Medical rhinoplasty by hyaluronic acid injection (HA) has become nowadays a common practice. The number of patients requesting surgical rhinoplasty and having already undergone one or more injections ...of HA is increasing. However, the literature lacks publications regarding the management of these patients.
The aim of this study is to discuss the management of patients who have been treated with previous nasal HA injections and who seek surgical rhinoplasty, and elaborate a treatment protocol and algorithm to standardize surgical plans.
We are reporting case studies based on our clinical experience. We also reviewed the literature to suggest perioperative management for rhinoplasty with previous HA injections.
Hyaluronidase injection preoperatively allows to carry out an accurate preoperative analysis of the nasal deformities to treat, in order to make an adapted treatment plan. Postoperative course is similar to other rhinoplasty cases without the use of this enzyme.
Hyaluronidase should be used in all patients with nasal injections of HA (unless contraindications), who are willing to undergo a surgical rhinoplasty. The operation can be undertaken at one-week interval as soon as the edema subsides and no further treatments are necessary.
The type VI secretion system (T6SS) operons of
Vibrio cholerae
contain extraordinarily diverse arrays of toxic effector and cognate immunity genes, which are thought to play an important role in the ...environmental lifestyle and adaptation of this human pathogen. Through the T6SS, proteinaceous “spears” tipped with antibacterial effectors are injected into adjacent cells, killing those not possessing immunity proteins to these effectors. Here, we investigate the T6SS-mediated dynamics of bacterial competition within a single environmental population of
V. cholerae
. We show that numerous members of a North American
V. cholerae
population possess strain-specific repertoires of cytotoxic T6SS effector and immunity genes. Using pairwise competition assays, we demonstrate that the vast majority of T6SS-mediated duels end in stalemates between strains with different T6SS repertoires. However, horizontally acquired effector and immunity genes can significantly alter the outcome of these competitions. Frequently observed horizontal gene transfer events can both increase or reduce competition between distantly related strains by homogenizing or diversifying the T6SS repertoire. Our results also suggest temperature-dependent outcomes in T6SS competition, with environmental isolates faring better against a pathogenic strain under native conditions than under those resembling a host-associated environment. Taken altogether, these interactions produce density-dependent fitness effects and a constant T6SS-mediated arms race in individual
V. cholerae
populations, which could ultimately preserve intraspecies diversity. Since T6SSs are widespread, we expect within-population diversity in T6SS repertoires and the resulting competitive dynamics to be a common theme in bacterial species harboring this machinery.
Antebrachial phalloplasty is considered as the standard technique in total penile reconstruction. This technique allows the creation of a phallus and a neourethra in one step at the cost of ...significant sequelae of the donor site. Thus, this technique has been replaced in some centers by other techniques such as the MSLD flap or the ALT flap. However, in Western populations, these techniques require the addition of a technique dedicated to the urethroplasty. The scapular flap is a technique that is not widely described in the literature and, like the antebrachial flap, allows the creation of a phallus and a urethra in one step according to the "tube within tube" technique.
The aim of the study was to detail this technique, to study its vascularization and to adapt the measurements of the flap to a western population.
Six cadaveric dissections were performed in the laboratory. Intravascular injection of colored latex allowed easier identification of the vessels of interest and study of the subcutaneous vascular tree. Scapular flaps of variable size were raised to adapt the size to a Western population.
Six dissections were performed in Caucasian subjects. The scapular circumflex artery was constant and had a mean diameter of 3.5mm (3.3mm-3.8mm). The mean pedicle length was 7.3cm (6.8cm-8.1cm). The size of the flaps was adapted to the subcutaneous tissue and flaps of at least 14×16cm allowed the "tube within tube" technique to be performed.
The scapular flap has the advantage of allowing phalloplasty with urethroplasty to be performed at the same time. The pedicle is constant and of good diameter. In addition, the sequelae of the donor site are minimal. On the other hand, the pedicle used is short and the flap cannot be surgically reinnervated. Nevertheless, the restoration of a protective sensitivity allows the implantation of a penile prosthesis.
The Latissimus Dorsi flap (or LD flap) was first described by the Tansini in 1896 and published in 1906. It concerned a case of chest wall reconstruction after breast amputation. The use of the LD ...flap in all its variants is very frequent in breast reconstruction. In these indications, the muscle is harvested for skin paddle vascularization and/or for bringing volume to the reconstructed breast. When all or most of the muscle is taken, its motor function is completely lost. The functional sequelae due to the loss of the latissimus dorsi muscle are then definitive. Tobin et al. showed that the LD muscle can be separated into two flaps based on the division of the thoracodorsal artery; the concept of muscle-sparing was then posed (Muscle-Sparing Latissimus Dorsi MSLD). The MSLD as we perform now, concerns only a thin muscle strip and preserves 95% of the LD muscle with its vascularization and motor innervation. This technique is quick with very low donor site morbidity. The functional sequelae and postoperative complications appear limited compared to the harvest of a total LD whatever the posterior scar. The volume of the breast to be reconstructed is obtained by several sessions of fat grafting. We present here the anatomical bases and the surgical technique of the muscle-sparing latissimus dorsi associated with a thoracoabdominal advancement flap and fat grafting in breast reconstruction.
Savanna is a species-rich biome, that includes many modern mammal lineages and C₄ grass (Poaceae) species. The greater productivity and grazing pressure associated with savannas is likely ...attributable to the foliar traits of the grasses they support. Thus, it is important to understand the complex relationships between the abiotic environment, foliar attributes and the floristic composition of savanna grasses, and the supported grazer densities. We sampled 37 grass communities in the Kruger National Park (South Africa) across three soil types and along a rainfall gradient and found that these communities lack strong phylogenetic structure. We then measured specific leaf area and leaf tensile strength for 384 individuals representing 66 species and found that both traits were strongly phylogenetically structured and associated with both rainfall and soil type. Finally, we found that grazer densities in the Park are correlated with the foliar traits of the associated grass communities, but the resolution of our data do not allow for a thorough analysis of this association. Our results demonstrate the complex interactions between climate, soils and grazer densities relative to C₄ grass functional traits.
To provide an overview of cadaver models for cardiac arrest and to identify the most appropriate cadaver model to improve cardiopulmonary resuscitation through a systematic review.
The search ...strategy included PubMed, Embase, Current contents, Pascal, OpenSIGLE and reference tracking. The search concepts included “heart arrest”, “cardiopulmonary resuscitation” and “cadavers”. All studies, published until February 2019, in English or French, on research or simulation in the field of cardiac arrest and using cadaver models were eligible for inclusion.
Overall, 29 articles out of the 244 articles located were selected. The characteristics of the studies and the cadaver models were heterogenous. Indeed, 31% of the studies lacked a proper description of the model used and its specificities. Fresh cadavers were used in 55% of the studies and chest compressions were performed in 90%. This model was appreciated for its realism in terms of mechanical properties and tissue conservation. Thiel-embalmed cadavers also showed promising results concerning lung and chest compliance. The lack of circulation stood out as the strongest limitation of all types of human cadaver models.
Four types of cadaver models are used in cardiac arrest research. The great heterogeneity of these models coupled with unequal quality in reporting makes comparisons between studies difficult. There is a need for uniform reporting and standardisation of human cadaver models in cardiac arrest research.
This study investigated the associations of both bacteriological cure and quarter somatic cell count (SCC) after intramammary antibiotic treatment with treatment duration, cow characteristics, and ...pretreatment bacteriology and SCC. For the purpose of this paper, data from 2 treatment groups in each of 2 multi-location studies were selected. These studies were conducted to evaluate the efficacy of daily intramammary infusions with 50mg of pirlimycin hydrochloride for the treatment of subclinical mastitis. Data from study 1 allowed for comparison of a group of cows that received pirlimycin intramammarily for 2 d with a group that received no treatment, and study 2 provided data for comparison of pirlimycin for 2 d with pirlimycin for 8 d. Quarter milk samples from cows with a high monthly SCC were tested for bacteriology and SCC. If one or more quarters had both a positive bacteriology and an SCC ≥300,000 cells/mL, the cow was enrolled and randomly allocated to a treatment group. Enrolled cows were monitored for clinical mastitis and other disease for 4 wk after treatment initiation. At 3 and 4 wk after treatment initiation, milk samples were taken from each enrolled quarter to determine the SCC and conduct a bacteriological culture. Bacteriological culture results were interpreted such that quarters where the same bacterial species was cultured before treatment and found in at least 1 of the 2 posttreatment samples were considered a failure. The analysis of SCC used a mixed linear model (SAS proc mixed) and the analysis of bacteriological cure used a mixed logistic model (SAS glimmix macro). Bacteriological cure rate was significantly higher for lower parity, lower number of colonies in the pretreatment culture, longer treatment duration, and for streptococci compared with Staphylococcus aureus. However, treatment regimen affected bacteriological cure differently in major than in minor pathogens and there was a significant interaction of treatment regimen with stage of lactation. Posttreatment SCC was significantly higher with increasing parity, in rear quarters, and with shorter duration of treatment. In the group of second and third parity animals, post-treatment SCC was more reduced in front quarters than in rear quarters. Also, the difference in posttreatment SCC between younger and older cows increased with higher pretreatment SCC. In conclusion, when predicting bacteriological cure following treatment of subclinical mastitis during lactation both treatment regimen and other risk factors need to be considered. The other risk factors may vary with treatment regimen. Posttreatment SCC was associated with treatment regimen, other risk factors, and interactions among the other risk factors; but these other risk factors did not vary significantly with treatment regimen.
The status of the development of triple-junction (amorphous silicon/microcrystalline/microcrystalline silicon) test cells fabricated with up-scalable PECVD processes is given. A first draft of novel ...rather flat scattering superstrates with an optimized high bandgap amorphous silicon top cell including a carbon-free buffer at the p/i interface is presented. The careful optimization of the interfaces (including sub-oxide doped layers and buffers) and of the bulk crystallinity of the middle and bottom microcrystalline sub-cells allowed to reach a stabilized efficiency of 13.5 % (after 1000h light-soaking, internal measurement). Sub-cells individual developments are discussed and their specific integration into the full triple-junction device with its optimization for AM1.5G illumination relying on a partly LED supported solar simulator characterization is presented.
•The very high stable efficiency achieved: 13.5% (internal measurement).•Rather flat scattering substrate is favorable to a high quality top cell.•A carbon-free buffer has brought increased stability.•Oxide-based doped and buffer layers are introduced.•The precisely controlled crystallinity of the i-layers lead to a marked benefit.
Thin film tandem solar cells based on amorphous and microcrystalline silicon (MicromorphTM in superstrate configuration) benefit from strongly light-scattering nano-textured substrates. A development ...methodology for the evaluation of the performance of the Micromorph test cells deposited on such substrates with very different surface shapes is presented and illustrated. It is shown that growth related defects and non-conformal coverage of the silicon layers restrict the choice of surface shapes for this photovoltaic application. General guidelines are given in this study for the preferred selection of the surface geometry for MicromorphTM test cells. The results indicate that the application of advanced surface shapes for higher conversion efficiencies requires improved silicon deposition process compared to current industrial state-of-the-art.
•A Introduction of new statistical surface parameter called “Rare High Pyramid”.•Quantification of silicon thickness spatial distribution•A large set of nano-imprinted superstrates is evaluated.•PECVD processes are qualitatively assessed with respect to silicon layer quality.
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