An Innovative Technique of Microsurgical Training on Fresh "Chicken Quarter" Model: Our Experience.

Purpose Regular practice, quality clinical exposure, and academic discussion are essential in any surgical specialty training. This study discusses and validates the option of using a fresh "chicken quarter" model with a measurable scoring system, as a standard training regimen in microvascular surgery. This can be a very effective, economical, and easily accessible model for residents. Materials and Methods This study was conducted in the Department of Plastic surgery, from October 2020 to May 2021. Twenty-four fresh "chicken quarter" specimens were dissected and the ischial arteries and femoral veins' external diameter (ED) were measured. The microsurgical skills of the trainee were assessed in 6 months intervals using the Objective Structured Assessment of Technical Skills Scale (OSATS) as well as the time taken for anastomosis. All the data were analyzed using SPSS (statistical package for social sciences) version 21. Results A task-specific score value of 50% on October 2020 improved to 85.7% by May 2021. This was found to be statistically significant ( p = 0.043). The mean ED of the ischial artery and femoral vein was 2.07 and 2.26 mm, respectively. The mean width of the vein measured at the lower one-third of the tibia was 2.08 mm. A greater than 50% reduction in anastomosis time was observed after a period of 6 months. Conclusion In our minimal experience, the "chicken quarter model" with OSATS scoring system seems to be effective, economical, very affordable, and easily accessible microsurgery training model for the residents. Our study is done only as a pilot project due to limited resources and we have the plan to introduce it as a proper training method in the near future with more residents.

An Experience of Scalp Island Flap Based on the Posterior Branch of the Superficial Temporal Artery for Patients with Mucormycosis and Cancer.

To find out the utility of the scalp flap based on the posterior branch of the superficial temporal artery in patients with head and neck mucormycosis and malignancy. This was a multi-institutional observational study conducted at a tertiary cancer centre in North East India and a super-speciality hospital in Maharashtra from January 2021 to June 2021. Patients with malignancy and mucormycosis were only considered. In our study, we have seven patients (n = 7), two of them had mucormycosis and 5 had squamous cell carcinoma of the head and neck region. Out of the 5 cases of the head and neck malignancy, two cases were recurrent ones, another two cases where primary flap failed and in the last case, the patient was unfit for free tissue transfer due to cardiac issues. The mean age in the series was 50.42 years and the average duration of raising the flap was 22.86 min. Average hospital stays for head and neck cancer patients are 4.6 days and for mucormycosis patients, it is 22.5 days. No flap related complications were noted during the series. Scalp flap based on the posterior branch of the superficial temporal artery is a useful option in recurrent malignancy cases, in primary cases as a salvage option and in patients where long duration surgery is not possible due to poor general condition like in critical mucormycosis. Post-operative hair growth at the flap site and alopecia at the donor scalp are concerns and therefore, careful patient selection is a must.

PDS Plate Versus Bone Graft in Orbital Floor Reconstruction: A Prospective Study to Identify the Better Alternative.

The objective of this study is to compare the effect and outcome of orbital floor reconstruction with bone graft and PDS plate. A prospective cohort study was conducted at B J Medical College, Civil Hospital, Ahmedabad from 1st September 2013 to 28th February 2016 by the Department of Burns and Plastic Surgery on patients (N = 35) who reported with orbital floor fracture. Diplopia, enophthalmos, infection rate, hospital stay, and donor site complications were considered. The above variables were assessed as predictors of outcome in the management (PDS vs. bone graft). Inferential statistics was done by chi-square test. The significance level was kept at 5%. Follow-up of 35 patients (2 years), 26 male, and 9 females aged 26-65 years were made. Diplopia and enophthalmos were the main criteria's in the study and neither of them showed any statistical significance. Donor site morbidity was noted in 3 patients among the bone graft group which was managed conservatively. Both the bone graft and PDS plate in orbital floor reconstruction is comparable in almost all aspects of our study. No statistically significant differences were found between the two groups. Pain and wound site infection are possible complications when a bone graft is used as the reconstructive option.

Loupe Assisted Thyroidectomy: A Tool for Reducing Complications.

The objective of this study is to assess if the use of magnification can reduce the incidence of hypocalcemia and vocal cord palsy in thyroid surgery. Data of patients who underwent total thyroidectomy (N = 50) for thyroid malignancy were analyzed retrospectively for 1 year. The patients were divided into two groups based on surgery with and without loupes. Hypocalcemia and Vocal cord palsy was assessed pre as well as post-operatively and the observations were noted. Descriptive statistics were performed to assess the proportion of the respective groups. Inferential statistics to find out the difference between the groups was done using the chi-square test. Significance level was kept at 5%. The incidence of hypocalcemia was 36.9% in the group done without loupes compared to 7.6% with loupes. The event of vocal cord injury though transient was 33% when done without loupes (p < 0.05). Magnification is crucial for the visualization of the neurovascular anatomy which is depicted in our study. Although the study includes less number of cases, it is evident that the use of loupe magnification can reduce the morbidity associated with thyroid surgery to a great extent. We recommend the use of loupe magnification during surgery whenever possible.

Locoregional Flaps in Oncoreconstruction at a Tertiary Cancer Centre in North East India: a Review Through a Plastic Surgeon's Eye.

Local flaps are important parts of oncoreconstruction. The idea of writing this article is to give knowledge to my fellow aspiring plastic surgeons about the common locoregional flaps that are essentially done in a tertiary cancer centre. This is a retrospective study carried out in the Department of Plastic Surgery, Dr. B Borooah Cancer Institute, Guwahati, from May 2018 to April 2019. Musculoskeletal and soft tissue, head and neck and thorax and gynaecological malignancies which required locoregional flaps for reconstruction were taken up for the study. Flap reconstructions performed by oncosurgeons are not included in the study. We have done a total of 74 locoregional reconstructions during this 12-month period apart from 43 free tissue transfers. In our study, age ranged from 12 to 84 years. Most commonly performed flap during this time was pectoralis major myocutaneous flap. Complications of various flaps were assessed. Out of the 74 flaps, total necrosis of one flap occurred, and re-surgery was required in one case. Most of the oncosurgeons have a good idea of locoregional reconstructions in cancer centres. In such centres, the need of plastic surgeon for locoregional reconstruction is mainly for complex reconstructions and unfamiliar anatomic locations, for second flap after initial local flap failure or after free flap-related complications.

Pretreatment strategies for enhanced biogas production from lignocellulosic biomass.

The inclusion of a pretreatment step in anaerobic digestion processes increases the digestibility of lignocellulosic biomass and enhances biogas yields by promoting lignin removal and the destruction of complex biomass structures. The increase in surface area enables the efficient interaction of microbes or enzymes, and a reduction in cellulose crystallinity improves the digestion process under anaerobic conditions. The pretreatment methods may vary based on the type of the lignocellulosic biomass, the nature of the subsequent process and the overall economics of the process. An improved biogas production by 1200% had been reported when ionic liquid used as pretreatment strategy for anaerobic digestion. The different pretreatment techniques used for lignocellulosic biomasses are generally grouped into physical, chemical, physicochemical, and biological methods. These four modes of pretreatment on lignocellulosic biomass and their impact on biogas production process is the major focus of this review article.

A biorefinery-based approach for the production of ethanol from enzymatically hydrolysed cotton stalks.

Cotton post-harvest residue/cotton stalk (CS) - a major agro-residue in south asian countries was evaluated as a feed stock for bioethanol production. The common thermochemical pretreatment strategies based on dilute acid and alkali and different combinations of biomass hydrolyzing enzymes were evaluated for saccharification of CS biomass. A hydrolytic efficiency of 80% was achieved for alkali treated biomass using cellulase supplemented with beta glucosidase. Recycling of undigested/residual biomass and/or enzyme supported same final sugar concentration as for fresh hydrolytic experiments. Fermentation was carried out using a novel, inhibitor-resistant strain of Saccharomyces cerevisiae where 76% of theoretical maximum efficiency was attained. Material balances were derived for the entire process from biomass pre-processing to hydrolysis.

Polyphenol rich ethanolic extract from Boerhavia diffusa L. mitigates angiotensin II induced cardiac hypertrophy and fibrosis in rats.

Boerhavia diffusa is a renowned edible medicinal plant extensively used against different ailments including heart diseases in the traditional system of medicine in several countries. The present study aims to evaluate the therapeutic efficacy of ethanolic extract of Boerhavia diffusa (BDE) on cardiac hypertrophy and fibrosis induced by angiotensin II (Ang II) in male wistar rats and to identify the active components present in it. A substantial increase of hypertrophy markers such as cardiac mass index, concentration of ANP and BNP, cardiac injury markers like CK-MB, LDH and SGOT, has been observed in hypertrophied groups whereas BDE treatment attenuated these changes when compared to hypertrophied rats. Moreover, Ang II induced myocardial oxidative stress was reduced by BDE which was apparent from diminished level of lipid and protein oxidation products, increased activities of membrane bound ATPases and endogenous antioxidant enzymes along with enhanced translocation of Nrf2 from the cytosol to nucleus. It appears that BDE evokes its antioxidant effects by attenuating lipid peroxidation, enhancing the translocation of Nrf2 from the cytoplasm to nucleus as well as by regulating the metabolism of glutathione. The extent of fibrosis during cardiac hypertrophy was determined by histopathology analysis and the results revealed that BDE treatment considerably reduced the fibrosis in the heart. HPLC analysis of BDE leads to the identification of four compounds viz., quercetin, kaempferol, boeravinone B and caffeic acid. The study substantiate the effect of B. diffusa in protecting the heart from pathological hypertrophy and the attenuation of cardiac abnormalities may be partly attributed through the reduction of oxidative stress and cardiac fibrosis. Since the plant is widely used as a green leafy vegetable, incorporation of this plant in diet may be an alternative way for the prevention and better management of heart diseases and associated complications.

Harvesting of microalgal biomass: Efficient method for flocculation through pH modulation.

Harvesting of the micro alga Chlorococcum sp. R-AP13 through autoflocculation, chemical flocculants or by change in medium pH was evaluated. Surface charge of algal cells changed in response to the method used and affected flocculation efficiency. While aluminum sulfate and FeCl3 supported 87% and 92% efficiency, auto flocculation could recover 75% of biomass in 10min. Maximum efficiency (94%) was obtained with change in medium pH from 8.5 to 12.0 achieved through addition of 40mgl(-1) of NaOH. Since high concentrations of FeCl3 and AlSO4 were toxic to the cells, flocculation induced by pH change may be considered the most effective strategy. Residual medium after flocculation could be reused efficiently for algal cultivation, minimizing the demand for fresh water.

Mitochondrial dysfunction in H9c2 cells during ischemia and amelioration with Tribulus terrestris L.

AIMS: The present study investigates the protective effect of partially characterized Tribulus terrestris L. fruit methanol extract against mitochondrial dysfunction in cell based (H9c2) myocardial ischemia model. MAIN METHODS: To induce ischemia, the cells were maintained in an ischemic buffer (composition in mM -137 NaCl, 12 KCl, 0.5 MgCl2, 0.9 CaCl2, 20 HEPES, 20 2-deoxy-d-glucose, pH-6.2) at 37°C with 0.1% O2, 5% CO2, and 95% N2 in a hypoxia incubator for 1h. Cells were pretreated with various concentrations of T. terrestris L. fruit methanol extract (10 and 25µg/ml) and Cyclosporin A (1µM) for 24h prior to the induction of ischemia. KEY FINDINGS: Different parameters like lactate dehydrogenase release, total antioxidant capacity, glutathione content and antioxidant enzymes were investigated. Studies were conducted on mitochondria by analyzing alterations in mitochondrial membrane potential, integrity, and dynamics (fission and fusion proteins - Mfn1, Mfn2, OPA1, Drp1 and Fis1). Various biochemical processes in mitochondria like activity of electron transport chain (ETC) complexes, oxygen consumption and ATP production was measured. Ischemia for 1h caused a significant (p≤0.05) increase in LDH leakage, decrease in antioxidant activity and caused mitochondrial dysfunction. T. terrestris L. fruit methanol extract pretreatment was found effective in safeguarding mitochondria via its antioxidant potential, mediated through various bioactives. HPLC of T. terrestris L. fruit methanol extract revealed the presence of ferulic acid, phloridzin and diosgenin. SIGNIFICANCE: T. terrestris L. fruit ameliorate ischemic insult in H9c2 cells by safeguarding mitochondrial function. This validates the use of T. terrestris L. against heart disorders.

Detoxification of acidic biorefinery waste liquor for production of high value amino acid.

The current study evaluates the detoxification of acid pretreatment liquor (APL) using adsorbent (ADS 400 & ADS 800) or ion-exchange (A-27MP & A-72MP) resins and its potential for amino acid production. The APL is generated as a by-product from the pretreatment of lignocellulosic biomass and is rich monomeric sugars as well as sugar degradation products (fermentation inhibitors) such as furfural and hydroxymethyl furfural (HMF). Of the four resins compared, ADS 800 removed approximately 85% and 60% of furfural and HMF, respectively. ADS 800 could be reused for up to six cycles after regeneration without losing its adsorption properties. The study was further extended by assessing the fermentability of detoxified APL for l-lysine production using wild and mutant strains of Corynebacterium glutamicum. The detoxified APL was superior to APL for l-lysine production.

An overview of physico-chemical mechanisms of biogas production by microbial communities: a step towards sustainable waste management.

Biogas is a combination of methane, CO2, nitrogen, H2S and traces of few other gases. Almost any organic waste can be biologically transformed into biogas and other energy-rich organic compounds through the process of anaerobic digestion (AD) and thus helping in sustainable waste management. Although microbes are involved in each step of AD, knowledge about those microbial consortia is limited due to the lack of phylogenetic and metabolic data of predominantly unculturable microorganisms. However, culture-independent methods like PCR-based ribotyping has been successfully employed to get information about the microbial consortia involved in AD. Microbes identified have been found to belong mainly to the bacterial phyla of Proteobacteria, Chloroflexi, Firmicutes and Bacteroidetes. Among the archaeal population, the majority have been found to be methanogens (mainly unculturable), the remaining being thermophilic microbes. Thus, the AD process as a whole could be controlled by regulating the microbial consortia involved in it. Optimization in the feedstock, pH, temperature and other physical parameters would be beneficial for the microbial growth and viability and thus helpful for biogas production in AD. Besides, the biogas production is also dependent upon the activity of several key genes, ion-specific transporters and enzymes, like genes coding for methyl-CoM reductase, formylmethanofuran transferase, formate dehydrogenase present in the microbes. Fishing for these high-efficiency genes will ultimately increase the biogas production and sustain the production plant.