Ernstsenlindgren3460

• In silico tools can facilitate the optimization of gene- and protein-based factors.• Optimization of gene- and protein-based factors aids host-vector selection.• Statistical optimization is preferred for achieving optimal levels of process factors.BACKGROUND This study revisits the previously described technique of inverted-T skin-reducing mastectomy and dermal-muscle pocket as a single-stage breast reconstruction using anatomical implants in large and ptotic breasts. Refinements have been added to enhance the quality of implant coverage, improve aesthetic outcome, and augment the implant volume than previously described in the literature. SUBJECTS AND METHODS The study was performed in three centers in the UK, Egypt, and Libya. It included patients with large ptotic breasts with a breast cup size of D or larger. The areola-to-inframammary fold distance is of 8 cm or more, and a nipple-sternal notch distance is 25 cm or more. Modification of the dermal-muscle flap was made through dividing the medial and lateral ends of the de-epithelialized flap at a distance of one inch to create wings that could be sutured to the free edge of pectoralis major muscle to act as a hammock. RESULTS It included 42 patients, and the mean age of the patients was 44.4 years (range 28-62). The mean body mass index was 34.2 (range 24-42). The reconstruction was unilateral in 32 (76.2%) patients and bilateral in ten (23.8%) patients. The average implant volume was 498.5 CC (range 375-650). Seventeen (40.5%) patients had a symmetrizing breast reduction. The average follow-up time was 52 weeks. Major complications were noticed in four (7.7%) breasts Three breasts had major skin necrosis and one breast had hematoma that necessitated surgical evacuation. There were no reported cases of implant extrusion. Minor complications were recorded in six (11.5%) breasts; two had wound infection, and three had minor skin necrosis. CONCLUSION The hammock technique of dermal-muscle flap is safe and versatile in large and ptotic breasts. It also creates a natural-looking breast with bigger implants.The creation of protected conservation areas may result in protracted conflicts between stakeholders. In this study we examine the drivers of anthropogenic wildfire ignitions in the National Park of "los Alerces" (NPA) in Patagonia, Argentina. The NPA was established in 1937 to protect the native "andino-patagónico" forests from wildfires as well as preserving its scenic beauty and native flora and fauna. At the time of its creation state authorities prohibited all extractive human activities in the "intangible"-fully protected-"National Park" section, while other regulated extractive and ecotourism activities were allowed to continue in the "Natural Reserve" section in an effort to accommodate the historical entitlements of the displaced populations of "pobladores" (settlers) that had been living in the NPA for over a century. Here we interviewed the main stakeholder groups-"pobladores", forest rangers and administrators, ecolodge owners and angler club members-to identify the drivers of wildfire ignitions in the park. Wildfires have been singled out by state authorities as the main threat to the NPA though considerable scientific uncertainty exists regarding their complex ecological effects. This study argues, based on the human and biophysical system data collected, that two conflicting cultural frames exist within the NPA that provide the necessary backdrop for understanding the drivers of wildfire ignitions. In turn, these findings raise puzzling dilemmas for the main theoretical approaches that have been used to inform and design conflict management strategies in protected conservation areas.PURPOSE Anatomical variants in the posterior compartment of forearm and hand are not uncommon. Physicians should be aware of variations in this region for correct diagnosis and treatment of diseased hands. METHODS During a routine dissection at our department, an extremely rare case of deep hand extensor muscle was discovered. RESULTS A complete extensor digitorum profundus complex was found in the fourth extensor compartment in addition to the extensor indicis proprius. this website The complex consisted of two muscle bellies originating from the lateral aspect of distal ulna and the adjacent interosseous membrane. The first belly resembled the conventional extensor indicis proprius. The second belly gave off two tendon slips one inserted to the index and middle fingers and the other formed aponeurosis before inserting to the ring and little fingers. CONCLUSION To our knowledge, a complete extensor digitorum profundus complex which inserts to all medial four digits has never been reported in humans. Awareness of variations in this region is critical for surgeons operating in the forearm and hand. The present case also provides insights into the evolutionary and developmental origin of these structures.Critically ill patients often acquire neuropathy and/or myopathy labeled ICU-acquired weakness. The current insights into incidence, pathophysiology, diagnostic tools, risk factors, short- and long-term consequences and management of ICU-acquired weakness are narratively reviewed. PubMed was searched for combinations of "neuropathy", "myopathy", "neuromyopathy", or "weakness" with "critical illness", "critically ill", "ICU", "PICU", "sepsis" or "burn". ICU-acquired weakness affects limb and respiratory muscles with a widely varying prevalence depending on the study population. Pathophysiology remains incompletely understood but comprises complex structural/functional alterations within myofibers and neurons. Clinical and electrophysiological tools are used for diagnosis, each with advantages and limitations. Risk factors include age, weight, comorbidities, illness severity, organ failure, exposure to drugs negatively affecting myofibers and neurons, immobility and other intensive care-related factors. ICU-acquired weakness increases risk of in-ICU, in-hospital and long-term mortality, duration of mechanical ventilation and of hospitalization and augments healthcare-related costs, increases likelihood of prolonged care in rehabilitation centers and reduces physical function and quality of life in the long term. RCTs have shown preventive impact of avoiding hyperglycemia, of omitting early parenteral nutrition use and of minimizing sedation. Results of studies investigating the impact of early mobilization, neuromuscular electrical stimulation and of pharmacological interventions were inconsistent, with recent systematic reviews/meta-analyses revealing no or only low-quality evidence for benefit. ICU-acquired weakness predisposes to adverse short- and long-term outcomes. Only a few preventive, but no therapeutic, strategies exist. Further mechanistic research is needed to identify new targets for interventions to be tested in adequately powered RCTs.