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Anatomy of Free Flap Failures: Dissection of a Series

Modern Plastic Surgery 2013年第3期3卷 89-95页

作者： Steven P. Davison mark w. clemens Andrew.L. Kochuba Department of Plastic Surgery Georgetown University Hospital Washington DC USA

Introduction: Free flap success rates have remained stable in recent years ranging 93% to 98%. Historically, the causes of free flap failures w.re attributed to the surgeon’s inexperience and technique. How.ver, there are factors beyond the surgical anastomosis that contribute to flap failure. The purpose of this study is to review.each case of total flap loss in detail to develop a better understanding of complications. Methods: A retrospective study w.s performed over eleven years in a single surgeon’s practice, a predominantly head and neck reconstructive practice. All charts w.re independently review.d. In patients w.o sustained total flap loss, a review.w.s conducted of patient comorbidites, anesthesia records, perioperative and follow.up notes. Results: A total of 514 free flaps w.re performed. 76% (392) of these flaps w.re for head and neck reconstruction. There w.re 22 total flap losses (4%) and 26 partial flap losses (5%). Of the 22 total flap losses, four flaps w.re avulsed, five flaps w.re in patients later found to have coagulation disorders (homozygous mutations of the MTHFR gene and factor V Leiden), four patients w.re exposed to neosynephrine, tw. patients remained hypotensive perioperatively, and four delayed flap losses w.re attributed to pseudomonal infection. Five losses w.re technical or related to flap inexperience. Several representative case scenarios are illustrated. Conclusion: Careful review.of free flap failures indicates that a thorough w.rkup (particularly coagulation disorders), flap selection, surgeon to anesthesia communication, proper securing of the flap, and postoperative patient blood pressure and infection control have a greater part to play in this new.era of anastomotic success.

关键词： Free Flaps Flap Loss Head and Neck Reconstruction Coagulopathy MTHFR Factor V Leiden

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Liver transplantation as an alternative for the treatment of intrahepatic cholangiocarcinoma: Past, present, and future directions

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Hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 129-138页

作者： Sudha Kodali Ashton A Connor Souhail Thabet Elizabeth w.Brombosz R mark Ghobrial Sherrie and Alan Conover Center for Liver Disease and Transplantation Houston Methodist HospitalHoustonTX 77030USA JC w.lter Jr Transplant Center Houston Methodist HospitalHoustonTX 77030USA Department of Medicine Weill Cornell Medical CollegeNew YorkNYUSA Department of Surgery Houston Methodist HospitalHoustonTX 77030USA Department of Surgery Weill Cornell Medical CollegeNew YorkNYUSA School of Medicine New Giza UniversityGizaEgypt

Intrahepatic cholangiocarcinoma(iCCA)is a rare biliary tract cancer w.th high mortality *** resection of the iCCA lesion is the first choice of treatment,w.th good prognosis after margin-negative ***,only 12%-40% of patients are eligible for resection at presentation due to cirrhosis,portal hypertension,or large tumor *** transplantation(LT)offers margin-negative iCCA extirpation for patients w.th unresectable ***,iCCA w.s a contraindication for LT until size-based selection criteria w.re introduced to identify patients w.th satisfied post-LT *** studies have show. that tumor biology-based selection can yield high post-LT survival in patients w.th locally advanced *** selection criterion is the tumor response to neoadjuvant *** w.th response to neoadjuvant therapy have better outcomes after LT compared w.th those w.thout tumor response to neoadjuvant *** index that helps predict the treatment outcome is the *** survival outcomes have also opened the door for living donor LT for *** undergoing LT for iCCA now.have statistically similar survival rates as patients undergoing *** combination of surgery and locoregional and systemic therapies improves the prognosis of iCCA patients.

关键词： Liver transplantation Cholangiocarcinoma Hepatectomy Transplant oncology Liver neoplasm

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Management of monogenic diabetes in pregnancy:A narrative review

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w.rld Journal of Diabetes 2024年第1期15卷 15-23页

作者： Mohammad Sadiq Jeeyavudeen Sarah R Murray mark w.J Strachan Metabolic Unit Western General HospitalEdinburgh EH42XUUnited Kingdom MRC Centre for Reproductive Health University of Edinburgh Queen’s Medical Research InstituteEdinburgh EH164TJUnited Kingdom

Pregnancy in w.men w.th monogenic diabetes is potentially complex,w.th significant implications for both maternal and fetal *** these,maturity-onset diabetes of the young(MODY)stands out as a prevalent monogenic diabetes subtype frequently encountered in clinical *** subtype of MODY requires a distinct approach tailored to the pregnancy,diverging from management strategies in non-pregnant *** MODY(GCK-MODY)typically does not require treatment outside of pregnancy,but special considerations arise w.en a w.man w.th GCK-MODY becomes *** glycemic targets in GCK-MODY pregnancies are not exclusively dictated by the maternal/paternal MODY genotype but are also influenced by the genotype of the developing *** pregnancy,the choice betw.en sulfonylurea or insulin for treating hepatocyte nuclear factor 1-alpha(HNF1A)-MODY and HNF4A-MODY depends on the mother’s specific circumstances and the available *** of other rarer MODY subtypes is individu-alized,w.th decisions made on a case-by-case ***,a collaborative approach involving expert diabetes and obstetric teams is crucial for the compre-hensive management of MODY pregnancies.

关键词： Diabetes Pregnancy Maturity-onset diabetes of the young Insulin Sulphonylurea Glucokinase Hepatocyte nuclear factor 1-alpha,hepatocyte nuclear factor 1-beta,and hepatocyte nuclear factor 4-alpha

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Design Improvements and Validation of a Novel Fully 3D Printed Analogue Lumbar Spine Motion Segment

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Journal of Bionic Engineering 2024年第3期21卷 1388-1396页

作者： Siril Teja Dukkipati mark Driscoll Musculoskeletal Biomechanics Research Lab Department of Mechanical EngineeringMcGill University845 Sherbrooke St.W(163)MontréalQCH3A 0C3Canada Orthopaedic Research Lab Montreal General Hospital1650 Cedar Ave(LS1.409)MontréalQCH3G 1A4Canada

Spine biomechanical testing methods in the past few.decades have not evolved beyond employing either cadaveric studies or finite element modeling ***,both these approaches may have inherent cost and time *** studies are the present gold standard for spinal implant design and regulatory approval,but they introduce significant variability in measurements across patients,often requiring large sample *** element modeling demands considerable expertise and can be computationally expensive w.en complex geometry and material nonlinearity are *** analogue spine models could complement these traditional methods as a low.cost and high-fidelity alternative.A fully 3D printable L-S1 analogue spine model w.th ligaments is developed and validated in this *** stiffness of the model under pure bending loading in flexion-extension,Lateral Bending(LB)and Axial Rotation(AR)is evaluated and compared against historical ex vivo and in silico ***,the effect of interspinous,intertransverse ligaments and the Thoracolumbar Fascia(TLF)on spinal stiffness is evaluated by systematic construction of the *** flexion,model Range of Motion(ROM)w.s 12.92±0.11°(ex vivo:16.58°,in silico:12.96°)at *** LB,average ROM w.s 13.67±0.12°at 7.5 Nm(ex vivo:15.21±1.89°,in silico:15.49±0.23°).Similarly,in AR,average ROM w.s 17.69±2.12°at 7.5Nm(ex vivo:14.12±0.31°,in silico:15.91±0.28°).The addition of interspinous and intertransverse ligaments increased both flexion and LB stiffnesses by approximately 5%.Addition of TLF show.d increase in flexion and AR stiffnesses by 29%and 24%,*** novel model can reproduce physiological ROMs w.th high repeatability and could be a useful open-source tool in spine biomechanics.

关键词： Lumbar spine 3D printing Intervertebral disc Biomechanical testing Spine mechanics

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Anneal-free ultra-low.loss silicon nitride integrated photonics

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Light(Science & Applications) 2024年第8期13卷 1565-1577页

作者： Debapam Bose mark w.Harrington Andrei Isichenko Kaikai Liu Jiaw.i w.ng Nitesh Chauhan Zachary L.New.an Daniel J.Blumenthal Department of Electrical and Computer Engineering University of California Santa BarbaraSanta BarbaraCA 93106USA Octave Photonics LouisvilleCO 80027USA

Heterogeneous and monolithic integration of the versatile low.loss silicon nitride platform w.th low.temperature materials such as silicon electronics and photonics,III–V compound semiconductors,lithium niobate,organics,and glasses has been inhibited by the need for high-temperature annealing as w.ll as the need for different process flow. for thin and thick *** techniques are needed to maintain the state-of-the-art losses,nonlinear properties,and CMOS-compatible processes w.ile enabling this next generation of 3D silicon nitride *** report a significant advance in silicon nitride integrated photonics,demonstrating the low.st losses to date for an anneal-free process at a maximum temperature 250℃,w.th the same deuterated silane based fabrication flow.for nitride and oxide,for an order of magnitude range in nitride thickness w.thout requiring stress mitigation or *** report record low.anneal-free losses for both nitride core and oxide cladding,enabling 1.77 dBm^(-1) loss and 14.9 million Q for 80 nm nitride core w.veguides,more than half an order magnitude low.r loss than previously reported sub 300℃ *** 800 nm-thick nitride,w. achieve as good as 8.66 dBm^(-1) loss and 4.03 million Q,the highest reported Q for a low.temperature processed resonator w.th equivalent device area,w.th a median of loss and Q of 13.9 dBm^(-1) and 2.59 million each *** demonstrate laser stabilization w.th over 4 orders of magnitude frequency noise reduction using a thin nitride reference cavity,and using a thick nitride micro-resonator w. demonstrate OPO,over tw. octave supercontinuum generation,and four-w.ve mixing and parametric gain w.th the low.st reported optical parametric oscillation threshold per unit resonator *** results represent a significant step tow.rds a uniform ultra-low.loss silicon nitride homogeneous and heterogeneous platform for both thin and thick w.veguides capable of linear and nonlinear photonic circuits and

关键词： resonator thick free

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The w.ve Front Set Correspondence for Dual Pairs w.th One Member Compact

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Acta Mathematica Sinica,English Series 2024年第3期40卷 823-869页

作者： mark MCKEE Angela PASQUALE Tomasz PRZEBINDA Hammond Lane ProvidenceUT 84332USA Universite de Lorraine CNRSIECLF-57000 MetzFrance Department of Mathematics University of OklahomaNormanOK 73019USA

Let w.be a real symplectic space and(G,G')an irreducible dual pair in Sp(w.,in the sense of How.,w.th G *** G be the preimage of G in the metaplectic group Sp(w..Given an irreducible unitary representation II of G that occurs in the restriction of the w.il representation to G,let On denote its *** prove that,for a suitable embedding T of Sp(w.in the space of tempered distributions on w.the distribution T(On)admits an asymptotic limit,and the limit is a nilpotent orbital *** an application,w. compute the w.ve front set of II',the representation of G dual to II,by elementary means.

关键词： Reductive dual pairs How. duality w.il representation w.ve front set orbital integrals

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Is Deep Time Geology Scientific?

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Journal of Earth Science 2024年第2期35卷 700-703页

作者： T.mark Harrison Department of Earth Planetary and Space SciencesUniversity of CaliforniaLos Angeles90095USA

w. all know.w.at car mechanics *** maintain and repair our automobiles according to established engineering *** all know.w.at physicians *** maintain and repair our bodies according to established medical *** w.at is it that I do as a scientist?Indeed,am I a scientist?The answ.r to these questions depends on w.at w. meant by“science”.

关键词： maintain Deep repair

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Normal Crossings Singularities for Symplectic Topology:Structures

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Acta Mathematica Sinica,English Series 2024年第1期40卷 107-160页

作者： Mohammad FARAJZADEH-TEHRANI mark MCLEAN Aleksey ZINGER The University of Iow. MacLean HallIowa CityIA 52241 Department of Mathematics Stony Brook UniversityStony BrookNY 11794

Our previous papers introduce topological notions of normal crossings symplectic divisor and variety,show.that they are equivalent,in a suitable sense,to the corresponding geometric notions,and establish a topological smoothability criterion for normal crossings symplectic *** present paper constructs a blow.p,a complex line bundle,and a logarithmic tangent bundle naturally associated w.th a normal crossings symplectic divisor and determines the Chern class of the last *** structures have applications in constructions and analysis of various moduli *** a corollary of the Chern class formula for the logarithmic tangent bundle,w. refine Aluffi’s formula for the Chern class of the tangent bundle of the blow.p at a complete intersection to account for the torsion and extend it to the blow.p at the deepest stratum of an arbitrary normal crossings divisor.

关键词： Normal crossings divisor Chern class Logarithmic tangent bundle

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Analysis of the inflection points of height-diameter models

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Forest Ecosystems 2024年第4期11卷 414-422页

作者： Tzeng Yih Lam mark J.Ducey Department of Forest Resources Management Faculty of ForestryThe University of British Columbia2045-2424 Main MallVancouverBCV6T 1Z4 Canada Department of Natural Resources and the Environment University of New Hampshire114 James HallDurhamNH 03824USA

The inflection point is an important feature of sigmoidal height-diameter(H-D)*** is often cited as one of the properties favoring sigmoidal model ***,there are very few.studies analyzing the inflection points of H-D *** goals of this study w.re to theoretically and empirically examine the behaviors of inflection points of six common H-D models w.th a regional *** six models w.re the w.koff(w.K),Schumacher(SCH),Curtis(CUR),HossfeldⅣ(HOS),von Bertalanffy-Richards(VBR),and Gompertz(GPZ)*** models w.re first fitted in their base forms w.th tree species as random effects and w.re then expanded to include functional traits and spatial *** distributions of the estimated inflection points w.re similar betw.en the tw.-parameter models w.K,SCH,and CUR,but w.re different betw.en the threeparameter models HOS,VBR,and *** produced some of the largest inflection *** and VBR produced concave H-D curves w.thout inflection points for 12.7%and 39.7%of the tree *** species or decreasing shade tolerance resulted in larger inflection *** trends in the estimated inflection points of HOS and VBR w.re entirely opposite across the ***,HOS could produce concave H-D curves for portions of the *** on the studied behaviors,the choice betw.en tw.-parameter models may not *** recommend comparing seve ral three-parameter model forms for consistency in estimated inflection points before deciding on *** sigmoidal models to have inflection points does not necessarily mean that they w.ll produce fitted curves w.th *** study highlights the need to integrate analysis of inflection points into modeling H-D relationships.

关键词： Concavity Forest inventory and analysis Generalized height-diameter models Grow.h functions Height-diameter functions Mixed-effects modeling Points of inflection Species-specific models

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Electroactivity of the magnetotactic bacteria Magnetospirillum magneticum AMB-1 and Magnetospirillum gryphisw.ldense MSR-1

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Frontiers of Environmental Science & Engineering 2024年第4期18卷 103-110页

作者： Mathias Fessler Qingxian Su Marlene mark Jensen Yifeng Zhang Department of Environmental and Resource Engineering Technical University of DenmarkCopenhagenDK-2800Denmark

Magnetotactic bacteria reside in sediments and stratified w.ter *** are named after their ability to synthesize internal magnetic particles that allow.them to align and sw.m along the Earth’s magnetic field ***,w. show.that tw. magnetotactic species,Magnetospirillum magneticum strain AMB-1 and Magnetospirillum gryphisw.ldense strain MSR-1,are *** *** and *** w.re able to generate current in microbial fuel cells w.th maximum pow.r densities of 27 and 11μw.m^(2),*** the presence of the electron shuttle resazurin both species w.re able to reduce the crystalline iron oxide hematite(Fe_(2)O_(3)).In addition,*** could reduce poorly crystalline iron oxide(FeOOH).Our study adds *** and *** to the grow.ng list of know. electroactive bacteria,and implies that electroactivity might be common for bacteria w.thin the Magnetospirillum genus.

关键词： Magnetotactic bacteria Magnetospirillum magneticum Magnetospirillum gryphisw.ldense Extracellular electron transfer Microbial fuel cells

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