Dual-pathway inhibition in patients with chronic limb-threatening ischemia requiring reintervention for infrapopliteal occlusions.

Our study aimed to assess the influence of incorporating new oral anticoagulant (NOAC) therapy on clinical outcomes among patients who underwent endovascular intervention for below-the-knee (BTK) occlusions necessitating reintervention. The inclusion criteria encompassed patients with chronic limb-threatening ischemia (CLTI) and had undergone a successful endovascular intervention for BTK artery occlusion, necessitating reintervention. Patients who underwent endovascular interventions for BTK reocclusion were compared to those who received dual-pathway inhibition with NOAC (rivaroxaban 2.5 mg 2 × 1) and clopidogrel (NOAC group), or dual-antiplatelet therapy with clopidogrel and aspirin (DAPT group). The primary endpoints were target vessel reocclusion and target lesion revascularization (TLR) at the 1-year follow-up, while major and minor amputations served as the secondary endpoint. Additionally, a one-year comparison was conducted between the two groups for major bleeding events. 64 patients in our clinic treated with endovascular reintervention (NOAC = 28, DAPT = 34). The TLR rate is 10.7% in NOAC group (N = 3) and 32.4% in DAPT group (N = 11, p = 0.043). The target vessel reocclusion rate is 17.8% in NOAC group (N = 5) and 41.2% in DAPT group (N = 14, p = 0.048). Minor or major amputation rate at 1-year follow-up was 3.6% in NOAC group (N = 1) and 11.7% in DAPT group (N = 4, p = 0.245). The patency rate is significantly higher, and the TLR rate is significantly lower in the NOAC group compared to the DAPT group, with no significant difference in major bleeding between the two groups. Although no statistically significant difference exists in amputation rates, a numerical distinction is evident.

Propeller and Pre-expanded Propeller Use of a Transversely Oriented Upper Trapezius Perforator Flap in Head and Neck Reconstruction: Clinical Experience and Review of Vascular Anatomy of the Supraspinal Trapezius Muscle.

Conventionally, trapezius musculocutaneous flap is raised to harbour perforators located inferior to the scapular spine (i.e. 'lower trapezius flap'). In this clinical study, we aimed to use trapezius perforators located superior to the scapular spine to raise a transversely oriented propeller fasciocutaneous flap based on the superficial cervical artery to reconstruct head and neck defects. Patients with head and neck defects who underwent reconstruction with a propeller trapezius perforator flap between August 2014 and October 2019 were evaluated. Demographic data of the patients, topographic data on defects and the flaps were analysed. A total of 14 patients underwent reconstruction with upper trapezius perforator flap with equal gender distribution. Defects were due to tumour resections, burn contractures and exposed foreign materials; located in occipital, temporal, parietal, midfacial and cervical areas; with sizes ranging between 8 × 7 cm and 22 × 19 cm. Overall patient satisfaction was assessed subjectively using a pre-determined set of questions. The sizes of the flaps ranged between 15 × 8 cm - 20 × 9 cm in non-expanded and 26 × 15 cm - 30 × 16 cm in expanded cases. One flap suffered distal superficial flap loss, which was treated with wound care. Follow up period of the patients ranged between 3 and 40 months with an average of 29 months. Using trapezius perforators located above the scapular spine provides thin transversely oriented propeller flaps to be used in head and neck reconstruction. In our series, this flap is further enhanced by pre-expansion for wider uses, e.g. facial resurfacing and releasing neck contractures.

Use of Dorsal Nasal Flap in Combination With Nasolabial Perforator Propeller Flap for Reconstruction of Nasal Skin Defects of Medium to Large Size; A Simpler Alternative to Frontal Flap.

ABSTRACT: Nasal reconstruction is one of the most challenging procedures in plastic surgery. To get optimal aesthetic and functional results, the surgeon should know all the options well. Forehead flap is the gold standard technique for closure of medium to large defects of the nose. Although it provides a very good color and texture match, it may become a difficult option in patients with poor condition. The aim of this study was to define a simpler technique for nasal reconstruction using combined local flaps.Twelve patients, operated using a dorsal nasal flap combined with a nasolabial perforator propeller flap, were presented in the study. Properties of the patients, defect size and locations, and complications were evaluated.The mean size of the reconstructed defects was 10.1 cm2. No flap loss was observed. Venous congestion was the most common complication and resolved spontaneously in all cases. Two cases had partial distal necrosis, which also healed spontaneously.Closure was achieved successfully in all cases with a medium to large nasal defect using a combined dorsal nasal flap and nasolabial perforator propeller flap. This method can be used as an alternative to forehead flap.

Influence of Compositional Variation on the Electrical Properties of [Pb(Zn1/3Nb2/3)O3]-[Pb(Zr,Ti)O3] Ceramics and Their Transducer Application.

The ternary system of x[Pb(Zn1/3Nb2/3O3. ( )[Pb(ZryTi1-y)O3] composition with " " varying from 0.1 to 0.6 with interval of 0.1 and " " varying from 0.46 to 0.52 with interval of 0.01 was studied. The main objective was to maximize the dielectric and electromechanical properties through compositional variation and then to establish the full property matrix of the optimized composition for further analysis and device applications. Ceramics with pure perovskite phase have been produced in the entire compositional range that was investigated. The highest ferroelectric and electromechanical properties were obtained at the 0.4[Pb(Zn1/3Nb2/3)O3-0.6[Pb(Zr0.48Ti0.52)O3]-(0.4 PZN-0.6 PZT) composition with remanent polarization ( ) of /cm2, piezoelectric charge coefficient (d33) of 465 pC/N, and electromechanical coupling coefficients ( , , and ) of 0.67, 0.52, and 0.77, respectively. Full property matrix for 0.4 PZN-0.6 PZT was obtained and was used as input in the finite-elements analysis of ceramics in disc and hemispherical shell form. Hollow spherical omnidirectional transducers were fabricated from the lead zinc niobate-lead zirconate titanate (PZN-PZT) ceramics as a device prototype, and underwater characteristics have been determined and reported for these transducers.

Development and characterization of couscous-like product using bulgur flour as by-product.

Couscous is produced traditionally by agglomeration of Triticum durum semolina with water. The aims of this study were: to produce couscous-like product by substitution of semolina with bulgur by-product (undersize bulgur); to find optimum quantity of bulgur flour and processing conditions. In order to determine the optimum processing parameters and recipes; 0, 25 and 50% of bulgur containing couscous-like samples were prepared. The color, yield, sensory properties, total phenol and flavonoid contents, bulk density, protein and ash content, texture properties were determined. Two different types of dryer e.g. packed bed and microwave were used. Optimum parameters were predicted as 50% of bulgur flour for packed bed (60 °C) and microwave (180 W) drying with 50% (w/w) of water according to yields, color (L*, a*, b*) values and sensory properties (color, odor, general appearance). For packed bed drying at 60 °C yields were 54.28 ± 3.78, 47.70 ± 1.73 and 52.57 ± 7.04% for 0, 25 and 50% bulgur flour containing samples, respectively. Lightness (L*) values of couscous-like samples were decreased with increasing the quantity of bulgur flour after both drying processes. Results of sensory analysis revealed that couscous-like bulgur were more preferable for consumers.

Chronic noncancer pain management in primary care: family medicine physicians' risk assessment of opioid misuse.

OBJECTIVE: The majority of patients with chronic noncancer pain (CNCP) are managed in the primary care settings. The primary care family physician (PCFP) generally has limited time, training, or access to resources to effectively evaluate and treat these patients, particularly when there is the added potential liability of prescribing opioids. The aim of this study is to make a favorable change in PCFPs' knowledge, attitudes, and practices about opioid use in CNCP via education on assessment of the risk of opioid misuse. MATERIALS AND METHODS: The universe of this cross-sectional study comprised 36 family physicians working at Family Health Centers affiliated to Antalya Provincial Directorate of Health who volunteered to participate in the study. Initially, a survey on patients risk assessment was performed in both intervention and control groups; whereas the intervention group received education on assessment of the risk of opioid misuse, the control group did not. The survey was repeated after 6 months and the intervention group underwent a core examination. Data obtained were analyzed with Statistical Package for the Social Sciences 18.0 statistics program. Intervention and control groups were compared. Additionally, pre- and post-education results of the intervention group were also compared. RESULTS: About 61.1% of family physicians reported concern and hesitation in prescribing opioids due to known risks, such as overdose, addiction, dependence, or diversion, and agreed that family physicians should apply risk assessment before opioid use in CNCP. Only 16.6% of PCFP reported that risk assessment is not so necessary, whereas 22.2% of PCFP were undecided. Although 47.2% of the family physicians expressed a willingness to apply risk assessment before starting opioids, the rate of eagerness increased markedly to 77.7% after the education, but the rate of increase in practicing was not statistically significant. CONCLUSION: Knowledge and competency of the family physicians in managing CNCP were improved as was expected. Although the rate of eagerness about risk assessment of opioid misuse was increased, expected increase in the rate of using risk assessment was not achieved. Further studies are needed to identify the reasons of the difficulties on changing the attitudes and practices of primary care physicians about this subject.

Effect of soaking and ultrasound treatments on texture of chickpea.

Effect of soaking time (20, 40, 60, 80, 100, 120, 140, 160, 180, 200, 220, 240, 260, 280, 300, 320, 340, 360, 380, 400, 420, 440, 460, 480 and 500 min) and temperature (20, 30, 40, 50, 60, 70, 87, 92 and 97°C) together with ultrasound application (25 kHz 100 W and 25 kHz 300 W) on texture of chickpea was investigated. Soaking time, temperature, application of ultrasounds and power of ultrasounds had significant effect (P < 0.05) on texture of chickpea. An Asymptotic first order texture model was successfully fitted to correlate texture of chickpea with soaking time and temperature. Texture model rate constant (kF) increased from 1.68 × 10(-4) to 19.20 × 10(-4) s(-1) for a temperature change from 20 to 97°C without and with 25 kHz 100 W, 25 kHz 300 W ultrasound treatments. Average gelatinization temperature of chickpea using the model was found to be 60 ± 1°C. Activation energy (Ea) values of chickpea for below and above gelatinization temperature were found to be 26.49 and 9.73 kJ mol(-1), respectively. Time to reach equilibrium texture level (te) of soaked chickpeas decreased from 941 to 82 min with increase of temperature from 20 to 97°C ultrasounds of 25 kHz 100 W and 25 kHz 300 W. In the food industry, chickpea is pre-processed (soaked and cooked) to produce humus, canned products and blended powder products. Ultrasonic treatments can be applied to soften and inturn decrease the cooking time of the chickpeas.

Family medicine and sports medicine students' perceptions of their educational environment at a primary health care center in Germany: using the DREEM questionnaire.

The medical learning environment is changing progressively due to its crucial importance in clinical learning and educational performance. The purpose of this study was to investigate student perceptions of the medical learning environment at a primary health care center outside of a university hospital using the Dundee Ready Educational Environment Measure (DREEM) questionnaire. Various aspects of the environment were compared between family medicine (FM) and sports medicine (SM) students to assess the role of these different rotations and their effect on student perceptions. The DREEM questionnaire, a validated tool for measuring perceptions of educational environments in medical educational environments, was completed by 110 students who were enrolled in FM and SM rotations at Wuppertal Primary Health Care and Research Center in Wuppertal, Germany. Other than 9 of the 50 items, there were no statistically significant differences in DREEM questionnaire scores between these 2 groups, indicating that students' perceptions of the educational environment were not remarkably affected by their rotations. Scores across the sample were fairly high (FM students, 139.45/200; SM students, 140.05/200; overall total score, 139.85/200). These high scores suggest that students enrolled in FM and SM health science programs generally hold positive perceptions of their course environment outside of the university hospital. The positive perception of the educational environment at this primary health care center is hopefully indicative of similar rotations' perceptions internationally. While future studies are needed to confirm this, the current findings offer a chance to identify and explore the areas that received low scores in greater detail.

Paclitaxel plus doxorubicin chemotherapy as second-line therapy in patients with advanced urothelial carcinoma pretreated with platinum plus gemcitabine chemotherapy.

BACKGROUND: We retrospectively evaluated the efficacy and toxicity of paclitaxel plus doxorubicin as a second-line treatment in patients with urothelial carcinoma, who had not responded to a prior platinum plus gemcitabine combination. PATIENTS AND METHODS: All patients received intravenous infusions of paclitaxel (175 mg/m(2)/h) and doxorubicin (50 mg/m(2)/30 min) on day 1. Chemotherapy courses were repeated every 21 days. RESULTS: The median followup duration was 13.5 months (range 2.8-22.4 months). Complete and partial responses were observed in 2 (5.6%) and 10 (27.8%) patients, respectively. Median overall survival was 8.9 months (95% confidence interval (CI): 6.2-11.6). Median time to progression was 3.8 months (95% CI: 2.7-4.8). The most common hematologic toxicities were neutropenia (n = 21, 58.3%), thrombocytopenia (n = 10, 27.8%), and anemia (n = 9, 25%). The most common nonhematologic toxicities consisted of fatigue (n = 15, 41.7%), nausea/vomiting (n = 13, 36.1%), peripheral neuropathy (n = 11, 30.6%), and mucositis (n = 6, 16.7%). Dose reductions by 25-35% were performed in 6 (16.7%) patients because of grade 3/4 toxicity. Anthracycline-related heart failure did not occur. CONCLUSION: 3-weekly courses of cyclic paclitaxel plus doxorubicin were found to be effective and tolerable in patients with urothelial carcinoma, who had not responded to prior platinum- and gemcitabine-based chemotherapy.