Successful treatment of pseudomyxoma peritonei (PMP) through cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC): A case report and literature review.

INTRODUCTION AND IMPORTANCE: Pseudomyxoma peritonei (PMP) is characterized by the accumulation of mucinous fluid in the abdominal cavity, typically originating from mucin-producing tumors, most commonly arising in the appendix. CASE PRESENTATION: A 63-year-old male patient presented to the hospital with complaints of abdominal pain, significant weight loss, a palpable mass in the right iliac fossa, and evidence of ascites. A diagnosis of PMP was proposed based on findings from a computed tomography (CT) scan, which was subsequently confirmed through histopathological examination of a biopsy. The patient underwent successful treatment with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC). CLINICAL DISCUSSION: Diagnosing PMP presents challenges due to its rarity and the potential for extensive spread throughout the peritoneal cavity, necessitating a multidisciplinary approach for successful treatment. CONCLUSION: Pseudomyxoma peritonei is a rare yet medically significant condition. Documenting a case of this ailment in Palestine has the potential to advance medical understanding, raise awareness, and improve patient care standards within the local healthcare system. By documenting this uncommon condition, healthcare practitioners in Palestine can gain valuable insights into its manifestations, diagnostic processes, and treatment modalities. This contribution not only enriches the global medical literature but also promotes collaboration in addressing the challenges associated with rare diseases.

Yield and Energy Modeling for Biochar and Bio-Oil Using Pyrolysis Temperature and Biomass Constituents.

Pyrolysis offers a sustainable and efficient approach to resource utilization and waste management, transforming organic materials into valuable products. The quality and distribution of the pyrolysis products highly depend on the constituents' properties and set process parameters. This research aims to investigate and model this dependency, offering decision-makers a tool to guide them when designing the process for a particular application. Experimental data on the pyrolysis of various types of feedstocks processed at a wide range of pyrolysis temperatures (350-650 °C) are utilized to develop the prediction models. Four variables are modeled: the yield and energy content for both the biochar and bio-oil as a function of the pyrolysis temperature and feedstock characteristics. The models developed had very good prediction power with the coefficient of determination above 90%. The results highlight the advantages of food waste (leftover) as a suitable feedstock to produce biochar at the pyrolysis temperature within the range of 450-550 °C. Furthermore, the biofuels produced from food waste are found to be of good quality, with the bio-oil exceptionally high in energy content (HHV = 34.6 MJ/kg), which is almost 80% of that of diesel. The developed models provide a tool for predicting the biofuel yield and quality based on the feedstock selection and process temperature.

Ovary of Zebrafish during Spawning Season: Ultrastructure and Immunohistochemical Profiles of Sox9 and Myostatin.

This study sought to examine the ovarian cellular and stromal components of the zebrafish (Danio rerio) throughout the spawning season using light and electron microscopic tools. The ovaries of zebrafish showed oocytes in all stages of follicular development and degeneration (atresia). Six stages of oogenesis were demonstrated: oogonia, early oocytes, late oocytes, vacuolated follicles, the yolk globule stage (vitellogenesis), and mature follicles. The SOX9 protein was expressed in the ooplasm of the primary and previtellogenic oocytes and the theca cell layer of the mature follicles. Myostatin was expressed in the granulosa and theca cells. Many stem cells in the ovarian stroma expressed myostatin and SOX9. During the spawning season, the EM results indicated that the zona radiata increased in thickness and was crossed perpendicularly by pore canals that contained processes from both oocytes and zona granulosa. The granulosa cells contained many mitochondria, rER, sER, and vesicles. Meanwhile, the thecal layer consisted of fibroblast-like cells. Atretic follicles could be demonstrated that involved both oocytes and their follicular walls. Several types of cells were distinguished in the ovarian stroma, including mast cells, telocytes, lymphocytes, fibroblasts, endocrine cells, macrophages, adipocytes, dendritic cells, and steroidogenic (stromal) cells. The ovary of the zebrafish serves as a model to investigate follicular development.

Catfish Epidermal Club Cell Morphologic and Immunologic Attributes: Heterogeneous S-100 Immunoreactivity and Possible Neuroendocrine Function.

The fish epidermis (EP) contains several cell types, and it has several functional roles, though the secretory role prevails. The alarm or epidermal club cells (ECCs) represent a voluminous immune cell secreting an alarm substance. Our work targeted the histochemical and immunologic attributes of the ECCs in catfish. Matrix metalloproteinase (MMP-9) immunostaining revealed strong immunoreactive signals in the cytoplasm of all ECCs, while S-100 protein immunoreactivity selectively marked the ECCs. Individual ECCs exhibit intense S-100 immunoreactivity compared to neighboring ECCs. The difference in the intensity of the S-100 immunostaining was associated with the difference in the ECC size. This was confirmed by the semithin results where several developmental stages of ECCs could be distinguished. Some eosinophilic granular cells with their characteristic metachromatic granules were recorded juxtaposing the ECCs. Moreover, some free electron-dense granules could be demonstrated in the intercellular spaces surrounding the ECCs. Collectively, these findings suggest several functional profiles for the catfish ECCs depending on their developmental stage. Most importantly, S-100 immunoreactivity in the ECCs suggests its neuroendocrine function. Moreover, the difference in the intensity and polar distribution of S-100 staining is a sign of its role in the differentiation of the ECCs.

A machine learning approach on chest X-rays for pediatric pneumonia detection.

Background: According to the World Health Organization (WHO), pneumonia is the leading infectious cause of death in children below 5 years old. Hence, the early detection of pediatric pneumonia is crucial to reduce its morbidity and mortality rates. Even though chest radiography is the most commonly employed modality for pneumonia detection, recent studies highlight the existence of poor interobserver agreement in the chest X-ray interpretation of healthcare practitioners when it comes to diagnosing pediatric pneumonia. Thus, there is a significant need for automating the detection process to minimize the potential human error. Since Artificial Intelligence tools such as Deep Learning (DL) and Machine Learning (ML) have the potential to automate disease detection, many researchers explored how such tools can be implemented to detect pneumonia in chest X-rays. Notably, the majority of efforts tackled this problem from a DL point of view. However, ML has shown a higher potential for medical interpretability while being less computationally demanding than DL. Objective: The aim of this paper is to automate the early detection process of pediatric pneumonia using ML as it is less computationally demanding than DL. Methods: The proposed approach entails performing data augmentation to balance the classes of the utilized dataset, optimizing the feature extraction scheme, and evaluating the performance of several ML models. Moreover, the performance of this approach is compared to a TL benchmark to evaluate its candidacy. Results: Using the proposed approach, the Quadratic SVM model yielded an accuracy of 97.58%, surpassing the accuracies reported in the current ML literature. In addition, this model classification time was significantly smaller than that of the TL benchmark. Conclusion: The results strongly support the candidacy of the proposed approach in reliably detecting pediatric pneumonia.

Development and evaluation of a dual-purpose machine for chopping and crushing forage crops.

Reducing reliance on fossil fuels with clean and sustainable alternatives is essential for mitigating climate change and global warming-related environmental concerns. Previous researchers have studied the performance of choppers and crushers as separate units powered by diesel or gasoline engines. Nowadays, an increasing interest in producing Eco-friendly machines that stand out for being dual purposes, cost-effectiveness, and with lengths suitable for feeding ruminants are imperative to achieving economic and sustainable goals. Therefore, this study aims to solve these issues and gaps by developing and evaluating a dual-purpose forage machine for chopping and crushing operations to achieve both operations more efficiently and at a lower cost. The developed forage machine's performance was evaluated for chopping operation using maize stalks with four different rotational speeds of 1200, 1400, 1600, and 1800 rpm and four different moisture contents of 22.7, 43.3, 59.8, and 74.6% (w.b.). Also, the crushing operation was evaluated using maize ears with four different crusher speeds of 1200, 1400, 1600, and 1800 rpm and three different sieves with holes' diameters of 6, 8, and 10 mm. The results concluded that the highest efficiencies with values of 94.17 and 92.85% were obtained at 1800 rpm chopper rotational speed and 22.7% moisture content for the chopper and 1200 rpm crusher rotational speed and 10 mm sieve hole diameter for the crusher, respectively. At these proper operational parameters, the machine productivity of 2.44 and 0.31 ton.hr-1, the specific energy requirements of 3.22 and 4.50 kW h.ton-1, and the estimated production costs of 23.56 and 121.24 EGP.ton-1 (1.25 and 6.38 USD.ton-1) were obtained for chopper and crusher, respectively.

The relationship between ovarian hormones and mast cell distribution in the ovaries of dromedary camel (Camelus dromedaries) during the follicular wave.

Background and Aim: Mast cells (MCs) play an essential role in regulating tissue homeostasis through various non-allergic immune reactions. This study aimed to describe the salient features of MCs during different phases of the estrous cycle and evaluate the relationship between ovarian hormones and the presence of MCs in camel ovaries. Materials and Methods: Genital tracts (n = 28) of healthy, non-pregnant camels were collected from a local slaughterhouse. The follicular wave stage was determined according to structures on the ovaries using an ultrasound device. Stages were classified as "growing" (n = 12, FØ = 0.3-0.8 cm), "mature" (n = 9, FØ = 0.9-2.2 cm), or "regression" phase (n = 7, FØ >2.5). Blood samples were collected at slaughter to determine serum estradiol-17ß and progesterone levels using an immunoassay. Safranin-O, periodic acid/Schiff, alcian blue, or methylene blue stains were used to detect MCs. Results: Follicular numbers at the growing, mature, and regression phases were determined to be 36, 14, and 7 follicles, respectively. Mast cells were widely but sparsely distributed within the ovarian tissue (9.3 MCs in the growing phase, 10.7 in the mature phase, and 7.0 in the regression phase). Typical histological features of MCs were observed in ovarian stromal tissue. Some MCs were found in the interstitial tissue, either near the follicular wall or the interstitial gland. Mast cells were present at a higher density during the mature phase than in the growing and regression phases in the ovarian matrix. A significantly reduced presence of MCs was found in the regression phase than in both the growing and mature phases (p < 0.05). A very strong positive correlation was observed between serum estradiol-17ß concentrations and MC density in the ovaries (r = 0.9; p < 0.001). In addition, a strong negative correlation (r = -0.65; p = 0.03) was observed between the presence of MCs and serum progesterone concentrations. Conclusion: These findings suggest that the follicular wave phase and the associated hormonal concentration induce changes in the number of MCs in the camel ovary.

Multi-institutional search for patient factors associated with adverse events following tracheotomy.

BACKGROUND: Tracheotomy is a common procedure for otolaryngologists. The risk of complications is difficult to predict. This study aims to identify measurable preoperative indicators associated with adverse events following tracheotomy. METHODS: The charts of adults undergoing tracheotomy for respiratory failure at one of four university-affiliated hospitals between 1/2012 and 8/2018 were reviewed. Complications were analyzed in the context of demographics, physiologic parameters, and comorbidities. RESULTS: Among 507 tracheotomies performed, the most common complications included infection, bleeding, and cardiac arrest. Mortality was 39 % in patients with pulmonary hypertension, 42 % in those with ejection fraction ≤ 40 and 32 % in those with abnormal right ventricular function, double the rates in patients without each of these findings. CONCLUSION: Many critically ill tracheotomy patients experience significant rates of adverse events. Risk factors for mortality include ejection fraction ≤ 40, pulmonary hypertension, and abnormal ventricular function. These should be considered for use in preoperative counseling.

A combined machine for collecting and chopping rice straw.

Due to the recent high prices of livestock feed in the world and the new sustainable management practices of rice straw, livestock farmers are obligated to either use or purchase rice straw and cut it to desired lengths to feed ruminants. Therefore, this study aimed to construct a combined machine for collecting and chopping rice straw for lengths preferred in feeding ruminants. The combined machine comprises three main units: a picking up unit, a chopping unit, and a takeout unit. Field experiments were performed on average rice straw moisture content of 25% (w.b.) to evaluate the performance of the combined machine, under factors of 1.3, 1.6, 1.9, and 2.2 km h-1 forward speeds, elevator velocities of 0.79, 0.94, and 1.10 m s-1, and chopping knives rotational speeds of 1600, 2000 and 2400 rpm. The obtained results indicated that the consumed specific energy was 90.94 kWh ha-1 to achieve the highest field capacity of 0.24 ha h-1, with collecting efficiency of 95.30% at a forward speed of 2.2 km h-1, elevator velocity of 1.10 m s-1 and rotational speed of 2400 rpm for chopping knives. In order to achieve the highest chopping quality of 95%, it is recommended to operate the elevator velocity at 0.79 m s-1, rotate chopping knives at 2400 rpm, and drive the tractor at a forward speed of 1.3 km h-1. The total operating cost of the combined machine is lower than the traditional methods by about 49.84%.

New onset hypertension after transplantation.

It has been reported that up to 90% of organ transplant recipients have suboptimal blood pressure control. Uncontrolled hypertension is a well-known culprit of cardiovascular and overall morbidity and mortality. In addition, rigorous control of hypertension after organ transplantation is a crucial factor in prolonging graft survival. Nevertheless, hypertension after organ transplantation encompasses a broader range of causes than those identified in non-organ transplant patients. Hence, specific management awareness of those factors is mandated. An in-depth understanding of hypertension after organ transplantation remains a debatable issue that necessitates further clarification. This article provides a comprehensive review of the prevalence, risk factors, etiology, complications, prevention, and management of hypertension after organ transplantation.

Pulmonary Guardians and Special Regulatory Devices in the Lung of Nile Monitor Lizard (Varanus niloticus) with Special Attention to the Communication Between Telocyte, Pericyte, and Immune Cells.

Monitor lizards are acclimatized to a variety of environments. Most of the monitor species are terrestrial, although there are arboreal and semiaquatic monitors. Such accommodation requires unique cellular structure and regulatory devices in various organs, particularly their lungs. This study aimed to report the pulmonary guardians and special regulatory devices that may guard and promote the function of the lungs of the Nile monitor lizards (Varanus niloticus). Specially structured vessels were recorded in the pulmonary tissue involving atypical glomus vessels, vessels with variable wall thickness, and a venule with specialized internal elastic membrane. Moreover, numerous lung resident guardians could be identified including both alveolar and interstitial macrophages, dendritic cells, mast cells, and B- and T-lymphocytes. Pericytes were demonstrated surrounding the capillary endothelium with a characteristic direct hetero-cellular junction with telocytes. Telocytes established a microenvironment through an indirect hetero-cellular junction with the interstitial macrophage, dendritic cells, and pneumocyte type II. Collectively, these data indicate a significant role played by the specially structured vessels and the resident immune cells in guarding the pulmonary tissue of the Nile monitor lizards and promoting its function. Telocytes are suggested to play a key role in angiogenesis and cellular communication to promote the function of the immune cells.

Migrating and Nerve Fibers-Associated Eosinophilic Granule Cells in the Olfactory Organ of Catfish (Clarias garpienius): Light and Electron Microscopic Evidence.

Piscine mast cells or eosinophilic granule cells (EGCs) of fish are equivalent to the mammalian mast cells. Recently, a better understanding of EGCs functions is allowed because of the growing interest in fish models. Herein, we present a trial to furnish data regarding the distribution of the EGCs in the fish olfactory organ, an issue that has not been reported so far. Regarding their distribution, two kinds of EGCs had been identified. An intra-epithelial one was detected in the olfactory epithelium lining of the olfactory lamellae. The stromal one was identified in the connective tissue core of the olfactory lamellae and in the lamina propria underlying the olfactory epithelium. Some were detected in the capillary lumen. The cytoplasm of the EGCs reacted strongly with the MMP-9 antibody. Stimulating a migration perspective for the olfactory EGCs which was confirmed by their location in the blood capillaries. Several EGCs could be verified in close relation, some underneath the epineurium, with the nerve fiber. Mutually, this verifies the existence of intra-epithelial and stromal migrating EGCs in the catfish olfactory organ and their inclusion in the olfactory immune response. Additionally, this provides evidence for an immune­nervous interaction to influence both the immune reactions and the nervous scheme in catfish.

Histological, Histochemical, and Ultrastructural Approach to the Ductus Deferens in Male Nile Monitor Lizard (Varanus niloticus).

The ductus deferens is a fundamental part of the male genital tract and the continuation of the epididymal duct. As a male secondary sex organ, the ductus deferens plays a crucial role in the nourishment, storage, and maturation of spermatozoa. Some studies have provided information about the ductus deferens structure in reptiles; however, the full description of the ductus deferens remains to be clarified. The current study aimed to describe the Nile monitor lizard (Varanus niloticus) ductus deferens from histological, histochemical, and ultrastructural perspectives. The results revealed that the ductus deferens is formed histologically from two main cell types: principal and basal. The principal cells were tall and filled with periodic acid Schiff (+)/alcian blue (−) cytoplasmic granules. The basal cells were found just above the basement membrane. By transmission electron microscopy, the principal cells exhibited typical protein-secreting cell features. Additionally, some intraepithelial cells, such as halo cells, undifferentiated mesenchymal cells, and agranular leukocytes, were identified. This study presents the first detailed description of the Varanus niloticus ductus deferens. Further immunohistochemical studies are required to explore the function(s) of the cellular components.

Enhanced antimicrobial activity and physicochemical stability of rapid pyro-fabricated silver-kaolinite nanocomposite.

The present research aims to enhance the antimicrobial activity of kaolinite surfaces by a one-step cost-effective and energy-efficient dry thermal reaction, producing an antibacterial and antifungal silver-kaolinite (Ag-Kao) nanocomposite agent. Pharmaceutical grade kaolin powder samples, with variable kaolinite structural order-disorder degree, were homogeneously mixed with silver nitrate in a proportion 1:4 AgNO3:kaolin (w/w) and sintered at 400 °C for 30 min. The composition, microstructure, microtexture and surface characteristics of the pyro-fabricated nanocomposites were characterized by XRD/XRF diffractometry, differential scanning calorimetry DSC, FT-IR spectroscopy, TEM/EDX, zeta potential (mV) measured within the 2-12 pH range, and BET method. Physicochemical stability was evaluated by silver dissociation testing under close-neutral and acidic conditions with Ag content assay using ICP-OES. The resulting Ag-Kao nanocomposites exhibited bulk silver contents ranging from 9.29% to 13.32% with high physicochemical stability in both neutral and acidic mediums (Ag dissociation rate <0.5% in 5 days). Ag nanocrystals exhibited particle sizes ranging from 5 to 30 nm, which were embedded and reinforced within the kaolinite matrix. The sizes of the Ag nanocrystals and their distribution patterns on the edges and faces of kaolinite platelets were controlled by the structural order-disorder degree. Highly ordered kaolinites (Hinckley Index, HI > 1) produced platelet edge-clustered silver nanocrystals due to the abundance of the dangling hydroxyls on platelet edges, while the highly disordered kaolinite (HI < 1) provided homogeneous platelet basal-doped silver nanocrystals due to the presence of some residual charges by exposed basal hydroxyl groups with interplatelet silver diffusivity. At pH 2, the magnitude of the positive surface charge was influenced by the silver nanocrystal size. Nanocomposites with the smallest silver nanocrystals (10-5 nm) exhibited the highest positive zeta potential (+15.2 mV to +17.0 mV), while those with larger silver nanocrystals (up to 30 nm) indicated lower positive zeta potential values (+9.5 mV to +3.6 mV). Under the same testing conditions using the Mueller-Hinton broth microdilution method, the raw kaolin samples did not show any significant antimicrobial activity, while all the pyro-fabricated Ag-Kao nanocomposite samples showed potent antibacterial and antifungal activity at low doses (MIC range 0.1-0.0125 mg/mL). Therefore, modulation of the effective electrostatic surface charge of the kaolinite platelets, via thermal doping of silver within their basal planes and edges, was found to be strongly dependent on the pH as well as the size and microtexture of the silver nanocrystals (mainly controlled by the order-disorder degree HI). The resulting modified nanostructure, with physicochemical stability and the efficient surface properties of the designed pyro-fabricated nanocomposite, led to an enhanced synergistic biophysical antimicrobial activity.

Modeling of the adsorption of a protein-fragment on kaolinite with potential antiviral activity.

This work aimed at studying the potentiality of interactions between kaolinite surfaces and a protein-fragment (350-370 amino acid units) extracted from the glycoprotein E1 in the transmembrane domain (TMD) of hepatitis C virus capsid. A computational work was performed for locating the potential electrostatic interaction sites between kaolinite aluminol and siloxane surfaces and the residues of this protein-fragment ligand, monitoring the possible conformational changes. This hydrated neutralized kaolinite/protein-fragment system was simulated by means of molecular modeling based on atomistic force fields based on empirical interatomic potentials and molecular dynamic (MD) simulations. The MD calculations indicated that the studied protein-fragment interacted with the kaolinite surfaces with an exothermic process and structural distortions were observed, particularly with the hydrophilic aluminol surface by favorable adsorption energy. The viral units isolation or trapping by the adsorption on the kaolinite nanoparticles producing structural distortion of the peptide ligands could lead to the blockage of the entry on the receptor and hence a lack of viral activity would be produced. Therefore, these findings with the proposed insights could be an useful information for the next experimental and development studies in the area of discovering inhibitors of the global challenged hepatitis and other pathogenic viruses based on the phyllosilicate surface activity. These MD studies can be extended to other viruses like the COVID-19 interacting with silicate minerals surfaces.

Tracheostomy protocols during COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has resulted in the implementation of rapidly changing protocols and guidelines related to the indications and perioperative precautions and protocols for tracheostomy. The purpose of this study was to evaluate current guidelines for tracheostomy during the COVID-19 pandemic to provide a framework for health systems to prepare as the science evolves over the upcoming months and years. METHODS: Literature review was performed. Articles reporting clinical practice guidelines for tracheostomy in the context of COVID-19 were included. RESULTS: A total of 13 tracheotomy guidelines were identified. Two were available via PubMed, five in society or organization websites, and six identified via health system websites or other sources. Five were from Otolaryngology-Head and Neck Surgery specialties, six from Anesthesiology and one from Pulmonary/Critical Care. All (100%) studies recommended postponing elective OR cases in COVID-19 positive patients, while seven recommended reducing team members to only essential staff and three recommended forming a designated tracheostomy team. Recommendations with supporting references are summarized in the article. CONCLUSIONS: Tracheostomy guidelines during the COVID-19 pandemic vary by physician groups and specialty, hospital systems, and supply-chain/resource availability. This summary is provided as a point-in-time current state of the guidelines for tracheotomy management in April 2020 and is expected to change in coming weeks and months as the COVID-19 pandemic, virus testing and antibody testing evolves.

IoT Based Predictive Maintenance Management of Medical Equipment.

Technological advancements are the main drivers of the healthcare industry as it has a high impact on delivering the best patient care. Recent years witnessed unprecedented growth in the number of medical equipment manufactured to aid high-quality patient care at a fast pace. With this growth of medical equipment, hospitals need to adopt optimal maintenance strategies that enhance the performance of their equipment and attempt to reduce their maintenance costs and effort. In this work, a Predictive Maintenance (PdM) approach is presented to help in failure diagnosis for critical equipment with various and frequent failure mode(s). The proposed approach relies on the understanding of the physics of failure, real-time collection of the right parameters using the Internet of Things (IoT) technology, and utilization of machine learning tools to predict and classify healthy and faulty equipment status. Moreover, transforming traditional maintenance into PdM has to be supported by an economic analysis to prove the feasibility and efficiency of transformation. The applicability of the approach was demonstrated using a case study from a local hospital in the United Arab Emirates (UAE) where the Vitros-Immunoassay analyzer was selected based on maintenance events and criticality assessment as a good candidate for transforming maintenance from corrective to predictive. The dominant failure mode is metering arm belt slippage due to wear out of belt and movement of pulleys which can be predicted using vibration signals. Vibration real data is collected using wireless accelerometers and transferred to a signal analyzer located on a cloud or local computer. Features extracted and selected are analyzed using Support Vector Machine (SVM) to detect the faulty condition. In terms of economics, the proposed approach proved to provide significant diagnostic and repair cost savings that can reach up to 25% and an investment payback period of one year. The proposed approach is scalable and can be used across medical equipment in large medical centers.

Intraoperative and postanesthesia care unit fluid administration as risk factors for postoperative complications in patients with head and neck cancer undergoing free tissue transfer.

BACKGROUND: This study aims to evaluate the impact of perioperative fluid administration, defined as fluid delivered intraoperatively and in the postanesthesia care unit, on postoperative outcomes. METHODS: Medical records of 102 patients with oral cavity squamous cell carcinoma undergoing free flap reconstruction between January 2011 and December 2015 were reviewed. The primary endpoint was development of a postoperative complication according to the Clavien-Dindo classification. Perioperative factors recorded were Washington University Head and Neck Comorbidity Index, operating time, vasopressor use, blood loss, intraoperative fluid, and perioperative fluid. RESULTS: Greater perioperative fluid administration was independently associated with surgical complications, flap complications, overall incidence of any complication, and increased length of stay. Greater intraoperative fluid administration was independently associated with higher rates of surgical complications. Intraoperative delivery of vasopressors was not associated with flap or surgical complications. CONCLUSION: Receiving less perioperative fluid was associated with fewer complications and decreased length of stay.

Onset of Appearance and Potential Significance of Telocytes in the Developing Fetal Lung.

CD34, vimentin, and vascular endothelial growth factor immunohistochemical analysis and electron microscopic tools were employed to record the initial appearance of telocytes (TCs) and stage-by-stage variations in TC localizations in the developing rabbit lung. TCs could not be identified in the primitive embryonic lung until day 18 of gestation. In the pseudoglandular lung, CD34+ TCs had been recorded under the cartilage of the main bronchus, in the wall of large-sized pulmonary vessels and large epithelial tubes. In the canalicular phase, TCs could be demonstrated in the smooth muscle layer of the bronchioles including the terminal ones. The strength of CD34 immunoreactive signals had been amplified by age until the day of parturition. Ultrastructurally, TCs consisted of a tiny body and exceptionally long telopodes (Tps). The Tp consisted of alternating thin segments (podomers) and dilated ones (podoms). The Tp sometimes branched with a dichotomous pattern. TCs interconnected in a network either by homocellular junctions with neighboring TCs or by heterocellular junctions with smooth muscle cells and alveolar cells. Collectively, early detection of TCs in pulmonary vessels suggests a potential role for TCs in their angiogenesis. For the lung tissue, TCs seem to be involved in the regulation of lung histogenesis.