Assessment of Carbon Sequestration in Private Forests across Two Different Physiographic Regions of Nepal: Implications for Conservation and Climate Change Mitigation.

Private forests offer diverse ecosystem services, including carbon sequestration and biodiversity conservation, which are crucial for Nepal. However, there is a notable absence of comprehensive research on these services. Assessing carbon sequestration in private forests can have economic advantages for forest owners by promoting resource conservation and contributing to greenhouse gas reduction. This study aims to estimate and compare carbon stocks in private forests located in two distinct physiographic regions of Nepal while also identifying the factors influencing these carbon stocks. The analysis focuses on 16 private forests (with 0.1 to 0.5 hectares) each from Chitwan district (Terai region) and Kavrepalanchok district (Hilly region). Field data collection involved direct measurements of tree and sapling diameter at breast height (DBH), as well as height and class of trees and poles, utilizing a total enumeration method. These collected values were utilized to calculate aboveground biomass (AGTB), aboveground sapling biomass (AGSB), belowground biomass, and carbon stock. Private forests of Terai region were dominated by Shorea borneensis, Tectona grandis, and Dalbergia sissoo, whereas the Hilly region was dominated by Pinus patula, Alnus nepalensis, Schima wallichii, and Quercus leucotrichophora. The aboveground biomass carbon in the Terai region's private forests was estimated to be 83.53 t·ha-1, while in the Hilly region, it was 37.32 t·ha-1. The belowground biomass carbon in the Terai region's private forests was found to be 21.72 t·ha-1, compared to 9.70 t·ha-1 in the Hilly region. Consequently, the estimated total carbon stock in the Terai and Hilly regions' private forests was 105.25 t·ha-1 (386.26 t·ha-1 CO2-eq) and 47.02 t·ha-1 (172.57 t·ha-1 CO2-eq), respectively. Carbon sequestration in the Terai region's private forests was discovered to be 2.24 times higher than that in the Hilly region. These findings underscore the significant potential of private forests, which can generate economic benefits through carbon trading and leverage mechanisms such as REDD+/CDM to promote sustainable conservation practices.

Above ground tree biomass modeling using machine learning algorithms in western Terai Sal Forest of Nepal.

The monitoring of forest biomass is a crucial biophysical parameter in forest ecosystems, as it provides valuable information for managing forests sustainably and tracking carbon circulation statistics. To achieve sustainable forest management, it is essential to monitor and study forest resources, particularly biomass. This study aimed to model above ground tree biomass (AGTB) using Machine Learning Algorithms (MLAs) in the western terai Sal forest of Nepal. AGTB was calculated using a systematic inventory sample plot, while spectral and textural variables were processed and masked for the study area using Sentinel-2A satellite imagery. Three MLAs namely support vector machine (SVM), random forest (RF), and stochastic gradient boosting (SGB), were employed for modeling with eight categorized variable datasets. Among the MLAs, the RF algorithm with a combination of gray-level co-occurrence matrix (GLCM) and raw bands (RB) dataset variable demonstrated the best performance, with a low RMSE value of 78.81 t ha-1 in the test data. However, the AGTB range from this model ranged from 118.34 to 425.97 t ha-1. The study found that traditional indices, raw bands, and GLCM texture from near-infrared were important variables for AGTB. Nevertheless, the RF algorithm and the dataset combination of GLCM plus raw bands (RB) exhibited excellent performance in all model runs. Thus, this pioneering study on comparative MLAs-based AGTB assessment with multiple datasets variables can provide valuable insights for new researchers and the development of novel approaches for biomass/carbon estimation techniques in Nepal.

Dual-specificity protein phosphatase 6 (DUSP6) overexpression reduces amyloid load and improves memory deficits in male 5xFAD mice.

Background: Dual specificity protein phosphatase 6 (DUSP6) was recently identified as a key hub gene in a causal network that regulates late-onset Alzheimer's disease. Importantly, decreased DUSP6 levels are correlated with an increased clinical dementia rating in human subjects, and DUSP6 levels are additionally decreased in the 5xFAD amyloidopathy mouse model. Methods: AAV5-DUSP6 or AAV5-GFP (control) were stereotactically injected into the dorsal hippocampus (dHc) of female and male 5xFAD or wild type mice to overexpress DUSP6 or GFP. Spatial learning memory of these mice was assessed in the Barnes maze, after which hippocampal tissues were isolated for downstream analysis. Results: Barnes maze testing indicated that DUSP6 overexpression in the dHc of 5xFAD mice improved memory deficits and was associated with reduced amyloid plaque load, Aß 1-40 and Aß 1-42 levels, and amyloid precursor protein processing enzyme BACE1, in male but not in female mice. Microglial activation and microgliosis, which are increased in 5xFAD mice, were significantly reduced by dHc DUSP6 overexpression in both males and females. Transcriptomic profiling of female 5xFAD hippocampus revealed upregulated expression of genes involved in inflammatory and extracellular signal-regulated kinase (ERK) pathways, while dHc DUSP6 overexpression in female 5xFAD mice downregulated a subset of genes in these pathways. A limited number of differentially expressed genes (DEGs) (FDR<0.05) were identified in male mice; gene ontology analysis of DEGs (p<0.05) identified a greater number of synaptic pathways that were regulated by DUSP6 overexpression in male compared to female 5xFAD. Notably, the msh homeobox 3 gene, Msx3 , previously shown to regulate microglial M1/M2 polarization and reduce neuroinflammation, was one of the most robustly upregulated genes in female and male wild type and 5xFAD mice overexpressing DUSP6. Conclusions: In summary, our data indicate that DUSP6 overexpression in dHc reduced amyloid deposition and memory deficits in male but not female 5xFAD mice, whereas reduced neuroinflammation and microglial activation were observed in both males and females. The sex-dependent regulation of synaptic pathways by DUSP6 overexpression, however, correlated with the improvement of spatial memory deficits in male but not female 5xFAD.

Electronic correlations in epitaxial CrN thin film.

Chromium nitride (CrN) spurred enormous interest due to its coupled magnetostructural and unique metal-insulator transition. The underneath electronic structure of CrN remains elusive. Herein, the electronic structure of epitaxial CrN thin film has been explored by employing resonant photoemission spectroscopy (RPES) and X-ray absorption near edge spectroscopy study in combination with the first-principles calculations. The RPES study indicates the presence of a charge-transfer screened 3[Formula: see text] ([Formula: see text]: hole in the N-2[Formula: see text]) and 3[Formula: see text] final-states in the valence band regime. The combined experimental electronic structure along with the orbital resolved electronic density of states from the first-principles calculations reveals the presence of Cr(3[Formula: see text])-N(2[Formula: see text]) hybridized (3[Formula: see text]) states between lower Hubbard (3[Formula: see text]) and upper Hubbard (3[Formula: see text]) bands with onsite Coulomb repulsion energy (U) and charge-transfer energy ([Formula: see text]) estimated as [Formula: see text] 4.5 and 3.6 eV, respectively. It verifies the participation of ligand (N-2[Formula: see text]) states in low energy charge fluctuations and provides concrete evidence for the charge-transfer ([Formula: see text]U) insulating nature of CrN thin film.

Management of Biliary Cysts in Adults: A Single-Center 10-Year Experience.

BACKGROUND: A choledochal cyst is a cystic dilatation of the biliary tree, also termed a biliary cyst, including an intrahepatic cyst as well. Magnetic resonance cholangiopancreatography (MRCP) is the gold standard investigation of choice for this pathology. Todani classification is most commonly used to classify choledochal cysts. MATERIALS AND METHODS: A total of 30 adult patients with choledochal cysts presenting at our center from December 1, 2009, to October 31, 2019, were studied retrospectively. RESULTS: The mean age was 35.13 years ranging from 18 to 62 years with a male-to-female ratio of 1:3.29. Of the patients, 86.6% presented with abdominal pain. Total serum bilirubin was raised in six patients with a mean of 1.84 mg/dL. MRCP was done in all patients, which had almost 100% sensitivity. Two cases had anomalous pancreaticobiliary duct union. In our study, we found only type I and type IVA cysts according to the Todani classification (type IA = 56.3%, IB = 11%, 1C = 16%, and IVA = 17%). The mean size of the cyst was 2.37 cm. Complete cyst excision with Roux-en-Y hepaticojejunostomy was performed in all patients. Four patients had surgical site infections and two had bile leaks. One patient developed hepatic artery thrombosis. All complications were eventually managed conservatively. Mortality was nil in our study with the mean postoperative stay being 7.97 days. CONCLUSION: Adult presentation of biliary cysts is not an uncommon entity in the Indian population and should be considered as a differential diagnosis of biliary pathology in adult patients. Complete excision of cysts with bilioenteric anastomosis is the current treatment of choice.

Dual-Specificity Protein Phosphatase 4 (DUSP4) Overexpression Improves Learning Behavior Selectively in Female 5xFAD Mice, and Reduces ß-Amyloid Load in Males and Females.

Recent multiscale network analyses of banked brains from subjects who died of late-onset sporadic Alzheimer's disease converged on VGF (non-acronymic) as a key hub or driver. Within this computational VGF network, we identified the dual-specificity protein phosphatase 4 (DUSP4) [also known as mitogen-activated protein kinase (MAPK) phosphatase 2] as an important node. Importantly, DUSP4 gene expression, like that of VGF, is downregulated in postmortem Alzheimer's disease (AD) brains. We investigated the roles that this VGF/DUSP4 network plays in the development of learning behavior impairment and neuropathology in the 5xFAD amyloidopathy mouse model. We found reductions in DUSP4 expression in the hippocampi of male AD subjects, correlating with increased CDR scores, and in 4-month-old female and 12-18-month-old male 5xFAD hippocampi. Adeno-associated virus (AAV5)-mediated overexpression of DUSP4 in 5xFAD mouse dorsal hippocampi (dHc) rescued impaired Barnes maze performance in females but not in males, while amyloid loads were reduced in both females and males. Bulk RNA sequencing of the dHc from 5-month-old mice overexpressing DUSP4, and Ingenuity Pathway and Enrichr analyses of differentially expressed genes (DEGs), revealed that DUSP4 reduced gene expression in female 5xFAD mice in neuroinflammatory, interferon-gamma (IFNγ), programmed cell death protein-ligand 1/programmed cell death protein 1 (PD-L1/PD-1), and extracellular signal-regulated kinase (ERK)/MAPK pathways, via which DUSP4 may modulate AD phenotype with gender-specificity.

Neurotrophin Crosstalk in the Etiology and Treatment of Neuropsychiatric and Neurodegenerative Disease.

This article reviews the current progress in our understanding of the mechanisms by which growth factors, including brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF), and select neurotrophin-regulated gene products, such as VGF (non-acronymic) and VGF-derived neuropeptides, function in the central nervous system (CNS) to modulate neuropsychiatric and neurodegenerative disorders, with a discussion of the possible therapeutic applications of these growth factors to major depressive disorder (MDD) and Alzheimer's disease (AD). BDNF and VEGF levels are generally decreased regionally in the brains of MDD subjects and in preclinical animal models of depression, changes that are associated with neuronal atrophy and reduced neurogenesis, and are reversed by conventional monoaminergic and novel ketamine-like antidepressants. Downstream of neurotrophins and their receptors, VGF was identified as a nerve growth factor (NGF)- and BDNF-inducible secreted protein and neuropeptide precursor that is produced and trafficked throughout the CNS, where its expression is greatly influenced by neuronal activity and exercise, and where several VGF-derived peptides modulate neuronal activity, function, proliferation, differentiation, and survival. Moreover, levels of VGF are reduced in the CSF of AD subjects, where it has been repetitively identified as a disease biomarker, and in the hippocampi of subjects with MDD, suggesting possible shared mechanisms by which reduced levels of VGF and other proteins that are similarly regulated by neurotrophin signaling pathways contribute to and potentially drive the pathogenesis and progression of co-morbid neuropsychiatric and neurodegenerative disorders, particularly MDD and AD, opening possible therapeutic windows.

Economic burden of hospital malnutrition: A cost-of-illness model.

BACKGROUND & AIMS: Hospital malnutrition is a highly prevalent condition that leads to an increased risk of clinical complications and a corresponding increase in healthcare resource utilisation. Despite the high prevalence and adverse clinical consequences, limited data are available on the magnitude of the economic burden associated with hospital malnutrition in Asian countries. The aim of the present analysis was to calculate country-specific estimates of the economic burden of hospital malnutrition in Asia. METHODS: Country-specific cost and prevalence data were used to calculate the incremental healthcare costs attributable to hospital malnutrition in 11 countries in Asia. The cost-of-illness was evaluated from the public perspective. Sources of increased cost included increased length of stay (LOS) and increased antibiotic use in malnourished patients who develop a healthcare-associated infection. Costs were calculated separately for the ward and intensive care unit (ICU) and currencies were converted to US$ to facilitate comparison. RESULTS: The estimated annual economic burden attributable to hospital malnutrition in Asia is $30.1 billion. Increased LOS accounts for the largest portion of the incremental cost, totalling $23.2 billion (77.2%) in the ward and $3.5 billion (11.5%) in the ICU. Medication costs related to the treatment of infectious complications account for an additional $3.4 billion (11.3%). Countries with the highest incremental costs include Japan ($19 billion), South Korea ($2.5 billion), and Taiwan ($2.2 billion). CONCLUSIONS: Hospital malnutrition imposes a substantial economic burden on Asian countries, resulting in an estimated $30 billion per year in additional healthcare costs. This finding underscores the need for rigorous screening and assessment as well as continuous monitoring of nutrition status in hospitalised patients to facilitate early identification and proactive management of hospital malnutrition.

Land Cover Change and Its Impact in Crop Yield: A Case Study from Western Nepal.

This study was conducted in Tanahun district of Gandaki Province, Nepal, to analyze the land cover change over two decades, the migration effect in land cover, and the impact caused in crop production by Rhesus macaque. Landsat TM/ETM+ for land use of 2000 and 2010 extracted by ICIMOD and Landsat 8 OLI/TIRS satellite images for land cover 2019 were downloaded from the USGS website. A purposive sample for household survey was carried out based on crops damaged by the monkey. Two hundred and fifty households were taken as samples. The Landsat images were analyzed by ArcGIS, and the social data were analyzed using SPSS and MS Excel. Land cover change data revealed increment of forest cover from 36.57% to 40.91% and drastic decrease in agriculture crops from 57.52% to 43.78% in the period of 20 years. The accuracy of the data showed overall classification accuracy of 86.11%, 81.08%, and 75% with overall kappa statistics 0.83, 0.77, and 0.74, respectively. The migration effect in the land cover was related to remittance and migrated members and found a significant positive relationship. Analyzing the trend of production with an increase in the forest cover, 21% decrease in paddy, 5% decrease in maize, and 26% decrease in millet were found as compared to the production in 2000. The econometric model concluded that the quantity of crop damage was negatively significant in relation to distance from forest and distance from water body while positively significant to distance from settlements and distance from owner's home. The quantity of crop damage was estimated 113.89 kg per household, and the cost was 78.82 USD. This study recommends active forest management; regular thinning, and weeding. Remittance generated should be invested in the agriculture field by the households. Damage relief should be made available for the damage cost by Rhesus macaque.

Synthesis of hierarchical structured Gd doped α-Sb2O4 as an advanced nanomaterial for high performance energy storage devices.

Bimetallic oxide nanostructures (NS) of Gdx: α-Sb2O4 (x = 5, 8, 10 wt.%) emerged as novel electrode material for batteries as they exhibit large specific capacity and cyclic stability. Crystal structure of Gd: α-Sb2O4 NS investigated by X-ray diffraction (XRD) patterns and identified as mixed orthorhombic phase. Surface chemical composition, binding energies of the metal oxides and incorporation of Gd into α-Sb2O4 NS analysed by XPS (X-ray photoelectron spectral) studies. Microstructure analysis reveals that distinctive flower/flake like arrays with agglomeration. Morphology, structure and physical/chemical properties of the resulting nanostructure were analysed by SEM (scanning electron microscopy), SEM-EDX (scanning electron microscopy-energy dispersive X-ray), BET (Brunauer-Emmett-Teller), XPS, UV-Visible and XRD studies. Electrochemical performances of Gdx: α-Sb2O4 (x = 10 wt.%) in 6 M KOH aqueous solution dipped in three electrode system evaluated by CV (cyclic voltammetry), GCD (galvanostatic charge-discharge) and EIS (electrochemical impedance spectroscopy) measurements. The as-synthesized NS exhibited higher specific capacitance of 958 mAh/g at a current density of 0.15 A/g and excellent cyclic stability with 86.5% capacitive retention after 1000 cycles. Distinctive flower/flake like structure, large surface area, and abundant active sites of Gdx: α-Sb2O4 NS could be the reason for significant increase in charge transfer and storage. In brief this work offers facile method to synthesize Gdx: α-Sb2O4 NS are promising electrode materials for potential applications in high performance super capacitor.

A multinational observational study of clinical nutrition practice in patients undergoing major gastrointestinal surgery: The Nutrition Insights Day.

BACKGROUND AND AIMS: Patients undergoing major gastrointestinal (GI) surgery, particularly those with malignancies, have a high risk for malnutrition, requiring perioperative nutritional support to reduce complications. During the Nutrition Insights Day (NID), nutritional data of this patient population were documented in seven Asian countries. METHODS: Observational, cross-sectional study with retrospective data collection of nutritional status, calorie/protein targets/intake, and type of clinical nutrition for up to 5 days before NID. INCLUSION CRITERIA: Adult patients following major GI surgery, pre-existing/at (high) risk for malnutrition, on enteral (EN) and/or parenteral nutrition (PN) and latest surgery within 10 days before the NID. EXCLUSION CRITERIA: Burns, mechanical ventilation on NID, oral nutrition and/or oral nutritional supplements (ONS) on the day before the NID, and emergency procedures. RESULTS: 536 patients from 83 hospitals, mean age 58.8 ± 15.1 years, 59.1% males, were eligible. Leading diagnosis were GI diseases (48.7%) and GI cancer (45.9%). Malnutrition risk was moderate to high in 54% of patients, low in 46%. Hospital length of stay (LOS) before the NID was 9.3 ± 19.0 days, and time since last surgery 3.7 ± 2.4 days. Lowest caloric/protein deficits were observed in patients receiving EN + PN, followed by PN alone and EN alone. Type of clinical nutrition, Body Mass Index and LOS on surgical intensive care unit (SICU) and/or surgical ward were independent predictors of caloric and of protein deficit. CONCLUSION: There is a high prevalence of postoperative nutritional deficits in Asian GI surgery patients, who are either preoperatively malnourished or at risk of malnutrition, indicating a need to improve nutritional support and education.

Hospital malnutrition in northeast and southeast Asia: A systematic literature review.

BACKGROUND & AIMS: Hospital malnutrition is a prevalent yet frequently under-recognised condition that is associated with adverse clinical and economic consequences. Systematic reviews from various regions of the world have provided regional estimates of the prevalence of malnutrition and the magnitude of the associated health and economic burden; however, a systematic assessment of the prevalence and consequences of hospital malnutrition in northeast and southeast Asia has not been conducted. METHODS: We performed a systematic literature search for articles on hospital malnutrition in 11 Asian countries published in English between January 1, 1997 and January 15, 2018. Studies reporting data on the prevalence, clinical consequences, or economic impact of hospital malnutrition in an adult inpatient population with a sample size ≥30 were eligible for inclusion. RESULTS: The literature search identified 3207 citations; of these, 92 studies (N = 62,280) met the criteria for inclusion. There was substantial variability in study populations and assessment methods; however, a majority of studies reported a malnutrition prevalence of >40%. Malnutrition was associated with an increase in clinical complications, mortality, length of hospitalisation, hospital readmissions, and healthcare costs. CONCLUSIONS: Hospital malnutrition is a highly prevalent condition among hospitalised patients in northeast and southeast Asia. Additionally, poor nutritional status is associated with increased morbidity and mortality and increased healthcare costs. Further research aimed at improving the identification and proactive management of hospitalised patients at risk for malnutrition is necessary to improve patient outcomes and alleviate the burden on local healthcare budgets.

Arterioenteric Fistulae Due to Pseudoaneurysms of the Right Common Iliac and Splanchnic Vessels Presenting as Upper GI Bleed.

Arterial pseudoaneurysms are relatively rare complications of the vascular system. Many cases may remain asymptomatic for a lifetime only to be discovered incidentally, whereas others may cause fatal hemorrhage. Majority of cases present with local compressive symptoms. Rarely, it has been implicated as an etiology for gastrointestinal (GI) bleed by eroding into an adjacent bowel, with splanchnic pseudoaneurysm being more commonly responsible as compared to peripheral ones. Although rare, they are an important consideration because of the high mortality rate. They require a high index of suspicion with prompt diagnosis and expedient treatment, either surgical or endovascular. In this study, we report a case series of a right iliacoduodenal and 2 splanchnic pseudoaneurysms presenting as upper GI bleeding. These 3 cases presented with occult source of hematemesis due to the formation of arterioenteric fistula. Also discussed are the diagnostic approach used and successful treatment methods, which included placing endoprosthesis in the aorta and common iliac artery and endovascular coiling for respective cases. To the best of our knowledge, such a case of common iliac pseudoaneurysm presenting with massive hematemesis due to fistulization into duodenum has never been reported previously.

Midterm survivorship and clinical outcome of INDUS knee prosthesis: 5 year followup study.

BACKGROUND: INDUS knee implant has been designed as per the anatomical morphology of the Indian population and has shown good clinical outcome in short term studies. The purpose of the present study was to report the midterm survivorship and clinical outcome of this implant. MATERIALS AND METHODS: Two hundred and twenty three primary total knee arthroplasties in 209 consecutive patients using the INDUS knee prosthesis were prospectively enrolled. There were 145 females (155 knees) and 64 males (68 knees) with a mean age of 69.95 years (range 42-86 years). Annual followup with clinical and radiological examination was conducted, and a survivorship analysis was done using the Kaplan-Meier analysis. RESULTS: Mean followup was 5.8 years (range 5-6.5 years). Eleven patients died while eight were lost to followup and a total of 204 knees were available for followup. The mean knee flexion improved from preoperative 110.4° ± 11.24° (range 60°-130°) to 128.17° ± 8.32° (range 100°-140°) at the final followup. The mean knee score improved from 40.1 ± 10.7 to 90.3 ± 5.34 while the function score improved from 44.35 ± 12.9 to 89.58 ± 7.43. Two patient developed infection and required revision. The Kaplan-Meier analysis reported a survivorship of 98.6% (confidence interval 95.7-99.6%) at the end for 5 years for INDUS knee prosthesis. CONCLUSION: INDUS knee prosthesis has excellent survivorship with a good clinical outcome and low failure rate.

A Rare Case of Urachal Sinus.

Abnormalities in the closure of the intraembryonic portion of the allatoic lumen result in urachal abnormalities. Urachal remnant diseases are rare in adults. Malignant urachal neoplasms, like adenocarcinoma which may probably occur due to metaplasia of the transitional epithelium of the urachal remnant are very rare. Surgical excision of the urachus is needed. The imaging features of the urachal abnormalities are important for correct diagnosis and surgical management.

Echocardiography before and after resect-plicate-release surgical myectomy for obstructive hypertrophic cardiomyopathy.

BACKGROUND: Anatomic features of obstructive hypertrophic cardiomyopathy are septal hypertrophy, elongated mitral leaflets, and anterior displacement of the papillary muscles. In addition to extended myectomy, the resect-plicate-release operation adds horizontal plication of the anterior mitral leaflet (AML) and release of the anterolateral papillary muscle (APM) in selected patients. The aim of this study was to test the hypotheses that (1) preoperative findings would be associated with procedures applied, (2) anatomic corrections would be observable postoperatively, and (3) there would be consistently good physiologic outcomes. METHODS: A retrospective study was conducted of patients with obstructive hypertrophic cardiomyopathy who had adequate echocardiograms before and 9.5 ± 12 months after the resect-plicate-release operation was performed from 2006 to 2012. RESULTS: Seventy-seven patients underwent myectomy, 50 AML plication, and 50 APM release. Patients who underwent plication had longer AMLs (32 ± 4 vs 28 ± 4 mm; P < .004). Anterior extension of the APM was more common with papillary muscle release (86% vs 62%, P < .04). Twenty-seven (35%) had septal thickness ≤ 18 mm; mitral valve-sparing operations were possible because of plication in 19 patients (70%), papillary release in 21 (78%), and one or both in 96%. Patients who underwent plication had decreased AML length by 16%, residual leaflet length by 33%, and protrusion by 24%. After APM release, there was decreased distance from mitral coaptation to the posterior wall. Surgery abolished severe systolic anterior motion and resting gradients and reduced mitral regurgitation. CONCLUSIONS: Echocardiographic AML length and directly observed slack provides a basis to recommend performance of plication and define its extent; plication decreases AML protrusion and stiffens the leaflet. Anterior APM recommends release, which drops the coaptation point posteriorly. Systematic relief of all aspects of obstructive pathophysiology results in consistent outcomes.

Hypergiant hepatic hemangiomas: case series.

Hemangiomas are the most common benign tumors of the liver. Hepatic hemangiomas originate from the proliferation of vascular endothelial cells, and enlarge by ectasia rather than hyperplasia. They are very variable in size and are classified accordingly and their management in the larger variety is debatable. Hypergiant hepatic hemangiomas are defined as those which are more than 10 cm in size. These are fairly uncommon in clinical practice. The treatment spectrum varies from masterly inactivity to resection depending upon a number of factors. We report a series of 10 cases of hyper giant hepatic hemangiomas studied and reviewed over a period of 5 years. These were evaluated with respect to their age, gender, clinical presentation, investigation findings, treatment offered, and final outcome. Five were treated with resection, four with enucleation, and one was kept under observation. All operated patients had an uneventful post-operative recovery and the one managed conservatively was asymptomatic on follow-up.

Pocket infections of cardiac implantable electronic devices treated by negative pressure wound therapy.

AIMS: Managing an infection of the pocket of a cardiac implantable electronic device (CIED) is frequently challenging. The wound is often treated with a drain or wet-to-dry dressings that allow healing by secondary intention. Such treatment can prolong the hospital stay and can frequently result in a disfiguring scar. Negative pressure wound therapy (NPWT) has been frequently used to promote the healing of chronic or infected surgical wounds. Here we describe the first series of 28 patients in which NPWT was successfully used to treat CIED pocket infections. METHODS AND RESULTS: After removal of the CIED and debridement of the pocket, a negative pressure of 125 mmHg continuously applied to the wound through an occlusive dressing. Negative pressure wound therapy was continued for a median of 5 days (range 2-15 days) and drained an average of 260 mL sero-sanguineous fluid (range 35-970 mL). At the conclusion of NPWT, delayed primary closure of the pocket was performed with 1-0 prolene mattress sutures. The median length of stay after CIED extraction was 11.0 days (range 2-43 days). Virtually all infected pockets healed without complications and without evidence of recurrent infection over a median follow-up of 49 days (range 10-752 days). One patient developed a recurrent infection when NPWT was discontinued prematurely and a new device was implanted at the infected site. CONCLUSION: We conclude that NPWT is a safe and effective means to promote healing of infected pockets with a low incidence of recurrent infection and a satisfactory cosmetic result.