Homodigital Pedicled Digital Artery Perforator flaps for fingertip reconstruction - a review of flap options.

Background: Digital artery perforator flaps provide a useful option for reconstruction of soft tissue defects of the digits, and many variations of these flaps have been described for fingertip defects. This review aims to summarize various pedicled digital artery perforator flap anatomical configurations described in literature for fingertip reconstruction and their results. Methods: A literature review of PubMed, Medline and Embase databases was conducted. Studies reporting homodigital digital artery perforator flaps for fingertip reconstruction without sacrificing the proper digital artery were included in the review. Data collected included flap design, perforator location, pathology, defect location, flap dimensions, flap survival, sensory recovery, range of movement, outcome measures, and complications. The flaps were analysed and categorized based on flap location, flap design, transfer method, and flap innervation. Results: Pedicled digital artery perforators have been described in various configurations by different authors including propeller, bilobed, V-Y advancement, rotation and turnover flaps. Variations to make these flaps sensate have also been described. According to the available reports, these flaps have low complications and high patient satisfaction rates. Conclusion: Pedicled digital artery perforator flaps provide a versatile option for the reconstruction of fingertip and thumb tip defects. Various flap options are available for use depending on the reconstructive need. They are quicker and easier to perform than free flaps and can provide excellent outcomes in suitable cases.

Identification, kinetics and thermodynamic analysis of novel ß-galactosidase from Convolvulus arvensis seeds: An efficient agent for delactosed milk activity.

The ß-galactosidase was extracted and purified from 100 g of C. arvensis seeds using a variety of protein purification procedures such as ammonium sulphate fractionation, gel filtration, and finally chromatography on a cationic ion exchanger. The effects of metal ions, kinetics parameters, and glycoprotein nature were determined, as well as the optimal pH and temperature of the purified enzyme. With a high specific activity (72 units/mg), ß-galactosidase was isolated to a 24-fold apparent electrophoretic homogeneity. The molecular mass of ß-galactosidase was determined as monomeric, which was further confirmed by SDS-PAGE and MALDI-TOF/MS analysis, with a 45 kDa molecular weight. The enzyme has a Km of 0.33 mM and a Vmax of 42 µmol/min Lactose in milk was reduced by 38.5 and 70 % after 4 h of incubation with ß-galactosidase from C. arvensis. The ß-galactosidase thermal inactivation kinetic parameters ΔH°, ΔS°, and ΔG° were calculated, indicating that the enzyme undergoes significant unfolding events during denaturation. Using ß-galactosidase from C. arvensis seeds, lactose hydrolysis in milk up to approx. 50 % was observed. The findings indicate the potential use of C. arvensis seeds for the production of low/delactosed milk for lactose-intolerant population.

Enhanced Anomaly Detection System for IoT Based on Improved Dynamic SBPSO.

The Internet of Things (IoT) supports human endeavors by creating smart environments. Although the IoT has enabled many human comforts and enhanced business opportunities, it has also opened the door to intruders or attackers who can exploit the technology, either through attacks or by eluding it. Hence, security and privacy are the key concerns for IoT networks. To date, numerous intrusion detection systems (IDS) have been designed for IoT networks, using various optimization techniques. However, with the increase in data dimensionality, the search space has expanded dramatically, thereby posing significant challenges to optimization methods, including particle swarm optimization (PSO). In light of these challenges, this paper proposes a method called improved dynamic sticky binary particle swarm optimization (IDSBPSO) for feature selection, introducing a dynamic search space reduction strategy and a number of dynamic parameters to enhance the searchability of sticky binary particle swarm optimization (SBPSO). Through this approach, an IDS was designed to detect malicious data traffic in IoT networks. The proposed model was evaluated using two IoT network datasets: IoTID20 and UNSW-NB15. It was observed that in most cases, IDSBPSO obtained either higher or similar accuracy even with less number of features. Moreover, IDSBPSO substantially reduced computational cost and prediction time, compared with conventional PSO-based feature selection methods.

Trunkoplasty after massive weight loss - a case series with a one-stage body contouring procedure for the NHS patient.

Body contouring post massive weight loss (MWL) is a considerable task and is often a functional rather than esthetic operation. Clinicians are often encouraged to solve multiple issues in a single setting that can be difficult in the MWL patient. A simple abdominoplasty often does not provide a satisfactory outcome in such patients and may result in disharmony of the esthetic unit of the trunk. Trunkoplasty is a technique that combines a fleur-de-lis abdominoplasty and reverse abdominoplasty. This is a one-stage operation to address the extra skin of the whole trunk esthetic unit. The average operation time was 4 h with a 3-surgeon team. No blood transfusions were required. There were 3 out of 15 patients with wound-related problems and no incidence of postoperative hematomas. There were no returns to theaters. Seromas formed were not symptomatic and no interventions were required. The average inpatient stay was 6.9 days and a return to work after 4 weeks. It can improve abdominal contour, define the waist, and improve mons ptosis in one stage without any change in position. This procedure has some specific advantages (accommodates preexisting abdominal scars), but also has shortcomings as compared to "standard" circumferential body contouring.

Outcome of treatment of Zygomatic bone fracture by two point fixation versus three point fixation in Mayo Hospital Lahore.

OBJECTIVE: To compare the outcome of two-point internal fixation versus three-point internal fixation for the treatment of zygoma fractures. METHODS: The quassi-experimental study was conducted at the King Edward Medical University, Mayo Hospital, Lahore, Pakistan, from April to September 2016, and comprised patients with zygomatic bone fracture who were randomly divided into two groups. In Group A, patients were treated with two-point fixation and in Group B, patients were treated with three-point fixation. All patients were treated by the same consultant. Patients were followed up on first, third and sixth week postoperatively and malar height and mouth opening were recorded at the sixth week follow-up. Data was analysed using SPSS 17. RESULTS: Of the 60 patients, there were 30(50%) in each of the two groups. There were 39(65%) males and 21(35%) females. The mean age in Group A was 29.56±9.89 years (range: 17-50 years), while in Group-B it was 29.45±8.68 years (range: 17-49 years). Mean malar height at 6th week post-operative follow up showed a significant reduction in Group B compared to Group A (p= 0.001). Significant improvement in mouth opening was seen in Group B compared to Group A (p= 0.034). CONCLUSIONS: Three-point fixation was found to give more stable reduction compared to 2-point fixation for treating zygomatic bone fractures in terms of malar height and mouth opening.

Pedicled Supraclavicular Flap for Neck Defect Reconstruction in Poland Syndrome.

INTRODUCTION: The most accepted pathogenesis for Poland syndrome is the subclavian artery supply disruption sequence during embryonic growth. The result is associated with a constellation of abnormalities of structures supplied by the subclavian artery. We present a case of a neck defect reconstructed with a fasciocutaneous supraclavicular flap in a patient with Poland syndrome with the absence of a pectoralis major muscle. To the best of our knowledge, this is the first report of the use of the supraclavicular flap in patients with Poland syndrome. METHODS: An 80-year-old patient with a 14-mm-Breslow-thickness melanoma had undergone a 3-cm-wide local excision of the scar on his right neck and reconstruction with a pedicled supraclavicular flap despite him having Poland syndrome on the same side. RESULTS: The flap was well perfused, and the patient was discharged at postoperative day 5. Complete healing of the flap was observed without any flap loss. CONCLUSION: The supraclavicular fasciocutaneous flap is a versatile and useful pedicled flap reconstruction for head and neck defects. It is possible in patients with Poland syndrome as shown, and the pedicle should be checked with preoperative Doppler and an exploratory incision before completely raising it.

Venous Congestion in Pedicled Frontal Branch Superficial Temporal Artery Flaps Reconstructions for Head and Neck Defects: A Review.

The superficial temporal artery (STA) flap is a versatile flap for head and neck defect reconstruction. It can be based on the frontal branch of the STA and an islanded 360-degree rotation arc for various defects on the scalp, cheek, and auricular region. It provides a nonmicrosurgical option for reconstructing such defects, which is itself relatively easy to perform. However, venous congestion is a problem than often can cause worry to the clinician and hence preclude its use. In this review, we revisit this flap in head and neck reconstruction, with case examples used for reconstruction of defects on the scalp, maxilla, lip, ear, and retroauricular area. The STA flap in our review can be used either as a fasciocutaneous flap or with its fascia alone. The main issue with the STA flap is that it is generally a high-inflow flap with variable outflow. Venous congestion is frequently encountered in our practice, and adequate management of the venous drainage in the postoperative period is crucial in ensuring its success as a versatile and viable option for head and neck reconstruction.

Parenteral iron therapy in the treatment of iron deficiency anemia during pregnancy: a randomized controlled trial.

OBJECTIVE: To compare the efficacy and safety profile of total dose infusion of low molecular weight iron dextran with divided doses of intravenous iron sucrose for the treatment of iron deficiency anemia during pregnancy. STUDY DESIGN: Randomized controlled trial. PLACE AND DURATION OF STUDY: Shifa International Hospital, Islamabad, over a period of two years from January 2008 to December 2009. METHODOLOGY: Pregnant women at gestational age more than 12 weeks with the confirmed diagnosis of Iron Deficiency Anemia (IDA) were divided into two groups. In the group-A, intravenous iron sucrose was given in divided doses while in the group-B, total daily intake of Low Molecular Weight (LMW) of iron dextran was given. Post-infusion Hemoglobin (Hb) was checked at 4 weeks and at the time of delivery for both groups. Paired sample t-test is applied and comparison (in terms of rise in hemoglobin from pre to post) of both groups was not found to be significant. RESULTS: In the group-A (iron sucrose group), mean pre-infusion Hb levels was 9.09 ± 0.83 gm/dl. Mean increase in Hemoglobin (Hb) was 10.75 ± 1.097 gm/dl after 4 weeks of infusion and 11.06 ± 0.866 gm/dl at delivery (p < 0.001). In group-B (iron dextran group) pre-infusion haemoglobin was 8.735 ± 0.956 gm/dl and the mean increase in hemoglobin was 10.613 ± 1.22 gm/dl at 4-week while mean increase of 10.859 ± 1.11 gm/dl at the time of delivery (p < 0.001). CONCLUSION: Both LMW iron dextran, as well as iron sucrose are equally effective in treatment of IDA during pregnancy, however, LMW iron dextran has the advantage of single visit treatment.