An algorithmic approach to scalp reconstructive surgery: maximization of cosmetic and functional outcomes.

BACKGROUND: Scalp reconstruction requires knowledge of scalp anatomy and reconstructive options. Advances in the field have led to numerous procedures being at the disposal of the reconstructive surgeon, expanding treatment options for patients. OBJECTIVE: To provide an algorithmic approach and general guidelines to consider when deciding on which scalp surgery will optimize cosmetic and functional outcomes. METHODS & MATERIALS: Previous literature was searched for the last 20 years to provide an updated guide. RESULTS: Taking into consideration the location, size and local scalp anatomy of a presenting defect will lead to optimal surgical outcomes. Other confounding factors such as bone exposure and extremely large defects will affect decision making. An algorithmic approach has been provided in this review. CONCLUSION: While many reconstructive surgical options are available, the best ones will depend on individual presentation of scalp defects. Location and size are first line considerations while local scalp anatomy will allow for tailoring of reconstructive options. This will help to maximize cosmetic and aesthetic considerations.

Optimized DC-DC converter based on new interleaved switched inductor capacitor for verifying high voltage gain in renewable energy applications.

This paper introduces an optimized DC-DC converter that employs a modified switched inductor-capacitor technique to achieve ultra-high voltage gain for renewable energy systems. The development is based on adding one cell of modified switched inductor (MSL1) with series diodes interleaved with the main switch in the proposed DC-DC converter. The (MSL1) with capacitor operates in resonant mode to reduce current stress across the main switch when the charge in capacitor becomes zero. This approach also reduces voltage stress across the main switch, all inductors, and diodes. Furthermore, modified switched inductors (MSL2) with an auxiliary switch and a coupled capacitor are incorporated to provide double boosting voltage and to achieve high voltage gain. Additionally, a main and auxiliary switch are integrated with modified switched capacitors (MSC) to provide ultra-high voltage gain and to reduce voltage stress across auxiliary switch. Moreover, the proposed converter exhibits a continuous input current with zero pulsating, even at very low duty cycles. The advantages of the proposed converter are high efficiency, low voltage stress, and low values of inductors and capacitors when utilizing a high switching frequency. A mathematical model for the proposed converter is developed for both continuous conduction mode and discontinuous conduction mode. In addition, the PCB design for the proposed converter is presented, and experimental tests are conducted to verify the simulation and laboratory results. The proposed converter aims to boost the voltage from 20 to 40 V to a variable output voltage between 200 and 400 V, delivering 400 watts of power with an efficiency of 96.2%.

Effect of commercially pure titanium implant coated with calcium carbonate and nanohydroxyapatite mixture on osseointegration.

In this research, rabbit femurs were implanted with CP Ti screws coated with a combination of CaCO3 and nanohydroxyapatite, and the effect on osseointegration was assessed using histological and histomorphometric examination at 2 and 6 weeks. CaCO3 and nanohydroxyapatite were combined with the EPD to coat the surfaces of the CP Ti screws. The femurs of five male rabbits were implanted with coated and uncoated implant screws. Healing time was divided into two groups (2 and 6 weeks). After 2 and 6 weeks of implantation, the histological examination revealed an increase in the growth of bone cells for coated screws, and the histomorphometric analysis revealed an increase in the percentage of new bone formation (after 6 weeks, 5.08% for coated implants and 3.66% for uncoated implants). In addition, the uncoated implant, the CP Ti implant coated with a combination of CaCO3 and nanohydroxyapatite, stimulated early bone development after two weeks and mineralization and maturation after six weeks.

Farming lifestyle and human milk: Modulation of the infant microbiome and protection against allergy.

There has been an increased prevalence of several allergic manifestations such as food allergy, atopic eczema, allergic rhinitis and asthma. Several explanations have been proposed why this has occurred, but one of the main contributing factors may be the gradual loss of microbial exposures over time in regions where allergy is prevalent. Such exposures occur in individuals who practise a traditional farming lifestyle and are protected against allergy. Infant consumption of human milk, more commonly practised in these farming communities, may provide an alternative in combatting allergy, as it known to be beneficial to infant health. In this review, we cover human milk and its role in shaping the gut microbiome promoting the growth of beneficial bacteria like Bifidobacterium, as well as the downstream impact of the farming lifestyle, human milk and Bifidobacterium has on developing infant immunity.

Hibiscus sabdariffa, a Treatment for Uncontrolled Hypertension. Pilot Comparative Intervention.

In Iraq, in 2019, there were about 1.4 million Internally Displaced Persons (IDP); medical treatments were often interrupted. The feasibility of using Hibiscus sabdariffa (HS) decoction to curb hypertension was evaluated. A multicentric comparative pilot intervention for 121 participants with high blood pressure (BP) (≥140/90 mmHg) was conducted. Participants of the intervention group (with or without conventional medication) received HS decoction on a dose regimen starting from 10 grams per day. BP was measured five times over six weeks. The major active substances were chemically quantified. Results: After 6 weeks, 61.8% of participants from the intervention group (n = 76) reached the target BP < 140/90 mmHg, compared to 6.7% in the control group (n = 45). In the intervention group, a mean (±SD) reduction of 23.1 (±11.8) mmHg and 12.0 (±11.2) for systolic and diastolic BP, respectively, was observed, while in the control group the reduction was 4.4 (±10.2)/3.6 (±8.7). The chemical analysis of the starting dose indicated a content of 36 mg of total anthocyanins and 2.13 g of hibiscus acid. The study shows the feasibility of using HS decoction in IDP's problematic framework, as hibiscus is a safe, local, affordable, and culturally accepted food product.

Operative Times in Primary Total Knee Arthroplasty: Can We Predict the Future Based on Contemporary Nationwide Data.

Recently, the Centers for Medicare & Medicaid Services announced its decision to review "potentially misvalued" Current Procedural Terminology (CPT) codes, including those for primary total knee arthroplasty (TKA). CPT 27447 is being reevaluated to determine contemporary relative value units for work value, with operative time considered a primary factor in this revaluation. Despite broader indications for TKA, including extension of the procedure to more complex patient populations, it is unknown whether operative times may remain stable in the future. Therefore, the purpose of this study was to specifically evaluate future trends in TKA operative times across a large sample from a national database. The American College of Surgeons National Surgical Quality Improvement Project database was queried from January 1, 2008 to December 31, 2017 to identify 286,816 TKAs using the CPT code 27447. Our final analysis included 140,890 TKAs. Autoregressive integrated moving average forecasting models were built to predict 2- and 10-year operative times. While operative times were significantly different between American Society of Anesthesiologists (ASA) classes 1 and 2 (p = 0.035), there were not enough patients in ASA class 1 to perform rigorous inference. Additionally, operative times were not significantly different between ASA classes 3 and the combined ASA classes 4 and 5 cohort (p = 0.95). Therefore, we were only able to perform forecasts for ASA classes 2 and 3. Operative time was found to be nonstationary for both ASA class 2 (p = 0.08269) and class 3 (p = 0.2385). As a whole, the projection models indicated that operative time will remain within 2 minutes of the present operative time, up to the year 2027. Our projections indicate that operative times will remain stable over the next decade. This suggests that there is a lack of evidence for reducing the valuation of CPT code 27477 based on intraservice time for TKA. Further study should examine operative time trends in the setting of evolving alternative payment models, increasing patient complexity, and governmental restrictions.

Hybrid Coils-Based Wireless Power Transfer for Intelligent Sensors.

Most wearable intelligent biomedical sensors are battery-powered. The batteries are large and relatively heavy, adding to the volume of wearable sensors, especially when implanted. In addition, the batteries have limited capacity, requiring periodic charging, as well as a limited life, requiring potentially invasive replacement. This paper aims to design and implement a prototype energy harvesting technique based on wireless power transfer/magnetic resonator coupling (WPT/MRC) to overcome the battery power problem by supplying adequate power for a heart rate sensor. We optimized transfer power and efficiency at different distances between transmitter and receiver coils. The proposed MRC consists of three units: power, measurement, and monitoring. The power unit included transmitter and receiver coils. The measurement unit consisted of an Arduino Nano microcontroller, a heart rate sensor, and used the nRF24L01 wireless protocol. The experimental monitoring unit was supported by a laptop to monitor the heart rate measurement in real-time. Three coil topologies: spiral-spiral, spider-spider, and spiral-spider were implemented for testing. These topologies were examined to explore which would be the best for the application by providing the highest transfer power and efficiency. The spiral-spider topology achieved the highest transfer power and efficiency with 10 W at 87%, respectively over a 5 cm air gap between transmitter and receiver coils when a 200 Ω resistive load was considered. Whereas, the spider-spider topology accomplished 7 W and 93% transfer power and efficiency at the same airgap and resistive load. The proposed topologies were superior to previous studies in terms of transfer power, efficiency and distance.

Surgical Technique for Anterior Approach for Total Hip Arthroplasty After Bilateral Below-Knee Amputation: A Case Report.

CASE: We report a case of a 77-year-old man, with bilateral below-knee amputee, in whom the anterior approach (AA) for a left total hip arthroplasty was used successfully, with 3-year follow-up. This report also summarizes the key studies in the literature on this subject. CONCLUSIONS: The utility of AA surgery performed in the setting of bilateral below-knee amputation has not been previously described. We describe the surgical technique, including considerations and pearls in the amputee population, and particular technical tips related to the use of a fracture table and thin-wire femoral traction for optimum control of the residual limb.

Atopic Dermatitis Is Associated With Cervical High Risk Human Papillomavirus Infection.

OBJECTIVE: High-risk human papillomavirus (hrHPV) infection is more likely to persist and cause cervical cancer in immunosuppressed women. Atopic dermatitis, which is known to affect cell-mediated immunity and skin barrier function, is associated with recalcitrant warts; therefore, we hypothesized that women with atopic dermatitis may be more likely to be positive for hrHPV infection and progress to high-grade cervical dysplasia. MATERIALS AND METHODS: A retrospective case-control study of 1,160 women who were either positive or negative for hrHPV in their index cervical cytology. Patient age, race, history of atopic dermatitis, allergic rhinitis, smoking, body mass index, socioeconomic status, marital status, hormone contraceptive use, and 2-year clinical outcomes (follow-up hrHPV testing and cervical biopsy results) were recorded. All cases with atopic dermatitis (n = 74) were confirmed by a dermatologist. Analyses were restricted to females with documented clinical follow-up, which yielded 577 hrHPV-positive and 583 hrHPV-negative cases for comparison. Associations were examined by t test, χ test, and multivariate logistic regression. RESULTS: Atopic dermatitis was more common in the hrHPV-positive cases (48/577, 8.3%) compared with HPV-negative controls (26/583, 4.5%, p = .007). Multivariate logistic regression analysis revealed an adjusted odds ratio of 3.75 (95% CI = 1.3-10.9, p = .02) after controlling for significant covariates, such as age and marital status. Smoking was not associated with hrHPV infection, persistence, or high-grade cervical dysplasia in these cases. CONCLUSIONS: Atopic dermatitis is associated with cervical hrHPV infection in adult women.