large scale in the Mekong delta channels and upstream of the delta, is the main cause of these recent morphological changes. These changes are deemed to contribute actively to rampant bank erosion in the delta as well as to erosion of the Mekong delta shoreline. Other contributory activities include the numerous dykes and embankments. The role of existing dams in bed losses remains unclear in the absence of reliable data on the Mekong

  16. NALCN ion channels have alternative selectivity filters resembling calcium channels or sodium channels

    NARCIS (Netherlands)

    Senatore, A.; Monteil, A.; van Minnen, J.; Smit, A.B.; Spafford, J.D.


    NALCN is a member of the family of ion channels with four homologous, repeat domains that include voltage-gated calcium and sodium channels. NALCN is a highly conserved gene from simple, extant multicellular organisms without nervous systems such as sponges and placozoans and mostly remains a single

  17. Tubularized incised plate urethroplasty with or without stent in Hypospadias repair: a systematic review and meta-analysis

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    Seyed Abdollah Mousavi


    Full Text Available Numerous methods for repair of hypospadias have been introduced. The technique of Tubularized Incised Plate urethroplasty has gained widespread acceptance. In the classical method of Tubularized Incised Plate urethroplasty, to divert urine flow and preventing urethral stenosis, a stent was used, but its necessity is questionable for some surgeons. In this paper we systematically compared the results of operations in different studies. Searching the databases such as PubMed, SCOPUS, and Google Scholar was done and articles found from January 1994 to September 2013 were included. Then articles about the impact of use or non-use of urinary catheters on surgical outcomes were analyzed. By reviewing 168 studies related to repair of hypospadias with TIP, we selected 11 studies that met our inclusion criteria which did not use a stent. A total of 708 children had urethroplasty using the TIP method without stent. The overall complication rate such as meatal stenosis and fistula compared with stents was not significant. It could tell us that at least in some cases especially in distal types, use of stent can be avoided, because its least benefit would be reduction of bladder spasm and urinary tract infections.

  18. Transgressive systems tract development and incised-valley fills within a quaternary estuary-shelf system: Virginia inner shelf, USA (United States)

    Foyle, A.M.; Oertel, G.F.


    High-frequency Quaternary glacioeustasy resulted in the incision of six moderate- to high-relief fluvial erosion surfaces beneath the Virginia inner shelf and coastal zone along the updip edges of the Atlantic continental margin. Fluvial valleys up to 5 km wide, with up to 37 m of relief and thalweg depths of up to 72 m below modern mean sea level, cut through underlying Pleistocene and Mio-Pliocene strata in response to drops in baselevel on the order of 100 m. Fluvially incised valleys were significantly modified during subsequent marine transgressions as fluvial drainage basins evolved into estuarine embayments (ancestral generations of the Chesapeake Bay). Complex incised-valley fill successions are bounded by, or contain, up to four stacked erosional surfaces (basal fluvial erosion surface, bay ravinement, tidal ravinement, and ebb-flood channel-base diastem) in vertical succession. These surfaces, combined with the transgressive oceanic ravinement that generally caps incised-valley fills, control the lateral and vertical development of intervening seismic facies (depositional systems). Transgressive stratigraphy characterizes the Quaternary section beneath the Virginia inner shelf where six depositional sequences (Sequences I-VI) are identified. Depositional sequences consist primarily of estuarine depositional systems (subjacent to the transgressive oceanic ravinement) and shoreface-shelf depositional systems; highstand systems tract coastal systems are thinly developed. The Quaternary section can be broadly subdivided into two parts. The upper part contains sequences consisting predominantly of inner shelf facies, whereas sequences in the lower part of the section consist predominantly of estuarine facies. Three styles of sequence preservation are identified. Style 1, represented by Sequences VI and V, is characterized by large estuarine systems (ancestral generations of the Chesapeake Bay) that are up to 40 m thick, have hemicylindrical wedge geometries

  19. A systematic review of the clinical effectiveness and cost-effectiveness and economic modelling of minimal incision total hip replacement approaches in the management of arthritic disease of the hip. (United States)

    de Verteuil, R; Imamura, M; Zhu, S; Glazener, C; Fraser, C; Munro, N; Hutchison, J; Grant, A; Coyle, D; Coyle, K; Vale, L


    evaluations were identified, but they added little, if any, value to the current evidence base owing to their limited quality. In the economic model, mini-incision THR was less costly and provided slightly more QALYs in both the 1- and 40-year analyses. The mean QALYs at 1 year were 0.677 for standard THR and 0.695 for mini-incision THR. At 40 years, the mean QALYs were 8.463 for standard THR and 8.480 for mini-incision. At 1 year the probabilistic sensitivity analyses indicate that mini-incision THR has a 95% probability of being cost-effective if society's willingness to pay for a QALY were up to 50,000 pounds sterling. This is reduced to approximately 55% for the 40-year analysis. The results were driven by the assumption of a 1-month earlier return to usual activities and a decreased hospital length of stay and operation duration following mini-incision THR. If mini-incision THR actually required more intensive use of resources it would become approximately 200 pounds sterling more expensive and would only be cost-effective (cost per QALY>30,000 pounds sterling) if recovery was 1.5 weeks faster. A threshold analysis around risk of revision showed, using the same cost per QALY threshold, mini-incision THR would have to have no more than a 7.5% increase in revisions compared with standard THR for it to be no longer considered cost-effective (one more revision for every 200 procedures performed). Further sensitivity analysis involved relaxing assumptions of equal long-term outcomes where possible. and broadly similar results to the base-case analysis were found in this and further sensitivity analyses. Compared with standard THR, minimal incision THR has small perioperative advantages in terms of blood loss and operation time. It may offer a shorter hospital stay and quicker recovery. It appears to have a similar procedure cost to standard THR, but evidence on its longer term performance is very limited. Further long-term follow-up data on costs and outcomes including


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    Danijela Đerić


    Full Text Available Hypospadias does not present an isolated genital anomaly but a complex urological, sex-ual, psychological and psychiatric, reproductive and aesthetic problem. Although there are over 200 operative techniques, this great surgical challenge presently does not have ideal operative solution. Nowadays, the use of urethral plate for urethroplasty, through various surgical tech-niques, presents a revolutionary concept in hypospadias surgery and it is being accepted by an ever-increasing number of hypospadiologists.Tubularized incised plate urethroplasty (TIP -Snodgrass procedure was performed on a total of 22 boys; 16 distal (72.7%, 5 mid-penile (22.7% and 1 proximal hypospadias in period from 1.1.2000 to 30.08.2003, by the same surgical team. The average patient age was 4.5 years (6 mon. to 12 years. All reconstructions have been done as primary urethroplasty while one distal hypospadias had one previous, unsuccessful MAGPI procedure. Complication included small urethrocutaneous fistulas in 4 (18% and meatal stenosis in 1 (4.5% child. Snodgrass pro-cedure is a successful method for reparation of distal hypospadias for it provides an excellent aesthetic result with acceptable complications. In order to evaluate the success of this method in reparation of mid- and proximal hypospadias, as well as the possibility of its application on previously unsuccessful or circumcised patients, it is necessary to gain additional experience al-though the first results are encouraging.

  1. Curative effects of small incision cataract surgery versus phacoemulsification: a Meta-analysis

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    Chang-Jian Yang


    Full Text Available AIM: To evaluate the curative efficacy of small incision cataract surgery(SICSversus phacoemulsification(Phaco.METHODS: A computerized literature search was carried out in Chinese Biomedical Database(CBM, Wanfang Data, VIP and Chinese National Knowledge Infrastructure(CNKIto collect articles published between 1989-2013 concerning the curative efficacy of SICS versus Phaco. The studies were assessed in terms of clinical case-control criteria. Meta-analysis were performed to assess the visual acuity, the complications rates between SICS and Phaco 90 days after surgery. Treatment effects were measured as risk difference(RDbetween SICS and Phaco. Fixed and random effect models were employed to combine results after a heterogeneity test. RESULTS:A total of 8 studies were included in our Meta-analysis. At 90 days postoperative time, there were no significant differences between the two groups at the visual acuity >0.5(P=0.14; and no significant differences on the complications rates of corneal astigmatism, corneal edema, posterior capsular rupture and anterior iris reaction(P>0.05.CONCLUSION: These results suggest that there is no different on the curative effects of SICS and Phaco for cataract.

  2. Factors Influencing Efficacy of Peripheral Corneal Relaxing Incisions during Cataract Surgery

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    Nino Hirnschall


    Full Text Available Purpose. To evaluate influencing factors on the residual astigmatism after performing peripheral corneal relaxing incisions (PCRIs during cataract surgery. Methods. This prospective study included patients who were scheduled for cataract surgery with PCRIs. Optical biometry (IOLMaster 500, Carl Zeiss Meditec AG, Germany was taken preoperatively, 1 week, 4 months, and 1 year postoperatively. Additionally, corneal topography (Atlas model 9000, Carl Zeiss Meditec AG, Germany, ORA (Ocular Response Analyzer, Reichert Ophthalmic Instruments, USA, and autorefraction (Autorefractometer RM 8800 Topcon were performed postoperatively. Results. Mean age of the study population n=74 was 73.5 years (±9.3; range: 53 to 90 and mean corneal astigmatism preoperatively was −1.82 D (±0.59; 1.00 to 4.50. Mean corneal astigmatism was reduced to 1.14 D (±0.67; 0.11 to 3.89 4 months postoperatively. A partial least squares regression showed that a high eccentricity of the cornea, a large deviation between keratometry and topography, and a high preoperative astigmatism resulted in a larger postoperative error concerning astigmatism. Conclusions. PCRI causes a reduction of preoperative astigmatism, though the prediction is difficult but several factors were found to be a relevant source of error.

  3. Shifting "Ectasia": Interface Fluid Collection After Small Incision Lenticule Extraction (SMILE). (United States)

    Bansal, Aashish K; Murthy, Somasheila I; Maaz, Syed M; Sachdev, Mahipal S


    To report the first case and a new diagnostic sign of interface fluid collection following small incision lenticule extraction (SMILE). Case report. A 20-year-old man underwent SMILE for correction of compound myopic astigmatism. Postoperative follow-up examination included vision testing, slit-lamp examination, intraocular pressure measurement, corneal topography, and optical coherence tomography (OCT). The patient presented postoperatively with decreased vision in his right eye. Topography revealed an island of corneal steepening, the location of which kept shifting on successive visits. OCT revealed the presence of fluid pockets in the interface. The condition resolved with topical hypertonic saline and the uncorrected visual acuity recovered to 20/20. The intraocular pressure remained normal throughout. This is the first case report of interface fluid collection after SMILE. The report demonstrates shifting corneal "ectasia" (steepening) as a diagnostic sign of interface fluid collection. The authors recommend a new pathogenesis for this condition and suggest the use of topical hypertonic saline to treat this condition. [J Refract Surg. 2016;32(11):773-775.]. Copyright 2016, SLACK Incorporated.

  4. Bone-anchored hearing device surgery: Linear incision without soft tissue reduction. A prospective study. (United States)

    Altuna, Xabier; Navarro, Juan José; Palicio, Idoia; Álvarez, Leire


    The classic surgical procedure for percutaneous bone-anchored hearing devices involves removal of a large area of subcutaneous tissue down to the periosteum. This leads to alopecia and raises the risk of devascularization of the overlying skin with the potential for infection and scarring. The objective of this study was to determine the results of implant placement using a single, linear incision with no underlying soft tissue reduction. A prospective study was conducted in our hospital over a period of 14 months in all consecutive surgeries performed using this technique in adults. Patients were reviewed regularly (week 1, week 3, weeks 4-6 and months 3, 6 and 12) to assess wound healing including evaluation with the Holgers scale. Corresponding to 34 patients, 34 cases were consecutively enrolled in this study. We found that 15% of the patients had minor skin reactions during the first visit (Holgers grade 1 or 2); this number raised to 20% in week 3, but at week 4 only 1 patient had a reaction score of 1 (which was solved by week 6). None of the cases required revision surgery and all skin reactions were treated topically. Our results suggest that the tissue preservation technique is a simple and effective insertion technique with a favourable healing process and cosmesis. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  5. Cap morphology after small-incision lenticule extraction and its effects on intraocular scattering

    Directory of Open Access Journals (Sweden)

    Dan Fu


    Full Text Available AIM: To investigate cap morphology after small-incision lenticule extraction (SMILE and its effects on intraocular scattering. METHODS: Sixty-five eyes of 33 patients undergoing SMILE were enrolled. In addition to regular evaluation, Fourier-domain optical coherence tomography was used to investigate cap thickness at 1d, 1wk, 1 and 3mo postoperatively. The optical quality including modulation transfer function cutoff frequency, Strehl ratio, Optical Quality Analysis System (OQAS values, and objective scattering index (OSI, were evaluated using OQASTM. RESULTS: Cap thickness decreased from 1d to 1wk (P<0.001, but remained higher than intended thickness of 120 μm after 3mo (P<0.001. Cap thickness in central area was thinner than that of in the paracentral and peripheral areas (P<0.0001. Total number of microdistortions decreased from 1d to 3mo (P<0.0001. Pearson analysis revealed a weak correlation between OSI and standard deviation of cap thickness at 1d and 1mo, as well as between range of cap thickness and OSI at 1mo. No correlation was found between microdistortion and OSI, but a negative correlation existed between microdistortion and range at 1d and 1moafter surgery. CONCLUSION: The corneal cap tends to be more accurate and regular with time lapse. Better cap morphology tends to contribute less intraocular scattering in the eyes undergoing SMILE.

  6. Latest Quaternary rapid river incision across an inactive fold in the northern Chinese Tian Shan foreland (United States)

    Lu, Honghua; Cheng, Lu; Wang, Zhen; Zhang, Tianqi; Lü, Yanwu; Zhao, Junxiang; Li, Youli; Zheng, Xiangmin


    This work focuses on the incision process over the Tuostai anticline, a fold of the proximal structure Belt I in the northern Chinese Tian Shan foreland, where the Sikeshu River has incised deeply into the alluvial gravels and the fold's underlying bedrock strata. Field investigation and geomorphic mapping define five terraces of the Sikeshu River (designated as T1 to T5 from oldest to youngest) preserved within the Tuostai anticline. 10Be surface exposure dating and optically stimulated luminescence dating constrain stabilization of the highest three terrace surfaces at about 80 ka (T1), 16 ka (T2), and 15 ka (T3), respectively. Around 16 ka, the calculated river incision rates significantly increase from 6 mm/yr. Undeformed longitudinal profiles of terraces T2, T3 and T4 over the Tuostai anticline suggest that this structure may have been tectonically inactive since stabilization of these three terraces. We thus think that the observed rapid river incision over the Tuostai anticline has not been largely forced by tectonic uplift. Instead, the progressively warmer and wetter palaeoclimatic condition within the Tian Shan range and its surrounding area during the period of ∼20-10 ka may have enhanced river incision across the Tuostai anticline. A reduced sediment/water ratio might have lowered the gradient of the Sikeshu River.

  7. Dual daughter strand incision is processive and increases the efficiency of DNA mismatch repair. (United States)

    Hermans, Nicolaas; Laffeber, Charlie; Cristovão, Michele; Artola-Borán, Mariela; Mardenborough, Yannicka; Ikpa, Pauline; Jaddoe, Aruna; Winterwerp, Herrie H K; Wyman, Claire; Jiricny, Josef; Kanaar, Roland; Friedhoff, Peter; Lebbink, Joyce H G


    DNA mismatch repair (MMR) is an evolutionarily-conserved process responsible for the repair of replication errors. In Escherichia coli, MMR is initiated by MutS and MutL, which activate MutH to incise transiently-hemimethylated GATC sites. MMR efficiency depends on the distribution of these GATC sites. To understand which molecular events determine repair efficiency, we quantitatively studied the effect of strand incision on unwinding and excision activity. The distance between mismatch and GATC site did not influence the strand incision rate, and an increase in the number of sites enhanced incision only to a minor extent. Two GATC sites were incised by the same activated MMR complex in a processive manner, with MutS, the closed form of MutL and MutH displaying different roles. Unwinding and strand excision were more efficient on a substrate with two nicks flanking the mismatch, as compared to substrates containing a single nick or two nicks on the same side of the mismatch. Introduction of multiple nicks by the human MutLα endonuclease also contributed to increased repair efficiency. Our data support a general model of prokaryotic and eukaryotic MMR in which, despite mechanistic differences, mismatch-activated complexes facilitate efficient repair by creating multiple daughter strand nicks. © The Author(s) 2016. Published by Oxford University Press on behalf of Nucleic Acids Research.

  8. Circumareolar incision-subdermal tunneling dissection for excision of multiple breast fibroadenomata

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    S O Agodirin


    Full Text Available Excision of multiple fibroadenomas (MF in separate breast quadrants presents difficulties of number and location of incision(s and extent of tissue dissection and may be associated with more complications and poorer cosmetic outcome. This is a report of excision of MF in multiple quadrants of the breast using a modification of subcutaneous dissection technique dubbed the circumareolar incision and subdermal tunneling (CAST dissection. After exposure of the superficial fascia with circumareolar incision, subdermal cone-wise dissection was made to allow mobilization of the segment bearing the lump(s. The lump(s were enucleated and removed. MF were removed from four breasts in three young unmarried females. The first patient had multiple adenomas removed from three quadrants of both breasts: 14 on the right and six on the left. The second patient had excision of three lumps in three separate quadrants, and the third patient had excision of two lumps in two separate quadrants. All patients had edema and bruising. One breast had wound infection and dehiscence. There were no skin necrosis, no nipple loss, and no breast distortion. All ensuing scars were camouflaged. CAST dissection was used for excision of MF in multiple quadrants of the breast with preservation of excellent cosmetic outcome of a single circumareolar incision.

  9. Panoramic radiographs underestimate extensions of the anterior loop and mandibular incisive canal

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    De Brito, Ana Caroline Ramos; Nejaim, Yuri; De Freitas, Deborah Queiroz [Dept. of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Sao Paulo (Brazil); De Oliveira Santos, Christiano [Dept. of Stomatology, Public Oral Health and Forensic Dentistry, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Sao Paulo (Brazil)


    The purpose of this study was to detect the anterior loop of the mental nerve and the mandibular incisive canal in panoramic radiographs (PAN) and cone-beam computed tomography (CBCT) images, as well as to determine the anterior/mesial extension of these structures in panoramic and cross-sectional reconstructions using PAN and CBCT images. Images (both PAN and CBCT) from 90 patients were evaluated by 2 independent observers. Detection of the anterior loop and the incisive canal were compared between PAN and CBCT. The anterior/mesial extension of these structures was compared between PAN and both cross-sectional and panoramic CBCT reconstructions. In CBCT, the anterior loop and the incisive canal were observed in 7.7% and 24.4% of the hemimandibles, respectively. In PAN, the anterior loop and the incisive canal were detected in 15% and 5.5% of cases, respectively. PAN presented more difficulties in the visualization of structures. The anterior/mesial extensions ranged from 0.0 mm to 19.0 mm on CBCT. PAN underestimated the measurements by approximately 2.0 mm. CBCT appears to be a more reliable imaging modality than PAN for preoperative workups of the anterior mandible. Individual variations in the anterior/mesial extensions of the anterior loop of the mental nerve and the mandibular incisive canal mean that is not prudent to rely on a general safe zone for implant placement or bone surgery in the interforaminal region.

  10. Microincision versus small-incision coaxial cataract surgery using different power modes for hard nuclear cataract. (United States)

    Kim, Eun Chul; Byun, Yong Soo; Kim, Man Soo


    To compare the efficacy of microincision and small-incision coaxial phacoemulsification in treating hard cataracts using different ultrasound power modes. Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea. Randomized clinical trial. Eyes with hard cataract were randomized to have an initial incision of 1.80 mm, 2.20 mm, or 2.75 mm. The eyes in each group were equally randomized to treatment with burst, pulse, or continuous mode. Ultrasound time (UST), mean cumulative dissipated energy (CDE), corrected distance visual acuity (CDVA), surgically induced corneal astigmatism, incisional and central corneal thickness (CCT), and endothelial cell counts were evaluated. The study enrolled 180 eyes, 60 in each group. Two months postoperatively, there were no statistically significant differences in UST, CDE, CDVA, CCT, or percentage endothelial cell loss between the 3 incision groups. The 2.75 mm incision induced more astigmatism at 2 months and less incisional corneal edema at 1 week than the 1.80 mm or 2.20 mm incision (Phard cataract. The intraoperative energy use and ocular damage was less with the pulse and burst modes than with the continuous mode. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  11. Incision and stress regulation in borderline personality disorder: neurobiological mechanisms of self-injurious behaviour. (United States)

    Reitz, Sarah; Kluetsch, Rosemarie; Niedtfeld, Inga; Knorz, Teresa; Lis, Stefanie; Paret, Christian; Kirsch, Peter; Meyer-Lindenberg, Andreas; Treede, Rolf-Detlef; Baumgärtner, Ulf; Bohus, Martin; Schmahl, Christian


    Patients with borderline personality disorder frequently show non-suicidal self-injury (NSSI). In these patients, NSSI often serves to reduce high levels of stress. Investigation of neurobiological mechanisms of NSSI in borderline personality disorder. In total, 21 women with borderline personality disorder and 17 healthy controls underwent a stress induction, followed by either an incision into the forearm or a sham treatment. Afterwards participants underwent resting-state functional magnetic resonance imaging while aversive tension, heart rate and heart rate variability were assessed. We found a significant influence of incision on subjective and objective stress levels with a stronger decrease of aversive tension in the borderline personality disorder group following incision than sham. Amygdala activity decreased more and functional connectivity with superior frontal gyrus normalised after incision in the borderline personality disorder group. Decreased stress levels and amygdala activity after incision support the assumption of an influence of NSSI on emotion regulation in individuals with borderline personality disorder and aids in understanding why these patients use self-inflicted pain to reduce inner tension. © The Royal College of Psychiatrists 2015.

  12. Force modeling for incisions into various tissues with MRF haptic master (United States)

    Kim, Pyunghwa; Kim, Soomin; Park, Young-Dai; Choi, Seung-Bok


    This study proposes a new model to predict the reaction force that occurs in incisions during robot-assisted minimally invasive surgery. The reaction force is fed back to the manipulator by a magneto-rheological fluid (MRF) haptic master, which is featured by a bi-directional clutch actuator. The reaction force feedback provides similar sensations to laparotomy that cannot be provided by a conventional master for surgery. This advantage shortens the training period for robot-assisted minimally invasive surgery and can improve the accuracy of operations. The reaction force modeling of incisions can be utilized in a surgical simulator that provides a virtual reaction force. In this work, in order to model the reaction force during incisions, the energy aspect of the incision process is adopted and analyzed. Each mode of the incision process is classified by the tendency of the energy change, and modeled for realistic real-time application. The reaction force model uses actual reaction force information with three types of actual tissues: hard tissue, medium tissue, and soft tissue. This modeled force is realized by the MRF haptic master through an algorithm based on the position and velocity of a scalpel using two different control methods: an open-loop algorithm and a closed-loop algorithm. The reaction forces obtained from the proposed model are compared with a desired force in time domain.

  13. Uptake of gallium-67 citrate in clean surgical incisions after colorectal surgery

    International Nuclear Information System (INIS)

    Lin Wanyu; Wang Shyhjen; Tsai Shihchuan; Chao Tehsin


    Non-specific accumulation of gallium-67 citrate (gallium) in uncomplicated surgical incisions is not uncommon. It is important to know the normal pattern of gallium uptake at surgical incision sites in order to properly interpret the gallium scan when investigating possible wound infection in patients who have undergone abdominal surgery. We studied 42 patients without wound infection after colorectal surgery and performed gallium scans within 40 days after surgery. Patients were divided into three groups according to the interval between the operation and the scan. In group A (26 patients) gallium scan was performed within 7 days after surgery, in group B (8 patients) between 8 and 14 days after surgery, and in group C (8 patients) between 15 and 40 days after surgery. Our data showed that in group A, 61.5% had gallium accumulation at the surgical incision site. In group B, 50% had accumulation of gallium at the surgical incision site, while in group C only one patient (12.5%) showed gallium uptake. It is concluded that the incidence of increased gallium uptake at clean surgical incision sites is high after colorectal surgery. Nuclear medicine physicians should bear in mind the high incidence of non-specific gallium uptake at such sites during the interpretation of possible wound infection in patients after colorectal surgery. (orig.)

  14. Single incision laparoscopic pancreas resection for pancreatic metastasis of renal cell carcinoma. (United States)

    Barbaros, Umut; Sümer, Aziz; Demirel, Tugrul; Karakullukçu, Nazlı; Batman, Burçin; Içscan, Yalın; Sarıçam, Gülay; Serin, Kürçsat; Loh, Wei-Liang; Dinççağ, Ahmet; Mercan, Selçuk


    Transumbilical single incision laparoscopic surgery (SILS) offers excellent cosmetic results and may be associated with decreased postoperative pain, reduced need for analgesia, and thus accelerated recovery. Herein, we report the first transumbilical single incision laparoscopic pancreatectomy case in a patient who had renal cell cancer metastasis on her pancreatic corpus and tail. A 59-year-old female who had metastatic lesions on her pancreas underwent laparoscopic subtotal pancreatectomy through a 2-cm umbilical incision. Single incision pancreatectomy was performed with a special port (SILS port) and articulated equipment. The procedure lasted 330 minutes. Estimated blood loss was 100mL. No perioperative complications occurred. The patient was discharged on the seventh postoperative day with a low-volume (20mL/day) pancreatic fistula that ceased spontaneously. Pathology result of the specimen was renal cell cancer metastases. This is the first reported SILS pancreatectomy case, demonstrating that even advanced surgical procedures can be performed using the SILS technique in well-experienced centers. Transumbilical single incision laparoscopic pancreatectomy is feasible and can be performed safely in experienced centers. SILS may improve cosmetic results and allow accelerated recovery for patients even with malignancy requiring advanced laparoscopic interventions.

  15. A Semicircular Incision in the Superior Umbilical Fold for SILS Preserves the Umbilical Profile

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    S. C. Blackburn


    Full Text Available Background. Single Incision Laparoscopic Surgery (SILS has been highlighted in the recent literature as a means of performing a range of common, minimal access, paediatric surgical procedures. The primary attraction is the absence of visible scarring. Aim. This study aims to describe a cosmetically advantageous means of SILS port placement in children, which preserves the umbilical profile. Methods. We describe a paediatric case series utilising a semicircular incision in the superior umbilical fold for SILS procedures. The linea alba is exposed over 2 cm just superior to the umbilical ring and stay sutures are applied. A vertical incision is made over this distance without entering the umbilical ring. Data were recorded prospectively in a Microsoft Excel database. Results. Twenty-one cases were performed in a 1-year period. Ten appendicectomies, 5 ovarian/paraovarian cystectomies, 2 Palomo procedures, 3 nephrectomy/heminephrectomies, and 1 Meckel’s diverticulectomy were performed. There was 1 wound infection. No incisional hernias occurred. Discussion. We believe that our technique, which maintains the integrity of the umbilical ring and allows preservation of the umbilical profile, offers a distinct cosmetic advantage over other incisions for SILS which distort it. Conclusion. We have demonstrated the aesthetic benefits of utilising a superior umbilical-fold incision for SILS in children.

  16. A Semicircular Incision in the Superior Umbilical Fold for SILS Preserves the Umbilical Profile. (United States)

    Blackburn, S C; Adams, S D; Mahomed, A A


    Background. Single Incision Laparoscopic Surgery (SILS) has been highlighted in the recent literature as a means of performing a range of common, minimal access, paediatric surgical procedures. The primary attraction is the absence of visible scarring. Aim. This study aims to describe a cosmetically advantageous means of SILS port placement in children, which preserves the umbilical profile. Methods. We describe a paediatric case series utilising a semicircular incision in the superior umbilical fold for SILS procedures. The linea alba is exposed over 2 cm just superior to the umbilical ring and stay sutures are applied. A vertical incision is made over this distance without entering the umbilical ring. Data were recorded prospectively in a Microsoft Excel database. Results. Twenty-one cases were performed in a 1-year period. Ten appendicectomies, 5 ovarian/paraovarian cystectomies, 2 Palomo procedures, 3 nephrectomy/heminephrectomies, and 1 Meckel's diverticulectomy were performed. There was 1 wound infection. No incisional hernias occurred. Discussion. We believe that our technique, which maintains the integrity of the umbilical ring and allows preservation of the umbilical profile, offers a distinct cosmetic advantage over other incisions for SILS which distort it. Conclusion. We have demonstrated the aesthetic benefits of utilising a superior umbilical-fold incision for SILS in children.

  17. A theoretical model for fluvial channel response time during time-dependent climatic and tectonic forcing and its inverse applications (United States)

    Goren, Liran


    The fluvial response time dictates the duration of fluvial channel adjustment in response to changing climatic and tectonic conditions. However, when these conditions vary continuously, the channel cannot equilibrate and the response time is not well defined. Here I develop an analytical solution to the linear stream power model of fluvial incision that predicts the channel topography as a function of time-dependent climatic and tectonic conditions. From this solution, a general definition of the fluvial response time emerges: the duration over which the tectonic history needs to be known to evaluate channel topography. This new definition is used in linear inversion schemes for inferring climatic or tectonic histories from river long profiles. The analytic solution further reveals that high-frequency climatic oscillations, such as Milankovitch cycles, are not expected to leave significant fingerprints on the long profiles of fluvially incised detachment-limited rivers.

  18. Interior point decoding for linear vector channels

    International Nuclear Information System (INIS)

    Wadayama, T


    In this paper, a novel decoding algorithm for low-density parity-check (LDPC) codes based on convex optimization is presented. The decoding algorithm, called interior point decoding, is designed for linear vector channels. The linear vector channels include many practically important channels such as inter-symbol interference channels and partial response channels. It is shown that the maximum likelihood decoding (MLD) rule for a linear vector channel can be relaxed to a convex optimization problem, which is called a relaxed MLD problem

  19. Comparison of short-term outcomes between laparoscopically-assisted vs. transverse-incision open right hemicolectomy for right-sided colon cancer: a retrospective study

    Directory of Open Access Journals (Sweden)

    Akaraviputh Thawatchai


    Full Text Available Abstract Background Laparoscopically-assisted right hemicolectomy (LRH is an acceptable alternative to open surgery for right-sided colon cancer which offers patients less pain and faster recovery. However, special equipment and substantial surgical experience are required. The aim of the study is to compare the short-term surgical outcomes of LRH and open right hemicolectomy through right transverse skin crease incision (ORHT for right-sided colon cancer. Patients and methods This retrospective study included 33 patients with right-sided colon cancer who underwent elective right hemicolectomy by laparoscopic or open approaches through right transverse skin crease incision between March 2004 and September 2006 at the Department of Surgery, Faculty of Medicine Siriraj Hospital. Operative details, postoperative requirement of narcotics, recovery of bowel function, and oncological parameters were analyzed. Results Thirteen patients underwent LRH and 20 patients underwent ORHT. Both approaches achieved adequate oncological resection of the tumor. The laparoscopic group were characterized by shorter average incision lengths (7.7 vs 10.3 cm; p Conclusion LRH and ORHT for right-sided colon cancer resulted in the same short-term surgical outcomes including postoperative bowel function, narcotics consumption and length of hospital stay. However, LRH required a significantly longer operating time.

  20. Comparison of the effects of 23-gauge and 25-gauge microincision vitrectomy blade designs on incision architecture. (United States)

    Inoue, Makoto; Abulon, Dina Joy K; Hirakata, Akito


    To compare the effects of different 23- and 25-gauge microincision vitrectomy trocar cannula entry systems on incision architecture. We tested one ridged microvitreoretinal (MVR), one non-ridged MVR, one pointed beveled, and one round-tipped beveled blade (n=10 per blade design per incision type). Each blade's straight and oblique incision architecture was assessed in a silicone disc simulating the sclera. Wound leakage under pressure and endoscopic observations were conducted on sclerotomy sites of isolated porcine eyes (n=4 per blade design) after simulated vitrectomy. Differences in blade design created distinct incision architecture. Incisions were linear with the ridged MVR blade, flattened "M-shaped" with the non-ridged MVR blade, asymmetrical chevron-shaped with the pointed beveled blade, and curved with the round-tipped beveled blade. With the exception of oblique entry incision thickness, both MVR blade designs created thinner incisions than the beveled blades at entry and exit sites. Only the ridged MVR blade created incisions with no leakage. Vitreous incarceration was observed with all trocar cannula systems. Wound closure in porcine eyes was similar with all blades despite differences in incision architecture. Wound leakage occurred at low to moderate infusion pressures with most blades; no wound leakage was observed with ridged MVR blades.

  1. Mitigation of Flood Hazards Through Modification of Urban Channels and Floodplains (United States)

    Miller, A. J.; Lee, G.; Bledsoe, B. P.; Stephens, T.


    Small urban watersheds with high percent impervious cover and dense road and storm-drain networks are highly responsive to short-duration high-intensity rainfall events that lead to flash floods. The Baltimore metropolitan area has some of the flashiest urban watersheds in the conterminous U.S., high frequency of channel incision in affected areas, and a large number of watershed restoration projects designed to restore ecosystem services through reconnection of the channel with the floodplain. A question of key importance in these and other urban watersheds is to what extent we can mitigate flood hazards and urban stream syndrome through restoration activities that modify the channel and valley floor. Local and state governments have invested resources in repairing damage caused by extreme events like the July 30, 2016 Ellicott City flood in the Tiber River watershed, as well as more frequent high flows in other local urban streams. Recent reports have investigated how much flood mitigation may be achieved through modification of the channel and floodplain to enhance short-term storage of flood waters on the valley floor or in other subsurface structures, as compared with increasing stormwater management in the headwaters. Ongoing research conducted as part of the UWIN (Urban Water Innovation Network) program utilizes high-resolution topographic point clouds derived by processing of photographs from hand-held cameras or video frames from drone overflights. These are used both to track geomorphic change and to assess flood response with 2d hydraulic modeling tools under alternative mitigation scenarios. Assessment metrics include variations in inundation extent, water depth, hydrograph attenuation, and temporal and spatial characteristics of the 2d depth-averaged velocity field. Examples from diverse urban watersheds are presented to illustrate the range of anticipated outcomes and potential constraints on the effectiveness of downstream vs. headwater mitigation

  2. Oral subcutaneous midline leiomyomatous hamartoma presenting as congenital incisive papilla overgrowth in a toddler

    Directory of Open Access Journals (Sweden)

    Ashish Loomba


    Full Text Available Congenital soft-tissue tumors of oral cavity are mostly hyperplastic and benign in nature. This article presents an unusual case of congenital subcutaneous hamartoma of incisive papilla in a 2-year-old female child causing feeding and breathing difficulty. Total excisional biopsy was done under local anesthesia. Histopathology of tissue in reticulin-stained slide showed the presence of immature muscle fibers whereas Masson's trichrome stain revealed collagen fibers and smooth muscles confirming the diagnosis of oral midline subcutaneous smooth muscle (leiomyomatous hamartoma of incisive papilla. It is important for dental professionals to be aware of this oral lesion present from birth mimicking overgrowth of incisive papilla, by its presentation, differential diagnosis, histopathology, and management.

  3. Influence of Lateral Incision on Inhomogeneous Deformation of a Nickel [001] - Single Cristal at Axial Compression (United States)

    Lychagin, D. V.; Alfyorova, E. A.; Lychagin, M. V.; Dilun, Czyan


    We used the scanning electron microscopy and the electron backscattered diffraction to investigate a deformation relief and a crystallographic disorientation of a nickel [001] single crystal with {100} faces with a lateral incision. We identified that the lateral incision can change the shear domains distribution pattern in the sample by creating additional deformation domains near the incision. The change in the patterns of the misorientation accumulation on the mutually perpendicular faces accompanies this deformation. We established that the orientation alteration occurs toward the increase of the Schmid factor for the slip systems in two of the four (previously equally loaded) slip planes. This method of shear deformation contributes to an optimal mutually consistent deformation in the adjacent areas of the single crystal.

  4. Large flood on a mountain river subjected to restoration: effects on aquatic habitats, channel morphology and valley infrastructure (United States)

    Hajdukiewicz, Hanna; Wyżga, Bartłomiej; Mikuś, Paweł; Zawiejska, Joanna; Radecki-Pawlik, Artur


    The Biała River, Polish Carpathians, was considerably modified by channelization and channel incision in the twentieth century. To restore the Biała, establishing an erodible corridor was proposed in two river sections located in its mountain and foothill course. In these sections, longer, unmanaged channel reaches alternate with short, channelized reaches; and channel narrowing and incision increases in the downstream direction. In June 2010 an 80-year flood occurred on the river; and this study aims at determining its effects on physical habitat conditions for river biota, channel morphology, and valley-floor infrastructure. Surveys of 10 pairs of closely located, unmanaged and channelized cross sections, performed in 2009 and in the late summer 2010, allowed us to assess the flood-induced changes to physical habitat conditions. A comparison of channel planforms determined before (2009) and after (2012) the flood provided information on the degree of channel widening as well as changes in the width of particular elements of the river's active zone in eight stretches of the Biała. The impact of the flood on valley-floor infrastructure was confronted with the degree of river widening in unmanaged and channelized river reaches. Before the flood, unmanaged cross sections were typified by finer bed material and greater lateral variability in depth-averaged and near-bed flow velocity than channelized cross sections. The flood tended to equalize habitat conditions in both types of river cross sections, obliterating differences (in particular physical habitat parameters) between channelized and unmanaged channel reaches. River widening mostly reflected an increase in the area of channel bars, whereas the widening of low-flow channels was less pronounced. A comparison of channel planform from 2009 and 2012 indicated that intense channel incision typical of downstream sections limited river widening by the flood. Active channel width increased by half in the unmanaged


    Directory of Open Access Journals (Sweden)

    Enrique eBalderas


    Full Text Available Since its discovery in a glioma cell line 15 years ago, mitochondrial BKCa channel (mitoBKCa has been studied in brain cells and cardiomyocytes sharing general biophysical properties such as high K+ conductance (~300 pS, voltage-dependency and Ca2+-sensitivity. Main advances in deciphering the molecular composition of mitoBKCa have included establishing that it is encoded by the Kcnma1 gene, that a C-terminal splice insert confers mitoBKCa ability to be targeted to cardiac mitochondria, and evidence for its potential coassembly with β subunits. Notoriously, β1 subunit directly interacts with cytochrome c oxidase and mitoBKCa can be modulated by substrates of the respiratory chain. mitoBKCa channel has a central role in protecting the heart from ischemia, where pharmacological activation of the channel impacts the generation of reactive oxygen species and mitochondrial Ca2+ preventing cell death likely by impeding uncontrolled opening of the mitochondrial transition pore. Supporting this view, inhibition of mitoBKCa with Iberiotoxin, enhances cytochrome c release from glioma mitochondria. Many tantalizing questions remain. Some of them are: how is mitoBKCa coupled to the respiratory chain? Does mitoBKCa play non-conduction roles in mitochondria physiology? Which are the functional partners of mitoBKCa? What are the roles of mitoBKCa in other cell types? Answers to these questions are essential to define the impact of mitoBKCa channel in mitochondria biology and disease.

  6. The effect of kidney morcellation on operative time, incision complications, and postoperative analgesia after laparoscopic nephrectomy

    Directory of Open Access Journals (Sweden)

    Affonso H. Camargo


    Full Text Available INTRODUCTION: Compare the outcomes between kidney morcellation and two types of open specimen extraction incisions, several covariates need to be taken into consideration that have not yet been studied. MATERIALS AND METHODS: We retrospectively reviewed 153 consecutive patients who underwent laparoscopic nephrectomy at our institution, 107 who underwent specimen morcellation and 46 with intact specimen removal, either those with connected port sites with a muscle-cutting incision and those with a remote, muscle-splitting incision. Operative time, postoperative analgesia requirements, and incisional complications were evaluated using univariate and multivariate analysis, comparing variables such as patient age, gender, body mass index (BMI, laterality, benign versus cancerous renal conditions, estimated blood loss, specimen weight, overall complications, and length of stay. RESULTS: There was no significant difference for operative time between the 2 treatment groups (p = 0.65. Incision related complications occurred in 2 patients (4.4% from the intact specimen group but none in the morcellation group (p = 0.03. Overall narcotic requirement was lower in patients with morcellated (41 mg compared to intact specimen retrieval (66 mg on univariate (p = 0.03 and multivariate analysis (p = 0.049. Upon further stratification, however, there was no significant difference in mean narcotic requirement between the morcellation and muscle-splitting incision subgroup (p = 0.14. CONCLUSION: Morcellation does not extend operative time, and is associated with significantly less postoperative pain compared to intact specimen retrieval overall, although this is not statistically significant if a remote, muscle-splitting incision is made. Morcellation markedly reduces the risk of incisional-related complications.

  7. Comparison of Fasanella-Servat and Small-Incision Techniques for Involutional Ptosis Repair. (United States)

    Sohrab, Mahsa A; Lissner, Gary S


    To compare the results of the classic Fasanella-Servat internal approach to the newer, small-incision external approach in the repair of involutional ptosis. Retrospective review identified 93 patients (104 surgical procedures) at Northwestern Ophthalmology from June 2005 until October 2011 who underwent either the Fasanella-Servat or the small-incision approaches for involutional ptosis repair. Change in vertical palpebral fissure measurement, change in marginal reflex distance 1 (MRD1) measurement, patient satisfaction, surgical complications, operating time, and postoperative pain were compared between groups. Of the 93 patients, most were female with an average age of 69 years. Of the procedures, 48% were small incision and 52% were Fasanella-Servat approaches. Average postoperative follow up was 34.0 days. Vertical palpebral fissure height increased an average of 3.36 mm (±1.15) in the Fasanella-Servat group and 2.74 mm (±1.18) in the small-incision group (p = 0.003). Preoperative vertical palpebral fissure height was lower in the Fasanella-Servat group, but postoperative vertical palpebral fissure height was similar between the 2 groups (p=0.3). MRD1 increased an average of 3.42 mm (±0.86) in the Fasanella-Servat group and 2.68 mm (±0.93) in the small-incision group (p MRD1 was lower in the Fasanella-Servat group, but postoperative MRD1 was similar between the 2 groups (p = 0.15). Average operating time was 53 minutes (±16) in the small-incision group and 27 minutes (±6) in the Fasanella-Servat group (p MRD1.

  8. Incision of the Yangtze River at the First Bend Determined by Three-Nuclide Burial Dating (United States)

    McPhillips, D. F.; Hoke, G. D.; Rood, D. H.; Bierman, P. R.


    On the southeast margin of the Tibetan Plateau, the evolution of the Yangtze River and its major tributaries has become an important source of data for investigating geodynamics. In particular, the timing of river incision is frequently interpreted as a proxy for the timing of surface uplift in the absence of structural evidence. We investigate the timing of the incision of the gorge at the First Bend using cosmogenic nuclide burial dating of coarse, quartz sediments from caves. Sediments were deposited when the caves were near river level and subsequently abandoned as the river incised. To resolve burial ages >5 Ma, we measured the radionuclides 10Be and 26Al, and the stable nuclide 21Ne. Results from 4 caves show that 26Al and 10Be concentrations are an order of magnitude lower in abandoned cave samples than in a river-level cave sample where deposition is active (10Be: 1.3x104 and 3.4x105 at/g). In contrast, 26Al/10Be ratios in all caves are ≥6.2 and indistinguishable within error. 21Ne concentrations range from 2.1x106 to 7.8x106 at/g. The results are consistent with an old age for the abandoned cave deposits, such that most of the radionuclides initially present have decayed and the concentrations that we measure today are the result of millions of years of exposure to muons. We solve for burial ages, taking into account in situ muogenic production, and find that the majority of the gorge (1 km) was likely incised between ~12 and 9 Ma. The results also require that the rate of river incision declined after the gorge was cut below the lowest elevation cave at 9 Ma. Inverse modeling of published low-temperature thermochronology (Ouimet et al., 2010) supports our burial age results. River capture near the First Bend, which likely integrated the modern Yangtze, likely occurred prior to the mid-Miocene incision of the gorge. In view of the geographic position of the First Bend—just downslope from the southeast margin of the Plateau—it is difficult to explain

  9. Fingertip replantation using a single volar arteriovenous anastomosis and drainage with a transverse tip incision. (United States)

    Yabe, T; Muraoka, M; Motomura, H; Ozawa, T


    Four cases of fingertip replantation using a single volar arteriovenous anastomosis and drainage with a transverse tip incision are reported. Because of lack of suitable arteries for anastomosis in the amputated finger, in each case a volar radial vein was anastomosed to the proximal digital artery and external drainage was performed through a transverse tip incision. In 3 cases the replanted fingertip survived completely; partial necrosis occurred in 1 case. Because veins are more superficial and larger than arteries, they are more available for anastomosis. The results indicate that this method is a useful alternative in fingertip replantation.

  10. Valley-scale morphology drives differences in fluvial sediment budgets and incision rates during contrasting flow regimes (United States)

    Weber, M. D.; Pasternack, G. B.


    High-resolution topographic surveys using LiDAR and multibeam sonar can be used to characterize and quantify fluvial change. This study used repeat surveys to explore how topographic change, fluvial processes, sediment budgets, and aggradation and incision rates vary across spatial scales and across two contrasting decadal flow regimes in a regulated gravel/cobble river. A novel method for quantifying digital elevation model uncertainty was developed and applied to a topographic change detection analysis from 2006/2008 to 2014. During this period, which had four modest 3-5 year floods, most sediment was laterally redistributed through bank erosion and channel migration. Erosion primarily occurred in the floodplain (97,000 m3), terraces (80,000 m3), and lateral bars (58,000 m3); while deposition occurred in the adjacent pools (73,000 m3), fast glides (48,000 m3), and runs (36,000 m3). In contrast, significantly higher magnitude and longer duration floods from 1999 to 2006/2008 caused sediment to be displaced longitudinally, with the upstream reaches exporting sediment and the downstream reaches aggrading. The river maintained floodplain connectivity during both periods, despite different processes dominating the type of connectivity. Larger floods promoted overbank scour and avulsion, while smaller floods promoted bank erosion and lateral migration. This study explores and illustrates how the geomorphic response to contrasting flood regimes in a nonuniform river is highly dependent on which landforms are controlling hydraulics.

  11. Radio propagation measurement and channel modelling

    CERN Document Server

    Salous, Sana


    While there are numerous books describing modern wireless communication systems that contain overviews of radio propagation and radio channel modelling, there are none that contain detailed information on the design, implementation and calibration of radio channel measurement equipment, the planning of experiments and the in depth analysis of measured data. The book would begin with an explanation of the fundamentals of radio wave propagation and progress through a series of topics, including the measurement of radio channel characteristics, radio channel sounders, measurement strategies

  12. Dynamic Channel Allocation (United States)


    21 9. Beowulf Ethernet Channel Bonding.................................................22 F. SUMMARY...on demand, hybrid channel allocation in wireless networks, and 3 Beowulf Ethernet channel bonding. The background information presented in this...channels are available for dynamic allocation [Ref 32]. 9. Beowulf Ethernet Channel Bonding A by-product of using older computers in a NASA research lab

  13. Comparing the outcomes of incisions made by colorado microdissection needle, electrosurgery tip, and surgical blade during periodontal surgery: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Rampalli Viswa Chandra


    Full Text Available Context: Electrosurgery offers many unique advantages such as hemostasis and precise tissue cutting; however, there are a number of disadvantages including thermal injury and delayed wound healing. Aims: The aim of the present study was to compare the outcomes of incisions made by Colorado® microdissection needle, electrosurgery tip, and surgical blade during periodontal surgery. Settings and Design: Twenty-two individuals participated in this study. Three quadrants in each individual were randomly assigned into each of the following experimental groups: Colorado® microdissection needle (CMD, electrosurgery tip (EC and surgical blade (BP, in which, incisions were given with Colorado® microdissection needle, straight electrocautery tip, and a scalpel blade, respectively. Materials and Methods: Blood loss (BL was measured immediately after surgery, and changes in interdental papilla dimensions were recorded at baseline, 7, 30, 120, and 180 days after surgery. Measures of periodontal disease were recorded at baseline, 120, and 180 days after surgery. Postoperative pain and wound healing were recorded at 1, 7, and 15 days after surgery. Results: The use of CMD for periodontal surgery showed better results over EC in all parameters. CMD resulted in lesser bleeding and less postoperative pain and attained similar results to that of BP in clinical parameters of periodontal disease. Conclusions: Colorado® microdissection needle may be a better choice for incisions as it seems to show less tissue damage than cautery and offers tissue healing comparable to scalpel blade.

  14. Comparison of the effects of 23-gauge and 25-gauge microincision vitrectomy blade designs on incision architecture

    Directory of Open Access Journals (Sweden)

    Inoue M


    Full Text Available Makoto Inoue,1 Dina Joy K Abulon,2 Akito Hirakata1 1Kyorin Eye Center, School of Medicine, Kyorin University, Tokyo, Japan; 2Alcon Research, Ltd., Irvine, CA, USA Purpose: To compare the effects of different 23- and 25-gauge microincision vitrectomy trocar cannula entry systems on incision architecture.Methods: We tested one ridged microvitreoretinal (MVR, one non-ridged MVR, one pointed beveled, and one round-tipped beveled blade (n=10 per blade design per incision type. Each blade’s straight and oblique incision architecture was assessed in a silicone disc simulating the sclera. Wound leakage under pressure and endoscopic observations were conducted on sclerotomy sites of isolated porcine eyes (n=4 per blade design after simulated vitrectomy.Results: Differences in blade design created distinct incision architecture. Incisions were linear with the ridged MVR blade, flattened “M-shaped” with the non-ridged MVR blade, asymmetrical chevron-shaped with the pointed beveled blade, and curved with the round-tipped beveled blade. With the exception of oblique entry incision thickness, both MVR blade designs created thinner incisions than the beveled blades at entry and exit sites. Only the ridged MVR blade created incisions with no leakage. Vitreous incarceration was observed with all trocar cannula systems.Conclusion: Wound closure in porcine eyes was similar with all blades despite differences in incision architecture. Wound leakage occurred at low to moderate infusion pressures with most blades; no wound leakage was observed with ridged MVR blades. Keywords: entry system, incision closure, leakage, pars plana incision, sclerotomy, trocar blade 

  15. Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials. (United States)

    Antoniou, S A; Morales-Conde, S; Antoniou, G A; Granderath, F A; Berrevoet, F; Muysoms, F E


    Single-incision laparoscopic surgery has been developed with the objective to reduce surgical trauma, decrease associated surgical stress and to improve cosmetic outcome. However, concerns have been raised regarding the risk of trocar-site hernia following this approach. Previous meta-analyses have suggested a trend toward higher hernia rates, but have failed to demonstrate a significant difference between single-incision and conventional laparoscopic surgery. Medline, AMED, CINAHL and CENTRAL were searched up to May 2014. Randomized controlled trials comparing single-incision and conventional laparoscopic surgery were considered for inclusion. Studies with patients aged less than 18 years and those reporting on robotic surgery were disregarded. Pooled odds ratios with 95% confidence intervals were calculated to measure the comparative risk of trocar-site hernia following single-incision and conventional laparoscopic surgery. Nineteen randomized trials encompassing 1705 patients were included. Trocar-site hernia occurred in 2.2% of patients in the single-incision group and in 0.7% of patients in the conventional laparoscopic surgery group (odds ratio 2.26, 95% confidence interval 1.00-5.08, p = 0.05). Sensitivity analysis of quality randomized trials validated the outcome estimates of the primary analysis. There was no heterogeneity among studies (I2 = 0%) and no evidence of publication bias. Single-incision laparoscopic surgery involving entry into the peritoneal cavity through the umbilicus is associated with a slightly higher risk of trocar-site hernia than conventional laparoscopy. Its effect on long-term morbidity and quality of life is a matter for further investigation.

  16. Channeling through Bent Crystals

    Energy Technology Data Exchange (ETDEWEB)

    Mack, Stephanie; /Ottawa U. /SLAC


    Bent crystals have demonstrated potential for use in beam collimation. A process called channeling is when accelerated particle beams are trapped by the nuclear potentials in the atomic planes within a crystal lattice. If the crystal is bent then the particles can follow the bending angle of the crystal. There are several different effects that are observed when particles travel through a bent crystal including dechanneling, volume capture, volume reflection and channeling. With a crystal placed at the edge of a particle beam, part of the fringe of the beam can be deflected away towards a detector or beam dump, thus helping collimate the beam. There is currently FORTRAN code by Igor Yazynin that has been used to model the passage of particles through a bent crystal. Using this code, the effects mentioned were explored for beam energy that would be seen at the Facility for Advanced Accelerator Experimental Tests (FACET) at a range of crystal orientations with respect to the incoming beam. After propagating 5 meters in vacuum space past the crystal the channeled particles were observed to separate from most of the beam with some noise due to dechanneled particles. Progressively smaller bending radii, with corresponding shorter crystal lengths, were compared and it was seen that multiple scattering decreases with the length of the crystal therefore allowing for cleaner detection of the channeled particles. The input beam was then modified and only a portion of the beam sent through the crystal. With the majority of the beam not affected by the crystal, most particles were not deflected and after propagation the channeled particles were seen to be deflected approximately 5mm. After a portion of the beam travels through the crystal, the entire beam was then sent through a quadrupole magnet, which increased the separation of the channeled particles from the remainder of the beam to a distance of around 20mm. A different code, which was developed at SLAC, was used to

  17. Voltage-gated Proton Channels (United States)

    DeCoursey, Thomas E.


    Voltage-gated proton channels, HV1, have vaulted from the realm of the esoteric into the forefront of a central question facing ion channel biophysicists, namely the mechanism by which voltage-dependent gating occurs. This transformation is the result of several factors. Identification of the gene in 2006 revealed that proton channels are homologues of the voltage-sensing domain of most other voltage-gated ion channels. Unique, or at least eccentric, properties of proton channels include dimeric architecture with dual conduction pathways, perfect proton selectivity, a single-channel conductance ~103 smaller than most ion channels, voltage-dependent gating that is strongly modulated by the pH gradient, ΔpH, and potent inhibition by Zn2+ (in many species) but an absence of other potent inhibitors. The recent identification of HV1 in three unicellular marine plankton species has dramatically expanded the phylogenetic family tree. Interest in proton channels in their own right has increased as important physiological roles have been identified in many cells. Proton channels trigger the bioluminescent flash of dinoflagellates, facilitate calcification by coccolithophores, regulate pH-dependent processes in eggs and sperm during fertilization, secrete acid to control the pH of airway fluids, facilitate histamine secretion by basophils, and play a signaling role in facilitating B-cell receptor mediated responses in B lymphocytes. The most elaborate and best-established functions occur in phagocytes, where proton channels optimize the activity of NADPH oxidase, an important producer of reactive oxygen species. Proton efflux mediated by HV1 balances the charge translocated across the membrane by electrons through NADPH oxidase, minimizes changes in cytoplasmic and phagosomal pH, limits osmotic swelling of the phagosome, and provides substrate H+ for the production of H2O2 and HOCl, reactive oxygen species crucial to killing pathogens. PMID:23798303

  18. Quantum Correlations Evolution Asymmetry in Quantum Channels

    International Nuclear Information System (INIS)

    Li Meng; Huang Yun-Feng; Guo Guang-Can


    It was demonstrated that the entanglement evolution of a specially designed quantum state in the bistochastic channel is asymmetric. In this work, we generalize the study of the quantum correlations, including entanglement and quantum discord, evolution asymmetry to various quantum channels. We found that the asymmetry of entanglement and quantum discord only occurs in some special quantum channels, and the behavior of the entanglement evolution may be quite different from the behavior of the quantum discord evolution. To quantum entanglement, in some channels it decreases monotonously with the increase of the quantum channel intensity. In some other channels, when we increase the intensity of the quantum channel, it decreases at first, then keeps zero for some time, and then rises up. To quantum discord, the evolution becomes more complex and you may find that it evolutes unsmoothly at some points. These results illustrate the strong dependence of the quantum correlations evolution on the property of the quantum channels. (paper)

  19. Endoscope-assisted intraoral removal of the thyroid isthmus mass using a frenotomy incision. (United States)

    Woo, Seung Hoon


    A thyroid isthmus nodule is a relatively rare condition. A small number of patients will present with thyroid mass isolated at the thyroid isthmus, which can cause discomfort in swallowing and cosmetic problems. Thus, some patients choose to have these nodules excised. The surgical removal of the thyroid isthmus mass is usually accomplished through an external incision of the neck. However, this procedure inevitably results in a neck scar. We report a case of an 18-year-old woman with a thyroid isthmus mass. We implemented a modified approach for the removal of the thyroid isthmus mass by using a frenotomy incision of the mouth, accompanied by an endoscope system. A modified approach for the removal of the thyroid isthmus mass was used on the patient. The total operating time was 70 minutes. The patient continues to be free of any diseases 12 months after the excision. Resection of the thyroid isthmus mass can be performed by an intraoral endoscope-assisted approach through a frenotomy incision of the mouth. We described the detailed procedures for an endoscope-assisted transoral thyroid isthmus mass excision using a frenotomy incision.

  20. Normalized Urinary Flow at Puberty after Tubularized Incised Plate Urethroplasty for Hypospadias in Childhood. (United States)

    Andersson, Marie; Doroszkiewicz, Monika; Arfwidsson, Charlotte; Abrahamsson, Kate; Sillén, Ulla; Holmdahl, Gundela


    An obstructive urinary flow pattern is frequently seen after tubularized incised plate urethroplasty for hypospadias. However, the significance of this finding has not been determined and long-term results are few. We describe postoperative long-term uroflowmetry results after puberty in males who underwent tubularized incised plate urethroplasty in childhood. A total of 126 boys underwent tubularized incised plate urethroplasty for distal penile to mid shaft hypospadias at Queen Silvia Children's Hospital in Gothenburg between 1999 and 2003. Of the patients 48 were toilet trained at surgery. We report on 40 patients who had data available at 2 and 12 months postoperatively, 7 years postoperatively and at puberty (median age 15.0 years, range 13.7 to 17.1). Of the patients 31 had distal and 9 had mid penile hypospadias. Clinical examination, urinary medical history, uroflowmetry and ultrasound measuring residual urine were performed. Maximum urinary flow was correlated to age and voided volume, using Miskolc nomograms for comparison of percentiles. At 1 year postoperatively 15 boys (37.5%) had normal urinary flow (above 25th percentile), compared to 16 (40%) at 7 years and 38 (95%) at puberty (p hypospadias (p = 0.008), as well as in patients who did (p = 0.0078) and did not undergo intervention (p hypospadias treated with tubularized incised plate urethroplasty. Unless symptoms occur, a conservative approach seems preferable. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  1. The Evolution of the Appendectomy: From Open to Laparoscopic to Single Incision

    Directory of Open Access Journals (Sweden)

    Noah J. Switzer


    Full Text Available Beginning with its initial description by Fitz in the 19th century, acute appendicitis has been a significant long-standing medical challenge; today it remains the most common gastrointestinal emergency in adults. Already in 1894, McBurney advocated for the surgical removal of the inflamed appendix and is credited with the initial description of an Open Appendectomy (OA. With the introduction of minimally invasive surgery, this classic approach evolved into a procedure with multiple, smaller incisions; a technique termed Laparoscopic Appendectomy (LA. There is much literature describing the advantages of this newer approach. To name a few, patients have significantly less wound infections, reduced pain, and a reduction in ileus compared with the OA. In the past few years, Single Incision Laparoscopic Appendectomy (SILA has gained popularity as the next major evolutionary advancement in the removal of the appendix. Described as a pioneer in the era of “scarless surgery,” it involves only one transumbilical incision. Patients are postulated to have reduced post-operative complications such as infection, hernias, and hematomas, as well as a quicker recovery time and less post-operative pain scores, in comparison to its predecessors. In this review, we explore the advancement of the appendectomy from open to laparoscopic to single incision.

  2. Outcomes of single-stage total arch replacement via clamshell incision

    Directory of Open Access Journals (Sweden)

    Ishizaka Toru


    Full Text Available Abstract Background Treatment of complex aortic pathologies involving the transverse arch with extensive involvement of the descending aorta remains a surgical challenge. Since clamshell incision provides superior exposure of the entire thoracic aorta, we evaluated the use of this technique for single-stage total arch replacement by arch vessel reconstruction. Methods The arch-first technique combined with clamshell incision was used in 38 cases of aneurysm and aortic disease in 2008 and 2009. Extensive total arch replacement was used with clamshell incision for reconstruction of arch vessels under deep hypothermic circulatory arrest. Results Overall 30-day mortality was 13%. The mean operating time was approximately 8 hours. Deep hypothermia resulted in mean CPB time exceeding 4.5 hours and mean duration of circulatory arrest was 25 minutes. The overall postoperative temporary and permanent neurologic dysfunction rates were 3% and 3% for elective and 3% and 0% for emergency surgery, respectively. All patients except the five who died in hospital were discharged without nursing care after an average post-operative hospital stay of 35 days. Conclusions The arch-first technique, combined with clamshell incision, provides expeditious replacement of the thoracic aorta with an acceptable duration of hypothermic circulatory arrest and minimizes the risk of retrograde atheroembolism by using antegrade perfusion.

  3. Two-incision minimally invasive total hip arthroplasty - results and complications

    NARCIS (Netherlands)

    van Oldenrijk, Jakob; Hoogervorst, Paul; Schaap, Gerard R.; van Dijk, C. Niek; Schafroth, Matthias U.


    The purpose of this study was to determine the complication rate and functional result after two-incision minimally invasive total hip arthroplasty in a retrospective consecutive case series of the first 45 patients treated by a single surgeon. The mean follow up period was 2.1 years. There were 4

  4. Computed tomography contrast media extravasation: treatment algorithm and immediate treatment by squeezing with multiple slit incisions. (United States)

    Kim, Sue Min; Cook, Kyung Hoon; Lee, Il Jae; Park, Dong Ha; Park, Myong Chul


    In our hospital, an adverse event reporting system was initiated that alerts the plastic surgery department immediately after suspecting contrast media extravasation injury. This system is particularly important for a large volume of extravasation during power injector use. Between March 2011 and May 2015, a retrospective chart review was performed on all patients experiencing contrast media extravasation while being treated at our hospital. Immediate treatment by squeezing with multiple slit incisions was conducted for a portion of these patients. Eighty cases of extravasation were reported from approximately 218 000 computed tomography scans. The expected extravasation volume was larger than 50 ml, or severe pressure was felt on the affected limb in 23 patients. They were treated with multiple slit incisions followed by squeezing. Oedema of the affected limb disappeared after 1-2 hours after treatment, and the skin incisions healed within a week. We propose a set of guidelines for the initial management of contrast media extravasation injuries for a timely intervention. For large-volume extravasation cases, immediate management with multiple slit incisions is safe and effective in reducing the swelling quickly, preventing patient discomfort and decreasing skin and soft tissue problems. © 2016 Inc and John Wiley & Sons Ltd.

  5. Forensic aspects of incised wounds and bruises in pigs established post-mortem. (United States)

    Barington, Kristiane; Jensen, Henrik Elvang


    Recognizing post-mortem (PM) changes is of crucial importance in veterinary forensic pathology. In porcine wounds established PM contradicting observations regarding infiltration of leukocytes have been described. In the present study, skin, subcutis and muscle tissue sampled from experimental pigs with PM incised wounds (n=8), PM bruises (n=8) and no lesions, i.e. controls (n=4), were examined for signs of vitality over time. All tissue samples were subjected to gross and histopathological evaluation. Hemorrhages were present along the edges of PM incised wounds but deposits of fibrin were never observed. PM bruise led to hemorrhage in the subcutis visible on cross section of the skin in 3 out of 8 pigs. Histologically, hemorrhages in the subcutaneous tissue and disrupted muscle fibers were observed in PM bruises and could not be differentiated from similar lesions in ante-mortem (AM) bruises. Vital reactions, i.e. infiltrating leukocytes, hyper-leukocytosis and pavement of leukocytes, were absent in all incised wounds and bruises regardless of the time of sampling after traumatization. In conclusion, a vital reaction was not present in PM incised wounds, regardless of the time of sampling. Moreover, it was found that AM bruises free of leukocyte infiltration cannot be distinguished from PM bruises, an observation which is of crucial importance when timing bruises in forensic cases. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Holocene valley-floor deposition and incision in a small drainage basin in western Colorado, USA (United States)

    Jones, Lawrence S.; Rosenburg, Margaret; Figueroa, Maria del Mar; McKee, Kathleen; Haravitch, Ben; Hunter, Jenna


    The valley floor of a 33.9 km 2 watershed in western Colorado experienced gradual sedimentation from before ˜ 6765 to ˜ 500 cal yr BP followed by deep incision, renewed aggradation, and secondary incision. In contrast, at least four terraces and widespread cut-and-fill architecture in the valley floor downstream indicate multiple episodes of incision and deposition occurred during the same time interval. The upper valley fill history is atypical compared to other drainages in the Colorado Plateau. One possible reason for these differences is that a bedrock canyon between the upper and lower valley prevented headward erosion from reaching the upper valley fill. Another possibility is that widespread, sand-rich, clay-poor lithologies in the upper drainage limited surface runoff and generally favored alluviation, whereas more clay-rich lithologies in the lower drainage resulted in increased surface runoff and more frequent incision. Twenty-two dates from valley fill charcoal indicate an approximate forest fire recurrence interval of several hundred years, similar to that from other studies in juniper-piñon woodlands. Results show that closely spaced vertical sampling of alluvium in headwater valleys where linkages between hillslope processes and fluvial activity are relatively direct can provide insight about the role of fires in alluvial chronologies of semi-arid watersheds.

  7. Effects of Bank Vegetation and Incision on Erosion Rates in an Urban Stream

    Directory of Open Access Journals (Sweden)

    Emily Arnold


    Full Text Available Changing land-use associated with urbanization has resulted in shifts in riparian assemblages, stream hydraulics, and sediment dynamics leading to the degradation of waterways. To combat degradation, restoration and management of riparian zones is becoming increasingly common. However, the relationship between flora, especially the influence of invasive species, on sediment dynamics is poorly understood. Bank erosion and turbidity were monitored in the Tookany Creek and its tributary Mill Run in the greater Philadelphia, PA region. To evaluate the influence of the invasive species Reynoutria japonica (Japanese knotweed on erosion, reaches were chosen based on their riparian vegetation and degree of incision. Bank pins and turbidity loggers were used to estimate sediment erosion. Erosion calculations based on bank pins suggest greater erosion in reaches dominated by knotweed than those dominated by trees. For a 9.5-month monitoring period, there was 29 cm more erosion on banks that were also incised, and 9 cm more erosion in banks with little incision. Turbidity responses to storm events were also higher (77 vs. 54 NTU (nephelometric turbidity unit in reaches with knotweed, although this increase was found when the reach dominated by knotweed was also incised. Thus, this study linked knotweed to increased erosion using multiple methods.

  8. Single-incision sleeve gastrectomy versus conventional laparoscopic sleeve gastrectomy--a randomised pilot study. (United States)

    Lakdawala, Muffazal A; Muda, Nor Hisham; Goel, Sunita; Bhasker, Aparna


    This is a prospective pilot study done to evaluate the feasibility and to assess the outcomes and complication rates of the single-incision sleeve gastrectomy versus the conventional five-port laparoscopic sleeve gastrectomy. A prospective comparative analysis was done of 50 patients in each arm who underwent laparoscopic sleeve gastrectomy and single-incision sleeve gastrectomy from September 2009 until April 2010. Both groups were matched for age, gender and BMI and were then randomly assigned to either group. Postoperative pain scoring was done using the visual analogue scale. Postoperative outcomes in terms of pain scores, excess weight loss, resolution of comorbidities and complication rates were compared in both groups, at the end of 6 months. Operating times in both groups were comparable with experience. Intraoperative blood loss was similar in both groups. VAS scoring revealed lesser postoperative pain after the first 8 h in the single-incision group as compared to the laparoscopy group-P < 0.0001. At 6 months, excess weight loss and resolution of comorbidities were comparable in both groups. There were no major complications or mortalities in either group. Single-incision laparoscopic sleeve gastrectomy is a feasible surgical procedure for morbid obesity in selected individuals. When compared to conventional laparoscopic sleeve gastrectomy, it has equally effective weight loss and resolution of comorbidities. It also has the added benefits of little or no visible scarring and reduced postoperative pain.

  9. Quality-of-Life and Visual Function after Manual Small Incision ...

    African Journals Online (AJOL)

    Background: Outcome studies after cataract surgery should focus on functional status and quality of life instead of visual acuity measurement alone. Objective: To assess patients' quality of life (QoL) and overall visual function (VF) after manual small incision cataract surgery (SICS) with intraocular lens (IOL) implantation.

  10. Safety and feasibility of single-incision laparoscopic cholecystectomy in obese patients

    Directory of Open Access Journals (Sweden)

    Masaki Wakasugi


    Full Text Available Current literature frequently indicates that experienced laparoscopic surgeons can safely perform single-incision laparoscopic cholecystectomy, but there have been few reports evaluating the feasibility and safety of performing single-incision laparoscopic cholecystectomy for obese patients. Therefore, a large single-center database was retrospectively reviewed to evaluate the feasibility and safety of single-incision laparoscopic cholecystectomy for obese patients by comparing the outcomes of normal-weight and obese patients undergoing single-incision laparoscopic cholecystectomy.A retrospective analysis of 608 patients undergoing SILC between May 2009 and May 2015 at Osaka Police Hospital was performed, and the outcomes of obese [body mass index (BMI ≥ 30 kg/m2] and normal-weight patients (18.5 ≤ BMI < 25 kg/m2 were compared.Thirty-eight obese patients (mean BMI 32.5 kg/m2 were compared to 362 normal-weight patients (mean BMI 22.0 kg/m2. The American Society of Anesthesiologists (ASA scores of the obese patients were significantly higher than those of normal-weight patients. The mean operative times in the normal-weight and the obese groups were 110 min vs. 127 min, respectively (p < 0.05. There were no significant differences in the bleeding volume and the conversion rate to a different operative procedure. Perioperative complications were seen in 6% (23/362 of the patients in the normal-weight group and 8% (3/38 of the patients in the obese group (p = 0.7. The mean postoperative hospital stay was 4.5 days for the normal-weight group and 4.4 days for the obese group (p = 0.8.Single-incision laparoscopic cholecystectomy, which offers good cosmetic outcomes, seems feasible and safe in obese patients.•Single-incision laparoscopic cholecystectomy offers good cosmetic outcomes.•Single-incision laparoscopic cholecystectomy seems feasible and safe in obese patients.

  11. Single incision laparoscopic surgery (SILS) in gynaecology: feasibility and operative outcomes. (United States)

    Behnia-Willison, Fariba; Foroughinia, Leila; Sina, Maryam; McChesney, Phil


    Single incision laparoscopic surgery (SILS) represents the latest advancement in minimally invasive surgery, combining the benefits of conventional laparoscopic surgery, such as less pain and faster recovery, with improved cosmesis. Although the successful use of this technique is well reported in general surgery and urology, there is a lack of studies on SILS in gynaecology. To evaluate the feasibility, safety, cosmesis and outcome of SILS in gynaecology. A prospective case series analysis of 105 women scheduled to undergo surgery by SILS from August 2010 to November 2011. Intra-operative data such as operative time, estimated blood loss, complications, additional ports and hospital stay were collected. Post-operative pain and cosmetic outcomes (scar size) were also recorded. Out of 105 women, SILS was performed for 84 (60 excisions of endometriosis, 13 divisions of adhesions, five hysterectomies, two mesh sacrohysteropexies and four ovarian cystectomies). SILS was not undertaken for 21 women because of a number of factors, including the lack of required equipment (eg bariatric scope, SILS port, roticulating instruments and diathermy leads). Four women required insertion of additional ports because of surgical difficulties. One intra-operative (uterine perforation) and seven post-operative complications (six wound infections and one vault haematoma) occurred. Mean operation times were as follows: mesh sacrohysteropexy - 60 min, excision of endometriosis - 55 min, hysterectomy - 150 min, laparoscopic division of adhesions - 62 min and ovarian cystectomy - 40 min. Our experience shows that SILS is a feasible and safe technique for the surgical management of various gynaecological conditions. Satisfaction is high because of improved cosmesis and reduced analgesic requirements post-operatively. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  12. Risk Factors for Opaque Bubble Layer in Small Incision Lenticule Extraction (SMILE). (United States)

    Li, Liuyang; Schallhorn, Julie M; Ma, Jiaonan; Zhang, Lin; Dou, Rui; Wang, Yan


    To assess the independent effect of myopia and astigmatism on the risk of the occurrence of opaque bubble layer (OBL) in small incision lenticule extraction (SMILE) and further investigate the relationship between scanning depth and OBL. Twenty-two cases and 317 controls were included in a case-control study from the database of Tianjin Eye Hospital from April 2015 to July 2016. Baseline characteristics were recorded and all of the eyes were manually reviewed by two different observers masked to preoperative refractive status. Multiple regression analysis was used to assess the independent relationship between the attempted correction in diopters and the risk of OBL and to further analyze the association between scanning depth and the risk. The risk of OBL significantly decreased with increasing myopia (diopters) (odds ratio [OR] = 0.44; 95% confidence interval [CI]: 0.30 to 0.64; P < .0001). The risk of OBL also significantly decreased with increasing astigmatism (diopters) (OR = 0.10; 95% CI: 0.02 to 0.42; P = .0017). Lenticular thickness changed by 14.86 μm per diopter for myopia (β =14.86; 95% CI = 14.56 to 15.15; P < .0001) and 15.10 μm per diopter for astigmatism (β = 15.10; 95% CI = 13.96 to 16.24; P < .0001), respectively. A low correction was a significant independent risk factor for OBL during SMILE and the effect of astigmatism on OBL was greater than that of myopia. Deepening the photodisruption plane appropriately may reduce the risk of OBL. [J Refract Surg. 2017;33(11):759-764.]. Copyright 2017, SLACK Incorporated.

  13. Single incision versus reduced port splenectomy--searching for the best alternative to conventional laparoscopic splenectomy. (United States)

    Monclova, Julio Lopez; Targarona, Eduardo M; Vidal, Pablo; Peraza, Yerald; Garcia, Francisco; Otero, Carlos Rodriguez; Pallares, Luis; Balague, Carmen; Trias, Manuel


    Laparoscopic splenectomy (LS) is a well accepted approach for the treatment of multiple hematologic diseases. Single port access splenectomy (SPAS) emphasizes the concept of surgery through one small incision. The reduced port access splenectomy (RPAS) entails the use of fewer trocars of smaller sizes. The aim of this study was to compare the clinical outcomes after LS, SPAS, and RPAS, and to analyze the aesthetic result and patient satisfaction. We included patients who underwent LS (group 1, n = 15), SPAS (group 2, n = 8), and RPAS (group 3, n = 10) between June 2008 and February 2012, whose final spleen weight was less of 500 g. The outcome parameters analyzed were operative time, need of additional trocars, blood loss, blood transfusion, weight of the spleen, postoperative complications, and duration of hospital stay. To evaluate the cosmetic result, patients were asked to take the Body Image Questionnaire. Patients in group 3 were younger than group 1. Operative time was significantly longer in group 2 compared to groups 1 and 3 (83 ± 19 vs. 131 ± 43 vs. 81 ± 22 min, p = 0.01). There was no need to convert to open surgery in any group, nor were there differences in intra- or postoperative outcome. There were no differences between the groups in relation to the analgesic requirements. Twenty-two out of the 33 patients answered the questionnaire. There was a significant advantage in group 2 and 3 in the body image index with respect to group 1. There were no differences between groups 2 and 3 (7.3 ± 2.8 vs. 5.8 ± 1.3 vs. 5.1 ± 0.4, p RPAS is a good alternative to LS and SPAS. It improves the aesthetic results as compared to LS, whereas minimizes the technical challenges faced with SPAS.

  14. Random placenta margin incision for control hemorrhage during cesarean delivery complicated by complete placenta previa: a prospective cohort study. (United States)

    Fan, Dazhi; Wu, Shuzhen; Ye, Shaoxin; Wang, Wen; Wang, Lijuan; Fu, Yao; Zeng, Meng; Liu, Yan; Guo, Xiaoling; Liu, Zhengping


    Complete placenta previa (CPP) is one of the most problematic types of abnormal placenta, which is further complicated by placenta accreta or percreta that can unexpectedly lead to catastrophic blood loss, infection, multiple complications, emergency hysterectomy, and even death. The present study aimed to assess the efficacy of random placenta margin incision in controlling intraoperative and total blood loss during cesarean section for CPP women. A prospective cohort study, including a total of 100 consecutive pregnant women with CPP, was performed at a tertiary university-affiliated medical center between March 2016 and July 2017. All of them underwent random placenta margin incision, and intraoperative and total blood loss were analyzed. Through antenatal diagnosis using color Doppler, women were further divided into abnormally invasive placenta (AIP) and non-AIP groups, and anterior and posterior placenta groups. The protocol was registered with the Clinical Trial Registry under registration number NCT02695069. Mean maternal age and gestational age at delivery were 32.26 ± 5.03 years old and 36.21 ± 2.07 weeks, respectively. Total duration of the surgical procedure time was 52.50 (42.43-64.00) min. Median estimated intraoperation blood loss was 746.43 (544.44-1092.86) ml. Total blood loss was 875.00 (604.50-1196.67) ml, and 38 (38.0%) had post-partum hemorrhage. The change from baseline in the median hemoglobin level was -0.33 (6.00-13.20). No women underwent hysterectomy due to massive hemorrhage during the study period. No women had an intraoperative urinary bladder injury, postoperative wound infection, and required relaparotomy, owing to intra-abdominal bleeding. The median hospitalization time was 5.41 (4.18-7.58) d. The random placenta margin incision may be a potentially valuable surgical procedure to control the volumes of intraoperative and postoperative blood loss and reduce the incidence of postpartum hemorrhage among women with complete

  15. Customer Engagement Tool (Multi Channel Communication) (United States)

    Social Security Administration — Add new infrastructure within SSA's Enterprise Architecture to allow interactions over multiple, yet to be defined, channels. Possibilities include: Provide a portal...

  16. Learning Curve for Laparoendoscopic Single-Incision Live Donor Nephrectomy: Implications for Laparoendoscopic Practice and Training. (United States)

    Troppmann, Christoph; Santhanakrishnan, Chandrasekar; Fananapazir, Ghaneh; Troppmann, Kathrin M; Perez, Richard V


    The learning curve for laparoendoscopic single-incision live donor nephrectomy, which is technically more complex than the multiport, conventional laparoendoscopic approach, is unknown. In a retrospective cohort study, we analyzed the learning curve of the initial 114 consecutive single-incision laparoendoscopic nephrectomies performed in nonselected live kidney donors. Median donor body mass index was 26 kg/m 2 (range 20-34). In all, 92% of the nephrectomies were performed on the left side; 18% of the recovered kidneys had multiple renal arteries. Cumulative sum (CUSUM) analysis of operating time (OT) demonstrated that the learning curve was achieved after case 61. For the learning curve phase (Group 1 [cases 1-61]) vs the postlearning phase (Group 2 [cases 62-114]), the difference of the mean OT was 20 minutes (p = 0.05). Mean warm ischemic time in the donors was significantly longer during the learning phase (Group 1, 6 minutes; Group 2, 5 minutes; p = 0.04). Rates of conversions to multiport procedures and of donor complications were not significantly different between Groups 1 and 2. For the recipients, we observed delayed graft function in 2 (2%) cases, no technical graft losses; and 1-year death-censored graft survival was 100% (p = n.s. for all comparisons of Group 1 vs 2). Single-incision laparoendoscopic donor nephrectomy had a long learning curve (>60 cases), but resulted in excellent donor and recipient outcomes. The long learning curve has significant implications for the programs and surgeons who contemplate transitioning from multiport to single-incision nephrectomy. Furthermore, our observations are highly relevant for informing the development of training requirements for fellows to be trained in single-incision laparoendoscopic nephrectomy.

  17. [Is there a relation between mammaplasties incisions and the final shape of the breast?]. (United States)

    Moufarrège, R; Dionyssopoulos, A; Aymeric, A; Sauvageau, J


    The results of reduction mammoplasty and mastopexy demonstrate a great variety of shapes derived from the particularities inherent to each technique. More precisely, it has become apparent to us that the usage of an abnormally long vertical scar leads to a suboptimal final shape of the breast due to the excessive projection compared to its height. Although our clientele continually asks to minimize scars, we have noticed a resurgence in the literature of vertical incision mammoplasty techniques albeit with a scar of an excessive length. The multitude of publications leads to an evident and consistent conclusion: breasts reconstructed with an overly long vertical incision all suffer the same deformity characterized by a banana or squash-shaped breast. We studied the totality of publications on vertical incision technique mammoplasty from the last 15 years and realised they all presented the same problem: an abnormally low height/projection ratio. These numbers have been confronted by the golden ratio established by the first author (2005) [1]. The breast's golden ratio developed by Moufarrège is optimal at a number close to, or superior to 2. Results between 2 and 1.5 are acceptable. All height/projection ratios inferior to 1.5 correspond to suboptimal breast shapes. Furthermore, the totality of results in the vertical scar mammoplasty technique which displayed unsatisfying results had a height/projection ratio inferior to 1.5. Those who promote the vertical incision have the greatest drive to encourage other plastic surgeons to abandon the traditional mutilating boat anchor scar. Nevertheless, they should always remember the deforming effect caused by exaggerated vertical incisions which may be avoided by transforming it into an inverted T with short horizontal branches, a small price to pay to obtain a superior aesthetic result. Copyright 2009 Elsevier Masson SAS. All rights reserved.

  18. Mini-incision microdissection testicular sperm extraction: a useful technique for men with cryptozoospermia. (United States)

    Alrabeeah, K; Witmer, J; Ruiz, S; AlMalki, A; Phillips, S; Zini, A


    Microdissection testicular sperm extraction (micro-TESE) was developed to minimize the testicular injury associated with multiple open TESEs. We sought to evaluate a mini-incision micro-TESE in men with cryptozoospermia and non-obstructive azoospermia (NOA). We conducted a retrospective study of 26 consecutive men with NOA and cryptozoospermia who underwent a primary (first) micro-TESE between March 2015 and August 2015. Final assessment of sperm recovery (reported on the day of intra-cytoplasmic sperm injection (ICSI)) was recorded as (i) successful (available spermatozoa for ICSI) or (ii) unsuccessful (no spermatozoa for ICSI). The decision to perform a mini-incision micro-TESE (with limited unilateral micro-dissection) or standard/extensive (with unilateral or bilateral micro-dissection) was guided by the intra-operative identification of sperm recovery (≥5 spermatozoa) from the first testicle. Overall, sperm recovery was successful in 77% (20/26) of the men. In 37% of the men (8/26), the mini-incision micro-TESE was successful (positive sperm recovery). The remaining 18 men required a standard (extensive) microdissection: 61% (11/18) underwent a unilateral and 39% (7/18) a bilateral micro-TESE. We found that 90% (9/10) of the men with cryptozoospermia and 63% (10/16) of the men with NOA underwent a unilateral (mini or standard micro-TESE). The mini-incision micro-TESE allowed for successful sperm recovery in 60% (6/10) of the men with cryptozoospermia and 13% (2/16) of the men with NOA. The data demonstrate that a mini-incision micro-TESE together with rapid intra-operative assessment and identification of spermatozoa recovery can be useful in men undergoing microTESE, particularly, men with cryptozoospermia. © 2016 American Society of Andrology and European Academy of Andrology.

  19. A new technique, combined plication-incision (CPI, for correction of penile curvature

    Directory of Open Access Journals (Sweden)

    Hamed Abdalla Hamed

    Full Text Available ABSTRACT Introduction Penile curvature (PC can be surgically corrected by either corporoplasty or plication techniques. These techniques can be complicated by post-operative: penile shortening, recurrent PC, painful/palpable suture knots and erectile dysfunction. Objective To avoid the complications of corporoplasty and plication techniques using a new technique: combined plication-incision (CPI. Materials and Methods Two groups (1&2 were operated upon: group 1 using CPI and group 2 using the 16-dot technique. In CPI, dots were first marked as in 16 dot technique. In each group of 4 dots the superficial layer of tunica albuginea was transversely incised (3-6mm at the first and last dots. Ethibond 2/0, passed through the interior edge of the first incision plicating the intermediate 2 dots and passed out of the interior edge of the last incision, was tightened and ligated. Vicryle 4/0, passed through the exterior edges of the incisions, was tightened and ligated to cover the ethibond knot. Results Twelve (57.1 % participants in group 2 complained of a bothering palpable knot compared to none in group 1 with statistically significant difference (P=0.005. Postoperative shortening (5mm of erect penis, encountered in 9 participants, was doubled in group 2 but with insignificant difference (P>0.05. Post-operative recurrence of PC, was encountered in only 1 (4.8% participant in group 2, compared to none in group 1, with insignificant difference (P>0.05. Post-operative erectile rigidity was normally maintained in all participants. Conclusion The new technique was superior to the 16-dot technique for correction of PC.

  20. From incision to infill: What a Late Quaternary valley system records? (United States)

    Maselli, V.; Asioli, A.; Trincardi, F.; Ceregato, A.; Rizzetto, F.; Taviani, M.


    Erosional sequence boundaries and incised valleys buried in modern continental shelves represent the response of alluvial and coastal systems to Quaternary sea level oscillations. The study of the processes leading to valley incision reveals, at both regional and global scales, the influence of tectonics and eustatism on the evolution of fluvial landforms in coastal plains, while the sedimentary infill of the valley may represents one of the best archives to investigate past environmental changes. Although the time registered in the stratigraphic record represents only a small portion of the geological history, informations about the processes governing the evolution of past landscapes can be quantified by looking to erosional surfaces, where much of the time is condensed. The Manfredonia Incised Valley (southern Adriatic Sea), is a very interesting case of valley as it formed during a single episode of incision related to the last glacial sea level fall and was completely filled during the post-glacial sea level rise. The inverse-funnel shape of the incision, and its confinement toward the mid-inner shelf reveal the impact of the step-wise sea level fall on preexisting coastal morphologies, in particular during the MIS5-4 and MIS3-2 transitions. The 45 m thick sedimentary succession filling the valley recorded the post-glacial sea level rise, as revealed by the upward transition from fluvial to shallow-marine deposits, and the impact of base level and high-frequency climate change on river to coastal systems. The upper 15 m of infill, in particular, consist of multiple bayhead delta progradations occurred synchronously to the formation of sapropel S1, and represent the very-shallow water equivalent of the cm-thick sapropel layers accumulated offshore in the deeper southern Adriatic basin.

  1. Surgical management of stage I and II vulvar cancer:The role of the separated incision

    Directory of Open Access Journals (Sweden)

    Andrijono Andrijono


    Full Text Available Vulvar cancer is a gynecological cancer whose incidence rate is relatively low. Patients generally were admitted at advanced stage, and radiation therapy at advanced stage does not provide favorable prognosis. Two main modalities in the treatment of vulvar cancer are surgery and radiation therapy. However, radiation can be performed in early stage vulvar cancer but surgery is thought to have more benefits, such as in side effect on the ovary/ reproductive function disorder, patient's hygiene factor, and the ease in performing therapy if recurrence occurs. There are various techniques of vulvar cancer surgery, such as radical vulvectomy with butterfly incision (RVBI and radical vulvectomy with separated incision (RVSI. The objective of this study was to identify the benefits of radical vulvectomy with separated incision in comparison with radical vulvectomy with butterfly incision in terms of the length of surgery, wound recovery, infection incidence, length of hospital stay. This study was a clinical trial performed during the period of 1990-2000. Fifteen cases of vulvar cancer were found and underwent surgery. Fourteen cases were at stage II and 14 cases were histologically defined as squamous-cell carcinoma and 1 case was adenocarcinoma. The average length of surgery in RVSI was 168 minutes, this was shorter than that in VRBI which reached an average of 275 minutes. The incidence of infection in RVSI group was 3 of 11 cases (27.27%, while in RVBI group all cases had infection in surgical wound. Failure of surgical wound approximation was 1 of 12 cases (9.99%, while in RVBI all cases experienced the failure such that cosmetic surgery was required. Length of postoperative care in RVSI group was 12.3 days, while in RVBI 21.5 days. Thus, complications in VRBI were lower, and length of surgery and length of postoperative care were shorter. (Med J Indones 2003; 12: 103-8 Keywords: vulvar cancer, separated incision

  2. Assessment of treatment options for rectosigmoid cancer: single-incision plus one port laparoscopic surgery, single-incision laparoscopic surgery, and conventional laparoscopic surgery. (United States)

    Liu, Ruoyan; Wang, Yanan; Zhang, Ze; Li, Tingting; Liu, Hao; Zhao, Liying; Deng, Haijun; Li, Guoxin


    The advantages of reduced-port laparoscopic surgery (RPLS) for rectosigmoid cancer treatment have been disputed. This study evaluated the outcomes of RPLS compared to conventional laparoscopic surgery (CLS) for rectosigmoid cancer. Data from 211 patients who underwent a selective sigmoidectomy or anterior resection from August 2011 to June 2014 at a single institution were collected and analyzed via propensity score matching. Operative outcomes, inflammatory responses, pain intensity, oncologic outcomes, quality of life, and cosmetic results were compared between groups. After matching, 96 patients (48 CLS and 48 RPLS) were evaluated. Sixteen RPLS cases underwent single-incision laparoscopic surgery (SILS), and 32 underwent single-incision plus one port laparoscopic surgery (SILS + 1). Baseline clinical characteristics were comparable between the RPLS and the CLS groups. Morbidity, pathologic outcomes, and 3-year disease-free survival and overall survival rates were also comparable between the 2 groups. Compared with the CLS group, the RPLS group had a shorter total incision length (p time to liquid diet (p = 0.027), ambulation (p = 0.026), and discharge (p times, C-reactive protein levels at 24 h and 96 h, and interleukin-6 levels at 24 h postoperatively were significantly lower in the SILS + 1 group than those in the CLS and SILS groups (p cosmetic results, and both groups showed better results than the CLS group (p < 0.001). RPLS for rectosigmoid cancer is feasible, with short-term safety and long-term oncological safety comparable to that of CLS. Better cosmesis and accelerated recovery can be expected. SILS + 1 is a better choice than CLS or SILS for rectosigmoid cancer because it minimizes invasiveness and reduces technical difficulties.

  3. Single-incision laparoscopic surgery and conventional laparoscopic ...

    African Journals Online (AJOL)

    Indications for surgery included grades II-III varicocele or ipsilateral testicular hypotrophy. The SIL-V procedure was performed in 44 patients with roticulating and conventional 5 mm instruments. Testicular vessels were isolated “en bloc,” clipped and cut. Operating time, visual analogue scale and post-operative results were ...

  4. Amazon floodplain channels regulate channel-floodplain water exchange (United States)

    Bates, P. D.; Baugh, C.; Trigg, M.


    We examine the role of floodplain channels in regulating the exchange of water between the Amazon main stem and its extensive floodplains using a combination of field survey, remote sensing and numerical modelling for a 30,000 km2 area around the confluence of the Solimões and Purus rivers. From Landsat imagery we identified 1762 individual floodplain channel reaches with total length of nearly 9300 line km that range in width from 900m to 20m. Using a boat survey we measured width and depth along 509 line km of floodplain channels in 45 separate reaches and used these data to develop geomorphic relationships between width and depth. This enabled reconstruction of the depth of all other channels in the Landsat survey to an RMSE of 2.5m. We then constructed a 2D hydraulic model of this site which included all 9300km of floodplain channels as sub-grid scale features using a recently developed version of the LISFLOOD-FP code. The DEM for the model was derived from a version of the SRTM Digital Elevation Model that was processed to remove vegetation artefacts. The model was run at 270m resolution over the entire 30,000 km2 domain for the period from 2002-2009. Simulations were run with and without floodplain channels to examine the impact of these features on floodplain flow dynamics and storage. Simulated floodplain channel hydraulics were validated against a combination of in-situ and remotely sensed data. Our results show that approximately 100 km3 of water is exchanged between the channel and the floodplain during a typical annual cycle, and 8.5±2.1% of mainstem flows is routed through the floodplain. The overall effect of floodplains channels was to increase the duration of connections between the Amazon River and the floodplain. Inclusion of floodplain channels in the model increased inundation volume by 7.3% - 11.3% at high water, and decreased it at low water by 4.0% - 16.6%, with the range in these estimates due to potential errors in floodplain channel

  5. Minimal Nasolabial Incision Technique for Nasolabial Fold Modification in Patients With Facial Paralysis. (United States)

    Faris, Callum; Heiser, Alyssa; Jowett, Nate; Hadlock, Tessa


    Creation of symmetrical nasolabial folds (NLFs) is important in the management of the paralyzed face. Established techniques use a linear incision in the NLF, and technical refinements now allow the linear incision to be omitted. This retrospective case series was conducted in a tertiary care setting from February 2, 2017, to June 7, 2017. Participants were all patients (N = 21) with peripheral facial paralysis who underwent NLF modification that used the minimal nasolabial incision technique at the Massachusetts Eye and Ear Infirmary Facial Nerve Center from February 1, 2015, through August 31, 2016. Patient-reported outcome measures using the validated, quality-of-life Facial Clinimetric Evaluation (FaCE) Scale; clinician-reported facial function outcomes using a validated electronic clinician-graded facial paralysis assessment (eFACE); layperson assessment of the overall aesthetic outcome of the NLF; and expert-clinician scar assessment of the NLF. Of the 21 patients who underwent NLF modification that used the minimal nasolabial incision technique, 9 patients (43%) were female and 12 (57%) were male. The mean age was 41 (range, 9-90) years; 17 patients (81%) were adults (≥18 years) and 4 (19%) were children (<18 years). Overall, significant improvements were observed after NLF modification in all outcome measures as graded by both clinicians and patients. The mean (SD) scores for total eFACE were 60.7 (14.9) before the operation and 77.2 (8.9) after the operation (mean difference, 16.5 [95% CI, 8.5-24.2]; P < .001). The mean (SD) static eFACE scores were 61.4 (20.6) before the operation and 82.7 (12.4) after the operation (mean difference, 21.3 [95% CI, 10.7-31.9]; P < .001). The mean (SD) FaCE quality-of-life scores were 51.3 (20.1) before the operation and 70.3 (12.6) after the operation (mean difference, 19.0 [95% CI, 6.5-31.6]; P  =  .001). The layperson self-assessment of the overall aesthetic outcome of the NLF modification was

  6. Channel-changing processes on the Santa Cruz River, Pima County, Arizona, 1936-86 (United States)

    Parker, John T.C.; ,


    Lateral channel change on the mainly ephemeral Santa Cruz River, Pima County, Arizona, causes damage and has spawned costly efforts to control bank erosion. Aerial photographs, historical data, and field observations are used to document the history of channel change since 1936. Variability in the nature and degree of channel change over time and space is shown. Three major channel change processes are: (1) migration by bank erosion during meander migration or initiation; (2) avulsion by overbank flooding and flood plain incision; (3) widening by erosion of low, cohesionless banks during floods and arroyo widening by undercutting and mass wasting of deeply incised vertical walls. The first process generally is a product of low to moderate flows or waning high flows; the others result mainly from higher flows, though sensitive arroyo walls may erode during relatively low flows. Channel morphology, bank resistance, and hydrology are factors determining the dominant channel-changing process on a particular reach of the river. Present river morphology reflects high flows since the 1960's.

  7. FMCG companies specific distribution channels

    Directory of Open Access Journals (Sweden)

    Ioana Barin


    Full Text Available Distribution includes all activities undertaken by the producer, alone or in cooperation, since the end of the final finished products or services until they are in possession of consumers. The distribution consists of the following major components: distribution channels or marketing channels, which together form a distribution network; logistics o rphysical distribution. In order to effective achieve, distribution of goods requires an amount of activities and operational processes related to transit of goods from producer to consumer, the best conditions, using existing distribution channels and logistics system. One of the essential functions of a distribution is performing acts of sale, through which, with the actual movement of goods, their change of ownership takes place, that the successive transfer of ownership from producer to consumer. This is an itinerary in the economic cycle of goods, called the distribution channel.

  8. Multi-reaction-channel fitting calculations in a coupled-channel ...

    Indian Academy of Sciences (India)

    Gx; 13.75.Jz; 14.20.Gk; 25.80.-e. 1. Introduction. To describe channel coupling effects we adopt the K-matrix formalism. ... Also for some of the strangeness production channels the effect of including the ρ-channel clearly affects the .... The range multiplier for the values is given on top, the name of the parameter below. 220.

  9. 3D reconstruction of the source and scale of buried young flood channels on Mars. (United States)

    Morgan, Gareth A; Campbell, Bruce A; Carter, Lynn M; Plaut, Jeffrey J; Phillips, Roger J


    Outflow channels on Mars are interpreted as the product of gigantic floods due to the catastrophic eruption of groundwater that may also have initiated episodes of climate change. Marte Vallis, the largest of the young martian outflow channels (Mars hydrologic activity during a period otherwise considered to be cold and dry. Using data from the Shallow Radar sounder on the Mars Reconnaissance Orbiter, we present a three-dimensional (3D) reconstruction of buried channels on Mars and provide estimates of paleohydrologic parameters. Our work shows that Cerberus Fossae provided the waters that carved Marte Vallis, and it extended an additional 180 kilometers to the east before the emplacement of the younger lava flows. We identified two stages of channel incision and determined that channel depths were more than twice those of previous estimates.

  10. Cannabidiol Is a Potential Therapeutic for the Affective-Motivational Dimension of Incision Pain in Rats. (United States)

    Genaro, Karina; Fabris, Débora; Arantes, Ana L F; Zuardi, Antônio W; Crippa, José A S; Prado, Wiliam A


    Background: Pain involves different brain regions and is critically determined by emotional processing. Among other areas, the rostral anterior cingulate cortex (rACC) is implicated in the processing of affective pain. Drugs that interfere with the endocannabinoid system are alternatives for the management of clinical pain. Cannabidiol (CBD), a phytocannabinoid found in Cannabis sativa , has been utilized in preclinical and clinical studies for the treatment of pain. Herein, we evaluate the effects of CBD, injected either systemically or locally into the rACC, on mechanical allodynia in a postoperative pain model and on the negative reinforcement produced by relief of spontaneous incision pain. Additionally, we explored whether CBD underlies the reward of pain relief after systemic or rACC injection. Methods and Results: Male Wistar rats were submitted to a model of incision pain. All rats had mechanical allodynia, which was less intense after intraperitoneal CBD (3 and 10 mg/kg). Conditioned place preference (CPP) paradigm was used to assess negative reinforcement. Intraperitoneal CBD (1 and 3 mg/kg) inverted the CPP produced by peripheral nerve block even at doses that do not change mechanical allodynia. CBD (10 to 40 nmol/0.25 μL) injected into the rACC reduced mechanical allodynia in a dose-dependent manner. CBD (5 nmol/0.25 μL) did not change mechanical allodynia, but reduced peripheral nerve block-induced CPP, and the higher doses inverted the CPP. Additionally, CBD injected systemically or into the rACC at doses that did not change the incision pain evoked by mechanical stimulation significantly produced CPP by itself. Therefore, a non-rewarding dose of CBD in sham-incised rats becomes rewarding in incised rats, presumably because of pain relief or reduction of pain aversiveness. Conclusion: The study provides evidence that CBD influences different dimensions of the response of rats to a surgical incision, and the results establish the rACC as a brain area

  11. Cannabidiol Is a Potential Therapeutic for the Affective-Motivational Dimension of Incision Pain in Rats

    Directory of Open Access Journals (Sweden)

    Karina Genaro


    Full Text Available Background: Pain involves different brain regions and is critically determined by emotional processing. Among other areas, the rostral anterior cingulate cortex (rACC is implicated in the processing of affective pain. Drugs that interfere with the endocannabinoid system are alternatives for the management of clinical pain. Cannabidiol (CBD, a phytocannabinoid found in Cannabis sativa, has been utilized in preclinical and clinical studies for the treatment of pain. Herein, we evaluate the effects of CBD, injected either systemically or locally into the rACC, on mechanical allodynia in a postoperative pain model and on the negative reinforcement produced by relief of spontaneous incision pain. Additionally, we explored whether CBD underlies the reward of pain relief after systemic or rACC injection.Methods and Results: Male Wistar rats were submitted to a model of incision pain. All rats had mechanical allodynia, which was less intense after intraperitoneal CBD (3 and 10 mg/kg. Conditioned place preference (CPP paradigm was used to assess negative reinforcement. Intraperitoneal CBD (1 and 3 mg/kg inverted the CPP produced by peripheral nerve block even at doses that do not change mechanical allodynia. CBD (10 to 40 nmol/0.25 μL injected into the rACC reduced mechanical allodynia in a dose-dependent manner. CBD (5 nmol/0.25 μL did not change mechanical allodynia, but reduced peripheral nerve block-induced CPP, and the higher doses inverted the CPP. Additionally, CBD injected systemically or into the rACC at doses that did not change the incision pain evoked by mechanical stimulation significantly produced CPP by itself. Therefore, a non-rewarding dose of CBD in sham-incised rats becomes rewarding in incised rats, presumably because of pain relief or reduction of pain aversiveness.Conclusion: The study provides evidence that CBD influences different dimensions of the response of rats to a surgical incision, and the results establish the rACC as a

  12. Comparative healing of surgical incisions created by the PEAK PlasmaBlade, conventional electrosurgery, and a scalpel. (United States)

    Loh, Shang A; Carlson, Grace A; Chang, Edward I; Huang, Eric; Palanker, Daniel; Gurtner, Geoffrey C


    The PEAK PlasmaBlade is a new electrosurgical device that uses pulsed radiofrequency to generate a plasma-mediated discharge along the exposed rim of an insulated blade, creating an effective cutting edge while the blade stays near body temperature. Full-thickness incisions were made on the dorsums of pigs with the PlasmaBlade, a conventional electrosurgical device, and a scalpel, and blood loss was quantified. Wounds were harvested at designated time points, tested for wound tensile strength, and examined histologically for scar formation and tissue damage. Bleeding was reduced significantly (59 percent) in PlasmaBlade incisions compared with scalpel incisions, and acute thermal damage from the PlasmaBlade (66 +/- 5 microm) was significantly less than both cut and coagulation mode electrosurgical incisions (456 +/- 35 microm and 615 +/- 22 microm, respectively). Histologic scoring for injury and wound strength was equivalent between the PlasmaBlade and scalpel incisions. By 6 weeks, the healed PlasmaBlade and scalpel incisions were approximately three times stronger, and scar cosmetic appearance was significantly better compared with electrosurgical incisions. The PlasmaBlade is a promising new surgical instrument that provides atraumatic, scalpel-like cutting precision and electrosurgical-like hemostasis, resulting in minimal bleeding, tissue injury, and scar formation.

  13. The "Propeller" incision for transpalatal advancement pharyngoplasty: a new approach to reduce post-operative oronasal fistulae. (United States)

    Shine, Neville Patrick; Lewis, Richard Hamilton


    To present a new soft tissue approach for transpalatal advancement pharyngoplasty (TPA), the propeller incision, and to compare the rates of post-operative oronasal fistula in those undergoing TPA with the traditional "Gothic Arch" incision described by Woodson and those with the propeller incision. A prospectively maintained adult sleep apnoea surgery database was used to identify those patients undergoing TPA, either alone or in combination with other procedures, for obstructive sleep apnoea syndrome (OSAS) between February 2001 and September 2006 in a tertiary referral centre by a single surgeon (RHL). In addition to the incision used during TPA, patient demographic data, previous surgery of the upper airways, smoking history, pre-operative body mass index, respiratory disturbance index, oxygen saturation index and the occurrence of oronasal fistula post-operatively, were recorded. The propeller incision technique is described. A total of 89 patients who underwent TPA were identified. A total of 49 patients had a "Gothic Arch" incision and 40 had a "Propeller" incision. The two groups of patients were comparable in age, sex, previous tonsillar and uvulopalatopharyngoplasty surgery, smoking histories and pre-operative disease severity. In the "Gothic Arch" group, eight patients (16%) developed oronasal fistulae in the post-operative period versus only one patient (2.5%) in the "Propeller" group. The difference between the two groups was statistically significant (P=0.038, Fisher's exact test). Of the total cases with post-operative oronasal fistula (n=9), only one patient (from the Gothic Arch incision group) required operative closure which was performed under local anesthesia and healed without complication. The propeller incision provides an anatomically sensible axial-based flap that provides adequate access to perform TPA. It is associated with a lower incidence of oronasal fistula and is recommended by the authors.

  14. Post-Translational Modifications of TRP Channels

    Directory of Open Access Journals (Sweden)

    Olaf Voolstra


    Full Text Available Transient receptor potential (TRP channels constitute an ancient family of cation channels that have been found in many eukaryotic organisms from yeast to human. TRP channels exert a multitude of physiological functions ranging from Ca2+ homeostasis in the kidney to pain reception and vision. These channels are activated by a wide range of stimuli and undergo covalent post-translational modifications that affect and modulate their subcellular targeting, their biophysical properties, or channel gating. These modifications include N-linked glycosylation, protein phosphorylation, and covalent attachment of chemicals that reversibly bind to specific cysteine residues. The latter modification represents an unusual activation mechanism of ligand-gated ion channels that is in contrast to the lock-and-key paradigm of receptor activation by its agonists. In this review, we summarize the post-translational modifications identified on TRP channels and, when available, explain their physiological role.

  15. Long-term outcomes of limbal relaxing incisions during cataract surgery: aberrometric analysis

    Directory of Open Access Journals (Sweden)

    Monaco G


    Full Text Available Gaspare Monaco, Antonio ScialdoneDepartment of Ophthalmology, Ospedale Fatebenefratelli e Oftalmico, Milan, ItalyPurpose: To compare the final changes in corneal wavefront aberration by limbal relaxing incisions (LRIs after cataract surgery.Methods: This prospective cumulative interventional nonrandomized case study included cataract and astigmatic patients undergoing LRIs and phaco with intraocular lens implantation. LRIs were planned using Donnenfeld nomogram. The root mean square of corneal wave aberration for total Z(n,i(1≤n≤8, astigmatism Z(2,±1, coma Z(3–5–7,±1, trefoil Z(3–5–7,±2, spherical Z(4–6–8,0, and higher-order aberration (HOA Z(3≤n≤8 was examined before and 3 years after surgery (optical path difference-Scan II [OPD-Scan II]. Uncorrected distance visual acuity and best-corrected distance visual acuity (CDVA for distance, keratometric cylinder, and variations in average corneal power were also analyzed.Results: Sixty-four eyes of 48 patients were included in the study. Age ranged from 42 to 92 years (70.6±8.4 years. After LRIs, uncorrected distance visual acuity and best-corrected distance visual acuity improved statistically (P<0.01. The keratometric cylinder value decreased by 40.1%, but analysis of KP90 and KP135 polar values did not show any decrease that could be statistically confirmed (P=0.22 and P=0.24. No significant changes were detected in root mean square of total (P=0.61 and HOAs (P=0.13 aberrations. LRIs did not induce alteration in central corneal power confirming a 1:1 coupling ratio.Conclusion: LRIs determined a nonsignificant alteration of corneal HOA. Therefore, LRIs can be still considered a qualitatively viable mean in those cases where toric intraocular lenses are contraindicated or not available. Yet, the authors raise the question of nonpersonalized nomograms, as in the present study, LRIs did not reach the preset target cylinder. Keywords: astigmatism, ocular wavefront, intraocular

  16. Stratigraphy and paleohydrology of delta channel deposits, Jezero crater, Mars (United States)

    Goudge, Timothy A.; Mohrig, David; Cardenas, Benjamin T.; Hughes, Cory M.; Fassett, Caleb I.


    The Jezero crater open-basin lake contains two well-exposed fluvial sedimentary deposits formed early in martian history. Here, we examine the geometry and architecture of the Jezero western delta fluvial stratigraphy using high-resolution orbital images and digital elevation models (DEMs). The goal of this analysis is to reconstruct the evolution of the delta and associated shoreline position. The delta outcrop contains three distinct classes of fluvial stratigraphy that we interpret, from oldest to youngest, as: (1) point bar strata deposited by repeated flood events in meandering channels; (2) inverted channel-filling deposits formed by avulsive distributary channels; and (3) a valley that incises the deposit. We use DEMs to quantify the geometry of the channel deposits and estimate flow depths of ∼7 m for the meandering channels and ∼2 m for the avulsive distributary channels. Using these estimates, we employ a novel approach for assessing paleohydrology of the formative channels in relative terms. This analysis indicates that the shift from meandering to avulsive distributary channels was associated with an approximately four-fold decrease in the water to sediment discharge ratio. We use observations of the fluvial stratigraphy and channel paleohydrology to propose a model for the evolution of the Jezero western delta. The delta stratigraphy records lake level rise and shoreline transgression associated with approximately continuous filling of the basin, followed by outlet breaching, and eventual erosion of the delta. Our results imply a martian surface environment during the period of delta formation that supplied sufficient surface runoff to fill the Jezero basin without major drops in lake level, but also with discrete flooding events at non-orbital (e.g., annual to decadal) timescales.

  17. New Channels, New Possibilities

    DEFF Research Database (Denmark)

    Pieterson, Willem; Ebbers, Wolfgang; Østergaard Madsen, Christian


    In this contribution we discuss the characteristics of what we call the fourth generation of public sector service channels: social robots. Based on a review of relevant literature we discuss their characteristics and place into multi-channel models of service delivery. We argue that social robots...... is not one homogenous type of channels, but rather breaks down in different (sub)types of channels, each with different characteristics and possibilities to supplement and/or replace existing channels. Given the variety of channels, we foresee challenges in incorporating these new channels in multi-channel...... models of service delivery. This is especially relevant given the current lack of evaluations of such models, the broad range of channels available, and their different stages of deployment at governments around the world. Nevertheless, social robots offer an potentially very relevant addition...

  18. Single-incision Laparoscopic Surgery (SILS) in general surgery: a review of current practice. (United States)

    Froghi, Farid; Sodergren, Mikael Hans; Darzi, Ara; Paraskeva, Paraskevas


    Single-incision laparoscopic surgery (SILS) aims to eliminate multiple port incisions. Although general operative principles of SILS are similar to conventional laparoscopic surgery, operative techniques are not standardized. This review aims to evaluate the current use of SILS published in the literature by examining the types of operations performed, techniques employed, and relevant complications and morbidity. This review considered a total of 94 studies reporting 1889 patients evaluating 17 different general surgical operations. There were 8 different access techniques reported using conventional laparoscopic instruments and specifically designed SILS ports. There is extensive heterogeneity associated with operating methods and in particular ways of overcoming problems with retraction and instrumentation. Published complications, morbidity, and hospital length of stay are comparable to conventional laparoscopy. Although SILS provides excellent cosmetic results and morbidity seems similar to conventional laparoscopy, larger randomized controlled trials are needed to assess the safety and efficacy of this novel technique.

  19. Single-incision laparoscopic cholecystectomy for cholecystitis requiring percutaneous transhepatic gallbladder drainage. (United States)

    Igami, Tsuyoshi; Aoba, Taro; Ebata, Tomoki; Yokoyama, Yukihiro; Sugawara, Gen; Nagino, Masato


    Single-incision laparoscopic cholecystectomy (SILC) has been performed for patients with gallbladder stones but without acute cholecystitis. We report our experience of performing SILC for patients with cholecystitis requiring percutaneous transhepatic gallbladder drainage (PTGBD). We performed SILC via an SILS-Port with additional 5-mm forceps through an umbilical incision in ten patients with cholecystitis requiring PTGBD. All procedures were completed successfully. The mean operative time was 124 min (range 78-169 min) and there were no intraoperative or postoperative complications. The mean postoperative hospital stay was 2.7 days. All patients were satisfied with the cosmetic results. Our procedure may represent an alternative to conventional laparoscopic cholecystectomy (CLC) for patients who fervently demand the cosmetic advantages, despite cholecystitis requiring PTGBD. SILC should be performed carefully to avoid bile duct injury because the only advantage of SILC over CLC is cosmetic.

  20. Single-incision, laparoscopic-assisted jejunal resection and anastomosis following a gunshot wound. (United States)

    Rubin, Jacob A; Shigemoto, Reynsen; Reese, David J; Case, J Brad


    A 2 yr old castrated male Pomeranian was evaluated for a 6 wk history of chronic vomiting, intermittent anorexia, and lethargy. Physical examination revealed a palpable, nonpainful, soft-tissue mass in the midabdominal area. Abdominal radiographs and ultrasound revealed a focal, eccentric thickening of the jejunal wall with associated jejunal mural foreign body and partial mechanical obstruction. Following diagnosis of a partial intestinal obstruction as the cause of chronic vomiting, the patient underwent general anesthesia for a laparoscopic-assisted, midjejunal resection and anastomosis using a single-incision laparoscopic surgery port. The patient was discharged the day after surgery, and clinical signs abated according to information obtained during a telephone interview conducted 2 and 8 wk postoperatively. The dog described in this report is a unique case of partial intestinal obstruction treated by laparoscopic-assisted resection and anastomosis using a single-incision laparoscopic surgery port.

  1. Bariatric single incision laparoscopic surgery – review of initial experience

    Directory of Open Access Journals (Sweden)

    Agata Frask


    Full Text Available The aim of this review was to assess the results of published experience with bariatric SILS surgery, with a particular focus on treatment feasibility and safety. An EMBASE and MEDLINE database search was performed identifying 13 articles totalling 87 patients in the laparoscopic adjustable gastric banding (LAGB group, 10 patients in the laparoscopic sleeve gastrectomy (LSG group, and 1 patient in the Roux-en-Y SILS group. In most series the learning curve was steep and operating times halved with time, reaching 53 min for LAGB and 90 min for LSG. In single case reports using strict selection criteria patients were discharged up to 24 hours following surgery. Treatment safety was satisfactory. Only two studies reported some minor complications with rates of up to 9.8%, including port malposition, port site infection, and seroma or haematoma formation. There were no complications in other studies. LAGB, LSG and Roux-en-Y surgeries were feasible although technically demanding and difficult.

  2. Lateral Nail Fold Incision Technique for Venous Anastomosis in Fingertip Replantation. (United States)

    Jeon, Byung-Joon; Yang, Jae-Won; Roh, Si Young; Ki, Sae Hwi; Lee, Dong Chul; Kim, Jin Soo


    Successful venous anastomosis is one of the most important factors in fingertip replantation. Volar veins in the fingertip course proximally in a random pattern, which makes it difficult to find out the exact locations. Although dorsal veins in the lateral nail fold have constant location and adequate diameter for anastomosis, they have been known as hard to dissect from the immobile subcutaneous tissue. The authors present a new lateral nail fold incision technique for venous anastomosis in the fingertip amputations. From February 2010 to October 2010, 9 replantations using the new incision and venous anastomosis technique were performed in 9 patients. The levels of amputations were from the nail base to half of the nail bed. After repairing the proper digital arteries, a skin incision was made along the junction between the lateral nail fold and nail bed. Careful dissection was performed to isolate the veins in the lateral nail fold. After evaluation of the suitability of the vessel, venous anastomosis was performed. Seven male and 2 female patients were enrolled in this study. Appropriate dorsal veins for anastomosis could be found in 8 of 9 patients. All the replanted stumps survived without venous congestion and following additional procedures. A sizable volar or dorsal vein could not be found in 1 patient. The salvage technique was required in this patient. Dorsal veins in the lateral nail fold can be found easily because of the constant anatomical location. The new incision on the lateral nail fold provides not only sufficient operative field for anastomosis but also additional opportunity of successful venous anastomosis in the selected cases. The authors, therefore, propose this technique as an effective method for an alternative venous anastomosis in the zone I replantation.

  3. Single incision multi-trocar hepatic cyst excision with partial splenectomy

    Directory of Open Access Journals (Sweden)

    Palanivelu Chinnusamy


    Full Text Available Introduction: Surgery has the potential to remove the entire hydatid cyst and can lead to complete cure. Presence of hydatid cysts in multiple abdominal organs imposes special challenges for laparoscopic management. The patient position and port placement for one organ may not be adequate for other and proper exposure in hydatid cyst is of paramount importance to prevent spillage and complete removal of the cyst. Single incision multi-trocar technique has a unique advantage of allowing surgeon to work in different quadrants of abdomen using the same incision and ports. We report in this paper the first Laparo-endoscopic single-site hepatic cyst excision with partial splenectomy for hydatid cyst in liver and spleen using conventional laparoscopic instruments. Patient and Technique: The procedure was performed on a 64 year old female diagnosed to have Hydatid cyst in segment VIII of liver and another cyst in lower pole of spleen a transverse 3 cm incision was made 6 cm above umbilicus and was deepened up to fascia. Two 10mm and one 5mm ports were inserted. Procedure was completed in 160 minutes without any intra-operative complication. There were no post-operative complication and patient was discharged on day 5. Conclusion: Single incision multi-trocar surgery has cosmetic advantage over standard laparoscopic approach. It is even more marked when two procedures are combined in different quadrants of abdomen. As this is a rare combination procedure so it remains to be determined if this technique offers additional advantages of decreased analgesia, decreased hospital stay or cost effectiveness.

  4. Single incision multi-trocar hepatic cyst excision with partial splenectomy (United States)

    Chinnusamy, Palanivelu; Ahluwalia, Jasmeet Singh; Palanisamy, Senthilnathan; Seshiyer, Rajan Pidigu


    INTRODUCTION: Surgery has the potential to remove the entire hydatid cyst and can lead to complete cure. Presence of hydatid cysts in multiple abdominal organs imposes special challenges for laparoscopic management. The patient position and port placement for one organ may not be adequate for other and proper exposure in hydatid cyst is of paramount importance to prevent spillage and complete removal of the cyst. Single incision multi-trocar technique has a unique advantage of allowing surgeon to work in different quadrants of abdomen using the same incision and ports. We report in this paper the first Laparo-endoscopic single-site hepatic cyst excision with partial splenectomy for hydatid cyst in liver and spleen using conventional laparoscopic instruments. PATIENT AND TECHNIQUE: The procedure was performed on a 64 year old female diagnosed to have Hydatid cyst in segment VIII of liver and another cyst in lower pole of spleen a transverse 3 cm incision was made 6 cm above umbilicus and was deepened up to fascia. Two 10mm and one 5mm ports were inserted. Procedure was completed in 160 minutes without any intra-operative complication. There were no post-operative complication and patient was discharged on day 5. CONCLUSION: Single incision multi-trocar surgery has cosmetic advantage over standard laparoscopic approach. It is even more marked when two procedures are combined in different quadrants of abdomen. As this is a rare combination procedure so it remains to be determined if this technique offers additional advantages of decreased analgesia, decreased hospital stay or cost effectiveness. PMID:23741118

  5. A gross anatomic study of distal tibia and fibula for single-incision approach


    Ma, Hui; Zhao, Jie; Yu, Baoqing; Ye, Bin


    Objective This study aimed to investigate the feasibility of single incision for plating for the treatment of distal tibia and fibula fractures by a gross anatomic study. Methods The anatomical structures of the anterolateral lower legs were identified. The lower leg length was measured from the top of fibular head to the tip of lateral malleolus. The distances between the extensor digitorum longus and anterior border of distal thirds of the tibia as well as the fibula were also measured. Add...

  6. Single Incision Distal Biceps Repair With Hemi-Krackow Suture Technique: Surgical Technique and Early Outcomes


    Goljan, Peter; Patel, Nimit; Stull, Justin D.; Donnelly, Brandon P.; Culp, Randall W.


    Background: Many surgical methods exist for distal biceps repair. We present the technique and early outcomes of a series of distal biceps repairs completed with a novel suturing technique utilizing a hemi-Krackow locking stitch at the tendon-bone interface. Methods: A retrospective review was performed of patients who underwent primary distal biceps repair using a single anterior incision with 2 suture anchors utilizing a hemi-Krackow stitch. With both anchors, a locking stitch along the ten...

  7. Comparison of three suture techniques in closure of caprine skin incision: cosmetic and cost considerations


    Adamu Abdul Abubakar; John Bayo Adeyanju; Raphael O. Chukudi Kene; Mohammad Legbo Sonfada; Abubakar Sadiq Yakubu; Umaru Adamu


    The cosmetic and economic evaluations of three suture techniques were evaluated in closure of caprine skin incision. Fifteen apparently healthy male and female intact goats, free of any dermatological lesions were used for the investigation. They were randomly grouped into three; A (Subcuticular); B (Ford interlocking) and C (Simple interrupted). Cosmetic appearance of the surgical site was assessed on day 7, 14 and 21 post surgery using standard procedure as described by Sakka et al, 1995...

  8. New constraints on the late Cenozoic incision history of the New River, Virginia


    Ward, Dylan J.


    The New River crosses the core of the ancient, tectonically quiescent Appalachian orogen as it follows its course through North Carolina, Virginia, and West Virginia. It is ideally situated to record the changes in geomorphic process rates that occur in the Appalachians as a response to late Cenozoic climate variations. Active erosion features on resistant bedrock that floors the river at prominent knickpoints demonstrate that the river is currently incising toward base level. However, large ...

  9. Single-Incision Laparoscopic Splenectomy and Splenic Autotransplantation for an Enlarged Wandering Spleen with Torsion


    Katsura, Shunsaku; Kawamura, Daichi; Harada, Eijiro; Enoki, Tadahiko; Hamano, Kimikazu


    A wandering spleen is a rare condition in which the spleen is not located in the left upper quadrant, but instead is found in the lower abdomen or in the pelvic region because of the laxity of the peritoneal attachments. The unusually long pedicle is susceptible to twisting, which can lead to ischemia, and eventually to necrosis. We herein report a case of an enlarged wandering spleen with torsion, successfully treated by single-incision laparoscopic splenectomy and autotransplantation. The t...

  10. Preputial reconstruction and tubularized incised plate urethroplasty in proximal hypospadias with ventral penile curvature


    Bhat, Amilal; Gandhi, Ajay; Saxena, Gajendra; Choudhary, Gautam Ram


    Aims : Objective of this study was to assess the feasibility and results of preputial reconstruction and tubularized incised plate urethroplasty (TIP) in patients of proximal hypospadias with ventral penile curvature. Materials and Methods : Twenty-seven patients of proximal hypospadias who underwent preputioplasty with TIP were evaluated retrospectively. Ventral curvature was corrected by mobilization of the urethral plate with the corpus spongiosum and the proximal urethra; dorsal plica...

  11. Early response of local steroid injection versus mini incision technique in treatment of carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Awan, A.S.; Khan, A.; Afridi, S.A.; Khan, R.S.


    Carpal tunnel syndrome Carpal tunnel syndrome (CTS) is one of the commonest peripheral neuropathies which effects mainly middle aged women. Different techniques are being tried to decrease the post-operative pain in patients operated for CTS. The objective of this study was to compare effectiveness of local injection of steroid and mini incision technique in the treatment of carpal tunnel syndrome. Methods: This randomized control trial was conducted at department of Orthopedics and department of Neurosurgery, Ayub Teaching Hospital, Abbottabad from Aug 2011 to Feb 2013. A total of 116 patients of CTS were randomly allocated to either of the two groups. Fifty-eight Patient in Group A were subjected to local steroid injection and the same number of patient in Group B underwent mini incision technique. All patients of were advised to report to the OPD after one month to determine intervention effectiveness in terms of improvement in at least one grade of pain. Results: In this study mean age of the patients was 32.8 ± 5.1 years. Female gender was in dominance with 99 (86.3%) cases. In this study we compared the effectiveness of local steroid injection and mini incision technique in the treatment of carpel tunnel syndrome. We found out that the steroid injection was effective in 69.0% cases while mini incision technique was effective in 56.9% cases. The difference being statistically insignificant with a p-value of 0.17. Conclusion: The difference in pain after 1 month of the intervention was not statistically significant. (author)

  12. The 'French Fry' VAC technique: hybridisation of traditional open wound NPWT with closed incision NPWT. (United States)

    Chopra, Karan; Tadisina, Kashyap K; Singh, Devinder P


    Surgical site occurrences (SSO), specifically surgical site infections represent a significant burden in the US health care system. It has been hypothesised that postoperative dressing can help drive down SSO. We describe the successful use of a novel technique combining both closed incision and open negative pressure wound therapy in the management of a high-risk wound associated with lymphoedema of obesity. © 2014 The Authors. International Wound Journal © 2014 Inc and John Wiley & Sons Ltd.

  13. Influence of Channel Morphology on Flow Hydraulics in a Compound Meander Bend of the Lower Brazos River, Texas (United States)

    Hales, B. U.; Guneralp, I.; Filippi, A. M.


    At a meander-bend scale, process-form interactions between channel morphology and flow hydraulics generate unique features called geomorphic units, such as pools, sediment bars, and backwater regions. Geomorphic units play an important role as distinct habitats for aquatic species. In this study, we investigate channel morphology and flow structure of an incised meander bend on the lower Brazos River, Texas, to inform aquatic habitat assessment. The bend represents the characteristics of sand-bed and high-amplitude meandering rivers and contains a localized bank-protection structure along its cutbank. We examine: 1) the spatial characteristics of channel morphology (i.e., geomorphic units); 2) spatial characteristics of flow hydraulics in relation to geomorphic units at low- (Q1), medium- (Q2), and high- (Q3) discharge conditions; and 3) the influence of channel morphology on flow hydraulics within this meander bend. We utilize bathymetric and hydraulic surveys conducted using Acoustic Doppler Current Profiler (ADCP) and simultaneously collected bed-sediment samples. To characterize channel morphology, we use a digital terrain model (DTM) of the bend that we generate by fusing our bathymetric data and an airborne interferometric synthetic aperture radar (InSAR)-derived DTM. We examine flow hydraulics by performing quasi 3-D hydraulic modeling. Results show that channel morphology has a strong influence on the spatial distribution of hydraulic parameters, including water depth, flow velocities, Froude number, and helix strength. At Q1, the emergent mid-channel bar forces flow divergence/convergence and acts as a macro-roughness structure. High flow velocity concentrates in the deeper and narrower sub-channel along the cutbank side. At Q2, the location of the mid-channel bar shifts toward the point bar, forming a new chute sub-channel. Highest flow velocities are still concentrated in the permanent sub-channel along the cutbank, but shift downstream toward the exit

  14. Endoscope-assisted intraoral removal of ectopic thyroid tissue using a frenotomy incision. (United States)

    Woo, Seung Hoon; Jeong, Han-Sin; Kim, Jin Pyeong; Park, Jung Je; Baek, Chung-Hwan


    Ectopic thyroid tissue is a relatively rare condition and a developmental anomaly characterized by the aggregation of thyroid tissue. Usually, it occurs along the path of descent of the developing thyroid primordium from the foramen caecum, the most common being in the anterior midline of the neck at or below the level of the hyoid bone. Surgical removal of ectopic thyroid tissue is usually accomplished through an external incision in the neck. However, this procedure inevitably results in a neck scar. We report the case of a 30-year-old woman with ectopic thyroid tissue. We implemented a modified approach to ectopic thyroid tissue removal through a frenotomy incision of the mouth using an endoscope system. A modified approach to ectopic thyroid tissue removal was used in this patient. The total operative time was 50 minutes, and the patient remains free of disease 15 months after excision. Resection of ectopic thyroid tissue can be performed by a transoral endoscope-assisted approach through a frenotomy incision of the mouth.

  15. Comparison of laparoscopic and mini incision open donor nephrectomy: single blind, randomised controlled clinical trial. (United States)

    Kok, Niels F M; Lind, May Y; Hansson, Birgitta M E; Pilzecker, Desiree; Mertens zur Borg, Ingrid R A M; Knipscheer, Ben C; Hazebroek, Eric J; Dooper, Ine M; Weimar, Willem; Hop, Wim C J; Adang, Eddy M M; van der Wilt, Gert Jan; Bonjer, Hendrik J; van der Vliet, Jordanus A; IJzermans, Jan N M


    To determine the best approach for live donor nephrectomy to minimise discomfort to the donor and to provide good graft function. Single blind, randomised controlled trial. Two university medical centres, the Netherlands. 100 living kidney donors. Participants were randomly assigned to either laparoscopic donor nephrectomy or to mini incision muscle splitting open donor nephrectomy. The primary outcome was physical fatigue using the multidimensional fatigue inventory 20 (MFI-20). Secondary outcomes were physical function using the SF-36, hospital stay after surgery, pain, operating times, recipient graft function, and graft survival. Conversions did not occur. Compared with mini incision open donor nephrectomy, laparoscopic donor nephrectomy resulted in longer skin to skin time (median 221 v 164 minutes, P fatigue was less (difference - 1.3, 95% confidence interval - 2.4 to - 0.1) and physical function was better (difference 6.2, 2.0 to 10.3) after laparoscopic nephrectomy. Function of the graft and graft survival rate of the recipient at one year censored for death did not differ (100% after laparoscopic nephrectomy and 98% after open nephrectomy). Laparoscopic donor nephrectomy results in a better quality of life compared with mini incision open donor nephrectomy but equal safety and graft function.

  16. [Treatment of chalazion with incision and curettage in African patients of the negroid race]. (United States)

    Kaimbo W A Kaimbo, D; Nkidiaka, M C


    To evaluate the efficacy of incision and curettage in the treatment of chalazion in black African patients. In a prospective study performed between February 1999 and February 2000, 25 black African patients with chalazion (27 eyes, 30 chalazions), ranging in age from 15 to 51 years (mean age +/-SD, 25.2 years +/-7), were treated with incision and curettage. Measurements of eyebrow height, pretarsal skin height, crease height, inferior eyelid height and the palpebral fissure height were performed before and after treatment. Success was defined as a total disappearance or a decrease in size (less than one millimeter). Success was achieved in all of 25 patients. Recurrence occurred in 3.0% after 5 to 6 weeks. During a mean +/-SD of 4.7 months +/-2.9 of follow-up, fistula (3.0%) was noted as postincision ocular complication. After treatment, a significant decrease of pretarsal skin (P = 0.018) and inferior eyelid height (P=0.004) measurements and an increase in palpebral fissure height measurement (P = 0.025) were noted. Incision and curettage in chalazion treatment appears to be effective in managing chalazion in black African patients as reported in previous studies in Caucasian patients.

  17. A Modified Single Mini-Incision Complete Urinary Tract Exenteration for Urothelial Carcinoma in Dialysis Patients

    Directory of Open Access Journals (Sweden)

    I-Hsuan Chen


    Full Text Available Objective. To present our experience with single mini-incision complete urinary tract exenteration (CUTE for female dialysis patients suffering from urothelial carcinoma (UC. Patients and Methods. Institutional review board approval was obtained. From 2005 through 2012, 14 female dialysis patients with UC underwent single mini-incision CUTE, in combination with radical hysterectomy and bilateral salpingo-oophorectomy. All were placed in the modified dorsal lithotomy position without repositioning. An infraumbilical midline mini-incision was made. Bilateral nephroureterectomy was first performed entirely extraperitoneally, followed by radical cystectomy with removal of the uterus and ovaries transperitoneally. Results. All procedures were done successfully without major complications. The median operative time was 242.5 minutes, and estimated blood loss was 500 mL. The median time to oral intake was 2 postoperative days; the median hospital stay was 11 days. Ten patients remained cancer-free at a median follow-up of 46.5 months; six patients were confirmed as having preoperatively undetectable UC or renal cell carcinoma, even after reviewing preoperative computed tomography. Conclusions. This modified technique provides a time-saving complete urinary tract extirpation to eliminate preoperatively undetectable malignancy, reduce metachronous recurrences, and avert perioperative complications associated with pneumoperitoneum and repositioning. Good cancer control and early convalescence can mutually be achieved in experienced hands.

  18. Characteristics of Bone Injuries Resulting from Knife Wounds Incised with Different Forces. (United States)

    Humphrey, Caitlin; Kumaratilake, Jaliya; Henneberg, Maciej


    The aim of this research was to experimentally determine the characteristics of incised bone wounds, which are commonly found in defense injuries. A specially constructed pivoting arm device was used to inflict wounds with controlled forces and direction. Five knives were selected to inflict the wounds on porcine forelimbs. Eight incised wounds were made per knife per force. A larger knife and a greater force caused longer and wider bone wounds. Comparisons of individual knives at the two forces produced varying results in the bone wounds. A correlation was seen between the force and the length (r = 0.69), width (r = 0.63), and depth (r = 0.57) of bone wounds. Serrated-edge and nonserrated knives can be distinguished from the appearance of the wound. The outcomes may be applicable in forensic investigations to ascertain the forces associated with incised wounds and identify the specific knife used. © 2017 American Academy of Forensic Sciences.

  19. Appendectomy and pregnancy: gestational age does not affect the position of the incision. (United States)

    de Moya, Marc A; Sideris, Antonios C; Choy, Garry; Chang, Yuchiao; Landman, Wendy B; Cropano, Catrina M; Cohn, Stephen M


    The position of the base of the appendix during advancing gestational age is based on inadequate data. Therefore, the proper location for an appendectomy incision during pregnancy is highly unclear. This study investigated the location of the appendix during pregnancy to determine the optimal location for an incision in pregnant patients with appendicitis relative to McBurney's point. Magnetic resonance images (MRIs) were reviewed independently by two fellowship-trained abdominal MRI radiologists blinded to the imaging report. The distance of the appendix from anatomic landmarks was measured in a total of 114 pregnant women with an abdominal or pelvic MRI who were admitted between 2001 and 2011 at a Level I trauma center. Patients with a history of appendectomy were excluded. The distance from the base of the appendix to McBurney's point changed over the course of the gestation by only 1.2 cm and which did not amount to a clinically or statistically significant change in position. Our data provide evidence that there is minimal upward or lateral displacement of the appendix during pregnancy, and therefore its distance from the McBurney's point remains essentially unchanged. These findings justify the use of the McBurney's incision for appendectomy during pregnancy regardless of the trimester.

  20. Gas Hydrate Formation Amid Submarine Canyon Incision: Investigations From New Zealand's Hikurangi Subduction Margin (United States)

    Crutchley, G. J.; Kroeger, K. F.; Pecher, I. A.; Mountjoy, J. J.; Gorman, A. R.


    We investigate gas hydrate system dynamics beneath a submarine canyon on New Zealand's Hikurangi subduction margin using seismic reflection data and petroleum systems modeling. High seismic velocities just above the base of gas hydrate stability (BGHS) indicate that concentrated gas hydrates exist beneath the canyon. Two-dimensional gas hydrate formation modeling shows how the process of canyon incision at this location alters the distribution and concentration of gas hydrate. The key modeling result is that free gas is trapped beneath the gas hydrate layer and then "captured" into a concentrated gas hydrate deposit as a result of a downward-shift in the BGHS driven by canyon incision. Our study thus provides new insight into the functioning of this process. From our data, we also conceptualize two other models to describe how canyons could significantly change gas hydrate distribution and concentration. One scenario is related to deflection of fluid flow pathways from over-pressured regions at the BGHS toward the canyon, and the other is based on relationships between simultaneous seafloor uplift and canyon incision. The relationships and processes described are of global relevance because of considerations of gas hydrate as an energy resource and the influence of both submarine canyons and gas hydrate systems on seafloor biodiversity.

  1. The longitudinal epineural incision and complete nerve transection method for modeling sciatic nerve injury

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    Xing-long Cheng


    Full Text Available Injury severity, operative technique and nerve regeneration are important factors to consider when constructing a model of peripheral nerve injury. Here, we present a novel peripheral nerve injury model and compare it with the complete sciatic nerve transection method. In the experimental group, under a microscope, a 3-mm longitudinal incision was made in the epineurium of the sciatic nerve to reveal the nerve fibers, which were then transected. The small, longitudinal incision in the epineurium was then sutured closed, requiring no stump anastomosis. In the control group, the sciatic nerve was completely transected, and the epineurium was repaired by anastomosis. At 2 and 4 weeks after surgery, Wallerian degeneration was observed in both groups. In the experimental group, at 8 and 12 weeks after surgery, distinct medullary nerve fibers and axons were observed in the injured sciatic nerve. Regular, dense myelin sheaths were visible, as well as some scarring. By 12 weeks, the myelin sheaths were normal and intact, and a tight lamellar structure was observed. Functionally, limb movement and nerve conduction recovered in the injured region between 4 and 12 weeks. The present results demonstrate that longitudinal epineural incision with nerve transection can stably replicate a model of Sunderland grade IV peripheral nerve injury. Compared with the complete sciatic nerve transection model, our method reduced the difficulties of micromanipulation and surgery time, and resulted in good stump restoration, nerve regeneration, and functional recovery.

  2. Distinction of infected and non-infected post-surgical incisions with In-111-WBC scintigraphy

    International Nuclear Information System (INIS)

    Abdel-Nabi, H.; Hinkle, G.H.; Olsen, J.O.


    To determine if In-111-WBCs scintigraphy can distinguish between healing and infection in post-surgical wounds, a prospective study was performed in patients with 3-14 day old surgical incisions. Eighteen patients (11 males and 7 females) were scanned 24 hrs after injection of 0.5 mCi of In-111 labeled autologous leukocytes. The scan findings were correlated with blood and/wound cultures results and diagnosis at time of discharge. Incisional uptake of In-111-WBCs was noted in 9 patients with infected surgical wounds and was absent in those 9 patients with non-infected surgical wounds. The results of the authors' study show that In-111-WBCs do not accumulate in non-infected surgical incisions. This confirms their previous findings in rats. The high specificity of In-111 leukocytes imaging makes it a valuable study in the evaluation of post-operative patients with suspected surgical wound infections. In-111 WBCs scintigraphy can distinguish between normal healing and infection at the site of recent (3-14 days) surgical incisions

  3. Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus. (United States)

    Palanivelu, Praveenraj; Patil, Kedar Pratap; Parthasarathi, Ramakrishnan; Viswambharan, Jaiganesh K; Senthilnathan, Palanisami; Palanivelu, Chinnusamy


    The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them. A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11) and with corrugated drain (2.09) needlescopic method (1.2), Umbilical tape sling (1.95), crural stitch method (2.5). Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality. The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

  4. [Laparoscopic cholecystectomy with three-port and 25 millimeters long incision. (United States)

    Gómez Tagle-Morales, Enrique David


    Background: three-port and 25 mm total incision laparoscopic cholecystectomy has shown benefits compared to conventional laparoscopy. The aim was to examine the safety and feasibility of this technique. Methods: a three-port laparoscopic cholecystectomy trial was conducted through Cinvestav metasearcher, Seriunam and Rencis. The eligibility criteria were: three port laparoscopic cholecystectomy, 25 mm total incision, and score = 17 on Data Review System. Trials which employed instruments smaller than 5 mm in diameter were excluded. The comparative variables were documented and results obtained in the selected trials were described. Results: four trials were selected, comprising 1767 cases (1329 females and 438 males), average age was 44.3 years. Chronic cholecystitis was documented in 84.3 %, and acute cholecystitis in 14.7 %. Average surgical time was 54.5 minutes. An additional port was required in 4.8 % and 1.4 % was converted to open technique. Bile duct injury was presented in 0.11 %. The success rate was 94.9 %. Conclusions: three port and 25 mm total incision in laparoscopic cholecystectomy is safe and feasible.

  5. Single-incision laparoscopic partial gastrectomy for gastric submucosal tumors without compromising transumbilical stapling. (United States)

    Takata, Akihiro; Nakajima, Kiyokazu; Kurokawa, Yukinori; Takahashi, Tsuyoshi; Yamasaki, Makoto; Miyata, Hiroshi; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro


    Although SILS has become an increasingly popular type of surgery, its application for gastric submucosal tumors (SMT) has been only sporadically reported. We herein describe 12 recent cases with gastric SMT located in the greater curvature or anterior wall. The aim is to validate technical feasibility and safety of single-incision laparoscopic partial gastrectomy. Thus far, this is one of the largest series of patients with gastric SMT who underwent SILS. From July 2009 to April 2013, single-incision laparoscopic partial gastrectomy was attempted in 12 consecutive patients with gastric SMT. Three trocars were assembled in the umbilical incision, and the lesion was mobilized and staple-resected with endoscopic stapling devices. SILS surgery was successfully completed without any additional trocars. The median operating time was 96.5 min, and median blood loss was 7.5 mL. The median tumor size was 30 mm, with histopathologic diagnosis of gastrointestinal stromal tumor (10) and schwannoma (2). There was no immediate postoperative morbidity. During a median follow-up of 12 months, all patients were on full regular diet without any gastrointestinal symptoms. SILS with transumbilical gastric stapling is a safe and practical alternative to conventional multiport laparoscopy in patients with gastric SMT, except for cases originating in the lesser curvature and close to the cardia/ pylorus. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  6. A novel locally operated master-slave robot system for single-incision laparoscopic surgery. (United States)

    Horise, Yuki; Matsumoto, Toshinobu; Ikeda, Hiroki; Nakamura, Yuta; Yamasaki, Makoto; Sawada, Genta; Tsukao, Yukiko; Nakahara, Yujiro; Yamamoto, Masaaki; Takiguchi, Shuji; Doki, Yuichiro; Mori, Masaki; Miyazaki, Fumio; Sekimoto, Mitsugu; Kawai, Toshikazu; Nishikawa, Atsushi


    Single-incision laparoscopic surgery (SILS) provides more cosmetic benefits than conventional laparoscopic surgery but presents operational difficulties. To overcome this technical problem, we have developed a locally operated master-slave robot system that provides operability and a visual field similar to conventional laparoscopic surgery. A surgeon grasps the master device with the left hand, which is placed above the abdominal wall, and holds a normal instrument with the right hand. A laparoscope, a slave robot, and the right-sided instrument are inserted through one incision. The slave robot is bent in the body cavity and its length, pose, and tip angle are changed by manipulating the master device; thus the surgeon has almost the same operability as with normal laparoscopic surgery. To evaluate our proposed system, we conducted a basic task and an ex vivo experiment. In basic task experiments, the average object-passing task time was 9.50 sec (SILS cross), 22.25 sec (SILS parallel), and 7.23 sec (proposed SILS). The average number of instrument collisions was 3.67 (SILS cross), 14 (SILS parallel), and 0.33 (proposed SILS). In the ex vivo experiment, we confirmed the applicability of our system for single-port laparoscopic cholecystectomy. We demonstrated that our proposed robot system is useful for single-incision laparoscopic surgery.

  7. Transtibial technique versus two incisions in anterior cruciate ligament reconstruction: tunnel positioning, isometricity and functional evaluation

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    Ricardo Hideki Yanasse


    Full Text Available ABSTRACT OBJECTIVE: To compare the transtibial and two-incision techniques for anterior cruciate ligament (ACL reconstruction using a single band. METHODS: A prospective and randomized study was conducted in blocks. Patients underwent ACL reconstruction by means of two techniques: transtibial (group 1: 20 patients or two incisions (group 2: 20 patients. The radiographic positioning of the tunnel, inclination of the graft, graft isometricity and functional results (IKDC and Lysholm were evaluated. RESULTS: The positioning of the femoral tunnel on the anteroposterior radiograph, expressed as a mean percentage relative to the medial border of the tibial plateau, was 54.6% in group 1 and 60.8% in group 2 (p 0.05. Group 2 had better results from the pivot-shift maneuver (p < 0.05. CONCLUSION: The technique of two incisions allowed positioning of the femoral tunnel that was more lateralized and anteriorized, such that the graft was more inclined and there was a clinically better result from the pivot-shift maneuver. There was no difference in isometricity and no final functional result over the short follow-up time evaluated.

  8. Prophylactic plastic surgery closure of neurosurgical scalp incisions reduces the incidence of wound complications in previously-operated patients treated with bevacizumab (Avastin®) and radiation. (United States)

    Golas, Alyssa Reiffel; Boyko, Tatiana; Schwartz, Theodore H; Stieg, Philip E; Boockvar, John A; Spector, Jason A


    Neurosurgical craniotomy, craniectomy, or other trans-galeal interventions are performed for a variety of indications, including the resection of benign or malignant tumors, hematoma evacuation, and for the management of intractable seizure disorders. Despite an overall low complication rate of intervention, wound healing complications such as dehiscence, surgical site infection, and cerebrospinal fluid leak are not uncommon. A retrospective review was performed of all patients who underwent scalp incision closure at a single institution by a single plastic surgeon between 2006 and 2013. Sixty patients (83 procedures) were included in the study. Fifty-seven patients (95.0 %) underwent previous craniotomy, craniectomy, or other trans-galeal procedure. Of the total 60 patients, 35 patients received preoperative radiation. Sixteen patients received bevacizumab prior to their index case, while 12 received bevacizumab postoperatively. Ten patients (16.7 %) required additional plastic surgical intervention for wound complications after their index plastic surgery procedure. Plastic surgery was consulted prophylactically in 34 patients (38 procedures). When plastic surgery was consulted prophylactically, 4 patients (11.8 %) required further wound revision. None of the 14 patients who underwent prophylactic plastic surgery closure for previous scalp incision, preoperative bevacizumab, and XRT administration required re-intervention. Plastic surgery closure of complex scalp incisions reduces the incidence of wound complications among patients who underwent previous neurosurgical intervention, XRT administration, and preoperative bevacizumab administration. This is particularly true when plastic surgery closure is performed "prophylactically." Further collaboration between the neurosurgical and plastic surgery teams is therefore warranted, particularly in the setting of these high-risk cases.

  9. VKCDB: Voltage-gated potassium channel database

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    Gallin Warren J


    Full Text Available Abstract Background The family of voltage-gated potassium channels comprises a functionally diverse group of membrane proteins. They help maintain and regulate the potassium ion-based component of the membrane potential and are thus central to many critical physiological processes. VKCDB (Voltage-gated potassium [K] Channel DataBase is a database of structural and functional data on these channels. It is designed as a resource for research on the molecular basis of voltage-gated potassium channel function. Description Voltage-gated potassium channel sequences were identified by using BLASTP to search GENBANK and SWISSPROT. Annotations for all voltage-gated potassium channels were selectively parsed and integrated into VKCDB. Electrophysiological and pharmacological data for the channels were collected from published journal articles. Transmembrane domain predictions by TMHMM and PHD are included for each VKCDB entry. Multiple sequence alignments of conserved domains of channels of the four Kv families and the KCNQ family are also included. Currently VKCDB contains 346 channel entries. It can be browsed and searched using a set of functionally relevant categories. Protein sequences can also be searched using a local BLAST engine. Conclusions VKCDB is a resource for comparative studies of voltage-gated potassium channels. The methods used to construct VKCDB are general; they can be used to create specialized databases for other protein families. VKCDB is accessible at

  10. Hadamard quantum broadcast channels (United States)

    Wang, Qingle; Das, Siddhartha; Wilde, Mark M.


    We consider three different communication tasks for quantum broadcast channels, and we determine the capacity region of a Hadamard broadcast channel for these various tasks. We define a Hadamard broadcast channel to be such that the channel from the sender to one of the receivers is entanglement-breaking and the channel from the sender to the other receiver is complementary to this one. As such, this channel is a quantum generalization of a degraded broadcast channel, which is well known in classical information theory. The first communication task we consider is classical communication to both receivers, the second is quantum communication to the stronger receiver and classical communication to other, and the third is entanglement-assisted classical communication to the stronger receiver and unassisted classical communication to the other. The structure of a Hadamard broadcast channel plays a critical role in our analysis: The channel to the weaker receiver can be simulated by performing a measurement channel on the stronger receiver's system, followed by a preparation channel. As such, we can incorporate the classical output of the measurement channel as an auxiliary variable and solve all three of the above capacities for Hadamard broadcast channels, in this way avoiding known difficulties associated with quantum auxiliary variables.

  11. Single-Incision Versus Three-Port Laparoscopic Appendectomy: Short- and Long-Term Outcomes. (United States)

    Vellei, Samatha; Borri, Alessandro


    To compare the outcome of patients who had undergone single-incision laparoscopic appendectomy (SILA) with others who had undergone three-port laparoscopic appendectomy (3-PORT). Data from all adults with uncomplicated appendicitis treated by laparoscopic appendectomy between June 2012 and December 2015 were prospectively collected. Patients with chronic pain, appendix malignancy, at least two previous laparotomies, and those undergoing concomitant surgery for different condition were excluded from analysis. Postoperative pain was assessed by a visual analog scale (VAS). Patients were reviewed postoperatively at 7 days and 1 month in the outpatient clinic. Late complications were assessed with a telephonic interview. A total of 91 patients were included (46 SILA; 45 3-PORT). There were 16 males and 30 females in the SILA group (mean age = 26.76 ± 10.58 years) and 18 males and 27 females in the 3-PORT group (mean age = 26.84 ± 10.79 years). The mean operative time for SILA was 48.54 ± 12.80 min, for the 3-PORT group the mean operative time was 46.33 ± 15.54 min (P = 0.46). No case required conversion. Mean postoperative hospital length of stay was 1.87 ± 0.69 days for SILA and 2.38 ± 1.11 days for 3-PORT (P = 0.01). VAS value of 3.91 ± 1.96 and mean ketorolac usage of 0.38 ± 0.65 in 3-PORT group and SILA patients reported 3.70 ± 1.58 and 0.39 ± 0.58, respectively (P = 0.91). Our mean follow-up in SILA group was 25.75 ± 10.82 months, for 3-PORT group the mean follow-up was 26.9 ± 11.8 months. Eleven patients missed long-term follow-up. No incisional hernia was found. There is a statistically significant difference in cosmetic evaluation in favor of SILA (P PORT laparoscopic appendectomy, but after SILA procedure discharge was quicker and long-term cosmetic satisfaction was superior.

  12. Control of port-site bleeding from smaller incisions after laparoscopic cholecystectomy surgery: a new, innovative, and easier technique. (United States)

    Rastogi, Vijay; Dy, Victor


    Laparoscopic cholecystectomy has become the standard of care for patients with acute cholecystitis, symptomatic cholelithiasis, and biliary dyskinesia. Most surgeons now perform this procedure as outpatient surgery. In a standard laparoscopic cholecystectomy procedure, three trocar incisions are made outside the umbilicus. Stopping the bleeding from these port sites can be problematic because of the small size of the incision and the fact that these bleeding points are situated deep in the incision. This is especially true in obese patients and patients taking Asprin or Plavix and undergoing emergency cholecystectomy. In these circumstances, control of the bleeding requires either enlargement of the incision or placement of deep sutures, leading to an ugly scar. We present a simple and innovative technique for controlling port-site bleeding, which involves plugging the port-site hole with Surgicel (Johnson & Johnson Medical, Inc., Arlington, Texas). Our experience with 20 patients to date has shown wound healing to be excellent, with no complications such as hematoma or infection.

  13. Investigation of postoperative intraocular pressure in cases of silicone oil removal using 25-gauge transconjunctival sutureless vitrectomy with oblique incisions. (United States)

    Takashina, Hirotsugu; Watanabe, Akira; Tsuneoka, Hiroshi


    The purpose of this study was to investigate postoperative intraocular pressure (IOP) in cases of silicone oil (SO) removal when using 25-gauge transconjunctival sutureless vitrectomy (TSV) with oblique incisions. We enrolled ten consecutive eyes with SO removal (SO group) and eleven consecutive eyes with idiopathic epiretinal membrane (ERM) as the initial vitrectomy (ERM group) in cases using 25-gauge TSV with oblique incisions. Postoperative IOPs were compared between the two groups at each of the four examination periods. No significant differences were identified in any of the periods examined. The use of 25-gauge TSV with oblique incisions resulted in almost equivalent postoperative IOPs between cases with SO removal and idiopathic ERM as the initial operation. Self-sealing sclerotomy in 25-gauge TSV with oblique incisions may primarily involve the valve architecture, and be complemented by vitreous incarceration.

  14. Surgical site wound infection in relation to antibiotic prophylaxis given before skin incision and after cord clamping during cesarean delivery. (United States)

    Shrestha, B; Marhatha, R; Giri, A; Jaisi, S; Maskey, U


    Surgical site infection is one of the most common complications following Lower Segment Cesarean Section, which accounts for prolonged hospital stay thereby increasing expense. Prophylactic antibiotics in cesarean section reduces surgical site infection significantly. The best protection is provided when tissue level of antibiotics are adequate before incision, without prejudice to neonatal infectious morbidity. The objective of this study was to compare the incidence of surgical site wound infection with prophylactic antibiotics given before skin incision and after cord clamping following delivery of baby. This was a prospective, hospital based study, in which hundred cases of cesarean deliveries who received antibiotics prophylaxis one hour before the skin incision were compared with another 100 cases where antibiotic was given after cord clamping following delivery of the baby. Surgical site infection occurred in 3% of women who received antibiotics prophylaxis before skin incision as compared to 6% in whom antibiotic was given after cord clamping. It was statistically not significant (p = 0.465).

  15. Pannexin-1 channels in epilepsy. (United States)

    Aquilino, Mark S; Whyte-Fagundes, Paige; Zoidl, Georg; Carlen, Peter L


    Pannexin-1 (Panx1) expression is raised in several animal seizure models and in resected human epileptic brain tissue, suggesting relevance to epilepsy. Multiple factors that are characteristic of seizures are thought to regulate Panx1 channel opening, including elevated levels of extracellular K + . Panx1, when open, 1) releases ATP, glutamate, and other metabolites into the extracellular medium, and 2) may depolarize the membrane due to a channel reversal potential around 0mV. Resultant ATP release from stimulated Panx1 can activate purinergic receptors, including P2X7 receptors. Glutamate and other signaling molecules released by Panx1 opening may have both excitatory and inhibitory actions on seizure generation. This review examines the critical and complex roles of Panx1 channels in epilepsy, which could provide a basis for future therapeutics. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Analysis of the action of lidocaine on insect sodium channels


    Song, Weizhong; Silver, Kristopher S.; Du, Yuzhe; Liu, Zhiqi; Dong, Ke


    A new class of sodium channel blocker insecticides (SCBIs), which include indoxacarb, its active metabolite, DCJW, and metaflumizone, preferably block inactivated states of both insect and mammalian sodium channels in a manner similar to that by which local anesthetic (LA) drugs block mammalian sodium channels. A recent study showed that two residues in the cockroach sodium channel, F1817 and Y1824, corresponding to two key LA-interacting residues identified in mammalian sodium channels are n...

  17. Cervical and incisal marginal discrepancy in ceramic laminate veneering materials: A SEM analysis

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    Hemalatha Ranganathan


    Full Text Available Context: Marginal discrepancy influenced by the choice of processing material used for the ceramic laminate veneers needs to be explored further for better clinical application. Aims: This study aimed to evaluate the amount of cervical and incisal marginal discrepancy associated with different ceramic laminate veneering materials. Settings and Design: This was an experimental, single-blinded, in vitro trial. Subjects and Methods: Ten central incisors were prepared for laminate veneers with 2 mm uniform reduction and heavy chamfer finish line. Ceramic laminate veneers fabricated over the prepared teeth using four different processing materials were categorized into four groups as Group I - aluminous porcelain veneers, Group II - lithium disilicate ceramic veneers, Group III - lithium disilicate-leucite-based veneers, Group IV - zirconia-based ceramic veneers. The cervical and incisal marginal discrepancy was measured using a scanning electron microscope. Statistical Analysis Used: ANOVA and post hoc Tukey honest significant difference (HSD tests were used for statistical analysis. Results: The cervical and incisal marginal discrepancy for four groups was Group I - 114.6 ± 4.3 μm, 132.5 ± 6.5 μm, Group II - 86.1 ± 6.3 μm, 105.4 ± 5.3 μm, Group III - 71.4 ± 4.4 μm, 91.3 ± 4.7 μm, and Group IV - 123.1 ± 4.1 μm, 142.0 ± 5.4 μm. ANOVA and post hoc Tukey HSD tests observed a statistically significant difference between the four test specimens with regard to cervical marginal discrepancy. The cervical and incisal marginal discrepancy scored F = 243.408, P < 0.001 and F = 180.844, P < 0.001, respectively. Conclusion: This study concluded veneers fabricated using leucite reinforced lithium disilicate exhibited the least marginal discrepancy followed by lithium disilicate ceramic, aluminous porcelain, and zirconia-based ceramics. The marginal discrepancy was more in the incisal region than in the cervical region in all the groups.

  18. Incision and Landsliding Lead to Coupled Increase in Sediment Flux and Grain Size Export (United States)

    Roda-Boluda, D. C.; Brooke, S.; D'Arcy, M. K.; Whittaker, A. C.; Armitage, J. J.


    The rates and grain sizes of sediment fluxes modulate the dynamics and timing of landscape response to tectonics, and dictate the depositional patterns of sediment in basins. Over the last decades, we have gained a good quantitative understanding on how sediment flux and grain size may affect incision and basin stratigraphy. However, we comparably still have limited knowledge on how these variables change with varying tectonic rates. To address this question, we have studied 152 catchments along 8 normal fault-bounded ranges in southern Italy, which are affected by varying fault slip rates and experiencing a transient response to tectonics. Using a data set of 38 new and published 10Be erosion rates, we calibrate a sediment flux predictive equation (BQART), in order to estimate catchment sediment fluxes. We demonstrate that long-term sediment flux is governed by fault slip rates and the tectonically-controlled transient incision, and that sediment flux estimates from the BQART, steady-state assumptions, and incised volumes are highly correlated. This is supported by our 10Be erosion rates, which are controlled by fault slip and incision rates, and the associated landsliding. Based on a new landslide inventory, we show that erosion rate differences are likely due to differences in incision-related landslide activity across these catchments, and that landslides are a major component of sediment fluxes. From a data set of >13000 grain size counts on hillslope grain size supply and fluvial sediment at catchment outlets, we observe that landslides deliver material 20-200% coarser than other sediment sources, and that this coarse supply has an impact on the grain size distributions being exported from the catchments. Combining our sediment flux and grain size data sets, we are able to show that for our catchments, and potentially also for any areas that respond to changes in climate or tectonics via enhanced landsliding, sediment flux and grain size export increase

  19. Prime incision: A minimally invasive approach to breast cancer surgical treatment-A 2 cohort retrospective comparison with conventional breast conserving surgery.

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    Silvio Eduardo Bromberg

    Full Text Available The prime incision technique is an oncoplastic surgery aimed to remove both the breast tumor and the sentinel lymph node through one incision, thus providing better aesthetic results than the conventional breast conservative two incision technique. We retrospectively evaluated 2 cohorts of 60 consecutive breast cancer patients operated by either conventional breast conservative surgery (N = 26 or one incision surgery (N = 34. There were no recurrence or death events observed in any group. No difference was seen regarding the incidence of surgical complications. In the prime incision group the breast volume removed was significantly lower than in the conventional surgery group as well as was the surgical time and the number of dissected lymph nodes. Aesthetical results were better in the one incision group. Further prospective studies are needed to validate the one incision technique as a surgical option for selected early stage breast cancer patients.

  20. Calcium Channel Blockers (United States)

    ... conditions, such as Raynaud's disease For people of African heritage and older people, calcium channel blockers might ... high-blood-pressure/in-depth/calcium-channel-blockers/ART-20047605 . Mayo Clinic Footer Legal Conditions and Terms ...

  1. A combination of subcuticular sutures and a drain for skin closure reduces wound complications in obese women undergoing surgery using vertical incisions. (United States)

    Inotsume-Kojima, Y; Uchida, T; Abe, M; Doi, T; Kanayama, N


    Obesity is a risk factor for surgical site or wound complications in women undergoing surgery involving vertical incisions. Several investigators have reported the efficacy of subcutaneous drains in minimising the complication rate but there is no consensus on using these for surgery in obese patients. In 2006, the Scottish Surveillance of Healthcare Associated Infection Programme showed that using subcuticular sutures rather than staples to close incisions significantly reduced the risk of surgical site infection. Before January 2008 (group 1; N = 40), wound complications occurred in some obese patients in our hospital after obstetric and gynaecological surgery when only staples were used for skin closure. In January 2008 (group 2; N = 31), we changed the method of skin closure for obese patients [body mass index (BMI) > 28 kg/m(2)] and we now use a subcutaneous drain with four channels along the running tube and subcuticular sutures with interrupted, buried 4-0 polydioxanone sutures. The aim of this study was to assess the effects of these interventions for skin closure in obese women. The general characteristics (age, weight and BMI) were similar between the two groups. There were no wound complications in group 2. In group 1, wound disruptions and a seroma occurred in five (12.5%) and one (2.5%) patients, respectively. The wound complication rate in group 2 was significantly lower than that in group 1 (P = 0.0319). Thus, new materials and techniques for skin closure can reduce the wound complication rate in obese women. Copyright © 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

  2. NALCN ion channels have alternative selectivity filters resembling calcium channels or sodium channels.

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    Adriano Senatore

    Full Text Available NALCN is a member of the family of ion channels with four homologous, repeat domains that include voltage-gated calcium and sodium channels. NALCN is a highly conserved gene from simple, extant multicellular organisms without nervous systems such as sponges and placozoans and mostly remains a single gene compared to the calcium and sodium channels which diversified into twenty genes in humans. The single NALCN gene has alternatively-spliced exons at exons 15 or exon 31 that splices in novel selectivity filter residues that resemble calcium channels (EEEE or sodium channels (EKEE or EEKE. NALCN channels with alternative calcium, (EEEE and sodium, (EKEE or EEKE -selective pores are conserved in simple bilaterally symmetrical animals like flatworms to non-chordate deuterostomes. The single NALCN gene is limited as a sodium channel with a lysine (K-containing pore in vertebrates, but originally NALCN was a calcium-like channel, and evolved to operate as both a calcium channel and sodium channel for different roles in many invertebrates. Expression patterns of NALCN-EKEE in pond snail, Lymnaea stagnalis suggest roles for NALCN in secretion, with an abundant expression in brain, and an up-regulation in secretory organs of sexually-mature adults such as albumen gland and prostate. NALCN-EEEE is equally abundant as NALCN-EKEE in snails, but is greater expressed in heart and other muscle tissue, and 50% less expressed in the brain than NALCN-EKEE. Transfected snail NALCN-EEEE and NALCN-EKEE channel isoforms express in HEK-293T cells. We were not able to distinguish potential NALCN currents from background, non-selective leak conductances in HEK293T cells. Native leak currents without expressing NALCN genes in HEK-293T cells are NMDG(+ impermeant and blockable with 10 µM Gd(3+ ions and are indistinguishable from the hallmark currents ascribed to mammalian NALCN currents expressed in vitro by Lu et al. in Cell. 2007 Apr 20;129(2:371-83.

  3. Dam Breach Release of Non-Cohesive Sediments: Channel Response and Recovery Rates (United States)

    Collins, M. J.; Boardman, G.; Banks, W.; Andrews, M.; Conlon, M.; Dillow, J. J. A.; Gellis, A.; Lowe, S.; McClain, S.; Miller, A. J.; Snyder, N. P.; Wilcock, P. R.


    Dam removals featuring unchecked releases of non-cohesive sediments are excellent opportunities to learn more about stream channel response to abrupt increases in bed material supply that can occur deliberately or by natural processes like landslides and volcanic eruptions. Understanding channel response to sediment pulses, including response rates, is essential because human uses of river channels and floodplains are impacted by these events as are aquatic habitats. We had the opportunity to study a dam removal site at the Simkins Dam in Maryland, USA, that shares many important geophysical attributes of another well-studied dam removal in the humid northeast United States [Merrimack Village Dam, New Hampshire; Pearson et al., 2011]. The watershed sizes are the same order of magnitude (102 km2), and at both sites relatively low head dams were removed (~ 3-4 m) and ~60,000 m3 of dominantly sand-sized sediments discharged to low-gradient reaches immediately downstream. Analyzing four years of repeat morphometry and bed sediment grain size surveys at the Simkins site on the Patapsco River, as well as continuous discharge and suspended sediment gaging data, we clearly document a two-phase response in the upstream reach as described by Pearson et al. [2011] for their New Hampshire site and noted at other dam removals [e.g., Major et al., 2012]. In the early phase, approximately 50% of the impounded sediment mass was eroded rapidly over a period of about three months when flows were very modest (Figure 1). After incision to base level and channel widening in the former impoundment, a second phase began when further erosion depended on floods large enough to access impounded sediments more distant from the newly-formed channel. We also found important differences in the upstream responses at the Maryland and New Hampshire sites that appear to be related to valley type (non-glaciated versus glaciated, respectively). Response variances immediately downstream between the

  4. Controls on sediment cover in bedrock-alluvial channels of the Henry Mountains, Utah (United States)

    Hodge, R. A.; Yager, E.; Johnson, J. P.; Tranmer, A.


    The location and extent of sediment cover in bedrock-alluvial channels influences sediment transport rates, channel incision and instream ecology. However, factors affecting sediment cover and how it responds to changes in relative sediment supply have rarely been quantitatively evaluated in field settings. Using field surveys and SFM analysis of channel reach topography, we quantified sediment cover and channel properties including slope, width, grain size distributions, and bedrock and alluvial roughness in North Wash and Chelada Creek in the Henry Mountains, Utah. Along reaches where upstream sediment supply does not appear to be restricted, we find that the fraction of local bedrock exposure increases as a function of local relative transport capacity . In a downstream section of Chelada Creek, decadal-scale sediment supply has been restricted by an upstream culvert that has caused a backwater effect and corresponding upstream deposition. In this section, alluvial cover is uncorrelated with local stream power. To test the impact of relative sediment supply on sediment cover, a 1D sediment transport model was used to predict the equilibrium sediment cover in Chelada Creek under varying flow and sediment supply conditions. Sediment transport in each model section was predicted using the partial cover model of Johnson (2015), which accounts for differences in bedrock and alluvial roughness on critical shear stress and flow resistance. Model runs in which sediment supply was approximately equal to mean transport capacity produced a pattern of sediment cover which best matched the field observations upstream of the culvert. However, runs where sediment supply was under-capacity produced the pattern most similar to field observations downstream of the culvert, consistent with our field-based interpretations. Model results were insensitive to initial sediment cover, and equilibrium was relatively quickly reached, suggesting that the channel is responsive to changes in

  5. KV7 potassium channels

    DEFF Research Database (Denmark)

    Stott, Jennifer B; Jepps, Thomas Andrew; Greenwood, Iain A


    Potassium channels are key regulators of smooth muscle tone, with increases in activity resulting in hyperpolarisation of the cell membrane, which acts to oppose vasoconstriction. Several potassium channels exist within smooth muscle, but the KV7 family of voltage-gated potassium channels have been...

  6. Quantum Channels With Memory

    International Nuclear Information System (INIS)

    Rybar, T.


    Quantum memory channels represent a very general, yet simple and comprehensible model for causal processes. As such they have attracted considerable research interest, mostly aimed on their transfer capabilities and structure properties. Most notably it was shown that memory channels can be implemented via physically naturally motivated collision models. We also define the concept of repeatable channels and show that only unital channels can be implemented repeat ably with pure memory channels. In the special case of qubit channels we also show that every unital qubit channel has a repeatable implementation. We also briefly explore the possibilities of stroboscopical simulation of channels and show that all random unitary channels can be stroboscopically simulated. Particularly in qubit case, all indivisible qubit channels are also random unitary, hence for qubit all indivisible channels can be stroboscopically simulated. Memory channels also naturally capture the framework of correlated experiments. We develop methods to gather and interpret data obtained in such setting and in detail examine the two qubit case. We also show that for control unitary interactions the measured data will never contradict a simple unitary evolution. Thus no memory effects can be spotted then. (author)

  7. Channel morphology [Chapter 5 (United States)

    Jonathan W. Long; Alvin L. Medina; Daniel G. Neary


    Channel morphology has become an increasingly important subject for analyzing the health of rivers and associated fish populations, particularly since the popularization of channel classification and assessment methods. Morphological data can help to evaluate the flows of sediment and water that influence aquatic and riparian habitat. Channel classification systems,...


    Lin, Junshan; Li, Dumiao; Zhang, Jianxing; Wu, Qiang; Xu, Yali; Lin, Li


    To investigate effectiveness of advanced skin flap and V-shaped ventral incision along the root of penile shaft for concealed penis in children. Between July 2007 and January 2015, 121 boys with concealed penis were treated with advanced skin flap and V-shaped ventral incision along the root of penile shaft. The age varied from 18 months to 13 years (mean, 7.2 years). Repair was based on a vertical incision in median raphe, complete degloving of penis and tacking its base to the dermis of the skin. Advanced skin flap and a V-shaped ventral incision along the root of penile shaft were used to cover the penile shaft. The operation time ranged from 60 to 100 minutes (mean, 75 minutes). Disruption of wound occurred in 1 case, and was cured after dressing change; and primary healing of incision was obtained in the others. The follow-up period ranged from 3 months to 7 years (median, 24 months). All patients achieved good to excellent cosmetic results with a low incidence of complications. The results were satisfactory in exposure of penis and prepuce appearance. No obvious scar was observed. The penis had similar appearance to that after prepuce circumcision. A combination of advanced skin flap and V-shaped ventral incision along the root of penile shaft is a simple, safe, and effective procedure for concealed penis with a similar appearance result to the prepuce circumcision.

  9. A step-by-step oncoplastic breast conservation surgical atlas of reproducible dissection techniques and anatomically ideal incision placement. (United States)

    Mitchell, Sunny D


    To develop an atlas for oncoplastic surgery (OPS) with template dissection techniques via anatomically ideal incisions for breast conservation surgery. The evolution of breast conservation techniques has evolved from placing an incision directly over the lesion to the incorporation of a thoughtful decision making process utilizing oncoplastic surgical (OPS) techniques to combining OPS with incision placement in anatomically advantageous sites. The high survival rates of breast cancer and effect of breast surgery on quality of life reinforce emphasis of optimal oncologic as well as aesthetic outcome. OPS results in greater patient satisfaction, fewer surgeries, and is oncologically safe. Today's breast surgeon is tasked with optimizing both oncologic and aesthetic outcomes. Presentation of reproducible dissection techniques and incision placement strategies to afford surgeons a step-by-step approach of OPS via anatomically ideal incisions in breast conservation surgery. Demonstration of reproducible techniques to facilitate the decision making process of optimal breast conservation surgery, eliminate knowledge gaps for surgeons, optimize outcome for individuals undergoing breast conservation surgery, and decrease disparity of care. Adoption of OPS techniques utilizing an anatomically ideal incision in breast conservation surgery is a feasible and reproducible practice for breast surgeons. Application of these techniques results in maintained optimal shape, size, and contour without the typical overlying skin envelope scars. OPS techniques performed under the skin envelope result in expected OPS oncologic and aesthetic outcomes with the addition of the resulting scar(s) in anatomically discrete position(s).

  10. Formation of Valley Networks in a Cold and Icy Early Mars Climate: Predictions for Erosion Rates and Channel Morphology (United States)

    Cassanelli, J.


    Mars is host to a diverse array of valley networks, systems of linear-to-sinuous depressions which are widely distributed across the surface and which exhibit branching patterns similar to the dendritic drainage patterns of terrestrial fluvial systems. Characteristics of the valley networks are indicative of an origin by fluvial activity, providing among the most compelling evidence for the past presence of flowing liquid water on the surface of Mars. Stratigraphic and crater age dating techniques suggest that the formation of the valley networks occurred predominantly during the early geologic history of Mars ( 3.7 Ga). However, whether the valley networks formed predominantly by rainfall in a relatively warm and wet early Mars climate, or by snowmelt and episodic rainfall in an ambient cold and icy climate, remains disputed. Understanding the formative environment of the valley networks will help distinguish between these warm and cold end-member early Mars climate models. Here we test a conceptual model for channel incision and evolution under cold and icy conditions with a substrate characterized by the presence of an ice-free dry active layer and subjacent ice-cemented regolith, similar to that found in the Antarctic McMurdo Dry Valleys. We implement numerical thermal models, quantitative erosion and transport estimates, and morphometric analyses in order to outline predictions for (1) the precise nature and structure of the substrate, (2) fluvial erosion/incision rates, and (3) channel morphology. Model predictions are compared against morphologic and morphometric observational data to evaluate consistency with the assumed cold climate scenario. In the cold climate scenario, the substrate is predicted to be characterized by a kilometers-thick globally-continuous cryosphere below a 50-100 meter thick desiccated ice-free zone. Initial results suggest that, with the predicted substrate structure, fluvial channel erosion and morphology in a cold early Mars

  11. Sedimentary architecture and chronostratigraphy of a late Quaternary incised-valley fill: A case study of the late Middle and Late Pleistocene Rhine system in the Netherlands (United States)

    Peeters, J.; Busschers, F. S.; Stouthamer, E.; Bosch, J. H. A.; Van den Berg, M. W.; Wallinga, J.; Versendaal, A. J.; Bunnik, F. P. M.; Middelkoop, H.


    This paper describes the sedimentary architecture, chronostratigraphy and palaeogeography of the late Middle and Late Pleistocene (Marine Isotope Stage/MIS 6-2) incised Rhine-valley fill in the central Netherlands based on six geological transects, luminescence dating, biostratigraphical data and a 3D geological model. The incised-valley fill consists of a ca. 50 m thick and 10-20 km wide sand-dominated succession and includes a well-developed sequence dating from the Last Interglacial: known as the Eemian in northwest Europe. The lower part of the valley fill contains coarse-grained fluvio-glacial and fluvial Rhine sediments that were deposited under Late Saalian (MIS 6) cold-climatic periglacial conditions and during the transition into the warm Eemian interglacial (MIS 5e-d). This unit is overlain by fine-grained fresh-water flood-basin deposits, which are transgressed by a fine-grained estuarine unit that formed during marine high-stand. This ca. 10 m thick sequence reflects gradual drowning of the Eemian interglacial fluvial Rhine system and transformation into an estuary due to relative sea-level rise. The chronological data suggests a delay in timing of regional Eemian interglacial transgression and sea-level high-stand of several thousand years, when compared to eustatic sea-level. As a result of this glacio-isostatic controlled delay, formation of the interglacial lower deltaic system took only place for a relative short period of time: progradation was therefore limited. During the cooler Weichselian Early Glacial period (MIS 5d-a) deposition of deltaic sediments continued and extensive westward progradation of the Rhine system occurred. Major parts of the Eemian and Weichselian Early Glacial deposits were eroded and buried as a result of sea-level lowering and climate cooling during the early Middle Weichselian (MIS 4-3). Near complete sedimentary preservation occurred along the margins of the incised valley allowing the detailed reconstruction presented

  12. Pauli diagonal channels constant on axes

    Energy Technology Data Exchange (ETDEWEB)

    Nathanson, Michael [Department of Mathematics and Computer Science, St. Mary' s College of California, Moraga, CA 94575 (United States); Ruskai, Mary Beth [Department of Mathematics, Tufts University, Medford, MA 02155 (United States)


    We define and study the properties of channels which are analogous to unital qubit channels in several ways. A full treatment can be given only when the dimension d = p{sup m} a prime power, in which case each of the d + 1 mutually unbiased bases (MUB) defines an axis. Along each axis the channel looks like a depolarizing channel, but the degree of depolarization depends on the axis. When d is not a prime power, some of our results still hold, particularly in the case of channels with one symmetry axis. We describe the convex structure of this class of channels and the subclass of entanglement breaking channels. We find new bound entangled states for d = 3. For these channels, we show that the multiplicativity conjecture for maximal output p-norm holds for p = 2. We also find channels with behaviour not exhibited by unital qubit channels, including two pairs of orthogonal bases with equal output entropy in the absence of symmetry. This provides new numerical evidence for the additivity of minimal output entropy.

  13. Automated parallel recordings of topologically identified single ion channels. (United States)

    Kawano, Ryuji; Tsuji, Yutaro; Sato, Koji; Osaki, Toshihisa; Kamiya, Koki; Hirano, Minako; Ide, Toru; Miki, Norihisa; Takeuchi, Shoji


    Although ion channels are attractive targets for drug discovery, the systematic screening of ion channel-targeted drugs remains challenging. To facilitate automated single ion-channel recordings for the analysis of drug interactions with the intra- and extracellular domain, we have developed a parallel recording methodology using artificial cell membranes. The use of stable lipid bilayer formation in droplet chamber arrays facilitated automated, parallel, single-channel recording from reconstituted native and mutated ion channels. Using this system, several types of ion channels, including mutated forms, were characterised by determining the protein orientation. In addition, we provide evidence that both intra- and extracellular amyloid-beta fragments directly inhibit the channel open probability of the hBK channel. This automated methodology provides a high-throughput drug screening system for the targeting of ion channels and a data-intensive analysis technique for studying ion channel gating mechanisms.

  14. BK channel activators and their therapeutic perspectives

    DEFF Research Database (Denmark)

    Bentzen, Bo Hjorth; Olesen, Søren-Peter; Rønn, Lars C B


    The large conductance calcium- and voltage-activated K(+) channel (KCa1.1, BK, MaxiK) is ubiquitously expressed in the body, and holds the ability to integrate changes in intracellular calcium and membrane potential. This makes the BK channel an important negative feedback system linking increases...... in intracellular calcium to outward hyperpolarizing potassium currents. Consequently, the channel has many important physiological roles including regulation of smooth muscle tone, neurotransmitter release and neuronal excitability. Additionally, cardioprotective roles have been revealed in recent years. After...... a short introduction to the structure, function and regulation of BK channels, we review the small organic molecules activating BK channels and how these tool compounds have helped delineate the roles of BK channels in health and disease....

  15. Small-incision 4-point scleral suture fixation of a foldable hydrophilic acrylic intraocular lens in the absence of capsule support. (United States)

    Terveen, Daniel C; Fram, Nicole R; Ayres, Brandon; Berdahl, John P


    To determine the visual outcomes and complications of a new small-incision technique for 4-point fixation of a hydrophilic acrylic posterior chamber intraocular lens (IOL) in the absence of capsule support. Three North American tertiary referral centers and a private practice. Retrospective case series. Secondary IOL placement was performed from 2011 to 2014. Indications for surgery, clinical results, and complications were analyzed. Primary outcomes included postoperative corrected distance visual acuity (CDVA) and surgical complications. Charts of 35 patients (37 eyes) were reviewed. The mean age at surgery was 56 years, and the mean follow-up was 6 months (range 3 to 24 months). Clinical indications included a dislocated IOL (30%), ocular trauma (19%), crystalline lens subluxation (19%), uveitis-glaucoma-hyphema syndrome (5%), post-complicated cataract (8%), congenital cataract (8%), and decompensated cornea (3%). The mean CDVA improved from 20/80 preoperatively to 20/40 postoperatively (P IOL dislocation (3%). Small-incision 4-point scleral fixation of the Akreos AO60 hydrophilic acrylic IOL in the absence of capsule support appears to be a safe and effective technique for secondary IOL placement. Drs. Berdahl and Ayres are consultants to Bausch & Lomb, Inc. Drs. Ayres and Fram have received speaker fees from Bausch & Lomb. Dr. Terveen does not have a financial or proprietary interest in any material or methods mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  16. A safety study of transumbilical single incision versus conventional laparoscopic surgery for colorectal cancer: study protocol for a randomized controlled trial. (United States)

    Wang, Yanan; Liu, Ruoyan; Zhang, Ze; Xue, Qi; Yan, Jun; Yu, Jiang; Liu, Hao; Zhao, Liying; Mou, Tingyu; Deng, Haijun; Li, Guoxin


    Single-incision laparoscopic surgery (SILS) is an emerging minimally invasive surgery to reduce abdominal incisions. However, despite the increasing clinical application of SILS, no evidence from large-scale, randomized controlled trials is available for assessing the feasibility, short-term safety, oncological safety, and potential benefits of SILS compared with conventional laparoscopic surgery (CLS) for colorectal cancer. This is a single-center, open-label, noninferiority, randomized controlled trial. A total of 198 eligible patients will be randomly assigned to transumbilical single incision plus one port laparoscopic surgery (SILS plus one) group or to a CLS group at a 1:1 ratio. Patients ranging in age from 18 to 80 years with rectosigmoid cancer diagnosed as cT1-4aN0-2 M0 and a tumor size no larger than 5 cm are considered eligible. The primary endpoint is early morbidity, as evaluated by an independent investigator. Secondary outcomes include operative outcomes (operative time, estimated blood loss, and incision length), pathologic outcomes (tumor size, length of proximal and distal resection margins, and number of harvested lymph nodes), postoperative inflammatory and immune responses (white blood cells [WBC], neutrophil percentage [NE %], C-reactive protein [CRP], interleukin-6 [IL-6], and tumor necrosis factor-α [TNF-α]), postoperative recovery (time to first ambulation, flatus, liquid diet, soft diet, and duration of hospital stay), pain intensity, body image and cosmetic assessment, 3-year disease free survival (DFS), and 5-year overall survival (OS). Follow-up visits are scheduled for 1 and 3 months after surgery, then every 3 months for the first 2 years and every 6 months for the next 3 years. This trial will provide valuable clinical evidence for the objective assessment of the feasibility, safety, and potential benefits of SILS plus one compared with CLS for the radical resection of rectosigmoid cancer. The hypothesis is that SILS plus one is

  17. Channel responses to varying sediment input: A flume experiment modeled after Redwood Creek, California (United States)

    Madej, M.A.; Sutherland, D.G.; Lisle, T.E.; Pryor, B.


    At the reach scale, a channel adjusts to sediment supply and flow through mutual interactions among channel form, bed particle size, and flow dynamics that govern river bed mobility. Sediment can impair the beneficial uses of a river, but the timescales for studying recovery following high sediment loading in the field setting make flume experiments appealing. We use a flume experiment, coupled with field measurements in a gravel-bed river, to explore sediment transport, storage, and mobility relations under various sediment supply conditions. Our flume experiment modeled adjustments of channel morphology, slope, and armoring in a gravel-bed channel. Under moderate sediment increases, channel bed elevation increased and sediment output increased, but channel planform remained similar to pre-feed conditions. During the following degradational cycle, most of the excess sediment was evacuated from the flume and the bed became armored. Under high sediment feed, channel bed elevation increased, the bed became smoother, mid-channel bars and bedload sheets formed, and water surface slope increased. Concurrently, output increased and became more poorly sorted. During the last degradational cycle, the channel became armored and channel incision ceased before all excess sediment was removed. Selective transport of finer material was evident throughout the aggradational cycles and became more pronounced during degradational cycles as the bed became armored. Our flume results of changes in bed elevation, sediment storage, channel morphology, and bed texture parallel those from field surveys of Redwood Creek, northern California, which has exhibited channel bed degradation for 30??years following a large aggradation event in the 1970s. The flume experiment suggested that channel recovery in terms of reestablishing a specific morphology may not occur, but the channel may return to a state of balancing sediment supply and transport capacity.

  18. Distal biceps brachii tendon repairs: a single-incision technique using a cortical button with interference screw versus a double-incision technique using suture fixation through bone tunnels. (United States)

    Shields, Edward; Olsen, Joshua R; Williams, Richard B; Rouse, Lucien; Maloney, Michael; Voloshin, Ilya


    Distal biceps brachii tendon repairs performed with a tension slide technique using a cortical button (CB) and interference screw are stronger than those based on suture fixation through bone tunnels (BTs) in biomechanical studies. However, clinical comparison of these 2 techniques is lacking in the literature. To perform a clinical comparison of the single-incision CB and double-incision BT techniques. Cohort study; Level of evidence, 3. Distal biceps tendon ruptures repaired through either the single-incision CB or double-incision BT technique were retrospectively identified at a single institution. Patients>1 year out from surgery were assessed for range of motion, strength, and complications, and they completed a DASH questionnaire (Disabilities of the Arm, Shoulder, and Hand). Patients in the CB group (n=20) were older (52±9.5 vs 43.7±8.7 years; P=.008), had a shorter interval from surgery to evaluation (17.7±5 vs 30.8±16.5 months; P=.001), and were less likely to smoke (0% vs 28.5%; P=.02) compared with the BT patients (n=21). DASH scores were similar between groups (4.46±4.4 [CB] vs 5.7±7.5 [BT]; P=.65). Multivariate analysis revealed no differences in range of motion or strength between groups. More CB patients (30%; n=6) experienced a complication compared with those in the BT group (4.8%; n=1) (P=.04), and these complications were predominantly paresthesias of the superficial radial nerve that did not resolve. There were no reoperations or repair failures in either group. Both the single-incision CB and double-incision BT techniques provided excellent clinical results. Complications were more common in the single-incision CB group and most commonly involved paresthesias of the superficial radial nerve. © 2015 The Author(s).

  19. Radio Channel Modeling in Body Area Networks

    NARCIS (Netherlands)

    An, L.; Bentum, Marinus Jan; Meijerink, Arjan; Scanlon, W.G.


    A body area network (BAN) is a network of bodyworn or implanted electronic devices, including wireless sensors which can monitor body parameters or to de- tect movements. One of the big challenges in BANs is the propagation channel modeling. Channel models can be used to understand wave propagation

  20. Radio channel modeling in body area networks

    NARCIS (Netherlands)

    An, L.; Bentum, Marinus Jan; Meijerink, Arjan; Scanlon, W.G.


    A body area network (BAN) is a network of bodyworn or implanted electronic devices, including wireless sensors which can monitor body parameters or to detect movements. One of the big challenges in BANs is the propagation channel modeling. Channel models can be used to understand wave propagation in

  1. Transverse Skin Crease versus Vertical Midline Incision versus Laparoscopy for Right Hemicolectomy: A Systematic Review—Current Status of Right Hemicolectomy (United States)

    Santoro, Alberto; Gubbiotti, Francesca; Di Rocco, Giorgio


    Purpose. The right hemicolectomy may be conducted through laparoscopic or laparotomic surgery, transverse or midline incisions. The transverse laparotomy offers some advantages compared to the midline laparotomy and laparoscopy. A literature review was performed to evaluate the possible advantages of the transverse incision versus midline incision or laparoscopic right hemicolectomy. Methods. A systematic research was performed in Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, BioMed Central, and the Science Citation Index. Results. Laparotomic right hemicolectomy with transverse incision is preferable to laparotomic hemicolectomy with midline incision. A transverse incision offers a lessened postoperative pain following physical activity, a lessened need to administer analgesic therapy during the post-operative time, better aesthetic results, and a better post-operative pulmonary function. Open surgery with transverse or midline incision ensured a shorter operative time, lower costs and a greater length of the incision compared to the laparoscopic. However, there are no differences in the oncological outcomes. Conclusions. It was not possible to identify significant differences between the open right hemicolectomy with transverse incision versus the open right hemicolectomy with midline incision or laparoscopic hemicolectomy. PMID:24605333

  2. Pump apparatus including deconsolidator

    Energy Technology Data Exchange (ETDEWEB)

    Sonwane, Chandrashekhar; Saunders, Timothy; Fitzsimmons, Mark Andrew


    A pump apparatus includes a particulate pump that defines a passage that extends from an inlet to an outlet. A duct is in flow communication with the outlet. The duct includes a deconsolidator configured to fragment particle agglomerates received from the passage.

  3. Small-Incision Laparoscopy-Assisted Surgery Under Abdominal Cavity Irrigation in a Porcine Model (United States)

    Ishii, Takuro; Aoe, Tomohiko; Yu, Wen-Wei; Ebihara, Yuma; Kawahira, Hiroshi; Isono, Shiro; Naya, Yukio


    Abstract Background: Laparoscopic and robot-assisted surgeries are performed under carbon dioxide insufflation. Switching from gas to an isotonic irrigant introduces several benefits and avoids some adverse effects of gas insufflation. We developed an irrigating device and apparatus designed for single-incision laparoscopic surgery and tested its advantages and drawbacks during surgery in a porcine model. Materials and Methods: Six pigs underwent surgical procedures under general anesthesia. A 30-cm extracorporeal cistern was placed over a 5–6-cm abdominal incision. The abdomen was irrigated with warm saline that was drained via a suction tube placed near the surgical field and continuously recirculated through a closed circuit equipped with a hemodialyzer as a filter. Irrigant samples from two pigs were cultured to check for bacterial and fungal contamination. Body weight was measured before and after surgery in four pigs that had not received treatments affecting hemodynamics or causing diuresis. Results: One-way flow of irrigant ensured laparoscopic vision by rinsing blood from the surgical field. Through a retroperitoneal approach, cystoprostatectomy was successfully performed in three pigs, nephrectomy in two, renal excision in two, and partial nephrectomy in one, under simultaneous ultrasonographic monitoring. Through a transperitoneal approach, liver excision and hemostasis with a bipolar sealing device were performed in three pigs, and bladder pedicle excision was performed in one pig. Bacterial and fungal contamination of the irrigant was observed on the draining side of the circuit, but the filter captured the contaminants. Body weight increased by a median of 2.1% (range, 1.2–4.4%) of initial weight after 3–5 hours of irrigation. Conclusions: Surgery under irrigation is feasible and practical when performed via a cistern through a small abdominal incision. This method is advantageous, especially in the enabling of continuous and free

  4. Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus

    Directory of Open Access Journals (Sweden)

    Praveenraj Palanivelu


    Full Text Available Background: The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them. Material and Methods: A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11 and with corrugated drain (2.09 needlescopic method (1.2, Umbilical tape sling (1.95, crural stitch method (2.5. Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality. Conclusions: The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

  5. Oncoplastic surgery for inner quadrant breast cancer: fish-hook incision rotation flap. (United States)

    Lee, Seokwon; Lee, Jeeyeon; Jung, Younglae; Bae, Youngtae


    In oncoplastic breast surgery, the size and location of the defect are two of the major factors affecting the post-operative cosmetic outcome after partial mastectomy. We introduce a modified superior-based dermoglandular rotation flap technique, which can be applied for relatively large tumours and in cases of inner quadrant defects of the breast without surgery of the contralateral breast. Between January 2007 and December 2012, a total of 34 female patients with breast cancer underwent breast-conserving surgery using the 'fish-hook incision rotational flap'. A fish-hook-shaped skin incision line was designed from an axillary site to the tumour, about 2-3 cm below the skin crease of the inframammary fold. After partial mastectomy, a superior-based dermoglandular tissue flap was mobilized off the pectoralis major muscle and the lower abdominal flap was dissected downward. The dermoglandular flap was then rotated and the lower dissected lower abdominal flap was advanced in the upward direction to fill the defect and restore the breast shape. The cosmetic results were self-estimated 12 months after surgery. Mean excised volume of the breast was 23.2 ± 6.1%. The location of the tumours was as follows: upper inner (n = 13, 38.2%) and lower inner quadrant (n = 21, 61.8%). The overall cosmetic satisfaction was self-estimated as follows: excellent (n = 19, 55.9%); good (n = 10, 29.4%); fair (n = 4, 11.8%); poor (n = 1, 2.9%). The 'fish-hook incision rotation flap' is a feasible, effective oncoplastic technique that can be applicable to a relatively large defect located in the inner quadrant of the breast. © 2015 Royal Australasian College of Surgeons.

  6. Wound temperature profiles of coaxial mini-incision versus sleeveless microincision phacoemulsification. (United States)

    Belkin, Avner; Abulafia, Adi; Michaeli, Adi; Ofir, Shay; Assia, Ehud I


    Temperature profiles at the corneal wound of coaxial mini-incision (2.4 mm) cataract surgery and sleeveless microincision (1.1 mm) cataract surgery were compared. Prospective, controlled, paired-eye clinical trial conducted in a tertiary care hospital. Twenty patients with mild-to-moderate bilateral nuclear sclerotic cataract. Twenty patients underwent bilateral cataract surgery within a 1-month period. One eye was operated on by conventional coaxial mini-incision (2.4 mm) phacoemulsification. The second eye underwent microincision surgery by using a naked phacoemulsification tip and a specialized 19-gauge anterior chamber maintainer as the sole fluid source (three-port microincision cataract surgery technique). Patients had moderate bilateral cataracts with no other anterior segment pathology. Temperature at the corneal wound was constantly recorded by using infrared thermal imaging. Temperatures at the corneal wound. Mean temperatures at the corneal surgical wound were not significantly different between the coaxial and sleeveless groups (31.1 °C ± 2.3 vs. 31.0 °C ± 2. 0; P = 0.89). There was also no difference in maximum temperatures reached during phaco-emulsification. Temperatures did not rise above 40 °C during any surgery, and there were no corneal burns. Final visual acuity and intraoperative and postoperative complication rates were similar between the two groups. The temperature profile at the surgical wound using a microincisional sleeveless phacoemulsification technique is comparable with that of the conventional coaxial mini-incision method. © 2016 Royal Australian and New Zealand College of Ophthalmologists.

  7. Minimal incisions vertical endoscopic lifting and fat grafting as a systematic approach to the rejuvenation of the periocular esthetic unit. (United States)

    Bernardini, Francesco P; Gennai, Alessandro; Izzo, Luigi; Devoto, Martin H


    The forehead/brow complex, the temporal region, the upper eyelid, the zygomatic area, the lower eyelid, and the cheek comprise the periocular esthetic unit. The combination of variable degrees of tissue descent and fat deflation of the component parts of the unit determine its appearance with age. The authors report the results of tissue repositioning through a minimal incisions vertical endoscopic lift and volume restoration used in combination to restore the natural youthful appearance of the periocular esthetic unit. The authors retrospectively reviewed the charts of patients who underwent minimal incisions vertical endoscopic lift and fat grafting over a 12-year period in 3 different centers. Patients results were evaluated with standardized pre- and postoperative pictures graded by masked observers in a scale from poor, fair, satisfactory, to very satisfactory results. Patient satisfaction was self-graded in the same manner. The study consists of 400 patients, of whom 337 (85%) were women and 63 (14.8%) were men, with a mean age of 46 years (range 38-67) for women and mean age of 53 years (range 48-65) for men. Mean follow up was 16 months (range 6 months-8 years); in 180 patients follow up was 2 years or longer. Additional procedures included lower blepharoplasty in 205 patients (51%), neck lift in 102 patients (26%), upper blepharoplasty in 63 patients (15.7%), lateral canthoplasty in 9 patients (2.3%), and upper eyelid ptosis in 6 patients (1.5%). The results were graded as satisfactory or very satisfactory by 95% of patients and by 91% of observers. On the basis of the anatomical changes that occur in the periocular esthetic unit, tissue repositioning is indicated to address the descent of the superior complex and in minor part of the inferior complex, while volume restoration is indicated to address the volume depletion of the inferior and the lateral complexes and for refinements of the superior complex. The authors propose a systematic combination of

  8. Role of Algorithm-Based Levator Aponeurectomy in Small-Incision External Ptosis Surgery for Involutional Ptosis. (United States)

    Repp, Daniel J; Rubinstein, Tal J; Sires, Bryan S


    External surgical treatment of involutional ptosis with normal levator function is challenging owing to lack of an established algorithm. Developing an algorithm-based technique could improve postoperative results while limiting intraoperative inefficiencies. To investigate the postoperative success of an algorithmic external levator aponeurosis resection technique for aponeurotic ptosis with good levator function. This retrospective cohort study included patients with involutional ptosis and normal levator function who were treated from July 1, 2015, through November 30, 2016, at a private ophthalmic plastic surgery clinic. The technique involved a small incision in the eyelid crease, with dissection through the orbital septum to expose the levator aponeurosis. The leading edge of the aponeurosis was then clamped to a medical-grade spring scale to standardize the stress on the eyelid between patients. Two millimeters of aponeurosis were resected for every 1 mm of desired ptosis correction. Two sutures were then placed to connect the aponeurosis to the tarsus at predetermined locations. Preoperative predicted (goal) vs actual margin reflex distance-1 (MRD1). Twenty-six eyelids of 15 patients (6 men and 9 women; mean [SD] age, 65 years [range, 17-84 years]) met inclusion criteria. The mean follow-up was 189 days (range, 63-343 days). The mean preoperative MRD1 was 0.44 mm (range, -0.5 to 2 mm; 95% CI, 0.18-0.70 mm) compared with the final mean MRD1 of 3.2 mm (range, 2.5-4.0 mm; 95% CI, 3.1-3.4 mm; P MRD1 was 3.4 mm (range, 2.5-4.0 mm; 95% CI, 3.2-3.5 mm). The final MRD1 of all eyelids was within 1 mm of the goal MRD1. The mean surgical time per eyelid was 14.6 minutes (range, 10.5-34.0 minutes). Twelve eyelids (46%) did not have intraoperative suture adjustments. In correcting aponeurotic ptosis, a small-incision levator aponeurectomy incorporating an algorithm and consistent stress on the aponeurosis during resection achieves the goal MRD1 efficiently. The

  9. Meta-analysis of negative-pressure wound therapy for closed surgical incisions

    DEFF Research Database (Denmark)

    Hyldig, N; Birke-Sorensen, H; Kruse, M


    . RESULTS: Ten studies met the inclusion criteria, reporting on 1311 incisions in 1089 patients. NPWT was associated with a significant reduction in wound infection (relative risk (RR) 0·54, 95 per cent c.i. 0·33 to 0·89) and seroma formation (RR 0·48, 0·27 to 0·84) compared with standard care....... The reduction in wound dehiscence was not significant. The numbers needed to treat were three (seroma), 17 (dehiscence) and 25 (infection). Methodological heterogeneity across studies led to downgrading of the quality of evidence to moderate for infection and seroma, and low for dehiscence. CONCLUSION: Compared...

  10. Quantifying incision rates since the early Miocene: novelties, potentialities and limitations (United States)

    Sartégou, A.; Braucher, R.; Blard, P. H.; Bourlès, D. L.; Zimmermann, L.; Tibari, B.; Voinchet, P.; Bahain, J. J.; Sorriaux, P.; Leanni, L.; Team, A.


    The rates and chronologies of valley incision are closely modulated by the tectonic uplift of active mountain ranges and were controlled by repeated climate changes during the Quaternary. The Pyrenees are a continental collision between the Iberian and Eurasian plates induced a double vergence orogen, which has been considered as a mature mountain range in spite of significant seismicity and evidence of neotectonics. Nevertheless, recent studies indicate that the range may have never reached a steady state. One option for resolving this controversy is to quantify the incision rates since the Miocene by reconstructing the vertical movement of geometric markers. However, the few available ages from the Pyrenean terrace systems do not exceed the middle Pleistocene. To enlarge the time span of this dataset, we studied alluvium-filled horizontal epiphreatic passages in limestone karstic networks, which represent former valley floors. They record the transient position of former local base levels during the process of valley deepening. We used various suitable geochronological methods (26Al/10Be, 10Be/21Ne, ESR and OSL burial durations on quartz) on intrakarstic alluvial deposits from three valleys of the central and eastern Pyrenees, as well as on a recent analogue. In the Pyrenean context, under particular conditions, these geochronometers allow us to document incision processes since 16-13 Ma, and to study influences of external forcing and eustatism. In comparison with other studies, it appears that incision rates are higher in the central Pyrenees and for the Spanish slope. However, the density of horizontal levels on an altimetric range, the geodynamical and paleoclimatic contexts, the reorganization of the drainage networks can make the filling stories of the networks more complex than expected. Indeed, these radiometric approaches may be limited when some formations are reworked inside and/or outside the karst. The validity of dosimetric methods in a mountainous

  11. Bilateral Ectasia After Femtosecond Laser-Assisted Small Incision Lenticule Extraction (SMILE). (United States)

    Mattila, Jaakko S; Holopainen, Juha M


    To describe a case of bilateral ectasia after small incision lenticule extraction (SMILE) in a patient with early keratoconus. Case report. Bilateral SMILE was performed on a patient even though preoperative topographies showed changes indicating early keratoconus. The right eye underwent further photorefractive keratectomy enhancement 18 months later. The patient developed a bilateral corneal ectasia. This case underlines the importance of thorough preoperative assessment for possible keratoconus suspect changes with corneal topography to avoid postoperative ectasia. [J Refract Surg. 2016;32(7):497-500.]. Copyright 2016, SLACK Incorporated.

  12. Incision and loop drainage: a minimally invasive technique for subcutaneous abscess management in children. (United States)

    Tsoraides, Steven S; Pearl, Richard H; Stanfill, Amy B; Wallace, Lizabeth J; Vegunta, Ravindra K


    The aim of the study was to evaluate outcomes after a minimally invasive approach to pediatric subcutaneous abscess management as a replacement for wide exposure, debridement, and repetitive packing. A retrospective study was performed of all children who underwent incision and loop drainage for subcutaneous abscesses between January 2002 and October 2007 at our institution. Two mini incisions, 4-5 mm each, were made on the abscess, as far apart as possible. Abscess was probed, and pus was drained. Abscess was irrigated with normal saline; a loop drain was passed through one incision, brought out through the other, and tied to itself. An absorbent dressing was applied over the loop and changed regularly. One hundred fifteen patients underwent drainage procedures as described; 5 patients had multiple abscesses. Mean values (range) are as follows: age, 4.25 years (19 days to 20.5 years); duration of symptoms, 7.8 days (1-42 days); length of hospital stay, 3 days (1-39 days); duration of procedure, 10.8 minutes (4-43 minutes); drain duration, 10.4 days (3-24 days); and number of postoperative visits, 1.8 (1-17). Bacterial culture data were available for 101 patients. Of these, 50% had methicillin-resistant Staphylococcus aureus, 26% had methicillin-sensitive Staphylococcus aureus, and 9% streptococcal species. Of the 115 patients, 5 had pilonidal abscesses, 1 required reoperation for persistent drainage, and 1 had a planned staged excision. Of the remaining 110 patients, 6 (5.5%) required reoperation-4 with loop drains and 2 with incision and packing with complete healing. The use of loop drains proved safe and effective in the treatment of subcutaneous abscesses in children. Eliminating the need for repetitive and cumbersome wound packing simplifies postoperative wound care. Furthermore, there is an expected cost savings with this technique given the decreased need for wound care materials and professional postoperative home health services. We recommend this

  13. Dual-incision approach for repair of peroneal tendon dislocation associated with fractures of the calcaneus. (United States)

    Mak, May Fong; Tay, Guan Tzu; Stern, Richard; Assal, Mathieu


    Dislocation of the peroneal tendons associated with calcaneus fractures should be repaired during fracture fixation to prevent complications. The only documented approach for repair is by proximal extension of the vertical limb of the lateral extensile approach to the calcaneus. However, enlarging the inherently fragile calcaneus flap places it at further risk of damage. Using a separate anterior incision to repair the dislocation, thus avoiding problems caused by excessive flap elevation, seemed intuitive. This approach proved technically effective and reliable in producing favorable outcomes in a series of 14 patients. Copyright 2014, SLACK Incorporated.

  14. An explanation of a groove found on the nasal process of the equine incisive bone. (United States)

    Pérez, W; Martin, E


    Thirteen fresh equine heads were dissected in an attempt to determine the cause of a groove frequently found on the dorsal border and medial side of the nasal process of the incisive bone. This groove appeared on both sides in 40 out of 44 equine skulls. The sulcus seems to be caused by the combined action of the lateralis nasi muscle and the medial accessory cartilage of the nose (cartilago nasalis accessoria medialis). Other sulci found on the nasal process of the bone may be explained as impressions caused by nerves.

  15. Intra-parotid dermoid cyst: excision through a face lift incision. (United States)

    Shakeel, M; Keh, S M; Chapman, A; Hussain, A


    Intra-parotid dermoid cysts are extremely rare. Clinically, they present like any other parotid lump and pre-operative diagnosis is rarely possible. A 62 years old Caucasian man presented with a painless lump in his right parotid region. The Magnetic Resonance Imaging (MRI) scan revealed a 3 x 3 cm mass in the parotid tail. Cytological examination was unhelpful. The patient underwent successful excision of the cyst through a small face lift incision. No drain was inserted and the patient was discharged home the same day. The patient made an uneventful recovery and was highly satisfied with the aesthetic outcome. The definite histopathological diagnosis was an intra-parotid dermoid cyst.

  16. Optical modulator including grapene (United States)

    Liu, Ming; Yin, Xiaobo; Zhang, Xiang


    The present invention provides for a one or more layer graphene optical modulator. In a first exemplary embodiment the optical modulator includes an optical waveguide, a nanoscale oxide spacer adjacent to a working region of the waveguide, and a monolayer graphene sheet adjacent to the spacer. In a second exemplary embodiment, the optical modulator includes at least one pair of active media, where the pair includes an oxide spacer, a first monolayer graphene sheet adjacent to a first side of the spacer, and a second monolayer graphene sheet adjacent to a second side of the spacer, and at least one optical waveguide adjacent to the pair.

  17. Beyond ion-conduction: Channel-dependent and -independent roles of TRP channels during development and tissue homeostasis

    NARCIS (Netherlands)

    Vrenken, K.S.; Jalink, K.; Leeuwen, F.N. van; Middelbeek, J.A.


    Transient receptor potential (TRP) channels comprise a family of cation channels implicated in a variety of cellular processes, including proliferation, cell migration and cell survival. As a consequence, members of this ion family play prominent roles during embryonic development, tissue

  18. Indoor MIMO Channel Measurement and Modeling

    DEFF Research Database (Denmark)

    Nielsen, Jesper Ødum; Andersen, Jørgen Bach


    Forming accurate models of the multiple input multiple output (MIMO) channel is essential both for simulation as well as understanding of the basic properties of the channel. This paper investigates different known models using measurements obtained with a 16x32 MIMO channel sounder for the 5.8GHz...... band. The measurements were carried out in various indoor scenarios including both temporal and spatial aspects of channel changes. The models considered include the so-called Kronecker model, a model proposed by Weichselberger et. al., and a model involving the full covariance matrix, the most...... accurate model for Gaussian channels. For each of the environments different sizes of both the transmitter and receiver antenna arrays are investigated, 2x2 up to 16x32. Generally it was found that in terms of capacity cumulative distribution functions (CDFs) all models fit well for small array sizes...

  19. Coupled analysis of hillslope and channel metrics for erosion rates in a tectonically active landscape (United States)

    Hurst, M. D.; Grieve, S. W. D.; Mudd, S. M.


    Topography reflects the competition between tectonic process and climate, mediated by surface processes. Tectonic processes generally act to create topographic gradients and relief, whilst surface processes tend to reduce these, and the efficiency by which they do so is controlled by climate. In tectonically-active landscapes, surface processes attempt to "keep up" with the boundary conditions of surface uplift, and the topography may reflect the history of surface uplift experienced. Channels and hillslopes steepen in response to uplift, manifest as waves of topographic adjustment that propagate up the channel network, onto hillslopes and up to drainage divides. Channels set the base-level condition for hillslopes and hillslope response is expected to lag the channel adjustment. Studies investigating links between erosion rates and topography focus either on hillslopes or channels but, to date, few have explored coupled channel-hillslope morphology in the face of transient landscape adjustment to tectonic boundary conditions. Developments in topographic analysis of hillslopes allow us to assess the spatial distribution of erosion rate metrics and identify transient hillslopes adjusting to changing channel incision rates. The steepness of channels (normalised for drainage area) has been demonstrated to reflect the spatial distribution of erosion rate in the channel network. In this contribution, we compare topographic metrics for erosion rates derived from both channel and hillslope morphology, focusing on the actively uplifting landscape of the Bolinas Ridge, California. This ridgeline is experiencing a gradient in uplift rates due to a blind thrust adjacent to the San Andreas Fault. The ridgeline feature is drained by a series of small catchments that trend roughly perpendicular to the ridgeline axis, and channel steepness has previously been demonstrated to reflect the spatial distribution of surface uplift. We measure hillslope form by extracting individual

  20. Comparison of loop and primary incision & drainage techniques in adult patients with cutaneous abscess: A preliminary, randomized clinical trial. (United States)

    Özturan, İbrahim Ulaş; Doğan, Nurettin Özgür; Karakayalı, Onur; Özbek, Asım Enes; Yılmaz, Serkan; Pekdemir, Murat; Suner, Selim


    The aim of this study is to compare efficacy of loop drainage and standard incision & drainage (I&D) in adult patients with cutaneous abscess in the emergency department. This study is an interventional, parallel group, randomized clinical trial. Adult patients with cutaneous abscess were randomized into loop drainage and standard I&D groups. The primary outcome was defined as change in diameter of abscess and cellulitis 7days after procedure. Secondary outcome measures were pain intensity at the end of the procedure and procedure duration. Also patient satisfaction, need for antibiotics and repetitive drainage were recorded. A total of 46 patients were included in the study (23 in each group). Both groups had similar baseline characteristics. Median abscess diameters were 3.2 (1.9-4.0) cm and 3.0 (2.4-4.8) cm in loop drainage and I&D groups respectively. In the loop drainage group there was a -0.6cm (95% CI: -1.7-0.5) difference in abscess diameter compared to the I&D group. There was also a reduction in cellulitis diameter (-1.3cm, 95% CI: -3.4-0.8). No statistically significant difference was found between groups in patient satisfaction, use of antibiotics or need for repetitive drainage. This preliminary study revealed that, loop drainage technique is similar to standard I&D technique in abscess resolution and complications. (Clinical Trials Registration ID: NCT02286479). Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Comparison of the clinical outcomes of transobturator and single-incision slings for stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Ling-Ying Wu


    Full Text Available The aim of this study was to compare the clinical outcomes of anti-incontinence surgeries employing the transobturator sling and single-incision sling (SIS. Our hypothesis is that the outcome of the SIS is not inferior to the obturator sling. This retrospective study reviewed the medical records of patients who underwent anti-incontinence surgery with the transobturator sling or SIS from July 2005 to November 2014. Patients who underwent concomitant pelvic organ reconstruction with an artificial mesh were excluded. Assessments included preoperative and postoperative urodynamic examinations, perioperative complications, and postoperative urogenital symptoms. A total of 122 women were recruited according to the inclusion and exclusion criteria. Among them, 68 patients underwent transobturator sling procedures while 54 patients underwent SIS procedures. The subjective failure rate of the transobturator sling and SIS were 10.2% and 18.5%, respectively (p = 0.292. The objective failure rate, defined as a pad test showing more than 2 g of urine, was 10.2% for the transobturator sling and 12.9% for the SIS (p = 0.777. SIS resulted in less blood loss, operative time, length of hospital stay, and transient voiding dysfunction after the operation. No major complication occurred after either surgical intervention. In conclusion, SIS and transobturator slings might have similar efficacy, safety, and effects on new-onset urogenital symptoms.

  2. A randomized controlled trial of uterine exteriorization versus in situ repair of the uterine incision during cesarean delivery. (United States)

    El-Khayat, Waleed; Elsharkawi, Mohamed; Hassan, Amr


    To compare extra-abdominal repair of the uterine incision at cesarean delivery with in situ repair. The present study was a double-blind randomized controlled trial conducted at a university hospital in Egypt during 2012-2013, and included women with an indication for cesarean delivery. Extra-abdominal repair was used in group 1 (n=500) and in situ repair in group 2 (n=500). The primary outcome measure was the surgery duration. Surgery duration was significantly longer in group 1 than group 2 (49.9±2.3 minutes vs 39.9±1.8 minutes; P<0.001). More patients in group 1 than in group 2 had postoperative moderate-to-severe pain (165 [33.0%] vs 115 [23.0%]; P=0.001) and needed additional postoperative analgesia (100 [20.0%] vs 50 [10.0%]; P<0.001). Moreover, mean time to bowel movement was longer in group 1 than in group 2 (17.0±2.7 hours vs 14.0±1.9 hours; P<0.001). In situ uterine closure is more advantageous than extra-abdominal repair in terms of surgery duration, postoperative pain and need for additional analgesia, and return of bowel movement. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  3. Groundwater Discharge along a Channelized Coastal Plain Stream

    Energy Technology Data Exchange (ETDEWEB)

    LaSage, Danita M [Ky Dept for natural resources, Div of Mine Permits; Sexton, Joshua L [JL Sexton and Son; Mukherjee, Abhijit [Univ of Tx, Jackson School of Geosciences, Bur of Econ. Geology; Fryar, Alan E [Univ of KY, Dept of Earth and Geoligical Sciences; Greb, Stephen F [Univ of KY, KY Geological Survey


    In the Coastal Plain of the southeastern USA, streams have commonly been artificially channelized for flood control and agricultural drainage. However, groundwater discharge along such streams has received relatively little attention. Using a combination of stream- and spring-flow measurements, spring temperature measurements, temperature profiling along the stream-bed, and geologic mapping, we delineated zones of diffuse and focused discharge along Little Bayou Creek, a channelized, first-order perennial stream in western Kentucky. Seasonal variability in groundwater discharge mimics hydraulic-head fluctuations in a nearby monitoring well and spring-discharge fluctuations elsewhere in the region, and is likely to reflect seasonal variability in recharge. Diffuse discharge occurs where the stream is incised into the semi-confined regional gravel aquifer, which is comprised of the Mounds Gravel. Focused discharge occurs upstream where the channel appears to have intersected preferential pathways within the confining unit. Seasonal fluctuations in discharge from individual springs are repressed where piping results in bank collapse. Thereby, focused discharge can contribute to the morphological evolution of the stream channel.

  4. HIPPI and Fibre Channel

    International Nuclear Information System (INIS)

    Tolmie, D.E.


    The High-Performance Parallel Interface (HIPPI) and Fibre Channel are near-gigabit per second data communications interfaces being developed in ANSI standards Task Group X3T9.3. HIPPI is the current interface of choice in the high-end and supercomputer arena, and Fibre Channel is a follow-on effort. HIPPI came from a local area network background, and Fibre Channel came from a mainframe to peripheral interface background

  5. Penile prosthesis implantation and tunica albuginea incision without grafting in the treatment of Peyronie's disease with erectile dysfunction (United States)

    Djordjevic, Miroslav L; Kojovic, Vladimir


    We evaluated penile prosthesis implantation with tunica albuginea-relaxing incisions without grafting in the treatment of Peyronie's disease associated with erectile dysfunction. Between April 2005 and June 2011, 62 patients underwent surgery due to severe Peyronie's disease associated with erectile dysfunction. Malleable and inflatable penile prostheses were inserted in 49 and 13 cases, respectively. Penile prostheses were inserted into the corpora cavernosa using the standard ventral approach. After lifting the neurovascular bundle, the tunica albuginea was incised and opened at the plaque region to correct the deformities and to lengthen the penis. Subsequently, the wide neurovascular bundle was replaced, and all incisions of the tunica albuginea were covered to prevent corporal grafting. In the median follow-up of 35 months (range 14–82 months), the penis was completely straightened in 59 (95%) patients. Numbness of the glans, which the patients found initially upsetting, decreased or disappeared spontaneously 3–6 months later. Penile prosthesis implantation with tunica albuginea incisions is a viable alternative in the treatment of Peyronie's disease because the extensive dissection of the neurovascular bundle allows a good approach to the plaque and provides excellent covering of the incised tunica albuginea without additional grafting. PMID:23435473

  6. Ion Channels in Leukocytes (United States)


    be fitted to a Hodgkin - conductance. K (1.0) > Rb (0.77) > NH4 (0.10) > Cs Huxley type n4j model (17, 38). However, the rate of K0 (0.02) > Na (ɘ.01...15, 25 activated) T- and B-cells, murine B-cells? SCG, single-channel conductance under physiological ionic gradient- tfor ructif~ y ig ehannel, largest...the channel induces a confor- kat T-cell line (52). Fina:! y , single-channel recordings of mational change that ina.-tix ates the channel rather human T

  7. A channel profile analyser

    International Nuclear Information System (INIS)

    Gobbur, S.G.


    It is well understood that due to the wide band noise present in a nuclear analog-to-digital converter, events at the boundaries of adjacent channels are shared. It is a difficult and laborious process to exactly find out the shape of the channels at the boundaries. A simple scheme has been developed for the direct display of channel shape of any type of ADC on a cathode ray oscilliscope display. This has been accomplished by sequentially incrementing the reference voltage of a precision pulse generator by a fraction of a channel and storing ADC data in alternative memory locations of a multichannel pulse height analyser. Alternative channels are needed due to the sharing at the boundaries of channels. In the flat region of the profile alternate memory locations are channels with zero counts and channels with the full scale counts. At the boundaries all memory locations will have counts. The shape of this is a direct display of the channel boundaries. (orig.)

  8. Lateral suboccipital retrosigmoid approach with tent