Mohs surgery for female genital Paget's disease: a prospective observational trial.

BACKGROUND: Extramammary Paget's disease recurs often after traditional surgical excision. Margin-controlled surgery improves the recurrence rate for male genital disease but is less studied for female anatomy. OBJECTIVE: This study aimed to compare surgical and oncologic outcomes of margin-controlled surgery vs traditional surgical excision for female genital Paget's disease. STUDY DESIGN: We conducted a prospective observational trial of patients with vulvar or perianal Paget's disease treated with surgical excision guided by Mohs micrographic surgery between 2018 and 2022. The multidisciplinary protocol consisted of office-based scouting biopsies and modified Mohs surgery followed by surgical excision with wound closure under general anesthesia. Modified Mohs surgery cleared peripheral disease margins using a moat technique with cytokeratin 7 staining. Medial disease margins (the clitoris, urethra, vagina, and anus) were assessed using a hybrid of Mohs surgery and intraoperative frozen sections. Surgical and oncologic outcomes were compared with the outcomes of a retrospective cohort of patients who underwent traditional surgical excision. The primary outcome was 3-year recurrence-free survival. RESULTS: Three-year recurrence-free survival was 93.3% for Mohs-guided excision (n=24; 95% confidence interval, 81.5%-100.0%) compared to 65.9% for traditional excision (n=63; 95% confidence interval, 54.2%-80.0%) (P=.04). The maximum diameter of the excisional specimen was similar between groups (median, 11.3 vs 9.5 cm; P=.17), but complex reconstructive procedures were more common with the Mohs-guided approach (66.7% vs 30.2%; P<.01). Peripheral margin clearance was universally achieved with modified Mohs surgery, but positive medial margins were noted in 9 patients. Reasons included intentional organ sparing and poor performance of intraoperative hematoxylin and eosin frozen sections without cytokeratin 7. Grade 3 or higher postoperative complications were rare (0.0% for Mohs-guided excision vs 2.4% for traditional excision; P=.99). CONCLUSION: Margin control with modified Mohs surgery significantly improved short-term recurrence-free survival after surgical excision for female genital Paget's disease. Use on medial anatomic structures (the clitoris, urethra, vagina, and anus) is challenging, and further optimization is needed for margin control in these areas. Mohs-guided surgical excision requires specialized, collaborative care and may be best accomplished at designated referral centers.

Early evidence for bear exploitation during MIS 9 from the site of Schöningen 12 (Germany).

A cutmarked bear metatarsal and phalanx from the German open-air sites of Schöningen 12 II-1 and 12 B, respectively, correlated with the interglacial optimum of MIS 9 (ca. 320 ka), provide early evidence for the exploitation of bear skins. Archaeological sites with evidence of bear exploitation from the Lower Paleolithic are rare, with only Boxgrove (United Kingdom) and Bilzingsleben (Germany) yielding cutmarked bear bones indicating skinning. We interpret these finds as evidence for bear hunting and primary access since bear skins are best extracted shortly after the animal's death. The very thin cutmarks found on the Schöningen specimens indicate delicate butchering and show similarities in butchery patterns to bears from other Paleolithic sites. The Eurasian Lower Paleolithic record does not show any evidence for the exploitation of bear meat; only Middle Paleolithic sites, such as Biache-Saint-Vaast (France; ca. 175 ka) and Taubach (Germany; ca. 120 ka), yield evidence for the exploitation of both skin and meat from bear carcasses. Bear skins have high insulating properties and might have played a role in the adaptations of Middle Pleistocene hominins to the cold and harsh winter conditions of Northwestern Europe.

Rectal Shaving for Bowel Endometriosis by Laparoscopic Reverse Submucosal Dissection for Easier, Safer and More Complete Excision of Disease.

STUDY OBJECTIVE: To demonstratefull-thickness excision of the affected muscularis along the submucosal plane. DESIGN: Stepwise demonstration of LRSD technique with narrated video footage. SETTING: LRSD takes advantage of the submucosal layer of the bowel wall and uses it as an easier line of excision for rectal endometriosis compared with the very difficult traditional line of excision of irregular disease-muscularis interface. The expansion of the submucosal layer by the injection separates the affected muscularis away from the mucosa, making it safer to excise the lesion with less chance of entering the bowel lumen. Excision of disease is more complete with LRSD because the full-thickness excision of the muscularis layer includes the healthy deep muscularis, which will form the disease-free deep excision margin. INTERVENTION: This video will highlight anatomic and technical aspects of LRSD including the following key steps: 1. Mobilization of diseased bowel segment 2. Submucosal injection 3. Circumferential incision of the muscularis 4. Submucosal dissection along the submucosal plane 5. Bowel wall integrity test 6. Muscularis defect repair CONCLUSION: Rectal shaving by LRSD appears to be easier, safer, and more complete in excision of bowel endometriosis than the classical rectal shaving technique. This modification requires further evaluation to confirm its potential in the surgical management of rectosigmoid deep infiltrative endometriosis.

The Origin of the Sheet Size Predicament in Graphene Macroscopic Papers.

The larger size of graphene sheets should intuitively generate higher overall properties of their macroscopic materials. However, this intuitive notion still remains ambiguous. Here, we uncover that the wrinkle formation causes the counterintuitive size predicament of graphene sheets in their macroscopic materials. In the model of graphene oxide assembled papers, we reveal that the giant size of graphene oxide sheets aggravates the formation of larger wrinkles and more microvoids, causing the negative size effect in mechanical strength. A major microscopic origin of the size predicament is the skin wrinkling in the drying process, and the wrinkling behavior follows a general rule of deformation of an elastic thin plate. We use a wrinkle-engineering strategy to depress the spontaneously formed large wrinkles and succeed in the resolution of the size predicament. After wrinkle modulation, an authentically positive size effect reversely appears in which giant graphene sheets generate ultrahigh mechanical strength and superior functionalities of graphene papers. The origin of the size predicament reminds us of the hidden importance of modulating wrinkles for graphene macroscopic materials and provides a guidance of wrinkle engineering for graphene materials with advanced performances.

The Structure of the Barley Husk Influences Its Resistance to Mechanical Stress.

This paper explores the links between genotype, plant development, plant structure and plant material properties. The barley husk has two organs, the lemma and the palea, which protect the grain. When the husk is exposed to mechanical stress, such as during harvesting, it can be damaged or detached. This is known as grain skinning, which is detrimental to grain quality and has a significant economic impact on industry. This study focused on the lemma, the husk organ which is most susceptible to grain skinning. This study tested three hypotheses: (1) genotype and plant development determine lemma structure, (2) lemma structure influences the material properties of the lemma, and (3) the material properties of the lemma determine grain skinning risk. The effect of genotype was investigated by using plant material from four malting barley varieties: two with a high risk of grain skinning, two with a low risk. Plant material was assessed at two stages of plant development (anthesis, GS 65; grain filling, GS 77). Structure was assessed using light microscopy to measure three physiological features: thickness, vasculature and cell area. Material properties were approximated using a controlled impact assay and by analyzing fragmentation behavior. Genotype had a significant effect on lemma structure and material properties from anthesis. This indicates that differences between genotypes were established during floral development. The lemma was significantly thinner in high risk genotypes, compared to low risk genotypes. Consequently, in high risk genotypes, the lemma was significantly more likely to fragment. This indicates a relationship between reduced lemma thickness and increased fragmentation. Traditionally, a thin husk has been considered beneficial for malting quality, due to an association with malt extract. However, this study finds a thin lemma is less resistant to mechanical stress. This may explain the differences in grain skinning risk in the genotypes studied.

The quality of barley husk-caryopsis adhesion is not correlated with caryopsis cuticle permeability.

Adhesion of the barley husk to the underlying caryopsis requires the development of a cuticular cementing layer on the caryopsis surface. Differences in adhesion quality among genotypes have previously been correlated with cementing layer composition, which is thought to influence caryopsis cuticle permeability, the hypothesised mechanism of adhesion mediation. It is not yet known whether differences in adhesion quality among genotypes are determined by changes in caryopsis cuticle permeability. We examined changes in candidate cementing layer biosynthetic and regulatory genes to investigate the genetic mechanisms behind husk adhesion quality. We used both commercially relevant UK malting cultivars and older European lines to ensure phenotypic diversity in adhesion quality. An ethylene responsive transcription factor (NUD) is required for the development of the cementing layer. To examine correlations between gene expression, cementing layer permeability and husk adhesion quality we also treated cultivars with ethephon (2-chloroethylphosphonic acid) which breaks down to ethylene, and silver thiosulphate which inhibits ethylene reception, and measured caryopsis cuticle permeability. Differential adhesion qualities among genotypes are not determined by NUD expression during development of the cementing material alone, but could result from differences in biosynthetic gene expression during cementing layer development in response to longer-term NUD expression patterns. Altered caryopsis cuticle permeability does result in altered adhesion quality, but the correlation is not consistently positive or negative. Cuticle permeability is therefore not the mechanism that determines husk adhesion quality, but is likely a consequence of the required cuticular compositional changes that determine adhesion.

Development and Quality of Barley Husk Adhesion Correlates With Changes in Caryopsis Cuticle Biosynthesis and Composition.

The caryopses of barley become firmly adhered to the husk during grain development through a cuticular cementing layer on the caryopsis surface. The degree of this attachment varies among cultivars, with poor quality adhesion causing "skinning", an economically significant grain quality defect for the malting industry. Malting cultivars encompassing a range of husk adhesion qualities were grown under a misting treatment known to induce skinning. Development of the cementing layer was examined by electron microscopy and compositional changes of the cementing layer were investigated with gas-chromatography followed by mass spectroscopy. Changes in gene expression during adhesion development were examined with a custom barley microarray. The abundance of transcripts involved early in cuticular lipid biosynthesis, including those encoding acetyl-CoA carboxylase, and all four members of the fatty acid elongase complex of enzymes, was significantly higher earlier in caryopsis development than later. Genes associated with subsequent cuticular lipid biosynthetic pathways were also expressed higher early in development, including the decarbonylation and reductive pathways, and sterol biosynthesis. Changes in cuticular composition indicate that lowered proportions of alkanes and higher proportions of fatty acids are associated with development of good quality husk adhesion, in addition to higher proportions of sterols.

Use of Raman microspectroscopy to predict malting barley husk adhesion quality.

Good quality husk-caryopsis adhesion is essential for malting barley, but that quality is influenced by caryopsis surface lipid composition. Raman spectroscopy was applied to lipid extracts from barley caryopses of cultivars with differential adhesion qualities. Principal component regression indicated that Raman spectroscopy can distinguish among cultivars with good and poor quality adhesion due to differences in compounds associated with adhesion quality.

Survey of Salmonella spp. in beef meat for export at slaughterhouses in Brazil / Pesquisa de Salmonella spp. em carcaças bovinas durante o processamento em abatedouros-frigoríficos exportadores

The aim of the present study was to investigate the presence of Salmonella spp. in samples collected from beef meat at three points of the slaughter line (after skinning, washing and cooling) at three slaughterhouses in Brazil that export meat. Detection was based on ISO 6579:2002 and confirmed by PCR and qPCR. The isolates were typified using slide agglutination tests and PFGE. The antibiotic sensitivity profile was determined using the disk diffusion method. Contamination was detected in only one slaughterhouse. The overall frequency of contamination by Salmonella spp. was 6.7% of carcasses (6/90) and 2.6% of carcass surface samples (7/270). All isolates were confirmed by PCR and qPCR. The serological analysis and the PFGE showed a single profile: Typhimurium. The strains demonstrated 100% susceptibility to ampicillin, cefotaxime, ciprofloxacin, chloramphenicol, gentamicin and tetracycline. Positive carcasses after cooling pose a direct risk to consumers, since the meat is considered ready to be marketed after this process.(AU)

O objetivo deste trabalho foi investigar a presença de Salmonella spp. em amostras coletadas de carcaças de bovinos, em três pontos da linha de abate (após a esfola, lavagem e refrigeração) de três frigoríficos exportadores no Brasil. A detecção foi realizada pela ISO 6579:2002, e confirmada por PCR e qPCR. Os isolados foram tipificados por testes de soroaglutinação e PFGE e avaliado o perfil de sensibilidade aos antibióticos pelo método de difusão em disco. A contaminação foi detectada em apenas um abatedouro-frigorífico. As contaminações das carcaças (n=90) e amostras de carne (n=270) por Salmonella spp. foram 6 (6,7%) e 7 (2,6%), respectivamente. Todos os isolados foram confirmados por PCR e qPCR. A análise sorológica e o PFGE mostraram um único perfil: Typhimurium. As cepas apresentaram 100% de suscetibilidade à ampicilina, cefotaxima, ciprofloxacina, cloranfenicol, gentamicina e tetraciclina. As carcaças positivas após a refrigeração apresentam um risco direto para o consumidor, uma vez que, após este processo, a carne está pronta para ser comercializada.(AU)

Subject-Specific Biomechanical Modelling of the Oropharynx: Towards Speech Production.

Biomechanical models of the oropharynx are beneficial to treatment planning of speech impediments by providing valuable insight into the speech function such as motor control. In this paper, we develop a subject-specific model of the oropharynx and investigate its utility in speech production. Our approach adapts a generic tongue-jaw-hyoid model (Stavness et al. 2011) to fit and track dynamic volumetric MRI data of a normal speaker, subsequently coupled to a source-filter based acoustic synthesizer. We demonstrate our model's ability to track tongue tissue motion, simulate plausible muscle activation patterns, as well as generate acoustic results that have comparable spectral features to the associated recorded audio. Finally, we propose a method to adjust the spatial resolution of our subject-specific tongue model to match the fidelity level of our MRI data and speech synthesizer. Our findings suggest that a higher resolution tongue model - using similar muscle fibre definition - does not show a significant improvement in acoustic performance, for our speech utterance and at this level of fidelity; however we believe that our approach enables further refinements of the muscle fibres suitable for studying longer speech sequences and finer muscle innervation using higher resolution dynamic data.

Husk to caryopsis adhesion in barley is influenced by pre- and post-anthesis temperatures through changes in a cuticular cementing layer on the caryopsis.

BACKGROUND: At ripeness, the outer husk of "covered" barley grains firmly adheres to the underlying caryopsis. A cuticular cementing layer on the caryopsis is required for husk adhesion, however the quality of adhesion varies significantly among cultivars which produce the cementing layer, resulting in the economically important malting defect, grain skinning. The composition of the cementing layer, and grain organ development have been hypothesised to influence the quality of husk adhesion. Plants of Hordeum vulgare 'Concerto' were grown at different temperatures pre- and post-anthesis to effect changes in the development of the husk, caryopsis and cuticular cementing layer, to determine how these variables influence the quality of husk-to-caryopsis adhesion. RESULTS: Warm conditions pre-anthesis decreased the quality of husk adhesion, and consequently increased the incidence of grain skinning. Cool post-anthesis conditions further decreased the quality of husk adhesion. The composition of the cementing layer, rather than its structure, differed with respect to husk adhesion quality. This cementing layer was produced at the late milk stage, occurring between nine and 29 days post-anthesis, conditional on the temperature-dependent growth rate. The compounds octadecanol, tritriacontane, campesterol and ß-sitosterol were most abundant in caryopses with high-quality husk adhesion. The differences in adhesion quality were not due to incompatible husk and caryopsis dimensions affecting organ contact. CONCLUSIONS: This study shows that husk-to-caryopsis adhesion is dependent on cementing layer composition, and implies that this composition is regulated by temperature before, and during grain development. Understanding this regulation will be key to improving husk-to-caryopsis adhesion.

CCD-Based Skinning Injury Recognition on Potato Tubers (Solanum tuberosum L.): A Comparison between Visible and Biospeckle Imaging.

Skinning injury on potato tubers is a kind of superficial wound that is generally inflicted by mechanical forces during harvest and postharvest handling operations. Though skinning injury is pervasive and obstructive, its detection is very limited. This study attempted to identify injured skin using two CCD (Charge Coupled Device) sensor-based machine vision technologies, i.e., visible imaging and biospeckle imaging. The identification of skinning injury was realized via exploiting features extracted from varied ROIs (Region of Interests). The features extracted from visible images were pixel-wise color and texture features, while region-wise BA (Biospeckle Activity) was calculated from biospeckle imaging. In addition, the calculation of BA using varied numbers of speckle patterns were compared. Finally, extracted features were implemented into classifiers of LS-SVM (Least Square Support Vector Machine) and BLR (Binary Logistic Regression), respectively. Results showed that color features performed better than texture features in classifying sound skin and injured skin, especially for injured skin stored no less than 1 day, with the average classification accuracy of 90%. Image capturing and processing efficiency can be speeded up in biospeckle imaging, with captured 512 frames reduced to 125 frames. Classification results obtained based on the feature of BA were acceptable for early skinning injury stored within 1 day, with the accuracy of 88.10%. It is concluded that skinning injury can be recognized by visible and biospeckle imaging during different stages. Visible imaging has the aptitude in recognizing stale skinning injury, while fresh injury can be discriminated by biospeckle imaging.

Eosinophilic Angiocentric Fibrosis of Sinonasal Region: A Rare & Under Reported Entity.

Eosinophilic angiocentric fibrosis is a rare pathology of the sinonasal tract and the upper respiratory system characterised by fibrosis with poorly understood pathogenesis. A 47-year-old male presented with a swelling over the dorsum of the nose. The possibility of fungal granuloma was being suggested on Magnetic Resonance Imaging (MRI). Histopathology showed thick collagen bundles whorling around vessels giving an onion skin appearance with focal area of vasculitis. An inflammatory reaction rich in eosinophils along with a fibrotic stroma was seen which was highly characteristic of eosinophilic angiocentric fibrosis. Clinically & microscopically it mimics Granuloma faciale, Wegener's Granulomatosis, Churg-Strauss Syndrome, Kimura's disease and few other granulomatous conditions thus making diagnosis difficult. A probable allergic origin is being suggested because of the typical eosinophil-rich inflammatory reaction. Finally the diagnosis of Eosinophilic Angiocentric Fibrosis was given. It is a diagnosis of exclusion having characteristic histomorphological findings thus biopsy is always required to distinguish it from other lesions whose treatment differs.

Laser-skinning colpectomy for extended vaginal intraepithelial neoplasia and microinvasive cancer.

OBJECTIVE: The aim of this study is to analyze the efficacy of colposcopic-guided laser-skinning colpectomy to treat extended high-grade vaginal intraepithelial neoplasia (VaIN). METHODS: Retrospective review of 33 heavily pretreated patients with high-grade VaIN extending over 20-100% of the vaginal surface treated between 2003 and 2013 with colposcopic-guided laser-skinning colpectomy. The vaginal epithelium including all VaIN lesions was excised in one piece with a depth of 2-3mm. RESULTS: Vaginal cancer was diagnosed in 10 patients (nine microinvasive squamous cell carcinoma and one vaginal carcinoma). No serious adverse events related to laser-skinning colpectomy were observed. Of 33 patients, 23 were followed up with cytology and colposcopy for at least 12months at our institution (median follow 26.5months; range 12-104months), while five had a shorter follow-up, four an external follow-up and one patient was lost. Of 23 patients with follow-up ≥12months, 20 were disease free after a single laser-skinning colpectomy (overall cure rate 87.0%). Moderate shortening of the vagina was observed in two patients and another two required reconstruction of vaginal strictures during long-term follow-up. CONCLUSION: Laser-skinning colpectomy appears to be a feasible treatment for extended high-risk VaIN3. The procedure avoids the mutilation associated with colpectomy and allows early diagnosis and staging of invasive disease.

Traumatismo materno grave y cirugía múltiple con resultado perinatal exitoso / Multiple surgery in severe maternal trauma with successful perinatal outcome

El traumatismo mayor de la embarazada es frecuente, tiene riesgo de muerte y agrega a sus complicaciones propias, las generadas por el embarazo como prematurez, desprendimiento placentario y daño perinatal. Presentamos el caso de una embarazada de 27 semanas, con traumatismo grave por atropello, fracturas óseas y desforramiento extenso de extremidad inferior derecha, que fue sometida a tratamiento quirúrgico con reducción y corrección de luxofracturas, aseo e injertos cutáneos. Se complica con infección grave de foco cutáneo, persistente, permaneciendo 24 días en Unidad de Cuidad Intensivo (UCI) en tratamiento antibiótico, 10 drenajes quirúrgicos, nutrición enteral y manejo continuo del dolor, antes del parto. Inicia síndrome de respuesta inflamatoria sistémica y se efectúa operación cesárea. El recién nacido prematuro pesó 1500 gramos y evolucionó favorablemente. En su puerperio permanece 60 días hospitalizada en UCI con 14 cirugías de reparación y mejoría completa. Se analiza las características singulares de morbilidad materna del caso, discutiendo los aspectos obstétricos, quirúrgicos y de cuidado intensivo, la evolución materna, el manejo de la infección y el rol de la cirugía en la prolongación del embarazo y su influencia en el resultado perinatal exitoso. Se concluye la importancia de la integración multidisciplinaria en la toma de decisiones médicas y quirúrgicas en el manejo del trauma materno grave.

Maternal trauma is a leading cause of morbidity and mortality for both, fetus and mother. In addition, trauma can generate risks as premature delivery, abruptio placentae and fetal damage. A pregnant women, at 27 gestational weeks had a car accident with dislocation and fractures and extensive skinning of right leg. The first surgery for fracture-dislocations, cleaning and muscle skin flap were complicated with infection from cutaneous focus, serious and persistent. She remainded for 24 days in Intensive Care Unit (ICU) with antibiotic therapy; she had 10 procedures of surgical drainage with anesthesia, catheter enteral nutrition and continuous pain medication before delivery. Then, she presented systemic inflammatory syndrome maternal and a cesarean section was done; the newborn weighted 1500 grams and had a favorable evolution. After delivery the mother stayed 60 days in ICU, with 14 reparatives surgeries and complete recovery. In this special patient with severe maternal morbidity we discuss the etiology of the oligoamnios observed, the maternal evolution in ICU, the handling of infection, the significance of surgical treatment in prolonging pregnancy and its influence on a successful perinatal outcome. We emphasize on the importance of a multidisciplinary approach in making the medical and surgical decisions in severe maternal trauma.