Use of Banked Tissue in Plastic Surgery

The availability of safe and reliable, banked tissues in India has enabled the use of human bone allografts as a viable alternative to autografts in reconstructive surgery. Lyophilised, irradiated bone grafts were used in 2 cases of rhinoplasty, a case of hemifacial atrophy, and as a chin implant.In the patient with revision rhinoplasty the rib graft was resorbed. The patient with hemifacial atrophy developed seroma and infection in the zygomatic and infraorbital area and the rib graft had to be removed. The graft from the same rib that was placed over the mandible was retained well and incorporated completely. The iliac crest cortico-cancellous grafts did well in the second case of augmentation rhinoplasty and in the augmentation of chin.The primary objective of reconstructive surgery in the treatment of burns, non-healing wounds and pressure sores is to remove the dead tissue and restore the continuity of the skin without delay. Lyophilised, irradiated, human amnion is a temporary biological dressing conveniently available off-the-shelf. It was used in twenty four patients with burns, eight patients with bedsores and six patients with non-healing ulcers mainly on the foot. The total surface areas of burns sustained were from 2% to 40%. The burns ranged from second degree to deep third degree burns. Amnion was not used in patients with infected third degree burns.The amnion provided good biological cover in all the patients. It was easy to handle and apply, and provided pain relief. The duration of healing varied depending on the extent and depth of the wound and the amount of exudate. The superficial bedsores healed with a single application of amnion. Reduced exudate, healthy granulation tissue and enhanced epithelisation were observed following application of amnion.     

Reconstruction of the STS 14 (Australopithecus africanus) pelvis

The study reports a reconstruction of the sacrum in STS 14 based on extrapolation from the measurements of the first two sacral vertebrae of STS 14 and of the angle formed by the anterior surfaces of their vertebral bodies. Reconstruction is based on comparisons of, and extrapolation from, sacra of Pan troglodytes, Homo sapiens, and Australopithecus afarensis. The reconstructed sacrum has an anterior sacral curvature of 39°. The two ossa coxae were also completed by mirror imaging of one side by the other. With the pelvis completely reconstructed, the pelvic dimensions for the antero-posterior (AP) diameters of the pelvic inlet, midpelvis, and pelvic outlet are 85, 68, and 69 mm and the corresponding transverse (TR) diameters are 109, 88, and 103 mm, respectively. The posterior sagittal diameters in the three pelvic planes are small compared to the anterior sagittal diameters. This analysis indicates that the STS 14 pelvis is platypelloid in the three pelvic planes; i.e., all the AP diameters are smaller than the corresponding TR diameters. This makes the STS 14 pelvis similar to that to Al 288-1, save for a less pronounced degree of platypelloidy at the inlet in the former. © 1995 Wiley-Liss, Inc.     

Prevalence of spina bifida occulta in patients with functional disorders of the lower urinary tract and its relation to urodynamic and neurophysiological measurements.

OBJECTIVE--To determine the relation between neurophysiological abnormalities and the radiological detection of spina bifida occulta in patients with dysfunction of the lower urinary tract. DESIGN--Blind assessment and subsequent decoding of mixed batch of abdominal radiographs from patients with and without urological symptoms for evidence of spina bifida occulta and comparison of results with those of previous control series. SETTING--Review study among tertiary referrals to an incontinence clinic of a city hospital. PATIENTS--One hundred and thirty eight adults with proved urodynamic abnormalities in whom neurophysiological measurements were available. INTERVENTIONS--None. END POINT--Correlation of neurophysiological abnormalities in lower urinary tract dysfunction with presence and type of spina bifida occulta and level of opening of posterior sacral arcs. MEASUREMENTS AND MAIN RESULTS--On decoding radiographs those from patients without urological symptoms showed a similar prevalence of spina bifida occulta to that in the control series (631/2707 controls; 23%). By contrast, patients with urological symptoms had a significantly increased prevalence of spina bifida occulta at S1 and S2 and a higher level of opening of posterior sacral arcs. The increased prevalence of the bony defect was particularly striking in men with urgency and instability and in women with stress incontinence. No significant correlation was found between any particular neurophysiological abnormality and the presence of spina bifida. CONCLUSIONS--In patients with dysfunction of the lower urinary tract neurophysiological abnormalities may be associated with congenital dysraphic lesions in the lower lumbar spine and sacrum. There appears to be no direct causal relation between the radiological and neurophysiological abnormalities but the findings suggest a common aetiological factor.     

The transverse lumbosacral back flap.

The transverse lumbosacral back flap is presented as a good one to use for coverage of sacral defects. Its reliability appears to be due to an axial pattern of its proximal portion, and to an uninterrupted subdermal vascular plexus across the midline of the back (supplying the terminal portion). A retrospective analysis of its use in 20 patients, over the last 3 years, suggests that when it is designed properly it can be most useful in the management of sacral pressure sores.     

The forgotten nodule: complications of sacral nodules in rheumatoid arthritis

Nodules commonly occur in rheumatoid arthritis and occasionally give rise to complications. The sacral nodule is easily missed and may ulcerate to produce extensive sacral sores which may lead to serious and even fatal complications in patients with rheumatoid arthritis. Seven cases are reported which illustrate some of these features.     

Does postcranial palaeoneurology provide insight into pterosaur behaviour and lifestyle? New data from the azhdarchoid Vectidraco and the ornithocheirids Coloborhynchus and Anhanguera

The postcranial palaeoneurology of fossil reptiles is understudied, and those studies that exist focus predominantly on crocodyliforms and dinosaurs. The intervertebral foramina of the spine house nerves that exit to innervate surrounding tissues and the extremities. In the heavily fused (and typically distorted or poorly preserved) pterosaurian sacrum, intervertebral foramina can be difficult to observe and are rarely identified. The Early Cretaceous azhdarchoid Vectidraco from the Isle of Wight, UK, exhibits large, paired foramina on each sacral vertebra, originally identified as pneumatic foramina. Micro‐computed tomography imaging reveals these communicate with the neural canal and are intervertebral foramina for sacral nerves. The sacral vertebrae of Vectidraco are fused, and intervertebral foramina occur dorsolaterally on the centra. We identified these structures in other pterosaur sacra, including those of the ornithocheiroids Anhanguera and Coloborhynchus. The sizes of the sacral and notarial neural canals are compared and considered within interpretations of palaeoecology and locomotion, following previous studies. The relatively large sacral neural canal of Vectidraco implies a sacral enlargement for innervation of the legs and lumbosacral plexus. When compared with Anhanguera, this supports indications that azhdarchoids were more hindlimb‐proficient than ornithocheiroids. Neural canal size in the Coloborhynchus notarium suggests that ornithocheirids spent less time on the ground, their brachial enlargement and small sacral region indicating enhanced innervation of the wings and poor innervation of the sacrum and legs. This is the first study focusing on pterosaur postcranial palaeoneurology; more studies on other taxa are needed to reveal patterns across Pterosauria as a whole.     

Comparison of contact pressures measured at the sacrum of young and elderly subjects

Contact (interface) pressure measurements were made between the sacrum of groups of young and elderly subjects lying upon two special mattresses used to prevent pressure sores. One mattress was an alternating air pressure mattress, the other a foam mattress. Contact pressures were measured using a hydraulic sensor taped directly to the skin over the sacrum. All mean pressures and ‘pressure impulses’ (total applied pressure per standard time period) appeared higher when measured among the elderly subjects. Compared with the pressures measured from young subjects, the maximum contact pressures were significantly higher (p < 0.05) on both mattresses, with the pressure impulse higher while lying upon the foam mattress (p < 0.05).     

Establishing predictive indicators for the status of loaded soft tissues.

Two complementary techniques were employed to assess the soft tissue response to applied pressure. The noninvasive methods involve the simultaneous measurement of the local tensions of oxygen and carbon dioxide (tcPO2 and tcPCO2) and the collection and subsequent analysis of sweat collected from the sacrum, a common site for the development of pressure sores. All tests were performed on able-bodied subjects. Results have indicated that oxygen levels (tcPO2) were lowered in soft tissues subjected to applied pressures of between 40 (5.3 kPa) and 120 mmHg (16.0 kPa). At the higher pressures, this decrease was generally associated with an increase in carbon dioxide levels (tcPCO2) well above the normal basal levels of 45 mmHg (6 kPa). There were also considerable increases, in some cases up to twofold, in the concentrations of both sweat lactate and urea at the loaded site compared with the unloaded control. By comparing selected parameters, a threshold value for loaded tcPO2 was identified, representing a reduction of ~60% from unloaded values. Above this threshold, there was a significant relationship between this parameter and the loaded/unloaded concentration ratios for both sweat metabolites. These parameters may prove useful in identifying those subjects whose soft tissue may be compromised during periods of pressure ischemia.     

Soft coral abundance on the central Great Barrier Reef: effects of Acanthaster planci, space availability, and aspects of the physical environment

 The distribution and abundance of soft coral genera on reefs of the central Great Barrier Reef was investigated in relation to reef position, recent history of disturbance, wave exposure, substratum slope and depth. Eighty-five 25 m long transects were surveyed at 10 m depth on windward sides of 14 mid- and outer-shelf reefs. A further 75 transects in different zones on one mid-shelf reef (Davies Reef) between 5 and 30 m depth were investigated. The crown-of-thorns starfish Acanthaster planci had caused large-scale mortality of scleractinians on eight of these reefs five to ten years prior to the study, and as a result, scleractinian cover was only 35–55% of that on the six unimpacted reefs. On the impacted reefs, stony corals with massive and encrusting growths form had smaller average colony diameters but similar or slightly lower numerical abundance. In contrast, mean colony size, cover and abundance of branching stony corals showed no difference between impacted and unimpacted reefs. Twenty-four genera of soft corals (in eight families) were recorded, and none showed different abundance or cover in areas of former A. planci impact, compared to unaffected sites. Similarly, no difference was detected among locations in the numbers or area cover of sponges, tunicates, zoanthids, Halimeda or other macro-algae. Mean soft coral cover was 2 to 5% at 10 m on sheltered mid-shelf reefs, and 12 to 17% on more current-exposed reefs. Highest cover and abundances generally occurred on platforms of outer-shelf reefs exposed to relatively strong currents but low wave energy. On Davies Reef, cover and colony numbers of the families Nephtheidae and Xeniidae were low within the zone of wave impact, in flow-protected bays and lagoons, on shaded steep slopes, and at depths above 10 and below 25 m. In contrast, distributions of genera of the family Alcyoniidae were not related to these physical parameters. The physical conditions of a large proportion of habitats appear “sub-optimal” for the fastest growing taxa, possibly preventing an invasion of the cleared space. Thus, in the absence of additional stress these shallow-water fore-reef zones appear sufficiently resilient to return to their pre-outbreak state of scleractinian dominance. Accepted: 20 August 1996     

Open access to orthopaedic appliances for general practitioners.

A clinic to which general practitioners can refer patients for some types of orthopaedic appliances was opened in North Clwyd in 1983. During 1985, 956 patients were referred by 82 general practitioners; 860 patients received an appliance, and the average waiting time was less than five weeks. Most referrals were for soft collars (44%), lumbar sacral supports (30%), and dorsilumbar supports (7%). Thirty eight patients failed to attend, 54 declined an appliance, and four referrals were considered to be inappropriate. A few patients were subsequently referred to consultant outpatient clinics, 22 for physiotherapy and 34 were referred simultaneously to the open access clinic. The referral rates for general practitioners with access to community hospitals were low. Such an arrangement merits wider consideration.     

Importance of coronoidotomy and masticatory muscle myotomy in surgical release of trismus caused by submucous fibrosis

Thirty patients with trismus resulting from betel nut chewing-induced oral submucous fibrosis were treated with either fibrotic tissue release only (group I) or fibrotic tissue release in combination with masticatory muscle myotomy and coronoidotomy (group II). The latter procedures were only performed in patients whose intraoperative interincisal distance remained less than 35 mm immediately after submucous fibrous tissue release. There were eight and 22 patients in groups I and II, respectively. In group I patients, the average intraoperative interincisal distance improved from 19.5 mm to 42 mm. In group II patients, the average intraoperative interincisal distance improved from 13.5 mm to 27 mm after fibrotic tissue release and further improved to 40 mm after masticatory muscle myotomy and coronoidotomy. At an average follow-up of 22.1 months (range, 7 to 70 months), the group I and II patients had an average interincisal distance of 41.5 mm (range, 35 to 50 mm) and 32.9 mm (range, 20 to 42 mm), respectively. These results demonstrate the efficacy of submucous fibrotic tissue release in treating trismus resulting from betel nut chewing-induced submucous fibrosis and confirm the role of additional masticatory muscle and coronoidotomy in treating its severe forms.     

Gluteal perforator flaps for coverage of pressure sores at various locations

Flap coverage is essential for successful treatment of pressure sores, and musculocutaneous flaps have been preferred universally. Development of perforator flaps supplied by musculocutaneous perforators has allowed reconstructive surgeons to harvest flaps without including muscles. Perforator flaps have enhanced the possibility of donor sites because a flap can be supplied by any musculocutaneous perforator, and donor-site morbidity is also reduced. Between November of 1998 and June of 2002, the authors used 35 gluteal perforator flaps in 32 consecutive patients for coverage of pressure sores located at sacral (n = 22), ischial (n = 7), and trochanteric (n = 6) regions. The mean age of the patients was 53.1 years (range, 5 to 87 years), and there were 16 male and 16 female patients. All flaps in this series were supplied by musculocutaneous arteries arising from gluteal muscles. Patients were followed up for a mean period of 13.6 months. Wound dehiscence was observed in two patients and treated by secondary closure. Three patients died during the follow-up period. All flaps survived except one that had undergone total necrosis, and only one recurrence was noted during the follow-up period. Gluteal perforator flaps are safe and reliable options for coverage of pressure sores located at different locations. Freedom in flap design and low donor-site morbidity make gluteal perforator flaps an excellent choice for pressure sore coverage.     

长白山暗针叶林苔藓植物群落特征与林木更新的关系

暗针叶林是长白山亚高山地区的主要森林植被,林下苔藓植物资源极其丰富,有些地段苔藓盖度可达80％以上。苔藓植物作为暗针叶林的主要活地被物,其对林木更新的影响不容忽视。研究了苔藓植物的盖度和厚度对暗针叶林主要树种更新的影响。对苔藓层盖度及厚度与主要针叶树种及亚乔木树种幼苗数量的相关关系分析发现,当苔藓盖度大于40％或厚度大于4cm时,苔藓层对红松、臭冷杉、花楷槭幼苗数量的负面影响较明显;而在苔藓厚度小于4cm时,苔藓层有利于花楷槭和花楸幼苗数量的增加;对苔藓层盖度及厚度与针叶树幼苗高度的相关关系分析发现,一定盖度和厚度的苔藓层对幼苗高生长有积极作用,但其影响程度在各树种间有明显差异。     

Sexual dimorphism in relative sacral breadth among catarrhine primates

As the sacrum contributes to the size and shape of the birth canal, the sexually dimorphic sacrum of humans is frequently interpreted within obstetric contexts. However, while the human sacrum has been extensively studied, comparatively little is known about sacral morphology in nonhuman primates. Thus, it remains unclear whether sacral sexual dimorphism exists in other primates, and whether potential dimorphism is primarily related to obstetrics or other factors such as body size dimorphism. In this study, sacra of Homo sapiens, Hylobates lar, Nasalis larvatus, Gorilla gorilla, Pongo pygmaeus, Pan troglodytes, and Pan paniscus were evaluated for sexual dimorphism in relative sacral breadth (i.e., the ratio of overall sacral breadth to first sacral vertebral body breadth). Homo sapiens, H. lar, N. larvatus, and G. gorilla exhibit dimorphism in this ratio. Of these, the first three species have large cephalopelvic proportions, whereas G. gorilla has small cephalopelvic proportions. P. pygmaeus, P. troglodytes, and P. paniscus, which all have small cephalopelvic proportions, were not dimorphic for relative sacral breadth. We argue that among species with large cephalopelvic proportions, wide sacral alae in females facilitate birth by increasing the pelvic inlet's transverse diameter. However, given the small cephalopelvic proportions among gorillas, an obstetric basis for dimorphism in relative sacral breadth appears unlikely. This raises the possibility that sacral dimorphism in gorillas is attributable to selection for relatively narrow sacra in males rather than relatively broad sacra in females. Accordingly, these results have implications for interpreting pelvic dimorphism among fossil primates, including hominins. Am J Phys Anthropol 152:435–446, 2013. © 2013 Wiley Periodicals, Inc.     

Endometrial thermal balloon ablation using a high temperature, pulsed system: a mathematical model

A new endometrial thermal balloon ablation treatment for menorrhagia is modeled mathematically to predict its efficacy and safety. A device preheats a fluid to 173 degrees C within a reservoir external to the uterus, and then pulses this fluid without further heating between the reservoir and the balloon for 2.1 min of treatment time. The model predicted this treatment to result in consistent immediate tissue death (coagulation) depths of 3.4 +/- 0.1 mm for uterine cavities of 7 to 26 mL, and that eventual necrosis (tissue death that would occur 1-5 days post burn) may occur to depths of 6.5 +/- 0.2 mm. Whereas, burn depths varied with uterine cavity volume when a low temperature treatment (constant 75 degrees C for 15 min) was modeled (2.3-2.9 mm and 6.8-8.2 mm, for immediate tissue death and eventual necrosis respectively). Similarly, the high temperature, pulsed treatment was less sensitive to blood perfusion rate than the low temperature treatment. Predicted eventual necrosis depth was 1.5 mm less for the high temperature, pulsed treatment than that predicted for a low temperature treatment (constant 87 degrees C for 7 min) for the same immediate tissue death depth (3.5 mm), indicating that the new high temperature treatment may result in less damage to non targeted tissues.     

High assimilation of the sacrum in a sample of American skeletons: Prevalence,pelvic size,and obstetrical and evolutionary implications

High assimilation sacrum is fusion of the caudal‐most lumbar vertebra to the first sacral vertebra. Previous studies have shown that high assimilation is associated with clinical problems, including obstetrical difficulty. This study used adult American males (n = 1,048) and females (n = 1,038) of the Hamann–Todd and Terry skeletal collections to determine the prevalence of high assimilation and its effect on pelvic size, and to consider the obstetrical and evolutionary implications of high assimilation. The prevalence of high assimilation in this sample is 6.3%, with males and females not differing significantly from one another in their prevalence. This prevalence is near the median for that reported in 41 other samples. In both males and females, individuals with high assimilation have significantly longer anteroposterior and posterior sagittal diameters of the inlet, and shorter sacrum compared to those with a nonassimilated sacrum. Females with high assimilation have a significantly narrower sacral angulation (i.e., reduced inclination of ventral axis of sacrum), and shorter posterior sagittal diameter of the outlet compared to those with a nonassimilated sacrum. A short posterior sagittal diameter of the outlet is associated with childbirth difficulty. As high assimilation is partial homeotic transformation of a lumbar vertebra, this study supports previous research that homeotic transformation of vertebrae is selectively disadvantageous. Am J Phys Anthropol, 2009. © 2008 Wiley‐Liss, Inc.     

Hydrological Response to Land Cover Changes and Human Activities in Arid Regions Using a Geographic Information System and Remote Sensing

The hydrological response to land cover changes induced by human activities in arid regions has attracted increased research interest in recent decades. The study reported herein assessed the spatial and quantitative changes in surface runoff resulting from land cover change in the Al-Baha region of Saudi Arabia between 1990 and 2000 using an ArcGIS-surface runoff model and predicted land cover and surface runoff depth in 2030 using Markov chain analysis. Land cover maps for 1990 and 2000 were derived from satellite images using ArcGIS 10.1. The findings reveal a 26% decrease in forest and shrubland area, 28% increase in irrigated cropland, 1.5% increase in sparsely vegetated land and 0.5% increase in bare soil between 1990 and 2000. Overall, land cover changes resulted in a significant decrease in runoff depth values in most of the region. The decrease in surface runoff depth ranged from 25-106 mm/year in a 7020-km² area, whereas the increase in such depth reached only 10 mm/year in a 243-km² area. A maximum increase of 73 mm/year was seen in a limited area. The surface runoff depth decreased to the greatest extent in the central region of the study area due to the huge transition in land cover classes associated with the construction of 25 rainwater harvesting dams. The land cover prediction revealed a greater than twofold increase in irrigated cropland during the 2000-2030 period, whereas forest and shrubland are anticipated to occupy just 225 km² of land area by 2030, a significant decrease from the 747 km² they occupied in 2000. Overall, changes in land cover are predicted to result in an annual increase in irrigated cropland and dramatic decline in forest area in the study area over the next few decades. The increase in surface runoff depth is likely to have significant implications for irrigation activities.     

安氏Ⅰ类错合拔牙与非拔牙矫治对口唇形态影响的研究

目的：研究安氏Ⅰ类错合拔牙与非拔牙矫治对口唇形态的影响。方法：从直丝弓矫治的AngleⅠ类错合患者治疗前后的X线侧位片中随机选取拔除4个第一前磨牙患者15例（A组）,非拔牙矫治患者15例（B组）,经X线头影软组织测量分析比较矫治前后拔牙组与非拔牙组口唇形态的变化,对所得数据进行统计学处理。结果：拔牙矫治后上下唇的突度有明显改善,平均减少1.42和2.03mm;上下唇的长度也平均增加0.51和1.58mm;非拔牙矫治患者治疗后鼻唇角、下唇突度、上下唇长度均有增加,但矫治前后无统计学差异。结论：拔牙矫治有利于减小上下唇突度从而改善软组织侧貌。     

安氏I类错合拔牙与非拔牙矫治对口唇形态影响的研究

目的:研究安氏Ⅰ类错合拔牙与非拔牙矫治对口唇形态的影响.方法:从直丝弓矫治的Angle Ⅰ类错合患者治疗前后的X线侧位片中随机选取拔除4个第一前磨牙患者15例(A组),非拔牙矫治患者15例(B组),经X线头影软组织测量分析比较矫治前后拔牙组与非拔牙组口唇形态的变化,对所得数据进行统计学处理.结果:拔牙矫治后上下唇的突度有明显改善,平均减少1.42和2.03 mm;上下唇的长度也平均增加0.51和1.58 mm;非拔牙矫治患者治疗后鼻唇角、下唇突度、上下唇长度均有增加,但矫治前后无统计学差异.结论:拔牙矫治有利于减小上下唇突度从而改善软组织侧貌.

Abstract：

Objictive: To investigate the effect of Angle Class Ⅰ malocclusion after orthodontic treatment, with and without extractions on lip position changes. Methods: 30 patients with Angle Class Ⅰ malocclusion were chosen. 15 patients were treated by 4 first-premolars extraction (Group A) and 15 patients were treated without extraction (Group B). The soft tissue X-ray cephalometric of the patients were measured before and after the treatment and compared statistically. Results: After the extraction treatment, the upper and lower projecting lip reduced by 1.42 mm and 2.03, mmrespectively. The length of the upper and lower lips increased by 0.51mm and 1.58mm, respectively. For the group B, the nasolabial angle, the lower lip protrusion, the length of upper and lower lips had been increased, though there had no statistical significance before and after treatment. Conclusions: After extraction treatment the upper and lower projecting lips decreased. The patients with extractment treatment had the facial aesthelics.     

Patterns in the use of space by benthic communities on two coral reefs of the Great Barrier Reef

A rapid benthic line-transect survey method for use by non-specialist observers is described. At both Davies Reef (mid-continental shelf) and Myrmidon Reef (outer-continental shelf) in the central Great Barrier Reef a set of 6 sites of varying depths on the reef flat, crest and slope were sampled using this method. At least 10 contiguous 10 m transects were made at each site. Benthic organisms were recorded as life forms with categories based on both high level taxa and morphologies, and including scleractinian corals, alcyonarians, sponges, algae and others. Percentage cover data for 19 benthic categories are presented for all sites. Coral cover on both reefs is high on the crest and slope but low on the reef flat. At all sites the cover of soft corals and sponges is much less than cover of hard corals and algae. Abundances of soft corals and sponges increase with depth. Analysis of gaps between hard corals show that many colonies grow close to each other (<1 cm)even when total coral cover is low.