Performance of CBNAAT on Pleural Biopsies Obtained by Semirigid Thoracoscopy for Diagnosis of Unexplained Pleural Effusion: A Prospective Study from North India.

BACKGROUND: Exudative pleural effusions are commonly encountered in clinical practice, but in about one-fourth of cases, etiology remains elusive after initial evaluation. Medical thoracoscopy with semirigid thoracoscope is a minimally invasive procedure with high diagnostic yield for diagnosing pleural diseases, especially these undiagnosed exudative pleural effusions. In tubercular endemic areas, often, these effusions turn out to be tubercular, but the diagnosis of tubercular pleural effusion is quite challenging due to the paucibacillary nature of the disease. Although culture is the gold standard, it is time-consuming. Cartridge-based nucleic acid amplification test (CBNAAT) is a novel rapid diagnostic test for tuberculosis (TB) and has been recommended as the initial diagnostic test in patients suspected of having extrapulmonary TB (EPTB). MATERIALS AND METHODS: We conducted a prospective observational study of 50 patients with undiagnosed pleural effusion admitted to our tertiary care hospital. The primary aim of the study is to evaluate the diagnostic performance of CBNAAT on thoracoscopic guided pleural biopsy and compare it with conventional diagnostic techniques like histopathology and conventional culture. RESULTS: Of 50 undiagnosed pleural effusions, TB (50%) was the most common etiology. The overall diagnostic yield of semirigid thoracoscopy in this study was 74%. Our study showed that CBNAAT of pleural biopsies had a sensitivity of 36% only but a specificity of 100%. The sensitivity of CBNAAT was not far superior to the conventional culture. CONCLUSION: Tuberculosis (TB) is a common cause of undiagnosed pleural effusion in our set-up. CBNAAT testing of pleural biopsy, though, is a poor rule-out test for pleural TB, but it may aid in the early diagnosis of such patients.

An integrative proteomics approach identifies tyrosine kinase KIT as a therapeutic target for SPINK1-positive prostate cancer.

Elevated serine peptidase inhibitor, Kazal type 1 (SPINK1) levels in ∼10%-25% of prostate cancer (PCa) patients associate with aggressive phenotype, for which there are limited treatment choices and dismal clinical outcomes. Using an integrative proteomics approach involving label-free phosphoproteome and proteome profiling, we delineated the downstream signaling pathways involved in SPINK1-mediated tumorigenesis and identified tyrosine kinase KIT as highly enriched. Furthermore, high to moderate levels of KIT expression were detected in ∼85% of SPINK1-positive PCa specimens. We show KIT signaling orchestrates SPINK1-mediated oncogenesis, and treatment with KIT inhibitor reduces tumor growth and metastases in preclinical mice models. Mechanistically, KIT signaling modulates WNT/ß-catenin pathway and confers stemness-related features in PCa. Notably, inhibiting KIT signaling led to restoration of AR/REST levels, forming a feedback loop enabling SPINK1 repression. Overall, we uncover the role of KIT signaling downstream of SPINK1 in maintaining lineage plasticity and provide distinct treatment modalities for advanced-stage SPINK1-positive patients.

Exosomes derived from LPS-preconditioned bone marrow-derived MSC modulate macrophage plasticity to promote allograft survival via the NF-κB/NLRP3 signaling pathway.

OBJECTIVES: This study investigated whether exosomes from LPS pretreated bone marrow mesenchymal stem cells (LPS pre-MSCs) could prolong skin graft survival. METHODS: The exosomes were isolated from the supernatant of MSCs pretreated with LPS. LPS pre-Exo and rapamycin were injected via the tail vein into C57BL/6 mice allografted with BALB/c skin; graft survival was observed and evaluated. The accumulation and polarization of macrophages were examined by immunohistochemistry. The differentiation of macrophages in the spleen was analyzed by flow cytometry. For in vitro, an inflammatory model was established. Specifically, bone marrow-derived macrophages (BMDMs) were isolated and cultured with LPS (100 ng/ml) for 3 h, and were further treated with LPS pre-Exo for 24 h or 48 h. The molecular signaling pathway responsible for modulating inflammation was examined by Western blotting. The expressions of downstream inflammatory cytokines were determined by Elisa, and the polarization of macrophages was analyzed by flow cytometry. RESULTS: LPS pre-Exo could better ablate inflammation compared to untreated MSC-derived exosomes (BM-Exo). These loaded factors inhibited the expressions of inflammatory factors via a negative feedback mechanism. In vivo, LPS pre-Exo significantly attenuated inflammatory infiltration, thus improving the survival of allogeneic skin graft. Flow cytometric analysis of BMDMs showed that LPS pre-Exo were involved in the regulation of macrophage polarization and immune homeostasis during inflammation. Further investigation revealed that the NF-κB/NLRP3/procaspase-1/IL-1ß signaling pathway played a key role in LPS pre-Exo-mediated regulation of macrophage polarization. Inhibiting NF-κB in BMDMs could abolish the LPS-induced activation of inflammatory pathways and the polarization of M1 macrophages while increasing the proportion of M2 cells. CONCLUSION: LPS pre-Exo are able to switch the polarization of macrophages and enhance the resolution of inflammation. This type of exosomes provides an improved immunotherapeutic potential in prolonging graft survival.

Implant Size Selection on the Basis of Period, Parity, and Age: A 22-year Retrospective Analysis of 2591 Primary Augmentation Mammoplasties.

The size of implants can be selected objectively or subjectively. However, there is a lack of information on whether there is a change in the trend in implant size selection or whether the parity or the age can have an impact on the implant size used. Methods: A retrospective study to analyze implant size selection following primary augmentation was performed. Data were divided into three groups. Group A had mammoplasties between 1999 and 2011 (group 1) and 2011 and 2022, respectively (group A2). Groups B and C were divided on the basis of age and the number of children. Results: Group A1 included 1902 patients and group A2 included 689 patients. Group B included three subgroups: group B1 included 1345 patients who were 18-29 years old, group B2 included 1087 patients who were 30-45 years old, and group B3 had 127 patients who were 45 years or older. Group C included four subgroups: group C1 had 956 patients without children, group C2 had 422 patients who had one child, group C3 had 716 patients who had two children, and group C4 had 453 patients who had three or more children. Conclusions: The data showed that there was a trend toward larger size implants, and patients with children had larger implants than nulliparous patients. There was no difference seen in implant size used when patients were compared on the basis of age.

The free chimeric medial sural artery perforator flap for individualised and three-dimensional reconstruction of complex soft-tissue defects in extremities.

Trauma or lesion resection often causes complex wounds with deep soft tissue defects in extremities. Simply covering with a skin flap will leave a deep dead space resulting in infection, non-healing wounds, and poor long-term outcomes. Thus, effectively reconstructing complex wounds with dead space leaves a clinical challenge. This manuscript presents our experience using chimeric medial sural artery perforator (cMSAP) flap, to reconstruct complex soft tissue defects of the extremities, thereby exploring broader analysis and indications for future reference. Between March 2016 and May 11, 2022, patients (8 males and 3 females) with a mean age of 41 years (range from 26 to 55 years) underwent reconstructive surgery with the cMSAP flap. The cMSAP flap consists of an MSAP skin paddle and a medial sural muscle paddle. The size of the MSAP skin paddle ranged between 9 × 5 cm and 20 × 6 cm, and the size of the medial sural muscle paddle ranged between 2 × 2 cm and 14 × 4 cm. Primary closure of the donor site was achieved in all cases. Of the 11 patients, the cMSAP flap survived in 10 cases. The vascular compromise occurred in one special case and was treated with surgical procedures. The mean follow-up duration was 16.5 months (range of 5-25 months). Most patients present satisfactory cosmetic and functional results. The free cMSAP flap is a good option for reconstructing complex soft tissue defects with deep dead space in extremities. The skin flap can cover the skin defect, and the muscle flap can fill the dead space against infection. In addition, three types of cMSAP flaps can be used in a broader range of complex wounds. This procedure can achieve an individualised and three-dimensional reconstruction of the defects and minimise the donor site morbidities.

Correlation Between Serum Tumor Necrosis Factor-Alpha (TNF-α) and Clinical Severity of Tuberculosis: A Hospital-Based Study.

AIM: The main aim of this study was to assess the correlation between serum tumor necrosis factor-alpha (TNF-α) levels the and clinical severity of tuberculosis. METHODS: This was a hospital-based case-control prospective study and was conducted at the Sher-i-Kashmir Institute of Medical Sciences, a tertiary care hospital in the northern part of India, from May 2016 to May 2018. The subjects were recruited in the study considering inclusion and exclusion criteria. All patients with pulmonary tuberculosis as well as patients with extrapulmonary tuberculosis were included as subjects and a clinical severity score based on anemia, weight loss, presence of hypoxia, and radiological features was calculated and compared with TNF-α levels. Age- and sex-matched healthy individuals were recruited as controls. RESULTS: A total of 75 subjects comprising 50 cases and 25 controls were taken for the study. There were 34 (68.0%) patients with elevated TNF-α levels while only 16 (32.0%) patients had normal TNF-α levels. And, TNF-α levels were normal in 21 (84%) control subjects as compared to tuberculosis (TB) patients. Such difference in serum TNF-α levels between cases and controls was statistically significant (p<0.05). The mean serum TNF-α level in TB cases was 1265.63 pg/mL, while the mean serum TNF-α level in controls was 312.06 pg/mL. The difference in serum TNF-α levels between the two groups was statistically significant (p<0.01). We observed a significant increase in serum TNF-α levels with the increase in clinical severity score. CONCLUSION: Serum TNF-α levels were significantly associated with increased severity of TB.

Successful management of a rare radius schwannoma mimicking malignant bone tumors: A case report and literature review.

Background: Schwannomas are benign tumors originating from Schwann cells, frequently occurring in the spinal cord and peripheral nerves. Intraosseous schwannomas, a rare subset, account for approximately 0.2% of schwannomas. Intraosseous schwannomas commonly impinge the mandible, followed by the sacrum and the spine. By far, only three cases of radius intraosseous schwannomas have been reported in PubMed. The tumor was treated differently in all three cases, resulting in different outcomes. Case presentation: A 29-year-old male construction engineer who complained of a painless mass on the radial aspect of the right forearm was diagnosed with an intraosseous schwannoma of the radius based on radiography, three-dimensional computed tomography reconstruction, magnetic resonance imaging, pathological examination, and immunohistochemistry. A different surgical approach was employed to reconstruct the radial graft defect using bone microrepair techniques, resulting in more reliable bone healing and early functional recovery. Meanwhile, no clinical and radiographic findings suggestive of recurrence were observed at the 12-month follow-up. Conclusion: Vascularized bone flap transplantation combined with three-dimensional imaging reconstruction planning might yield better results for repairing small segmental bone defects of the radius caused by intraosseous schwannomas.

Mathematical analysis of heat and mass transfer on unsteady stagnation point flow of Riga plate with binary chemical reaction and thermal radiation effects.

To aid in the prevention of reaction explosions, chemical engineers and scientists must analyze the Arrhenius kinetics and activation energies of chemical reactions involving binary chemical mixtures. Nanofluids with an Arrhenius kinetic are crucial for a broad variety of uses in the industrial sector, involving the manufacture of chemicals, thermoelectric sciences, biomedical devices, polymer extrusion, and the enhancement of thermal systems via technology. The goal of this study is to determine how the presence of thermal radiation influences heat and mass transfer during free convective unsteady stagnation point flow across extending/shrinking vertical Riga plate in the presence of a binary chemical reaction where the activation energy of the reaction is known in advance. For the purpose of obtaining numerical solutions to the mathematical model of the present issue the Runge-Kutta (RK-IV) with shooting technique in Mathematica was used. Heat and mass transfer processes, as well as interrupted flow phenomena, are characterized and explained by diagrams in the suggested suction variables along boundary surface in the stagnation point flow approaching a permeable stretching/shrinking Riga Plate. Graphs illustrated the effects of many other factors on temperature, velocity, concentration, Sherwood and Nusselt number as well as skin friction in detail. Velocity profile increased with Z , λ and S and decreased with ε . Increasing values of ε , λ and S decline the temperature profile. The concentration profile boosts up with Z , α and slow down with ε , S c , ß , δ and n 1 parameters. Skin friction profile increased with Z and S and decreased with ε . Nusselt number profile increased with S , Z , ε and radiation. Sherwood number profile shows upsurges with ε , Z , α , S c , ß , S and n 1 whereas slow down with δ . So that the verdicts could be confirmed, a study was done to compare the most recent research with the results that had already been published for a certain case. The outcomes demonstrated strong concordance between the two sets of results.

Mathematical analysis of nonlinear thermal radiation and nanoparticle aggregation on unsteady MHD flow of micropolar nanofluid over shrinking sheet.

Significance of study: Typical liquids aren't great for engineering because of their low heat conductivity. To enhance heat transfer capabilities in industries as diverse as computers, pharmaceuticals, and molten metals, researchers and scientists have developed nanofluids, which are composed of nanoparticles distributed in a base fluid. Aim of study: Mathematical modeling of micropolar C u - H 2 O nanofluid driven by a deformable sheet in the stagnation area with nanoparticle aggregation, thermal radiation, and the mass suction action has been investigated in this paper. In this case, copper ( C u ) nanoparticles make up the nanofluid. Method: ology: We have used suitable transformations to arrive at a system of nonlinear ODEs, which we then solve numerically in MATHEMATICA using Runge-Kutta methods of the fourth order coupled with shooting approaches. Findings: Tables and graphs are used to examine the effects of immersed flow and display profiles of physical parameters of interest. This includes velocities, temperatures, skin friction, and Nusselt numbers. The average heat transfer rate increased to 17 . 725 % as the volume percentage of copper nanoparticles in micropolar nanofluid increased from 0.0 to 0.01 . Additionally, the results showed that the local Nusselt number of the micropolar nanofluid increased along with an increase in the unsteady and radiation parameters. However, its value is reduced in an undeniable fashion if a material parameter is present. The impact of radiation on the aggregation of nanoparticles is compared and contrasted with the effects of a non-radiative scenario, and the resulting fluctuations in Nusselt numbers are provided in tables. When the results of this study were compared to data that had already been published about some cases, a lot of agreement was found.

Clinicopathological Features and Status of Programmed Death Ligand-1 (PD-L1) Expression in Lung Cancer: A Single Centre Study From North India.

Introduction Programmed death ligand-1 (PD-L1) is an immunological checkpoint that supports the inhibition of the anti-tumor immune system. A higher level of PD-L1 expression was also discovered on the cell surfaces of several cancer cells, including non-small cell lung carcinoma (NSCLC). Identifying individuals who would benefit from PD-1/PD-L1 antibody immunotherapy is crucial in the era of precision medicine. The study's objective was to assess the distribution and degree of PD-L1 ligand expression in various forms of lung cancer and examine its link to clinicopathological variables. Methods This prospective, observational, cross-sectional study was done in a tertiary care hospital in North India over 2 years from 2019 to 2021. A total of 100 patients diagnosed with lung cancer through either endobronchial or image-guided biopsies were enrolled. The biopsy specimens of lung cancer patients have been subjected to immunohistochemistry (IHC) staining. PD-L1 expression was positive when at least 1% of tumor cells were stained. In our study, we used the rabbit monoclonal Anti-PD-L1 antibody (CAL10) (ab237726) (Abcam Plc, UK).  Results  Of the 100 patients, Squamous cell carcinoma (SQCC) was the predominant histological pattern. The mean age of the study group was 57.26 ± 10.53 years. High PDL-1 positivity (>50% ) is seen in a total of 10 patients, while low PD-L1 positivity (1-50%) is seen in 24 patients. Of all patients with high PD-L1 positivity (n=10), 80% had stage IV at the time of diagnosis. However, on similar lines, 71 % of patients with low PD-L1 positivity presented with stage IV at the time of diagnosis. (p value=0.09). Among 10 patients with epidermal growth factor receptor (EGFR) positive status, high PD-L1 positivity is seen in 20%. Among 3 patients with anaplastic lymphoma kinase (ALK) positive status, only one patient showed high PD-L1 positivity, whereas negative PDL-1 was seen in 2 patients, which was not statistically significant. Conclusion  The management of lung cancer is driven by precision medicine, including PDL-1 expression, which correlates with immune checkpoint inhibitor response. In our cohort, PD-L1 expression appears to be mostly linked to the squamous cell subtype of lung cancer, with elevated tumor stage and mediastinal lymphadenopathy in Kashmiri people. Other oncogenic driver mutations are not connected to PD-L1 expression. The function of PD-L1 expression in lung tumors requires more study.

In vivo detection of bile duct pre-cancer with endoscopic light scattering spectroscopy.

Bile duct cancer is the second most common primary liver cancer, with most diagnoses occurring in the advanced stages. This leads to a poor survival rate, which means a technique capable of reliably detecting pre-cancer in the bile duct is urgently required. Unfortunately, radiological imaging lacks adequate accuracy for distinguishing dysplastic and benign biliary ducts, while endoscopic techniques, which can directly assess the bile duct lining, often suffer from insufficient sampling. Here, we report an endoscopic optical light scattering technique for clinical evaluation of the malignant potential of the bile duct. This technique employs an ultraminiature spatial gating fiber optic probe compatible with cholangioscopes and endoscopic retrograde cholangiopancreatography (ERCP) catheters. The probe allowed us to investigate the internal cellular composition of the bile duct epithelium with light scattering spectroscopy (LSS) and phenotypic properties of the underlying connective tissue with diffuse reflectance spectroscopy (DRS). In a pilot in vivo double-blind prospective study involving 29 patients undergoing routine ERCP procedures, the technique detected malignant transformation with 97% accuracy, showing that biliary duct pre-cancer can be reliably identified in vivo non-invasively.

Transcription networks rewire gene repertoire to coordinate cellular reprograming in prostate cancer.

Transcription factors (TFs) represent the most commonly deregulated DNA-binding class of proteins associated with multiple human cancers. They can act as transcriptional activators or repressors that rewire the cistrome, resulting in cellular reprogramming during cancer progression. Deregulation of TFs is associated with the onset and maintenance of various cancer types including prostate cancer. An emerging subset of TFs has been implicated in the regulation of multiple cancer hallmarks during tumorigenesis. Here, we discuss the role of key TFs which modulate transcriptional cicuitries involved in the development and progression of prostate cancer. We further highlight the role of TFs associated with key cancer hallmarks, including, chromatin remodeling, genome instability, DNA repair, invasion, and metastasis. We also discuss the pluripotent function of TFs in conferring lineage plasticity, that aids in disease progression to neuroendocrine prostate cancer. At the end, we summarize the current understanding and approaches employed for the therapeutic targeting of TFs and their cofactors in the clinical setups to prevent disease progression.

Double-diffusive stagnation point flow over a vertical surface with thermal radiation: Assisting and opposing flows.

In numerous industrial procedures, the main concern of design engineers is ensuring adequate heat and mass transfer, such as in the heating and cooling practices of solar water heaters, geothermal systems, extrusion of metal, insulation of buildings, electronics, turbines, aerodynamics, electronics, paper manufacturing, and glass fiber production. The unsteady double-diffusive mixed convection flow of boundary layer nanofluids above a vertical region near stagnation point flow is developed and examined here. The Brownian motion and thermophoresis effects are incorporated by using Buongiorno's model. In the thermal energy equations, diffusion of regular and cross types is also used. By the use of the local similarity method along with suitable similarity transformations, nonlinear unsteady partial differential equations are converted to nonlinear ordinary differential equations and are numerically solved by the Keller-Box method. The investigation expresses that these profiles of solute concentration and nanoparticle concentration, temperature, and velocity in their boundary layers, respectively, depending on several parameters. A graphic analysis of all these parameters' possessions on nature's boundary layers is depicted. The highest rate of heat transfer is obtained with negligible thermophoresis effect. Furthermore, it is perceived that an increase in Nc and Nt results in a reduction in the reduced Sherwood number of nanoparticles, whereas addition results in an increase in the Nb number. There is a reverse effect on the temperature field and layer thickness for heat generation. In the wake of the above-mentioned potential applications, the current study of fluid flow has been found to be very interesting and innovative in the analysis of the influence of Brownian motion and thermophoresis effects near stagnation point flow, which will further make revolutions in industrial fields. Moreover, Buongiorno's model predicts the characteristics of double-diffusive fluids in enhancing heat transfers. This investigation has been established as a result of the numerous industrial applications mentioned above.

A Rare Case of Brucellosis With Spontaneous Splenic Rupture Presenting as an Acute Abdomen.

Brucellosis is a common zoonotic infection worldwide caused by the bacterial species Brucella. It has a wide range of presentations from asymptomatic infection to multisystem involvement. Splenomegaly is seen in around 30-60% of cases, however, atraumatic spontaneous splenic rupture is extremely rare. We present a case of a 45-year-old man who presented with acute left upper quadrant pain and fever of five days duration without a history of antecedent trauma. He was hemodynamically stable with examination revealing left upper quadrant tender palpable mass. Ultrasonography followed by computed tomography revealed subcapsular hematoma with perisplenic and perihepatic free fluid. Viral markers (hepatitis B and C, cytomegalovirus {CMV}, Epstein-Barr virus {EBV}, HIV, and dengue) were negative. The autoimmune profile was negative. Brucella serum agglutination test was positive (1: 640) and blood cultures grew Brucella melitensis. He was managed conservatively for splenic hematoma and received one unit blood transfusion and treatment with combination of antibiotics (rifampicin and doxycycline) for brucella for six weeks. On follow-up, the patient reported no further complications. Spontaneous splenic rupture is a clinical rarity and should be considered in patients presenting with acute abdomen and suspected infective, neoplastic, and inflammatory pathology. Spontaneous splenic rupture in acute brucellosis requires prompt clinical recognition and immediate anti-Brucella therapy to prevent the catastrophic progression.

Tuberculosis of Finger Presenting As Non-healing Ulcer of Digit: A Case Report.

Tuberculosis (TB) is a chronic granulomatous infection which most often localises to the respiratory system. Extra-pulmonary tuberculosis is prevalent in immunocompromised individuals, of which cutaneous tuberculosis is exceedingly rare (0.5-2%). Cutaneous TB presents with varied clinical morphologies, either acquired exogenously via direct inoculation on the skin or endogenously due to systemic dissemination. Diagnosis is particularly challenging due to the multitude of differential diagnoses of skin lesions. Microbiological evidence from biopsy and histopathological findings suggestive of granulomatous inflammation are needed to make a definitive diagnosis. Herein we present a rare case of tuberculosis of the finger in a middle-aged man who presented with an ulcerating and erythematous lesion. As cutaneous TB is usually misdiagnosed at the earlier stages, dermatologists and primary care physicians should keep high suspicion for cutaneous TB in any non-healing ulcers which are otherwise unexplained.

Single-stage Layered versus Nonlayered Mastopexy with Augmentation in Muscle Splitting Biplane: A Comparative Analysis.

Single-stage layered mastopexy with augmentation is a modification of muscle-splitting pocket that reduces risk of complications and revision rate. Methods: A retrospective chart review of all the consecutive cases, performed by a single surgeon, from March 2007 to August 2019, was conducted. All patients had surgery with superomedial pedicle in an approved facility. The patients were divided into group A whose implants were placed through the mastopexy incision, and group B whose implants were placed first and access closed prior to mastopexy. Results: Nonlayered group A included 116 patients and layered group B included 102 patients. Groups A and B had a mean age of 32.3 + 9.70 and 34.8 + 10.39 years (range, 20-66), respectively (P value 0.070). In groups A and B, 95 (81.9%) and 74 (72.5%) patients underwent primary and 21 (18.1%) and 28 (27.5%) patients underwent secondary procedures, respectively (P value 0.099). There were no hematomas in group A and two patients had hematoma in group B (P value 0.218). In group A, one patient experienced periprosthetic infection with none in group B (P value 0.41). Wound breakdown was observed in ten (8.6%) patients in group A and four (3.9%) patients in group B (P value 0.128). In group A, there was a partial or complete nipple loss in two (1.7%) and none in group B (P value 0.412). In group A, 15 (12.9%) underwent revision surgery and six (6.5%) in group B (P value 0.127). Conclusion: Layered mastopexy with augmentation provides improved safety, fewer complications and revisions with adequate results.

Nanofluids modeling and energy transformation under the influence of mixed convection: Role of aluminum and γ-aluminum nanoparticles.

The analysis of nanofluids under various physical scenarios convinced the researchers and scientists because of their broad range of applications in potential area of the current time like chemical engineering, biomedical engineering and applied thermal engineering etc. To give the final shape of many industrial and engineering processes, enhanced heat transfer desired, therefore, the study of Al2O3-H2O, γAl2O3-H2O, Al2O3-C2H6O2, and γAl2O3- C2H6O2 nanofluids is reported. The model successfully achieved after mathematical operations and by appealing similarity transforms. To examine the behavior of heat transfer, numerical tools utilized and performed the results. It is observed that enhanced heat transfer in Al2O3-H2O, γAl2O3-H2O, Al2O3-C2H6O2, and γAl2O3-C2H6O2 could be attained by setting nanoparticles concentration up to 20%. For Al2O3-H2O, γAl2O3-H2O, optimum heat transfer trends noticed due to their prominent thermophysical values. Also, fewer effects of combined convection on θ(η) examined.

Mastopexy using de-epithelialised dermoglandular flaps: a case series for maximal volume conservation following breast implants removal.

AIMS AND OBJECTIVE: Removal of implants without replacement is often requested, and the procedure is more commonly performed today than ever before. However, the resultant loss of body image, secondary to the loss of breast volume, is not an outcome, that a patient is looking forward to. There is a lack of information on the options available to the patients following explantation. This case series presents an option of breast volume preservation and reshaping during mastopexy after breast implant removal that can be offered to selected patients. In the current case series, de-epithelialised dermoglandular flap mastopexy was used as an autologous tissue for breast reshaping and remodelling. MATERIAL AND METHODS: Since 2015, ten patients were selected for de-epithelialised dermoglandular mastopexy using wise pattern or vertical scar. Surgery was performed under general anaesthesia as a day case. A vertically oriented bipedicular dermoglandular flap was used for vertical scar mastopexy in two patients, and eight patients had Wise pattern incisions. Of these eight patients, four had superomedial and four had inferiorly based flaps for dermoglandular mastopexy and closure. All patients had a preoperative cup size D or larger. RESULTS: All patients had adequate results with an acceptable breast cup size. There was no skin breakdown, nipple loss, haematoma or infection. CONCLUSION: De-epithelialised dermoglandular flap mastopexy is a safe procedure and can be used as an option in selected patients. LEVEL OF EVIDENCE: IV.

Minimally invasive left internal mammary artery harvesting techniques during the learning curve are safe and achieve similar results as conventional LIMA harvesting techniques.

BACKGROUND: Internal thoracic arteries (ITAs) are considered to be the standard conduits used for coronary revascularization. Recently minimally invasive procedures are performed to harvest ITAs. The aim of this retrospective cohort study is to observe the effect and safety of less invasive LIMA harvesting approaches in the learning curve compared to conventional harvesting. METHODS: We retrospectively analyzed the data of 138 patients divided into three different groups based on the LIMA harvesting techniques: conventional sternotomy LIMA harvesting, CSLH (n: 64), minimally invasive direct LIMA harvesting, MIDLH (n: 42), and robotic-assisted LIMA harvesting, RALH (n: 32). The same 138 patients were also divided into sternotomy (n: 64), and non-sternotomy (n: 74) groups keeping both MIDLH and RALH in the non-sternotomy category. Parameters associated with LIMA's quality and some other perioperative parameters such as harvesting time, LIMA damage, perioperative myocardial infarction, ventilation time, 24 h drainage, ICU stay, hospital mortality, computed tomographic angiography (CTA) LIMA patency on discharge, and after one year were recorded. RESULTS: The mean LIMA harvesting time was 36.9 ± 14.3, 74.4 ± 24.2, and 164.7 ± 51.9 min for CSLH, MIDLH, and RALH groups respectively (p < 0.001). One patient 1/32 (3.1%) in the RALH group had LIMA damage while the other two groups had none. One-month LIMA CTA patency was 56/57 (98.2%), 34/36 (94.4%), and 27/27 (100%) (p = 0.339), while 1 year CTA patency was 47/51 (92.1%), 30/33 (90.9%), and 24/25 (96%) for CSLH, MIDLH, and RALH groups respectively (p = 0.754). In the case of sternotomy vs non-sternotomy, the LIMA harvesting time was 36.9 ± 14.3 and 113.6 ± 59.3 min (p < 0.001). CTA patency on discharge was 56/57 (98.2%) and 61/63 (96.8%) (p = 0.619), while 1 year CTA patency was 47/51 (92.1%) and 54/58 (93.1%) (p = 0.850) for sternotomy vs non-sternotomy groups. CONCLUSION: Minimally invasive left internal mammary artery harvesting techniques during the learning curve are safe and have no negative impact on the quality of LIMA. Perioperative outcomes are comparable to conventional procedures except for prolonged harvesting time. RALH is the least invasive and most time-consuming procedure during the learning curve. These procedures are safe and can be performed for selected patients even during the learning curve.