Separators Modified with Ultrathin Montmorillonite/Polymer Nanocoatings Achieve Dendrite-Free Lithium Deposition at High Current Densities.

Fatal dendritic growth in lithium metal batteries is closely related to the composition and thickness of the modified separator. Herein, an ultrathin nanocoating composed of monolayer montmorillonite (MMT), poly(vinyl alcohol) (PVA) on a polypropylene separator is prepared. The MMT was exfoliated into monolayers (only 0.96 nm) by intercalating PVA under ultrasound, followed by cross-linking with glutaraldehyde. The thickness of the nanocoating on the polypropylene separator, as determined using the pull-up method, is only 200-500 nm with excellent properties. As a result, the lithium-symmetric battery composed of it has a low overpotential (only 40 mV) and a long lifespan of more than 7900 h at high current density, because ion transport is unimpeded and Li+ flows uniformly through the ordered ion channels between the MMT layers. Additionally, the separator exhibited excellent cycling stability in Li-S batteries. This study offers a new idea for fabricating ultrathin clay/polymer modified separators for metal anode stable cycling at high current densities.

Road to Paris 2024: force-velocity profile in different speed climbers' abilities.

Speed climbing will be a new discipline in Paris 2024. The physical requirements of speed climbing are different from the other climbing modalities due to the short event time requiring higher level of strength and power. These parameters have been measured through the Force-Velocity (F-V) profile in different climbing disciplines. However, there are no known results evaluating different speed climbing abilities to establish whether F-V relationship is a determining factor between performance levels. The purpose of this study was to evaluate the upper and lower limbs F-V profile in different speed climbing abilities considering sex. Twenty-six speed climbers were divided into two groups based on their level of performance: international level (men n = 7 and women n = 2) and national level (men n = 8 and women n = 7). Participants performed pull-ups and squat incremental tests and F-V profile variables [Maximum theorical values of force (F0), velocity (V0) and power (Pmax)], one-repetition maximum value (1RM) and %1RM where peak power was expressed were collected using a linear encoder. There were significant differences in F0, relative force, %1RM where peak power was expressed, and 1RM in pull-ups (p < 0.05) between groups. However, there were not significant differences between groups in squat variables. No significant sex differences were found in any variable. There were moderate-strong correlations between running time and 1RM (pull-ups and squat), F0 and FV-slope (pull-ups) (p < 0.05) analyzed in the whole group. In conclusion, F0 and 1RM in pull-ups were significantly higher in international climbers. Therefore, national climbers should focus their training on improving force by training with heavy loads. Additionally, squat F-V profile variables do not seem to be as important as in the pull-up for performance.

Clinical outcome, quality of life, and mental health in long-gap esophageal atresia: comparison of gastric sleeve pull-up and delayed primary anastomosis.

INTRODUCTION: Pediatric surgeons have yet to reach a consensus whether a gastric sleeve pull-up or delayed primary anastomosis for the treatment of esophageal atresia (EA), especially of the long-gap type (LGEA) should be performed. Thus, the aim of this study was to evaluate clinical outcome, quality of life (QoL), and mental health of patients with EA and their parents. METHODS: Clinical outcomes of all children treated with EA from 2007 to 2021 were collected and parents of affected children were asked to participate in questionnaires regarding their Quality of Life (QoL) and their child's Health-Related Quality of Life (HRQoL), as well as mental health. RESULTS: A total of 98 EA patients were included in the study. For analysis, the cohort was divided into two groups: (1) primary versus (2) secondary anastomosis, while the secondary anastomosis group was subdivided into (a) delayed primary anastomosis and (b) gastric sleeve pull-up and compared with each other. When comparing the secondary anastomosis group, significant differences were found between the delayed primary anastomosis and gastric sleeve pull-up group; the duration of anesthesia during anastomosis surgery (478.54 vs 328.82 min, p < 0.001), endoscopic dilatation rate (100% vs 69%, p = 0.03), cumulative time spent in intensive care (42.31 vs 94.75 days, p = 0.03) and the mortality rate (0% vs 31%, p = 0.03). HRQoL and mental health did not differ between any of the groups. CONCLUSION: Delayed primary anastomosis or gastric sleeve pull-up appear to be similar in patients with long-gap esophageal atresia in many key aspects like leakage rate, strictures, re-fistula, tracheomalacia, recurrent infections, thrive or reflux. Moreover, HrQoL was comparable in patients with (a) gastric sleeve pull-up and (b) delayed primary anastomosis. Future studies should focus on the long-term results of either preservation or replacement of the esophagus in children.

Effects of Two vs. Four Weekly Campus Board Training Sessions on Bouldering Performance and Climbing-Specific Tests in Advanced and Elite Climbers.

This study examined the effects of two or four weekly campus board training sessions among highly accomplished lead climbers. Sixteen advanced-to-elite climbers were randomly allocated to two (TG2), or four weekly campus board training sessions (TG4), or a control group (CG). All groups continued their normal climbing routines. Pre- and post-intervention measures included bouldering performance, maximal isometric pull-up strength using a shallow rung and a large hold (jug), and maximal reach and moves to failure. Rate of force development (RFD; absolute and 100ms) was calculated in the rung condition. TG4 improved maximal force in the jug condition (effect size (ES) = 0.40, p = 0.043), and absolute RFD more than CG (ES = 2.92, p = 0.025), whereas TG2 improved bouldering performance (ES = 2.59, p = 0.016) and maximal moves to failure on the campus board more than CG (ES = 1.65, p = 0.008). No differences between the training groups were found (p = 0.107-1.000). When merging the training groups, the training improved strength in the rung condition (ES = 0.87, p = 0.002), bouldering performance (ES = 2.37, p = 0.006), maximal reach (ES = 1.66, p = 0.006) and moves to failure (ES = 1.43, p = 0.040) more than CG. In conclusion, a five-week campus board training-block is sufficient for improving climbing-specific attributes among advanced-to-elite climbers. Sessions should be divided over four days to improve RFD or divided over two days to improve bouldering performance, compared to regular climbing training.

14 Years' experience of esophageal replacement surgeries.

BACKGROUND: Esophageal replacement is a challenge to the therapeutic skills of surgeons and a technically demanding operation in the pediatric age group. Various conduits and routes have been described in the literature, each with their specific advantages and disadvantages. We carried out this retrospective study to share our experience of esophageal replacement. METHODOLOGY: This study was conducted at the department of pediatric surgery The Children's Hospital and The Institute of Child Health, Lahore. The records of patients treated for esophageal replacement were reviewed. The patients under follow-up were called for clinical evaluation and assessed of long terms complications if any. RESULTS: A total of 93 patients with esophageal replacement were included in the study. Esophageal replacement was done with gastric transposition in 84 cases (90%), colon interposition in 7 cases (7.5%) including one case of redo colonic interposition, and jejunal interposition in 2 cases (2%). Routes of esophageal replacement were trans-hiatal in 71 (76%), retrosternal in 13 (14%), and trans-hiatal with thoracotomy in 9 (10%) patients. Postoperatively, all of the conduits maintained viability. Wound infection was seen in 10 (11%), wound dehiscence in 5 (5%), anastomotic leak in 9 (10%), anastomotic stenosis in 12 (13%), fistula formation in 4 (4%), aortic injury 1 (1%), dumping syndrome 8 (9%), reflux 18 (19%), dysphagia 15 (16%) and death occurred in 12 patients (13%). CONCLUSION: There are problems with esophageal replacement in developing countries. In this context, gastric conduit appeared as the best conduit for esophageal replacement, using the trans-hiatal route for replacement, in the authors' experience.

Automated detection and removal of capillary electrophoresis artifacts due to spectral overlap.

While DNA detection using capillary electrophoresis has enabled improvements in both resolution and throughput, the use of CE - particularly with multiple dye channels - can introduce artifacts that can complicate analyses. Undetected pull-up artifacts can pose a challenge to investigators, especially in low-level samples, while partial pull-up peaks can distort peak height balance within a locus and impact the downstream likelihood ratio. Current methods for addressing pull-up are typically manually implemented. This study presents an effective alternative: a series of mathematical models, created using symbolic regression achieved through genetic programming. The models estimate the amount of pull-up expected in a peak from a true allele for a given dye-dye relationship and instrument type. This leads to the removal of artifactual pull-up peaks and peak height corrections when pull-up is present within true alleles. When models are used in conjunction with a dynamic threshold, pull-up peaks were automatically detected and removed with an accuracy rate of 96.1%. The removal of partial pull-up from true allele peaks led to a more accurate heterozygote balance for the affected locus. These models have been optimized for use with any analytical threshold and can be implemented by any lab using a 3100 or 3500 instrument series.

Preoperative endoscopic pyloric balloon dilatation decreases the rate of delayed gastric emptying after Ivor-Lewis esophagectomy.

Delayed gastric emptying (DGE) after Ivor-Lewis esophagectomy occurs postoperatively in up to 50% of the patients. This pyloric dysfunction can lead to severe secondary complications postoperatively such as early aspiration, pneumonia or may even have an impact on anastomotic healing and therefore leakage. Early detection of DGE is essential to prevent further complications. The common treatment postoperatively is endoscopic pyloric balloon dilatation (EPBD) after symptoms already occurred. In our work, we analyzed patients who received a preoperative EPBD during the routine restaging endoscopy and compared those patients to a control group to analyze if preoperative EPBD may prevent postoperative DGE and secondary additional complications. We performed a single-center retrospective analysis of 115 patients who received an Ivor-Lewis esophagectomy by the same surgeon between June 2015 and October 2017. Out of these 115 patients, 91 (79.1%) patients received EPBD preoperatively during the staging/restaging endoscopy (PDG, pyloric dilatation group). In 24 (20.9%) patients, preoperative EPBD was not performed due to stenotic esophageal tumors or logistic reasons (NDG, non-pyloric dilatation group). Data of the PDG and NDG group were compared regarding the rate of postoperative DGE as well as DGE and EPBD related complications. In total, 21 (18.3%) patients developed pyloric dysfunction requiring a total of 27 EPBD during follow-up. There were 12 (13.2%) patients in the PDG and 9 (37.5%) patients in the NDG (p = 0.014), respectively. DGE-related complications such as anastomotic leaks (p = 0.466), pulmonary complications (p = 0.466) and longer median hospital stay (p = 0.685) were more frequent in the NDG group; however this difference did not reach statistical significance. The success rate for postoperative EPBD with 20-mm balloons was lower (58.5%) compared to the usage of 30-mm balloons (93.3%). All pre- and postoperative EPBD were performed without any complications. Preoperative EPBD is feasible, safe and can be combined with restating endoscopy. It seems that preoperative EPBD reduces the incidence of DGE and can prevent the need for early postoperative endoscopic interventions. Our recommendation is therefore to perform an EPBD preoperatively when possible to reduce postoperative complications to a minimum. For postoperative EPBD, we recommend the use of the 30-mm balloon due to lower redilatation rates.

Performing pull-ups with small climbing holds influences grip and biomechanical arm action.

Pull-ups are often used by sport-climbers and other athletes to train their arm and back muscle capabilities. Sport-climbers use different types of holds to reinforce finger strength concomitantly. However, the effect of grip types on pull-up performance had not previously been investigated. A vertical force platform sensor measured the force exerted by climbers when performing pull-ups under six different grip conditions (gym-bar, large climbing hold, and four small climbing holds: 22mm, 18mm, 14mm, and 10mm). The electromyography of finger flexors and extensor muscles were recorded simultaneously. The maximal arm power and summed mechanical work were computed. The results revealed that the number of pull-ups, maximal power, and summed mechanical work decreased significantly with the size of the climbing hold used, even if no differences were found between a large climbing hold and a gym-bar. Electromyography of the forearm muscles revealed that the use of a climbing hold generated finger flexor fatigue and that the level of cocontraction was impacted by the different segment coordination strategies generated during the pull-ups. These findings are likely to be useful for quantifying training loads more accurately and designing training exercises and programs.

Risk assessment of asbestos-cement roof sheets in Chekka, North Lebanon.

Asbestos-cement was manufactured and used in Lebanon since the early 1950s. Corrugated rooftops of asbestos-cement were mostly spread within residential areas throughout the country. These rooftops are subject to weathering factors which are known to increase friability and risk of hazardous fiber release. This study aimed at assessing the asbestos-cement rooftop friability and the possible emerging risks in the urban-industrial city of Chekka, North Lebanon. The evaluation of the asbestos-cement included two field assessment algorithms and a standardized pull-up test. Hazard of fiber emissions was assessed by a pull-up test method, whereas vulnerability was determined by a level of interaction between people and the rooftops. Geographic object-based image analysis was used to map hazard, vulnerability, and risk of asbestos rooftops in the study area. The field algorithms classified most rooftops in a bad state compared with the pull-up test which ranked most of them as good. The X-ray diffraction analysis showed the presence of serpentine and amphibole fibers, except for crocidolite, in some rooftop samples. Hazard, vulnerability, and risk maps of the sampled area showed how hazard potential was amplified by vulnerability of population to possible fiber emission.

Hybrid minimally invasive esophagectomy vs. open esophagectomy: a matched case analysis in 120 patients.

PURPOSE: In esophageal surgery, total minimally invasive techniques compete with hybrid and robot-assisted procedures. The benefit of the individual techniques for the patient remains vague. At our institution, the hybrid minimally invasive laparoscopic-thoracotomic esophagectomy (HMIE) has been routinely applied since 2013. We conducted this retrospective study to analyze the perioperative outcome. METHODS: Since 2013, 60 patients were operated in HMIE technique for esophageal cancer. Each of these patients was paired according to the criteria of gender, BMI, age, tumor histology, pulmonary preexisting conditions, and a history of smoking with a patient treated by open esophagectomy (OE). Perioperative parameters were extracted from our prospectively maintained database and compared among the groups. RESULTS: The HMIE and OE groups were homogeneous in terms of patient- and tumor-related data. There was no difference in lymph nodes harvested (22 vs. 20, p = 0.459) and R0-resection rate (95 vs. 93%, p = 0.500). The operation time for the HMIE was significantly shorter (329 vs. 407 min, p < 0.001). There was no difference between the groups with respect to surgical complications (37 vs. 37%, p = 0.575), but the patients undergoing hybrid technique showed more delayed gastric emptying (23 vs. 10%, p = 0.042). Pulmonary morbidity was significantly reduced after HMIE (20 vs. 42%, p = 0.009). This affected both the occurrence of pneumonia and pleural effusions. The difference in the overall complication rate was not significant (50 vs. 60%, p = 0.179), but life-threatening complications (Clavien/Dindo 4/5) were less frequent (2 vs. 12%, p = 0.031). Overall, there was significantly less need for transfusion after HMIE (18 vs. 50%, p < 0.001), and hospital (and IMC) stay was significantly shorter (14 (6) vs. 18 (7) days, p = 0.002 (0.003)). The multivariate analysis confirms the surgical procedure as an independent risk factor for the development of pulmonary complications (OR 3.2, p = 0.011). Furthermore, preexisting pulmonary conditions were identified as a risk factor (OR 3.6, p = 0.006). CONCLUSION: Our retrospective analysis shows that reduction of postoperative pulmonary morbidity, perioperative blood loss, and shortening of hospital stay can be achieved by HMIE. The procedure is safe, and the rate of surgical complications and oncological radicality is comparable to the conventional procedure.

Venous superdrained gastric tube pull-up procedure for hypopharyngeal and cervical esophageal reconstruction reduces postoperative anastomotic leakage and stricture.

Gastric pull-up is a common procedure to reconstruct the continuity of the upper digestive tract after esophageal resection. However, this technique sometimes causes postoperative anastomotic leakage or stricture, resulting from insufficient blood flow at the distal end. To overcome this problem, additional microvascular venous anastomoses were performed. The purpose of this study was to compare the outcomes of post-surgical anastomotic leakage and stricture in patients with and without additional microvascular venous superdrainage after cervical esophageal and hypopharyngeal resection and gastric tube reconstruction. A total of 29 consecutive patients with esophageal or hypopharyngeal cancer who underwent total esophagectomy and hypopharyngectomy with gastric tube reconstruction in the National Organization Nagasaki Medical Center between April 2014 and May 2016 were analyzed in this study. Of these patients, 20 underwent additional venous anastomoses (superdrainage group), and 9 did not undergo additional procedures (standard group). We compared the frequency of post-surgical stricture and leakage in the two groups retrospectively. Three of nine patients (33.3%) developed postoperative leakage in the standard group, and 1 of 20 (5.0%) did so in the superdrainage group. Six of nine patients (66.7%) showed postoperative anastomotic stricture in the standard group, but none did so in the superdrainage group. Patients who did not undergo additional venous superdrainage were significantly more likely to develop postsurgical leakage (P < 0.05, Chi-square test) and anastomotic stricture (P < 0.001, Chi-square test). Our study revealed that only additional venous anastomoses could reduce the incidence of postoperative anastomotic leakage and stricture. This procedure is of merit to perform after total esophagectomy and hypopharyngectomy with gastric tube reconstruction.

Surgical techniques for esophageal replacement in children.

PURPOSE: Surgical techniques for esophageal replacement (ER) in children include colon interposition, gastric tube, gastric transposition, and jejunal interposition. This review evaluates the merits and demerits of each. METHOD: Surgical techniques, complications, and outcome of ER are reviewed over last seven decades. RESULTS: Colon interposition is the time-tested procedure with minimal and less serious complications. Long-term complications include reflux, halitosis, colonic segment dilatation, and anastomotic stricture, sometimes requiring surgical interventions especially for dilatation and reflux. Gastric tube is technically more risky, and associated with early serious complications like prolonged leak in neck or mediastinum, graft necrosis, and ischemia leading to stricture of the tube. Long-term results are good. Gastric transposition is much simpler, can be performed in emergency and in newborns. It involves a single anastomosis in the neck. Post-operative complications include gastric stasis, bile reflux, restricted growth, and decreased pulmonary functional capacity. Jejunal interposition has not been used extensively due to short mesentery but long-term results are good in expert hands. CONCLUSION: Colon is the most preferred and safest organ for ER. Stomach is a vascular and muscular organ with lower risk of ischemia. Gastric tube is a demanding technique. Jejunum or ileum is alternative for redo cases.

Revisiting the gastric pull-up for pharyngoesophageal reconstruction: A systematic review and meta-analysis of mortality and morbidity.

Gastric pull-up (GPU) is among the oldest techniques for reconstructing the pharyngoesophageal junction following cancer resection. This review examines morbidity and mortality rates following GPU pharyngoesophageal junction reconstruction from 1959 until present: 77 studies, 2,705 patients. The odds of mortality, anastomotic complications, and other complications decreased by 37.2% (95%CI = 28.0-45.3%; P < 0.0001), 8.0% (95%CI = -2.1 to 17.1%; P = 0.12), 21.0% (95%CI 3.5-35.2%; P = 0.021) per decade respectively. J. Surg. Oncol. 2016;114:907-914. © 2016 Wiley Periodicals, Inc.

[Gastric tube esophagoplasty using the retroesternal route in children]. / Sustitución esofágica con estómago tubulizado retroesternal en la infancia.

INTRODUCTION: Esophageal replacement is a surgical alternative once native esophagus can't be preserved. Different organs and routes for the replacement have been described, being the retroesternal route the least used. The aim is to present our results using gastric tube esophagoplasty with a retroesternal approach. PATIENTS AND METHODS: We performed a retrospective and descriptive study of 11 patients operated from 2000 to 2015. Median age at surgery was 2.2 years (5 months-9 years) and median weight was 11.2 kg (7.8-21). A gastric tube esophagoplasty using the retroesternal route, forced pyloric dilatation and end-to-side esophago-gastric cervical anastomosis were performed. RESULTS: Ten esophagus replacements had long-gap esophageal atresia and one, severe esophagus caustication secondary to button battery ingestion. No intraoperatory complications were observed. Three patients developed anastomosis leak. Two cases developed anastomotic stenosis managed with endoscopic dilatation in 2 and 4 occasions, respectively. Four patients showed occasional dumping syndrome and are asymptomatic after medical treatment. With a median follow up of 6.3 years (0.2-14.8), all our patients are alive and complete oral diet has been established in all of them. CONCLUSIONS: Gastric tube esophagoplasty using the retroesternal route is a suitable technique in order to reestablish gastrointestinal continuity once native esophagus can't be preserved. In our experience is a safe option, related to few complications.

INTRODUCCION: La sustitución esofágica es una de las opciones quirúrgicas en pacientes en los que no es posible la preservación del esófago. Existen diferentes técnicas según el órgano ascendido y la vía de ascenso, siendo la vía retroesternal la menos empleada. Se describen los resultados con el uso de estómago tubulizado retroesternal. PACIENTES Y METODOS: Estudio descriptivo retrospectivo de una serie de 11 pacientes intervenidos entre los años 2000 y 2015, con una edad media en el momento de la intervención de 2,2 años (5 meses-9 años) y un peso de 11,2 kg (7,8-21 kg). Se realizó gastroplastia tubulizada con dilatación forzada de píloro, ascenso gástrico por vía retroesternal y anastomosis esófago-gástrica cervical término-lateral. RESULTADOS: Diez sustituciones se realizaron en pacientes con atresia de esófago long-gap y una, tras una causticación esofágica por pila de botón. No hubo ninguna complicación intraoperatoria. En tres pacientes hubo fuga anastomótica. En dos pacientes se produjo estenosis que precisó dilataciones en 2 y en 4 ocasiones, respectivamente. Cuatro pacientes presentaron síndrome dumping ocasional que se resolvió con tratamiento médico. Con un seguimiento medio de 6,3 años (0,2-14,8), ningún paciente ha fallecido y en todos se ha logrado la nutrición oral completa. CONCLUSIONES: La gastroplastia tubulizada retroesternal es una técnica eficaz para restablecer la continuidad gastrointestinal en aquellos pacientes en los que no es posible preservar el esófago. Puede ser una opción segura y con escasas complicaciones.

Pediatric esophageal substitution by gastric pull-up and gastric tube.

AIM: The aim of this study was to report the results of pediatric esophageal substitution by gastric pull-up (GPU) and gastric tube (GT) from a tertiary care pediatric center. MATERIALS AND METHODS: Retrospective analysis of the surgical techniques, results, complications, and final outcome of all pediatric patients who underwent esophageal substitution in a single institution was performed. RESULTS: Twenty-four esophageal substitutions were performed over 15-year period. The indications were pure esophageal atresia (EA)-19, EA with distal trachea-esophageal fistula-2, EA with proximal pouch fistula-1, and esophageal stricture in two patients. Mean age and weight at operation were 17 months and 9.5 kg, respectively. GPU was the most common procedure (19) followed by reverse GT (4) and gastric fundal tube (1). Posterior mediastinal and retrosternal routes were used in 17 and 7 cases, respectively. Major complications included three deaths in GPU cases resulting from postoperative tachyarrhythmias leading to cardiac arrest, cervical anastomotic leak-17, and anastomotic stricture in six cases. Perioperative tachyarrhythmias (10/19) and transient hypertension (2/19) were observed in GPU patients, and they were managed with beta blocker drugs. Postoperative ventilation in Intensive Care Unit was performed for all GPU, but none of the GT patients. Follow-up ranged from 6 months to 15 years that showed short-term feeding difficulties and no major growth-related problems. CONCLUSIONS: Perioperative tachyarrhythmias are common following GPU which mandates close intensive care monitoring with ventilation and judicious use of beta blocking drugs. Retrosternal GT with a staged neck anastomosis can be performed without postoperative ventilation.

Combined use of gastric pull-up and pectoralis major flaps for massive defects after total laryngopharyngoesophagectomy in patients with advanced hypopharyngeal carcinoma.

Reconstruction for patients with advanced squamous cell carcinoma of the hypopharynx (SCCHP) after radical surgery is a challenge for head and neck surgeons, especially when one flap alone cannot entirely cover the defects. In this report, we describe the successful use of gastric pull-up combined with pectoralis major flaps for single-stage reconstruction after total laryngopharyngoesophagectomy in patients with SCCHP. We retrospectively reviewed the records of 23 patients with stage IV SCCHP who underwent this reconstructive procedure. Surgical details and perioperative morbidity were described, and functional and oncologic outcomes were evaluated. We used the gastric pull-up and pectoralis major flap procedure to reconstruct the defects for all 23 patients. In 13 patients the combined flaps were used to restore intestinal continuity, and in 10 patients the defects were repaired using gastric pull-up alone and covered by the pectoralis major flap. All the combined flaps worked well, and patients recovered normal swallowing function a mean 19.6 days after surgery. After an overall mean follow-up time of 25.3 months, six patients were still alive at the time of this analysis with no evidence of disease. Our results indicate that for patients with advanced SCCHP after total laryngopharyngoesophagectomy, using a pectoralis major flap combined with gastric pull-up enables one-stage reconstruction even when gastric pull-up alone cannot restore intestinal continuity. Furthermore, the functional and oncologic outcomes from this study suggest that this reconstructive procedure is safe and reliable, and more patients with advanced disease could be considered.

The pull-up spreader high (PUSH) technique for nasal tip support.

BACKGROUND: Nasal tip depression is associated with nasal valve collapse. The pull-up spreader high (PUSH) technique was developed to enlarge the nasal dorsum and upwardly rotate and define the nasal tip by lifting the domes. OBJECTIVES: The authors reviewed a case series to assess the long-term effectiveness of the PUSH technique in improving nasal airflow and aesthetic outcomes. METHODS: This retrospective study included 50 consecutive cases of PUSH rhinoplasty. Objective (acoustic rhinomanometry) and subjective (patient questionnaire) evaluations of the stability of the aesthetic result and improvement of airflow were conducted before and 3 years after PUSH rhinoplasty. RESULTS: PUSH rhinoplasty resulted in long-term stability of the aesthetic effect. All patients had pleasing aesthetic results and a general improvement in the nasal airway. When the degree of nasal obstruction was scored from 1 (greatest obstruction) to 10 (least obstruction), 22 patients rated their nasal function improved to a score of 10 and 28 patients to a score of 8. Rhinomanometry indicated that only 1 patient had worsened nasal airflow. CONCLUSIONS: The PUSH technique enables stable upward rotation and improved definition of the severely depressed nasal tip through an open approach. LEVEL OF EVIDENCE: 4.

Pull-Up Performance Is Affected Differently by the Muscle Contraction Regimens Practiced during Training among Climbers.

Sport climbing performance is highly related to upper limb strength and endurance. Although finger-specific methods are widely analyzed in the literature, no study has yet quantified the effects of arm-specific training. This study aims to compare the effects of three types of training involving different muscle contraction regimens on climbers' pull-up capabilities. Thirty advanced to high-elite climbers were randomly divided into four groups: eccentric (ECC; n = 8), isometric (ISO; n = 7), plyometric (PLYO; n = 6), and no specific training (CTRL; n = 9), and they participated in a 5-week training, twice a week, focusing on pull-ups on hangboard. Pre- and post-training assessments were conducted using a force-sensing hangboard, analyzing force, velocity, power, and muscle work during three pull-up exercises: pull-ups at body weight under different conditions, incremental weighted pull-ups, and an exhaustion test. The CTRL group showed no change. Maximum strength improved in all three training groups (from +2.2 ± 3.6% to +5.0 ± 2.4%; p < 0.001); velocity variables enhanced in the ECC and PLYO groups (from +5.7 ± 7.4 to +28.7 ± 42%; p < 0.05), resulting in greater power; amplitude increased in the ECC group; and muscle work increased in the PLYO group (+21.9 ± 16.6%; p = 0.015). A 5-week training period effectively enhanced arm performance, but outcomes were influenced by the chosen muscle contraction regimens and initial individual characteristics.

Surgical Outcomes of Cervical Esophageal Cancer: A Single-Center Experience.

Background: Cervical esophageal cancer is a rare malignancy that requires specialized care. While definitive chemoradiation is the standard treatment approach, surgery remains a valuable option for certain patients. This study examined the surgical outcomes of patients with cervical esophageal cancer. Methods: The study involved a retrospective review and analysis of 24 patients with cervical esophageal cancer. These patients underwent surgical resection between September 1994 and December 2018. Results: The mean age of the patients was 61.0±10.2 years, and 22 (91.7%) of them were male. Furthermore, 21 patients (87.5%) had T3 or T4 tumors, and 11 (45.8%) exhibited lymph node metastasis. Gastric pull-up with esophagectomy was performed for 19 patients (79.2%), while 5 (20.8%) underwent free jejunal graft with cervical esophagectomy. The 30-day operative mortality rate was 8.3%. During the follow-up period, complications included leakage at the anastomotic site in 9 cases (37.5%) and graft necrosis of the gastric conduit in 1 case. Progression to oral feeding was achieved in 20 patients (83.3%). Fifteen patients (62.5%) displayed tumor recurrence. The median time from surgery to recurrence was 10.5 months, and the 1-year recurrence rate was 73.3%. The 1-year and 3-year survival rates were 75% and 33.3%, respectively, with a median survival period of 17 months. Conclusion: Patients with cervical esophageal cancer who underwent surgical resection faced unfavorable outcomes and relatively poor survival. The selection of cases and decision to proceed with surgery should be made cautiously, considering the risk of severe complications.

Colorectal adenocarcinoma of the interposed colon after esophagectomy in infancy: a case report.

Colorectal carcinomas are a rare but possible complication in an interposed colonic segment used for reconstruction after esophagectomy. We report the case of a patient who underwent colonic interposition surgery in childhood due to esophageal atresia and was diagnosed with colorectal adenocarcinoma of the interposed colon ~57 years later. The patient underwent gastric pull-up after thoraco-abdominal resection of the colonic interposition en bloc with the adjacent remaining esophagus.