Three-Step Approach for the Decompression of Brachial Plexus Entrapment in Patients With Neurogenic Thoracic Outlet Syndrome.

Arthroscopic brachial plexus decompression is a technically demanding surgical procedure with a steep learning curve. Few techniques are reported in the literature. The aim of this Technical Note is to describe a direct, 3-step approach for the decompression of common sites of brachial plexus entrapment in patients with neurogenic thoracic outlet syndrome.

Proteomic analysis of bacterial communities associated with atopic dermatitis.

Atopic dermatitis (AD) is a relapsing, chronic, and inflammatory skin disorder. Its causes remain unclear. Here, we reported the first proteome study of the bacterial community in AD patients. Bacterial community in 7 patients and 1 healthy control using bottom-up proteomics were examined starting with in-solution digestion followed by purification steps with subsequent analysis using LC-MS/MS and ended with data processing and bioinformatic analysis. Overall, great bacterial changes between patient samples and healthy one were noticed with the presence of Staphylococcus aureus, Aeromonas hydrophila, and Shewanella species, and others that were present uniquely in patient samples suggesting their role in AD. Additionally, detection of some important proteins that trigger bacterial pathogenesis and the immune system such as enolase, glyceraldehyde-3-phosphate, Chaperone proteins DnaK and HtpG beside protein pathways needed for bacterial growth and pathogenesis like chaperones and folding catalysts; and Energy metabolism. These new findings of the microbiome and detected proteins could start a new era of proteomics to study the bacterial community as a whole and detect the way it interacts with each other and with the host. SIGNIFICANCE: This paper would represent a reference work for investigations on microbiota that present on AD, from both a microbiological and a functional proteomic point of view. We focused on analysisng bacteria community and proteins produced and its role in the disease, highlighting some functional characteristics of certain proteins and discussing its potential role in AD.

Decision Support System for Lymphoma Classification.

The diffuse lymphoma is a malignant tumor of lymphoid tissues. It is associated with abnormal, unlimited and uncontrolled proliferation of lymphoid cells. Until now, expert pathologists have identified diffuse lymphoma cells disease manually. This paper introduces automatic system with a friendly user interface to differentiate between the categories of the diffuse lymphoma cells. This research is based on the morphological features such as size, perimeter and circularity. The cell size is a critical element in the classification of diffuse lymphoma according to international formulation standards. Therefore, the applied procedures identify lymphoid cell population in digital microscopic images. The cells are classified using their morphological data according to the characteristics of each cell such as: circularity, perimeter, area, and color density. The number of cells is taken into consideration in the developed approach. Image processing techniques are applied to digital microscopic images to measure morphological parameters and to overcome image problems such as overlapping and cell distortion that affect the sensitivity of the measured data. The developed procedures help the pathologists to come to a decision regarding the classification of diffuse lymphoma. Moreover, it can be used to train medical students and young pathologists.

PLA/PBAT Bionanocomposites with Antimicrobial Natural Rosin for Green Packaging.

The use of biodegradable polymers is of great importance nowadays in many applications. Some of the most commonly used biopolymers are polylactic acid (PLA) and poly(butylene adipate-co-terephthalate) (PBAT) due to their superior properties and availability. In this manuscript, we use a facile and green modification method of organoclay (OC) by antimicrobial natural rosin which is considered as a toxicity-free reinforcing material, thus keeping the green character of the material. It increases the interlayer spacing between the clay platelets. This was proven by X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR) and found to impart antimicrobial properties to PLA/PBAT blends. The morphology of the resulting blends was conducted using scanning and transmission electron microscopies (SEM and TEM), and evidence of exfoliation and intercalation was observed. The thermal properties of the blends were studied using differential scanning calorimetry (DSC), and a detailed study of the crystallization of both PLA and PBAT was reported showing cold crystallization behavior of PLA. The final effect on mechanical and antimicrobial properties was also investigated. The obtained results reveal excellent possibility of using expanded OC modified PLA/PBAT polymer blends by adding a green material, antimicrobial natural rosin, for food packaging and biomembranes applications.

A Shortcut to Arthroscopic Suprascapular Nerve Decompression at the Suprascapular Notch: Arthroscopic Landmarks and Surgical Technique.

Arthroscopic suprascapular nerve decompression at the suprascapular notch is a technically demanding surgical procedure with a steep learning curve. The aim of this Technical Note is to describe important pearls for an arthroscopic decompression of the suprascapular nerve relying on the palpation of the coracoclavicular ligaments before starting the arthroscopic visualization. This reduces the time and minimizes the resection of the surrounding fat.

Percutaneous iliosacral screw fixation in vertically unstable pelvic injuries, a refined conventional method.

Percutaneous ilio-sacral screw fixation is a well-established method for fixation of unstable posterior pelvic lesions. Due to unavailability of the navigation system in our institute and the limits of using CT-guided method, we tried to refine the conventional method. Between March 2011 and Nov. 2012, twenty patients with closed vertical pelvic injuries were admitted. They were 17 males and three females with an average age of 34 years (range from 27 to 55). Percutaneous ilio-sacral screw fixation was done in the supine position using a Schanz screw marking of a fixed entry point in the outer iliac table. Closed reduction was done in all cases with excellent reduction in 14 cases, good in two and fair in four cases. The mean duration of screw insertion was 17 minutes (ranged from 10 to 25). One case of injury of the superior gluteal vessels was present and one case with misplacement through the ventral part of contra-lateral sacral ala. No neurological complications were detected. Ilio-sacral screw fixation by this refined technique allows safe stabilization of vertical pelvic lesions with an acceptable complication rate.

Clinical outcome of conventional versus biological fixation of subtrochanteric fractures by proximal femoral locked plate.

INTRODUCTION: Surgical fixation is the standard management of the subtrochanteric fractures. Proximal femoral locked plating (PF-LCP) provides a strong construct for fixation with a high success rate. However, some studies reported implant failure due to loss of the postero-medial bone support and recommended an anatomical reduction. Other studies reported excellent to good results with indirect (biological) fixation without anatomical reduction. In this study, we reviewed the short-term clinical results of PF-LCP fixation for subtrochanteric fractures using both conventional and biological fixation. MATERIALS AND METHODS: Forty six patients (34 males and 12 females) with comminuted subtrochanteric fractures were included aged between 18 and 74 (mean 44.3 years). They were treated in a single-blind random manner by either conventional (open, direct) or biological (indirect) reduction method and internal fixation with PF-LCP. Intra-operative variables including; duration of surgery, blood loss, fluoroscopy time and any complications were recorded. Post-operative differences including; duration of healing, implant failure, complications and the final clinical outcome by Harris Hip Score (HHS) were documented. RESULTS: 44 cases continued to the final follow-up (23 of the open fixation group and 21 of the biological fixation group). Patients of open group demonstrated greater blood loss (756±151 vs. 260±39ml; P<0.0001), longer operative times (129±16.9 vs. 91±8min; P<0.0001) and incisions (s) length (20.4±3 vs. 13.4±1cm; P<0.0001). More patients needed blood transfusion in open group (11 patients vs. six in closed group; P<0.0001). Patients of biological group demonstrated longer fluoroscopy time (80.9±7.3 vs. 47.2±5.8sec.; P<0.0001). For each group, one case of implant failure was recorded. Low patient compliance was a detrimental factor for the implant failure in both cases. No much difference was demonstrated for the healing rate (open group; 18.3±3.7 vs. biological group16.5±4 weeks; P<0.058) and for the functional outcome (open group; excellent/good: 54%/37%, biological group; excellent/good: 57%/33%; P=0.766). CONCLUSION: PF-LCP provided a strong construct for fixation of the comminuted subtrochanteric fractures either by open or biological techniques. Low patient compliance is an influential factor for implant failure in both types.

Latarjet Procedure for Anterior Shoulder Instability Due to Tramadol-Induced Seizures: A Multicenter Study.

BACKGROUND: Seizures, commonly due to epilepsy, are known to cause shoulder instability. Tramadol addiction has recently been found to induce seizures in patients who exceed the recommended dose. Because of the easy accessibility and low cost of tramadol, an increasingly alarming phenomenon of tramadol abuse has been demonstrated in recent years. PURPOSE/HYPOTHESIS: The purpose of this multicenter study was to investigate shoulder instability resulting from tramadol-induced seizure (TIS) as well as to recommended management for such shoulder instability. The hypothesis was that TIS leads to anterior shoulder dislocations with major bony defects, which favors bony reconstructive procedures as a suitable method of treatment. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This prospective case series study was conducted on 73 patients (78 shoulders) who presented with anterior shoulder dislocations and a clear history of tramadol abuse. The mean age of the patients was 26.8 years, and the mean number of dislocations was 14. The mean duration of addiction was 17 months, with a mean dose of 752 mg of tramadol hydrochloride per day. Glenoid and humeral bone loss ranged from 15% to 35% and from 15% to 40%, respectively. The mean follow-up period was 28 months. All patients underwent an open Latarjet procedure. RESULTS: Postoperative mean Rowe score and American Shoulder and Elbow Surgeons score at final follow-up (24 months) improved significantly from 20 to 84 and from 44 to 91, respectively (P < .05). The patient satisfaction rate reached 95%, and the mean period of return to work was 12.8 weeks. Five patients (9%) had postoperative seizures due to relapse of the tramadol abuse, but only 3 patients (5%) had redislocations with nonunion or breakage of the graft or hardware. CONCLUSION: Tramadol addiction has evolved as an important cause of seizures that can result in shoulder dislocation. Anterior shoulder instability with TIS occurs mainly with higher levels of addiction and results in significant humeral and/or glenoid bone defects. The Latarjet procedure is recommended for these patients, after control of addiction, and provides 95% satisfaction at midterm follow-up.

The added value of PET/Ce-CT/DW-MRI fusion in assessment of hepatic focal lesions: PET/Ce-CT/DW-MRI fusion in hepatic focal lesion.

INTRODUCTION: The liver hosts a variety of benign and malignant tumors. Accurate diagnosis can be challenging in certain cases, especially in patients with a history of malignancy or in those with underlying liver pathology, such as cirrhosis. OBJECTIVES: To evaluate the added clinical value of multi-modality liver imaging utilizing PET/Ce-CT/DW-MRI for characterization of hepatic focal lesions (HFL) and compare it with each diagnostic modality when interpreted alone. METHODS: The study included 35 patients with HFL. They were 7 females & 28 males; their age ranged from 41 to 78years, all patients underwent PET/Ce-CT and DW-MRI scans. Ce-CT, PET and DW-MR images were reviewed independently, and then combined PET/Ce-CT, PET/DW-MRI and PET/Ce-CT/DW-MRI scans were analyzed. The results were correlated with histopathology or clinical/imaging follow-up. RESULTS: The 35 patients had 98 focal lesions. Fifty-three lesions were finally diagnosed as primary hepatocellular carcinoma, 18 lesions were metastases, 7 lesions were lymphoma and 20 lesions were benign. On a patient based analysis; the sensitivity, specificity, PPV, NPV and accuracy were 100%, 67%, 94%, 100% and 94% for PET/Ce-CT compared to 97%, 83%, 97%, 83% and 94 % for DW-MRI, respectively. Combined PET/Ce-CT/DW-MR scans raise those parameters up to 100%. On a lesion based analysis; the sensitivity, specificity, PPV, NPV and accuracy were 94%, 75%, 94%, 75%, 90% for PET/Ce-CT compared to 94%, 95%, 99%, 97% and 94 % for DW-MRI, respectively. All these parameters were 100 % with PET/Ce-CT/DW-MRI. CONCLUSIONS: The addition of DW-MRI to PET/Ce-CT is valuable in the characterization of hepatic focal lesions.

Improving heating uniformity of pathological tissue specimens inside a domestic microwave oven.

A 3D coupled electromagnetic thermal model was developed using COMSOL 4.0 to predict the electromagnetic field distribution and temperature profile in pathological tissue samples immersed in a reagent inside the oven cavity. The effect of the volume of reagent on the mean heating rate and heating uniformity within the tissue sample was investigated. Also, the effect of using a water load, as a method of temperature control, is emphasized. A well insulated K type thermocouple connected to a PC is used for model validation. Good agreement is found between experimental and simulated temperature profiles. Results show that as the volume of reagent increases, the mean heating rate decreases and temperature homogeneity increases. Also, it is possible to minimize overshooting temperature values inside the tissue sample and enhance tissue uniformity by about 27% using 100 ml of water load and 42.26% using 150 ml. Domestic microwave oven is a low cost economical tool that can speed up tissue processing steps. Achieving uniform heating inside the microwave oven is the key factor for improving workflow inside pathological labs and maintaining tissue quality and integrity.

Three dimensional approach for realistic simulation of facial soft tissue response: a pilot study.

Facial attractiveness is ranked as a principal priority among patients seeking orthodontic treatment or combined surgical orthodontic therapy. A successful treatment planning process necessitates an accurate prediction of the postoperative facial profile. In this manuscript, the simulation procedure on a real clinical case using virtual volumetric 3D mesh through different scenarios of orthognathic procedures was done. Results depict several facial soft tissue outcomes, with the likelihood of sharing with the patient the most esthetically pleasing end result prior to carrying out the surgical procedure.

The role of high work-function metallic nanodots on the performance of a-Si:H solar cells: offering ohmic contact to light trapping.

Addition of carbon into p-type "window" layers in hydrogenated amorphous silicon (a-Si:H) solar cells enhances short circuit currents and open circuit voltages by a great deal. However, a-Si:H solar cells with high carbon-doped "window" layers exhibit poor fill factors due to a Schottky barrier-like impedance at the interface between a-SiC:H windows and transparent conducting oxides (TCO), although they show maximized short circuit currents and open circuit voltages. The impedance is caused by an increasing mismatch between the work function of TCO and that of p-type a-SiC:H. Applying ultrathin high-work-function metals at the interface between the two materials results in an effective lowering of the work function mismatch and a consequent ohmic behavior. If the metal layer is sufficiently thin, then it forms nanodots rather than a continuous layer which provides light-scattering effect. We demonstrate 31% efficiency enhancement by using high-work-function materials for engineering the work function at the key interfaces to raise fill factors as well as photocurrents. The use of metallic interface layers in this work is a clear contrast to previous work where attempts were made to enhance the photocurrent using plasmonic metal nanodots on the solar cell surface.

Polyelectrolyte layer-by-layer deposition in cylindrical nanopores.

Layer-by-layer (LbL) deposition of polyelectrolytes within nanopores in terms of the pore size and the ionic strength was experimentally studied. Anodic aluminum oxide (AAO) membranes, which have aligned, cylindrical, nonintersecting pores, were used as a model nanoporous system. Furthermore, the AAO membranes were also employed as planar optical waveguides to enable in situ monitoring of the LbL process within the nanopores by optical waveguide spectroscopy (OWS). Structurally well-defined N,N-disubstituted hydrazine phosphorus-containing dendrimers of the fourth generation, with peripherally charged groups and diameters of approximately 7 nm, were used as the model polyelectrolytes. The pore diameter of the AAO was varied between 30-116 nm and the ionic strength was varied over 3 orders of magnitude. The dependence of the deposited layer thickness on ionic strength within the nanopores is found to be significantly stronger than LbL deposition on a planar surface. Furthermore, deposition within the nanopores can become inhibited even if the pore diameter is much larger than the diameter of the G4-polyelectrolyte, or if the screening length is insignificant relative to the dendrimer diameter at high ionic strengths. Our results will aid in the template preparation of polyelectrolyte multilayer nanotubes, and our experimental approach may be useful for investigating theories regarding the partitioning of nano-objects within nanopores where electrostatic interactions are dominant. Furthermore, we show that the enhanced ionic strength dependence of polyelectrolyte transport within the nanopores can be used to selectively deposit a LbL multilayer atop a nanoporous substrate.

Methods for managing 3-dimensional volumes.

The introduction of 3-dimensional (3D) volumetric technology and the massive amount of information that can be obtained from it compels the introduction of new methods and new technology for orthodontic diagnosis and treatment planning. In this article, methods and tools are introduced for managing 3D images of orthodontic patients. These tools enable the creation of a virtual model and automatic localization of landmarks on the 3D volumes. They allow the user to isolate a targeted region such as the mandible or the maxilla, manipulate it, and then reattach it to the 3D model. For an integrated protocol, these procedures are followed by registration of the 3D volumes to evaluate the amount of work accomplished. This paves the way for the prospective treatment analysis approach, analysis of the end result, subtraction analysis, and treatment analysis.