Functional and aesthetic effects of spreader grafts technique in rhinoplasty

PURPOSE: Spreader grafts technique is recognized and widely employed in rhinoplasty for middle nasal vault reconstruction. The purpose of this study is to describe this method and analyze the functional and aesthetic effects of its application.MATERIAL AND METHODS: Autologous or alloplastic sticks with individually designed measurements were submucoperichondrially implanted between the frontmost parts of anterior septal edge and upper lateral cartilages. This technique was applied in 36 patients with different indications for middle nasal vault reconstruction. Of them, 26 underwent primary and 10 - secondary rhinoplasties. Open approach was used in 32 patients but endonasal one in the rest four patients only.RESULTS: We present our recent clinical material when using the spreader grafts technique. These grafts help to achieve harmonious dorsal aesthetic lines, internal nasal valve competence preservation or recreation, and maintenance of the straightened position of the corrected deviated cartilaginous septal dorsum.CONCLUSION:  Though the spreader grafts technique is the solution of choice in many cases, particularly in secondary rhinoplasties, it is neither universal, nor perfect. There is uninterrupted debate on its true value in nasal patency. The result depends considerably on the surgeon`s technical skills and precision. Based on the literature available and our own experience, we could conclude that the spreader grafts technique in rhinoplasty presents with both positive and negative patterns

Efficient path search in intermodal transportation optimization

As the economies of the world become more interrelated and Supply Chains are globalizing, the need arises to create efficient transportation network. This reality in conjunction with conservation of fuel and environmental friendliness gives rise to the research of Efficient Intermodal Transportation System. In particular, the underutilization of railroads in the United States motivates us to research the development of optimal procedures in the transportation of containers in a rail network. With this thesis we search for a cost, time and capacity effective algorithm for solving transportation problem in a graph of intermodal centers (IMC\u27s). We consider discrete model of the real time dynamic situation when all the arcs of the input graph can be affected by changes in their costs, the transportation means have limited and different container capacities at each IMC, and all the nodes (IMC\u27s) can be visited more than once either by different transport means or at different time. This is more general and real situation than the ones considered in the literature so far. The resulting optimization problem is computational intractable (NP-hard), which creates the necessity to develop, implement and test efficient heuristic optimization techniques. We will use Shortest Path Problem (SPP) as the basis for the development of three heuristics. Because of the nature of the problem and application, shortest path procedures provide a very flexible and computationally efficient technique for our model. We will compare the three heuristics with the optimal solution for small size problems for which we could find optimality. Furthermore, we will demonstrate that one of the heuristics perform very well when the fixed costs of running transportation modes is the dominant aspect of the cost structure

Pelvic pressure ulcer reconstructions by pedicled muscle flaps

Introduction: Pelvic region is the most predisposed topographic area of the body to pressure ulcers in immobile patients. This communication presents the experience of the authors and set to discussion the value of the pedicled muscle flaps in the management of pressure ulcers stage III and IV.Material and Methods: The study was conducted during the period from May 2006 to December 2014. A total of 11 muscle based flaps were applied on 5 male and one female patients with deep pressure ulcers in the pelvic region. Musculus gluteus maximus (MGM), musculus gracilis (MG), musculus hamstring (MH), musculus vastus lateralis femoris (MVLF) and musculus rectus abdominis (MRA) were designed as monocomponent muscle or compound skin-muscle flaps in accordance with the wound characteristics.Results: The patients were followed-up from 1 month to 6 years.  All flaps were vital. Small area partial skin necrosis of the MRA flap and MH advancement flap required secondary surgical procedures within a month after the reconstruction. Four recurrences through variable periods were observed in one patient, operated on by different muscle flaps.Conclusion: Pressure ulcers are a frequent complication in immobile patients. Surgery is the most effective treatment method for wounds at stages III and IV. Patient`s general condition and wound status should be taken into consideration when planning the reconstruction. The vitality and volume of the muscle flaps are the main advantages of that alternative for surgical treatment of pelvic pressure sores.

Assessment of Operative Risk in Colorectal Oncologic Surgery

The objective of the present study is to elaborate a prognostic index for qualitative assessment of the operative risk in the surgical treatment of colorectal cancer (CRC).The documentation of 150 CRC patients, 91 males and 59 females, operated on in the Clinic of Surgery, Marko A. Markov Specialized Hospital of Oncological Diseases of Varna during the period from June 2008 till April 2009 was analyzed. Mean patients` age was 64,2 years (range, 34-84 years).Seventy patients presented with colon cancer, 76 - with rectum cancer while 4 patients presented with multiple tumour localizations. The risk factors included the following: patient`s age and gender; ASA stage; CRC localization according to ICD of WHO; surgical procedure according to OPCS4 system; emergency; CRC stage according to TNM classification; resection type, and hematocrit level. There were 55 patients with TNM stage I, 80 patients with TNM stages II-III, and 15 patients with TNM stage IV. The most common interventions were anterior resection (in 48 patients), right hemicolectomy (in 41 patients), and sigmoidectomy (in 23 patients). Thirty-day operative lethality rate was zero.The created data-base can successfully be used for the purposes of CRC prognostication with the patients forwarded to operative treatment

Reconstruction of deep burns of the knee using gastrocnemius flap

PURPOSE: The objective of this paper was to share our surgical experience and discuss the application of the gastrocnemius flap in the reconstruction of deep burns of the knee.MATERIAL AND METHODS: We reported a reconstructive work using gastrocnemius flap in six patients with deep burns of the knee joint. The application of flap surgery was determined by the size and the depth of the defect without considering the etiology of the burn. Five patients were treated with the medial head and the sixth one was treated with the lateral head of the gastrocnemius muscle.RESULTS: Complete tissue coverage of the wounds was obtained. In one patient, partial split-thickness skin graft was lost, however, secondary healing of the wound occurred. Primary healing occurred in the donor areas. Full mobility and good aesthetic results were obtained in all the patients.CONCLUSION: The gastrocnemius flap is a valuable surgical method in the reconstruction of the deep burns of the knee joint. The final functional and aesthetic outcome is very good. Having considered the advantages of the technique, we believe that its application is appropriate in many cases of deep burns of the knee presenting with exposed bone and tendon.Scripta Scientifica Medica 2013; 45(4): 71-76

Application of the pedicled m. latissimus dorsi flap for trunk reconstructions

PURPOSE: M. latissimus dorsi flap is one of the most commonly used pedicled flaps in plastic surgery. It can be based either on the dominant thoracodorsal vessels, or, as a reverse flap, on its secondary segmental pedicles. The purpose of this paper is to evaluate our experience with pedicled flaps from m. latissimus dorsi for trunk reconstructions.MATERIAL AND METHODS: In the present study, we applied eight flaps on 7 patients: four flaps for breast reconstruction, one flap for postmastectomy radiation wound treatment, one flap to cover a defect on the anterior thoracic wall caused by toxic skin necrosis, one flap to correct axillary skin contracture after deep burn injury, and one for lumbar reconstruction after malignant melanoma radical excision.RESULTS: In the present paper, two cases with application of this flap were reported to illustrate the stages of the surgical technique. All the flaps were vital and adapted normally. Narrow partial skin necrosis and donor scar depression were observed in the largest skin-muscle flap only.CONCLUSION: M. latissimus dorsi pedicled flaps are reliable source for trunk reconstructions. They may transfer abundant plastic material to compensate tissue deficit of different etiology. The risk of complications is insignificant, whereas the patients' quality of life is considerably improved.Scripta Scientifica Medica 2013; 45(2): 86-90

Prognostic significance of Epidermal Growth factor receptor in colon cancer patients on surgical treatment

Recently, pathological expression of epidermal growth factor receptor (EGFR) is increasingly used in the diagnosis of various epidermal tumours. The aim of this study is to analyze the role of EGFR in comparison to p53 as a prognostic marker in patients with colon cancer who undergo surgical treatment.Two types of immunohistochemical examinations (for EGFR and p53) have been performed in 120 patients with colon cancer histologically verified by using of hematoxylin-eosin staining.Our results clearly demonstrate that EGFR expression is present in 18 patients (in 15% of the cases). It occurs much more often in the patient with TNM stage II and especially in those with TNM stage III and relatively more frequently in the patients aged between 51 and 70 years and presenting with a moderately differentiated tumour. Besides, this expression immediately relates to a recurrence of the disease and worsened clinical course. There exists a correlation between the enhanced expression of EGFR and that of p53. Because of the small sample, our results are not statistically significant.EGFR can serve as an independent prognostic factor and indicator of more common recurrences of the disease, worse quality of life and poorer prognosis in colon cancer patients. Further intensive collaboration between coloproctologists and pathologists is needed to improve the individualized surgical behaviour in such patients

TRY plant trait database – enhanced coverage and open access

Plant traits - the morphological, anatomical, physiological, biochemical and phenological characteristics of plants - determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait‐based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits - almost complete coverage for ‘plant growth form’. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait–environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives

Discrete Event System Modeling Of Demand Responsive Transportation Systems Operating In Real Time

Demand responsive transportation is a variable route service of passengers or freight from specific origin(s) to destination(s) in response to the request of users. Operational planning of DRT system encompasses the methods to provide efficient service to the passengers and to the system operators. These methods cover the assignments of vehicles to transportation requests and vehicle routings under various constraints such as environmental conditions, traffic and service limitations. Advances in the information and communication technologies, such as the Internet, mobile communication devices, GIS, GPS, Intelligent Transportation Systems have led to a significantly complex and highly dynamical decision making environment. Recent approaches to DRT operational planning are based on closed information loop to achieve a higher level of automation, increased flexibility and efficiency. Intelligent and effective use of the available information in such a complex decision making environment requires the application of formal modeling and control approaches, which are robust, modular and computationally efficient. In this study, DRT systems are modeled as Discrete Event Systems using Finite Automata formalism and DRT real time control is addressed using Supervisory Control Theory. Two application scenarios are considered; the first is based on air-charter service and illustrates uncontrolled system model and operational specification synthesis. The automatic synthesis of centralized and modular supervisors is demonstrated. The second scenario is a mission critical application based on emergency evacuation problem. Decentralized supervisory control architecture suitable for accommodating the real-time contingencies is presented. Conditions for parallel computation of local supervisors are specified and the computational advantages of alternative supervisory control architectures are discussed. Discrete event system modeling and supervisory control theory are well established and powerful mathematical tools. In this dissertation, they are shown to be suitable for expressing the modeling and control requirements of complex and dynamic applications in DRT. The modeling and control approaches described herein, coupled with the mature body of research literature in Discrete Event Systems and Supervisory Control Theory, facilitate logical analysis of these complex systems and provide the necessary framework for development of intelligent decision making tools for real time operational planning and control in a broad range of DRT applications