Propellar flap: safe, reliable option for coverage of exposed tendo achilles

Background: Stable skin cover over exposed tendo achilles is absolutely essential for proper healing and recovery of tendo achilles function. Exposed tendo achilles can be a result of open injuries, repair of closed TArupture, complications after repair like suture dehiscence, skin necrosis, infection, delayed exposure and recurrent rupture. Various methods have been described for coverage of repaired tendo achilles like distally based skin flaps, advancement flap, free tissue transfers and islanded flaps. This study describes the usefulness of islanded propeller flap for stable skin cover over tendo achilles.Methods: Over a period of 4 years from March 2012 to August 2016 with total cases were 6, all male patients between 16 to 56 years of age were included in the study. Method of tendo achilles repair/reconstruction was planned, based on individual case requirement. All patients underwent islanded propeller flap for coverage of exposed tendo achilles. All cases were followed up for at least 1 year.Results: All flaps except one case survived and on follow up the function of tendo achilles was excellent with stable, supple, healthy skin overlying the tendon. Tendoachilles strength was assessed by asking the patient to stand on toes.Conclusions: Islanded propeller flap cover over tendoachilles provides a stable, reliable, single stage procedure with good aesthetic appearance.

Review on Information Retrieval for Desktop Search Engine

Search is an important aspect of information management often taken for granted. Domain specific repositories are growing in both size and numbers calling for efficient search and retrieval of documents. This paper explores the possible techniques and necessary system components for a search engine charting several iterative optimizations over the last few years. This paper focuses on NLP models while retaining basic principles from other methods that assist in information search

Maintenance of leukemic cell identity by the activity of the Polycomb complex PRC1 in mice

Leukemia is a complex heterogeneous disease often driven by the expression of oncogenic fusion proteins with different molecular and biochemical properties. Whereas several fusion proteins induce leukemogenesis by activating Hox gene expression (Hox-activating fusions), others impinge on different pathways that do not involve the activation of Hox genes (non-Hox-activating fusions). It has been postulated that one of the main oncogenic properties of the HOXA9 transcription factor is its ability to control the expression of the p16/p19 tumor suppressor locus (Cdkn2a), thereby compensating Polycomb-mediated repression, which is dispensable for leukemias induced by Hox-activating fusions. We show, by genetically depleting the H2A ubiquitin ligase subunits of the Polycomb repressive complex 1 (PRC1), Ring1a and Ring1b, that Hoxa9 activation cannot repress Cdkn2a expression in the absence of PRC1 and its dependent deposition of H2AK119 monoubiquitination (H2AK119Ub). This demonstrates the essential role of PRC1 activity in supporting the oncogenic potential of Hox-activating fusion proteins. By combining genetic tools with genome-wide location and transcription analyses, we further show that PRC1 activity is required for the leukemogenic potential of both Hox-activating and non-Hox-activating fusions, thus preventing the differentiation of leukemic cells independently of the expression of the Cdkn2a locus. Overall, our results genetically demonstrate that PRC1 activity and the deposition of H2AK119Ub are critical factors that maintain the undifferentiated identity of cancer cells, positively sustaining the progression of different types of leukemia

The landscape of selection in 551 esophageal adenocarcinomas defines genomic biomarkers for the clinic.

Esophageal adenocarcinoma (EAC) is a poor-prognosis cancer type with rapidly rising incidence. Understanding of the genetic events driving EAC development is limited, and there are few molecular biomarkers for prognostication or therapeutics. Using a cohort of 551 genomically characterized EACs with matched RNA sequencing data, we discovered 77 EAC driver genes and 21 noncoding driver elements. We identified a mean of 4.4 driver events per tumor, which were derived more commonly from mutations than copy number alterations, and compared the prevelence of these mutations to the exome-wide mutational excess calculated using non-synonymous to synonymous mutation ratios (dN/dS). We observed mutual exclusivity or co-occurrence of events within and between several dysregulated EAC pathways, a result suggestive of strong functional relationships. Indicators of poor prognosis (SMAD4 and GATA4) were verified in independent cohorts with significant predictive value. Over 50% of EACs contained sensitizing events for CDK4 and CDK6 inhibitors, which were highly correlated with clinically relevant sensitivity in a panel of EAC cell lines and organoids.OCCAMS was funded by a Programme Grant from Cancer Research UK (RG66287), and the laboratory of R.C.F. is funded by a Core Programme Grant from the Medical Research Council. We thank the Human Research Tissue Bank, which is supported by the UK National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre, from Addenbrooke’s Hospital. Additional infrastructure support was provided from the Cancer Research UK–funded Experimental Cancer Medicine Centre

Rearrangement processes and structural variations show evidence of selection in oesophageal adenocarcinomas

Oesophageal adenocarcinoma (OAC) provides an ideal case study to characterize large-scale rearrangements. Using whole genome short-read sequencing of 383 cases, for which 214 had matched whole transcriptomes, we observed structural variations (SV) with a predominance of deletions, tandem duplications and inter-chromosome junctions that could be identified as LINE-1 mobile element (ME) insertions. Complex clusters of rearrangements resembling breakage-fusion-bridge cycles or extrachromosomal circular DNA accounted for 22% of complex SVs affecting known oncogenes. Counting SV events affecting known driver genes substantially increased the recurrence rates of these drivers. After excluding fragile sites, we identified 51 candidate new drivers in genomic regions disrupted by SVs, including ETV5, KAT6B and CLTC. RUNX1 was the most recurrently altered gene (24%), with many deletions inactivating the RUNT domain but preserved the reading frame, suggesting an altered protein product. These findings underscore the importance of identification of SV events in OAC with implications for targeted therapies

Propellar flap: safe, reliable option for coverage of exposed tendo achilles

Background: Stable skin cover over exposed tendo achilles is absolutely essential for proper healing and recovery of tendo achilles function. Exposed tendo achilles can be a result of open injuries, repair of closed TArupture, complications after repair like suture dehiscence, skin necrosis, infection, delayed exposure and recurrent rupture. Various methods have been described for coverage of repaired tendo achilles like distally based skin flaps, advancement flap, free tissue transfers and islanded flaps. This study describes the usefulness of islanded propeller flap for stable skin cover over tendo achilles.Methods: Over a period of 4 years from March 2012 to August 2016 with total cases were 6, all male patients between 16 to 56 years of age were included in the study. Method of tendo achilles repair/reconstruction was planned, based on individual case requirement. All patients underwent islanded propeller flap for coverage of exposed tendo achilles. All cases were followed up for at least 1 year.Results: All flaps except one case survived and on follow up the function of tendo achilles was excellent with stable, supple, healthy skin overlying the tendon. Tendoachilles strength was assessed by asking the patient to stand on toes.Conclusions: Islanded propeller flap cover over tendoachilles provides a stable, reliable, single stage procedure with good aesthetic appearance.

Reconstruction of Type II abdominal wall defects: Anterolateral thigh or tensor fascia lata myocutaneous flaps?

Introduction: Reconstruction of complex abdominal wall defects is both challenging and technically demanding for plastic surgeon. Objectives in abdominal wall reconstruction are consistent and include restoration of abdominal wall integrity, protection of intra abdominal viscera and prevention of herniation. Materials: We conducted a retrospective study on five patients in whom lateral thigh flaps such as anterolateral thigh (ALT) flaps and tensor fascia lata (TFL) myocutaneous flaps as pedicled or free flaps were used for complex abdominal wall Type II defects over a 5-years period between 2007 and 2012. Results: In two patients, free flaps were used for reconstruction of the upper abdomen and both were ALT. In three patients of lower abdominal defects, one patient had bilateral pedicled ALT flaps, one pedicled TFL myocutaneous and one free TFL myocutaneous in view of ipsilateral electric burn scars. There were no flap losses. Patients were followed up beyond 6 months and found to have a good abdominal contour and only one of five had clinical evidence of herniation. Conclusion: It can be concluded that flap from the Lateral thigh (ALT or TFL) is flap of choice for large Type II abdominal defects. Including vascularised fascia in the flap maintains abdominal wall integrity and use of synthetic mesh is not necessary. Upper abdominal defects need free flaps and in lower abdominal defects a pedicled flap suffices