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Management of Post-Mastectomy Radio-Necrotic Ulcers &Osteoradionecrosis

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Journal of Cancer Therapy 2019年第6期10卷 433-441页

作者： Alaadin Hussein Rimoun boutros Amani Saber Surgical Oncology Department National Cancer Institute Cairo University Cairo Egypt Radiotherapy Department National Cancer Institute Cairo University Cairo Egypt Clinical Oncology Department Minia Oncology Center Minia University Minia Egypt

Background: Breast cancer is still the most common indication for chest wall irradiation, despite the advances in RTH techniques complications still occur, and the time of its occurrence vary and could take few months to many years. ORN usually manifests with pain, exposed bone, fistulae and pathological fracture and the proper management needs proper debridement and coverage by thick musculocutaneous flaps. Objective: To evaluate different techniques of surgical management of post-irradiation persistent radio-necrotic ulcer & ORN with emphasis on the outcome of each technique. Patients and methods: A retrospective study from 2010 to 2015 reviewed 20 patients subjected to post-mastectomy radiotherapy as a treatment for breast cancer inNCICairo, and Minia oncology center Hospital, Egypt. Cases were biopsied to exclude local recurrence. The age, sex, type of ulcer, dose of radiotherapy received and the management done for these cases were recorded. Results: Only 4 patients responded to conservative treatment in the form of repeated dressings, and 16 patients needed surgical treatment;5 of them were treated with debridement and coverage with split thickness graft with high rate of complications reaching 80%, the other 11 patients were reconstructed with musculocutanoeus flaps, of these 7 patients were reconstructed with LD flaps with 57.14% success rate and minor complications only, the other 4 cases were reconstructed with TRAM flap with 50% success and major loss of the flap in one case that needed salvage by LD flap. Pre-operative comorbidity was found in 6 patients and all of them experienced complications while only 3 of the other 14 who had no comorbidity had postoperative complications. Conclusion: Pedicled flaps provide a good choice for reconstruction and provide chest wall support without the use of synthetic mesh.

关键词： Radionecrotic Ulcer Osteoradionecrosis Pedicled Myo-Cutaneous Flaps Breast Cancer

Wearable positive end-expiratory pressure valve improves exercise performance

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Sports Medicine and Health Science 2020年第3期2卷 159-165页

作者： Stephen F.Crouse Jason R.Lytle Sean boutros William Benton Michael Moreno Patrick C.McCulloch Brad S.Lambert Department of Health and Kinesiology Texas A&M UniversityCollege StationTXUSA My Houston Surgeons 9230 Katy FreewaySuite 600HoustonTXUSA PEEP Performance LLC.96 Siwanoy BlvdEastchesterNYUSA Department of Mechanical Engineering Texas A&M UniversityCollege StationTXUSA Houston Methodist Hospital HoustonTXUSA

We tested a PEEP(4.2 cmH_(2)O)mouthpiece(PMP)on maximal cycling performance in healthy ***-1,PMP ***-PMP mouthpiece(CON)[n=9(5♂),Age=30±2 yr];Experiment-2,PMP *** mouthpiece(NMP)[n=10(7♂),Age=27±1 yr].At timepoint 1 in both experiments(mouthpiece condition randomized)subjects performed graded cycling testing(GXT)(Corival®cycle ergometer)to determine VO_(2peak)(ml*kg*min^(-1)),O2pulse(mlO2*bt^(-1)),GXT endurance time(GXT-T(s)),and VO_(2)(ml*kg*min^(-1))-at-ventilatory-threshold(VO_(2)@VT).At timepoint 272 h later,subjects completed a ventilatory-threshold-endurance-ride[VTER(s)]timed to exhaustion at VO_(2)@VT power(W).One week later at timepoints 3 and 4(time-of-day controlled),subjects repeated testing protocols under the alternate mouthpiece *** results(paired T-test,p<0.05):Experiment 1 PMP ***,respectively:VO_(2peak)=45.2±2.4 vs.42.4±2.3 p<0.05;VO_(2)@VT=33.7±2.0 vs.32.3±1.6;GXTTTE=521.7±73.4 vs.495.3±72.8(p<0.05);VTER=846.2±166.0 vs.743.1±124.7;O2pulse=24.5±1.4 vs.23.1±1.3(p<0.05).Experiment 2 PMP ***,respectively:VO_(2peak)=43.3±1.6 vs.41.7±1.6(p<0.05);VO_(2)@VT=31.1±1.2 vs.29.1±1.3(p<0.05);GXT-TTE=511.7±49.6 vs.486.4±49.6(p<0.05);VTER 872.4±134.0 vs.792.9±122.4;O2pulse=24.1±0.9 vs.23.4±0.9(p<0.05).Results demonstrate that the PMP conferred a significant performance benefit to cyclists completing high intensity cycling exercise.

关键词： Oxygen uptake Cycling exercise Pulmonary system Maximal working capacity Oxygen saturation Respiration

The Impact of Social Media on Dietary Behaviors and Body Image of College Students: A Qualitative Approach

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Food and Nutrition Sciences 2024年第8期15卷 711-726页

作者： Basem Azmy Saad boutros Tabbetha D. Lopez Valencia Browning-Keen Department of Human Sciences Sam Houston State University Huntsville TX USA

Background: The use of social media platforms for health and nutrition information has become popular among college students. Although social media made information readily accessible in different formats, nutritional misinformation promoted by influencers and non-experts caused negative impact on diet behavior and perception of body image. Previous research indicated that extensive use of social media was positively linked to disordered eating behaviors. Social media platforms like Facebook and Instagram that allow users to follow celebrities intensified exposure to influencers’ messages and images and resulted in negative moods and body dissatisfaction. Objective: This paper aims to explore the impact of social media on college students’ dietary behaviors and body image. Participants: 18 undergraduate students from a public university in the Southern United States were recruited through a mass email. Methods: A cross-sectional qualitative study of three focus groups was conducted. The focus groups were based on guiding open-ended questions. *** was used to code and analyze the data using inductive and deductive codes. Results: Three main themes were identified. The conditions theme included elements that explain why and how social media influences the participants’ actions. The actions theme included eating behavior, physical activity, and dietary supplement intake. The consequences theme describes anticipated or actual outcomes of actions such as body image and ideal weight. Conclusions: Social media has had a negative influence on diet behaviors and a positive influence on physical activity. Evidence-based nutrition and weight management information is needed to thwart potential misinformation.

关键词： Social Media Nutrition Information Dietary Behavior Body Image College Students

Synergetic role of integrating the departments of cancer registry and clinical research at an academic comprehensive cancer center

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World Journal of Methodology 2017年第2期7卷 33-36页

作者： McKenzie Bedra Tammy Vyskocil Jennifer Emel Crystal Edwards Cherif boutros Tate Cancer Center University of Maryland Baltimore Washington Medical Center Department of Surgery University of Maryland School of Medicine

Integration of the cancer registry and clinical research departments can have a significant impact on the accreditation process of a Commission on Cancer(Co C) *** in we demonstrate that the integration of both departments will benefit as there is increased knowledge, manpower and crossover in job responsibilities in our Co C-accredited Academic Comprehensive Cancer *** our model this integration has led to a more successful cooperative interaction among departments, which has in turn created an enhanced combined effect on overall output and *** manpower for the cancer registry has led to increased caseloads, decreased time from date of first contact to abstraction, quality of data submissions, and timely follow-up of all patients from our reference date for accurate survival analysis along with completeness of *** 2016, our Annual Facility report showed an additional 163 cases over prediction by the state of Maryland Cancer Registry and a 39% increase in case *** proof of the synergetic effectiveness of our model within one year of its implementation, the cancer center was able to apply for, and was awarded membership from Alliance for Clinical Trials in Oncology, Central IRB, and in turn led to increased clinical trial accrual from 2.8% in 2014 compared to 13.2% *** cancer registry in year one submitted over 150 more cases than predicted, improved quality outcome measures displayed by our Cancer Program Practice Profile reports and had more timely and complete data submissions to national and state *** synergetic integration has led to a better understanding, utilization and analysis of data by an integrated team with Clinical Research expertise.

关键词： Cancer registry Clinical research Commission on Cancer Synergetic integration American College of Surgeons

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“难”就是难——谈游戏困难模式的设计

程序员（游戏创造） 2008年第7期 48-52页

作者： Dan boutros 韦欢（译）不详北方工业大学

游戏困难模式的设计在如今的游戏开发中很少受到重视，只有少数游戏能够制作出精良的困难模式来满足高级玩家的需要。大多数游戏的困难模式都成为了一种取悦开发商的手段，或是为各种水平玩家提供购买理由的补救措施。几乎所有的开发商... 详细信息

游戏困难模式的设计在如今的游戏开发中很少受到重视，只有少数游戏能够制作出精良的困难模式来满足高级玩家的需要。大多数游戏的困难模式都成为了一种取悦开发商的手段，或是为各种水平玩家提供购买理由的补救措施。几乎所有的开发商都是在最后对游戏进行调整时，才会着手处理有关困难模式的设定。由于没有足够的时间进行设计，游戏的困难模式通常很难赢得多数玩家的欣赏。

关键词：游戏开发设计开发商

Food Safety Traceability Systems in the Maritime Catering Logistics

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Food and Nutrition Sciences 2014年第15期5卷 1447-1455页

作者： Basem Azmy Saad boutros Mahmoud Mahmoud Hewedi Kevin R. Roberts Farida M. Megahid Department of Hospitality Management and Dietetics College of Human Ecology Kansas State University Manhattan USA Hotel Studies Department Faculty of Tourism and Hotels Fayoum University Fayoum Egypt Hotel Studies Department Faculty of Tourism and Hotels Menoufia University Sadat City Egypt

This paper aims to explore food safety traceability in the onboard food and beverage operations on cruise ships through a case study approach. Semi-structured interviews were conducted with galley and foodservice staff. Additionally, a self-administered questionnaire was designed and distributed to logistics managers and employees of three Egyptian cruise companies. Results indicated that cruise ships in this study use paper-based and manually-entered (electronically stored) data traceability systems. Managing food safety by effective product recall, complying with legislation, and improving product quality are among the most important perceived benefits identified by foodservice staff. Maintaining a good reputation, ensuring food safety, reducing foodborne illnesses, suppliers' commitment to quality specifications, and maintaining guest confidence are considered the most important benefits from implementing a food traceability system. The results also depicted that the challenges managers face implementing or improving a food traceability system included high cost, absence of unified traceability standards between cruise companies and food suppliers, shortage of skilled staff, and lack of knowledge and satisfaction with current foodservice operation systems onboard cruise ships. Other findings elucidated that the critical success factors for implementing traceability included strict food traceability legislation, ensuring the adequacy and correctness of traceability information, adopting a food traceability system by the cruise company management, the standardization of food traceability information identification, and technology support for food traceability systems implementation from government. Other factors were reported of less importance. This research concluded the urgent need for more cooperation between cruise companies, food suppliers, and relevant governmental authorities to adopt food traceability systems and the need of authorizing and setting compuls

关键词： Food Safety Traceability Cruise Ships Traceability Systems Logistics

Operative management of acute diverticulitis in immunosuppressed compared to immunocompetent patients: A systematic review

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World Journal of Surgical Procedures 2015年第1期5卷 155-166页

作者： Ahmed Al-Khamis Jad Abou Khalil Nazi Torabi Marie Demian Abbas Kezouh Philip H Gordon marylis. boutros Division of Colorectal Surgery Jewish General HospitalMc Gill University Schulich Library of Science and Engineering Mc Gill University Department of Statistics and Epidemiology Jewish General Hospital

AIM: To determine short and long-term outcomes following operative management of acute diverticulitis in immunosuppressed(IMS) compared to immunocompetent(IMC) ***: PRISMA guidelines were followed in conducting this systematic review. We searched Pub Med(1946 to present), OVID MEDLINE(R) In-Process and Other Non-Indexed Citations, OVID MEDLINE(R) Daily and OVID MEDLINE(R)(1946 to present), EMBASE on OVID platform(1947 to present), CINAHL on EBSCO platform(1981 to present), and Cochrane Library using a systematic search strategy. There were no restrictions on publication date and language. We systematically reviewed all published cohort comparative studies, casecontrol studies, and randomized controlled trials that reported outcomes on operative management of acute episode of colonic diverticulitis in IMS in comparison to IMC patients. RESULTS: Seven hundred and fifty-five thousand five hundred and eighty-three patients were included in this systematic review; of which 1478 were IMS and 754105 were IMC patients. Of the nine studies included there was one prospective cohort, seven retrospective cohorts, one retrospective case-control study, and no randomized controlled trials. With the exception of solid organ transplant patients, IMS patients appeared to be older than IMC when they presented with an acuteepisode of diverticulitis. IMS patients presented with more severe acute diverticulitis and more insidious onset of symptoms than IMC patients. In the emergency setting, peritonitis was the main indication for operative intervention in both IMS and IMC patients. IMS patients were more likely to undergo Hartmann's procedure and less likely to undergo reconstructive procedures compared to IMC patients. Furthermore, IMS patients had higher morbidity and mortality rates in the emergency setting compared to IMC patients. In the elective settings, it appeared that reconstruction with primary anastomosis with or without a diverting loop stoma is the procedure o

关键词： Diverticular disease Immunosuppression Diverticulitis Chemotherapy Transplant Steroids

Surgical Anatomy Around the Orbit: The System of Zones: A Continuation of Surgical Anatomy of the Orbit by Barry M. Zide and Glenn W. Jelks

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Management of Ruptured Scalp Arteriovenous Malformation: A Rare Case and Literature Review

丛书名： Includes CD-ROM

2006年

作者： boutros Sean G. Luce Craig A. Millman Arthur L. Zide Barry M

来源：畅想之星图书光盘版（南... 评论

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World Journal of Cardiovascular Surgery 2020年第12期10卷 271-278页

作者： Isaac Okyere Sanjeev Singh Perditer Okyere Paa Kwesi S. Fiifi-Yankson boutros F. Farhat Samuel Gyasi Brenu Department of Surgery Komfo Anokye Teaching Hospital Kumasi Ghana School of Medicine and Dentistry College of Health Sciences Kwame Nkrumah University of Science Kumasi Ghana Komfo Anokye Teaching Hospital Kumasi Ghana Department of Anaesthesia and Intensive Care Komfo Anokye Teaching Hospital Kumasi Ghana Renal Unit/Department of Medicine Komfo Anokye Teaching Hospital Kumasi Ghana

Arteriovenous malformation (AVM) are vascular anomalies that arise due to abnormal connection with shunting of blood from arteries to veins without an intervening capillary network. They are mostly found intracranially but extracranially, the scalp AVM cases are also well reported. However, arteriovenous malformation (AVM) of the scalp is a rare lesion whose natural history is not clearly understood. The clinical manifestation of AVM includes asymptomatic state, local discomfort, headaches and occasional scalp necrosis leading to massive haemorrhage. CT or MR angiography remains the cornerstone for investigation. The options of treatment include complete surgical excision, embolization or a combination of the two modalities. We present the successful management of a young man who presented with a torrential bleeding from a ruptured scalp arteriovenous malformation and had to undergo emergency complete excision followed with a rotational flap for the scalp reconstruction.

关键词： Scalp Arteriovenous Malformation Bleeding Surgery Rotational Flap