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Substrate controlled development of anaerobic acidifying aggregates at different shear rates in a gas lift reactor.

The influence of liquid shear rates on the development of acidifying mixed-culture aggregates was studied in a gas-lift reactor. The glucose concentration was kept at a constant and relatively high level by operating the reactor in pH-auxostat mode. Size, strength, and wet density of aggregates cultivated at different superficial gas velocities (Ug) were investigated. Image analysis showed that the Sauter mean diameter (Ds) decreased with increasing Ug. A stirred tank was used to characterize the surface detachment rate (Rd) under non-growth conditions. An exponential decrease was observed in Rd with the applied Ug during cultivation, i.e., aggregates became stronger. The increased strength coincided with an increase in aggregate wet density. Size classified aggregates showed an increase in Rd with the square of the aggregate diameter (Dp), however, this contribution was much smaller than the effect of adaptation. Experiments in a similar gas-lift reactor under dynamic conditions without adaptation, showed that Rd increased exponentially with increasing Ug. So, two important contributions to Rd can be distinguished: adaptation, which induces stronger aggregates, and aggregate size, which makes them less susceptible to hydrodynamic shear. A general expression for Rd was derived, which depends on Dp and Ug. Combining this equation with the surface biomass growth rate (Rg) allowed for the estimation of the maximal diameter (Dmax) aggregates can reach at any Ug, and it was found that the estimated and measured Dmax were in good agreement.

Anaerobiosis↗

An approach to face-lift surgery.

An approach to the aging face based upon an analysis of surgical principles and dynamics is presented. This approach emphasizes that the face-lift operation should be directed toward areas in which its potential for improvement is greatest, that is, the jowl and neck. Correction of associated manifestations of aging is best accomplished using ancillary procedures specifically designed for rejuvenating these areas rather than by extension of the face-lift operation per se.

Aging↗

Face lift, part I: Extent of undermining of skin flaps.

One theory in cheek-neck lifting is that it is necessary to undermine skin flaps widely to achieve adequate short and long term results. We have proven that extensive undermining allows no more skin to be excised than is permitted by more conservative undermining when snug skin closures are used. Another part of the theory is that a sheet of scar tissue ("favorable fibrosis") forms and that the larger sheet of scar from more extensive undermining maintains the improvement from the lift longer than would a smaller sheet from less undermining. Controlled studies presented here cast doubt on this part of the theory. Many years ago we ran a series on patients in whom one side had essentially twice as much undermining as did the other. Equal amounts of skin were removed on both sides. Short and long term results were essentially the same on the two sides.

Cicatrix↗

Face lift, part 5: suspending sutures for platysma cording.

We describe the technical details used in applying nonabsorbable sutures running from the anterior platysma muscles and/or adjacent fascia back to the fascia just in front of or covering the sternocleidomastoid muscles. These sutures usually pass 1.5-2 cm below the angle of the mandible. Anteriorly, they cover or are attached to the platysma muscles at the level of the cervical concavity or angle. The sutures suspend or draw back the superficial musculoaponeurotic system (SMAS) at this level, preventing some of the anterior displacement of the platysma when it is contracted in normal use. We believe that the sutures have relatively long-lasting effects and that they delay the early return of "platysma cording" after cheek-neck lifting. Their application using Reverdin and Keith needles is demonstrated. Differences in technique when submental lipectomy is and is not performed with the lift are shown.

Face↗

Bone regeneration in rabbit sinus lifting associated with bovine BMP.

Autogenous bone is considered the optimal grafting material for sinus lifting, although its harvesting causes great patient discomfort. Various approaches have been taken in order to obtain sinus lifting with preexisting tissue. However, because of the unsuitability of such tissue, additional materials have been required. Alternatively, biomaterials from humans or other animals are used. In this study, the efficacy of using morphogenetic bovine bone protein (BMPb) to augment the maxillary sinus floor was examined. Four grafting materials were employed: lyophilized bovine bone powder, absorbable collagen flakes, natural hydroxylapatite, and synthetic hydroxylapatite. Two groups of rabbits were studied. In one group, graft material only was used. In the other, graft material was combined with 0.5 mg BMPb. During 8 weeks of observation, polyfluorochrome tracers were injected in subcutaneous tissue to evaluate new bone- deposition periods. Following sacrifice, the samples were examined under fluorescent and light microscopes. Results indicated 33.34% more newly formed bone in BMPb animals than in controls. Graft-material resorption increased, but natural HA showed no significant alterations. The results show that the use of BMPb, although providing osteoinduction, might not promote sufficient bone formation. Nonetheless, this material could provide an alternative to autogenous grafts, thereby avoiding patient discomfort.

Animals↗

Coordination between posture and movement in a bimanual load-lifting task: is there a transfer?

The present experimental series was designed to test the possibility that an anticipatory postural adjustment learned during the performance of a bimanual load lifting task may be transferred between the upper extremities. Eight seated subjects were asked to maintain horizontally one forearm (postural arm) loaded with a 1-kg load, which was fixed to the arm by means of an electromagnet. The unloading was triggered either by the experimenter pressing a switch (control) or by the subjects making a voluntary movement with their other arm (moving arm). In the latter case, the subject lifted a 1-kg load resting on a force platform with the moving hand, and the switching off was triggered when the force level reached a threshold of 0.5 kg. The maximum amplitude (MA) and the maximum velocity (MV) of the postural forearm elbow joint rotation occurring after the unloading were measured at each trial. The learning process was estimated by performing a regression analysis on each series of trials, using an exponential model, and from the intercept of the regression curve with the ordinate. 1. During the original learning session (three series of 20 trials), a decrease in MA and MV was found to occur both within the series and between the series during a session. 2. After the initial learning session, the sides of the postural and moving arm were interchanged to test whether any transfer had occurred. The first series of trials in the second session (transfer) and the last series of trials in the original learning session were compared and found to be significantly different in terms of the intercept (seven subjects in the case of MA, five subjects in the case of MV) and the slope (five subjects), indicating a lack of transfer. 3. The data recorded during the second transfer learning session indicated that learning occurred in all eight subjects in the case of MA and in six subjects in the case of MV. It was observed that the original learning session did not facilitate the second one. 4. The lack of transfer of the anticipatory postural adjustment observed in this task is discussed with reference to the data in the literature.

Conditioning, Psychological↗

Roles of glabrous skin receptors and sensorimotor memory in automatic control of precision grip when lifting rougher or more slippery objects.

To be successful, precision manipulation of small objects requires a refined coordination of forces excerted on the object by the tips of the fingers and thumb. The present paper deals quantitatively with the regulation of the coordination between the grip force and the vertical lifting force, denoted as the load force, while small objects were lifted, positioned in space and replaced by human subjects using the pinch grip. It was shown that the grip force changed in parallel with the load force generated by the subject to overcome various forces counteracting the intended manipulation. The balance between the two forces was adapted to the friction between the skin and the object providing a relatively small safety margin to prevent slips, i.e. the more slippery the object the higher the grip force at any given load force. Experiments with local anaesthesia indicated that this adaptation was dependent on cutaneous afferent input. Afferent information related to the frictional condition could influence the force coordination already about 0.1 s after the object was initially gripped, i.e. approximately at the time the grip and load forces began to increase in parallel. Further, "secondary", adjustments of the force balance could occur later in response to small short-lasting slips, revealed as vibrations in the object. The new force balance following slips was maintained, indicating that the relationship between the two forces was set on the basis of a memory trace. Its updating was most likely accounted for by tactile afferent information entering intermittently at inappropriate force coordination, e.g. as during slips. The latencies between the onset of such slips and the appearance of the adjustments (0.06-0.08 s) clearly indicated that the underlying neural mechanisms operated highly automatically.

Adaptation, Physiological↗

Bicoronal forehead lift.

Although aesthetic surgery on the upper third of the face has received relatively little attention in recent literature, it is an extremely important component of facial aesthetic surgery and often yields results that are quite dramatic. Periorbital rejuvenation, either alone or in conjunction with other aesthetic surgical procedures, offers facial enhancement to younger patients. In addition, older patients may benefit from a "forehead lift" performed in conjunction with lower facial surgery. This benefit is derived because lower facial surgery may create facial disharmony by yielding a more youthful lower face while leaving a more mature upper face. In these cases a forehead lift serves to unify the patient's facial appearance. The coronal browlifting technique described here is a personal interpretation and modification of periorbital rejuvenation techniques. This approach represents an ideal aesthetic procedure: It is a technically straightforward operation that yields results which are predictable, natural appearing, and long lasting with minimal morbidity.

Adult↗

Fascio-fascial suspension technique in medial thigh lifts.

Redundant thigh tissue can be corrected by the thigh lift. However, this is a seldomly used procedure because of postoperative problems such as inferiorly displaced and wide scars, vulvar distortion, and early recurrence of ptosis. In order to limit these complications, we developed a deep anchoring technique based on the overlap of the adductor longus and gracilis fasciae. A group of 18 patients underwent a medial thigh lift using this technique and were followed for at least 12 months after surgery. The fascio-fascial suspension gives strong vertical support with minimal tension on the skin, thereby reducing the complications traditionally associated with this procedure.

Adult↗

Abdominal wall lift. Low-pressure pneumoperitoneum laparoscopic surgery.

A method of abdominal wall lift has been developed and evaluated clinically in this unit during the past 18 months. It permits the conduct of laparoscopic procedures at an intraabdominal pressure of 6-8 mm Hg. The technique was introduced for laparoscopic surgery in patients with preexisting cardiac disease and chronic bronchitis. The procedure, by lifting both the abdominal wall and the falciform ligament together, also elevates the central portion of the liver (segments 3-5), thereby improving the surgical exposure. For this reason it is now also used in fit patients with ptotic livers or hypertrophied quadrate lobes undergoing laparoscopic cholecystectomy and common bile duct exploration, and to facilitate left subhepatic exposure in patients during laparoscopic antireflux surgery and vagotomy.

Abdominal Muscles↗

A special tissue expander in combination with extensive scalp-lifting.

Although posterior closure of male pattern baldness is usually accomplished in two procedures when using extensive scalp-lifting, there is the occasional patient who will require three operations because of very poor scalp laxity. A newly developed horseshoe-shaped tissue expander was designed for these patients so that a third procedure could be eliminated. This differential expander is actually placed during the first extensive scalp-lifting operation. This differs from the conventional placement as a separate preliminary operation. The significant salient features of this expander and the technique of placement are discussed in detail.

Alopecia↗

A novel MALDI LIFT-TOF/TOF mass spectrometer for proteomics.

A new matrix-assisted laser-desorption/ionization time-of-flight/time-of-flight mass spectrometer with the novel "LIFT" technique (MALDI LIFT-TOF/TOF MS) is described. This instrument provides high sensitivity (attomole range) for peptide mass fingerprints (PMF). It is also possible to analyze fragment ions generated by any one of three different modes of dissociation: laser-induced dissociation (LID) and high-energy collision-induced dissociation (CID) as real MS/MS techniques and in-source decay in the reflector mode of the mass analyzer (reISD) as a pseudo-MS/MS technique. Fully automated operation including spot picking from 2D gels, in-gel digestion, sample preparation on MALDI plates with hydrophilic/hydrophobic spot profiles and spectrum acquisition/processing lead to an identification rate of 66% after the PMF was obtained. The workflow control software subsequently triggered automated acquisition of multiple MS/MS spectra. This information, combined with the PMF increased the identification rate to 77%, thus providing data that allowed protein modifications and sequence errors in the protein sequence database to be detected. The quality of the MS/MS data allowed for automated de novo sequencing and protein identification based on homology searching.

Amino Acid Sequence↗

Characteristics of target-reaching in cats. III. Lifting and protraction with an obstacle in the movement path and after its removal.

Three cats were trained to perform target-reaching to a horizontal tube with food placed at shoulder level, and the kinematic characteristics of the movements were investigated by recording the trajectory of the wrist. From the very onset of training, a vertical obstacle was placed in front of the cats. The obstacle forced the animals to perform movements with an initial phase dominated by limb-lifting to position the wrist above the obstacle, followed by a second phase of protraction towards the tube; in the sagittal plane, the movement paths were segmented with an upwards convexity. After a training period of 1 year (about 7000 movements), the obstacle was removed. All cats then quickly (within a few trials) changed the trajectory so that the main part of protraction now occurred in parallel with limb-lifting during the first half of the movement. The initial slope of the sagittal movement path became less steep and the upwards convexity less pronounced. Such trajectories, which predominated for several experiments after removal of the obstacle, were only slightly different from those observed in control cats not trained with an obstacle. The results are discussed in relation to a previously proposed hypothesis of motor "imprinting" during extensive training in a particular experimental paradigm.

Animals↗

Face lift postoperative recovery.

The purpose of this paper is to describe what I have studied and experienced, mainly regarding the control and prediction of the postoperative edema; how to achieve an agreeable recovery and give positive support to the patient, who in turn will receive pleasant sensations that neutralize the negative consequences of the surgery.After the skin is lifted, the drainage flow to the flaps is reversed abruptly toward the medial part of the face, where the flap bases are located. The thickness and extension of the flap determines the magnitude of the post-op edema, which is also augmented by medial surgeries (blepharo, rhino) whose trauma obstruct their natural drainage, increasing the congestion and edema. To study the lymphatic drainage, the day before an extended face lift (FL) a woman was infiltrated in the cheek skin with lynfofast (solution of tecmesio) and the absorption was observed by gamma camera. Seven days after the FL she underwent the same study; we observed no absorption by the lymphatic, concluding that a week after surgery, the lymphatic network was still damaged. To study the venous return during surgery, a fine catheter was introduced into the external jugular vein up to the mandibular border to measure the peripheral pressure. Following platysma plication the pressure rose, and again after a simple bandage, but with an elastic bandage it increased even further, diminishing considerably when it was released. Hence, platysma plication and the elastic bandage on the neck augment the venous congestion of the face. There are diseases that produce and can prolong the surgical edema: cardiac, hepatic, and renal insufficiencies, hypothyroidism, malnutrition, etc. According to these factors, the post-op edema can be predicted, the surgeon can choose between a wide dissection or a medial surgery, depending on the social or employment compromises the patient has, or the patient must accept a prolonged recovery if a complex surgery is necessary. Operative measures which prevent extensive edemas are: avoiding transection of the temporal pedicle, or to realizing platysma plication too tight by using strong aspirative drainage instead of elastic bandages. In the post-op, the manual lymphatic drainage is initiated on the third or fifth day, but must be done by a trained professional, in a method contrary to that specified in the books for non-operated individuals. An aesthetician washes the hair and applies decongestive cold tea on the face the second day, and on the fifth, moisturizes the skin and cosmetically conceals any signs of bruising. The psychological support provided by the staff keeps the patient calm and relaxed. Five years experience with this protocol has enabled us to minimize post-op pain. The edema can be predicted with certain consistency (in which surgery there will be more or less edema) and the proper technique can be selected, permitting the patient to choose the best moment for a FL while the surgeon can avoid intra and postoperative measures that increase the edema. After surgery, the patient receives the daily assistance of the staff, which rapidly and efficiently improves this condition. We can predict and control the post-op recovery and the patient feels fine, unlike the past when recovery was abandoned to its natural evolution. If the patient perceived an intensive, positive support on behalf of the entire staff that kept him or her content, then we have succeeded in doing an excellent marketing. This may encourage others to undergo aesthetic surgery, especially those who are convinced that after surgery they might have to endure considerable suffering.

Edema↗

MIDI face-lift and tricuspidal SMAS-flap.

Looking tired is enough for many 40-50-years-olds to ask a plastic surgeon for prophylactic rejuvenation. They want to achieve good and long lasting effects with harmonious features, small scars, and--as they are still very active in their professional and private lives--a quick recovery is very important to them. We have developed a modification of the short-scar face-lift with solid deep support. We call it the MIDI face-lift. MIDI stands for Minimal, Invasive, Deep, Intensive. Technical details are as follows. Two half Z-plasties were performed at each end of modest skin excision, supra-auriculary and retro-auriculary, to avoid even suture edges. By doing so we achieve very unobtrusive scarring. For solid SMAS tension we perform SMAS-plication, simple SMAS-flap, or tricuspidal SMAS-flap. This is an overview of 200 patients we treated over three years. By applying tumescent local anesthesia with adrenaline and ornipressin, and fibrin glue at the end of the procedure, we can the draining so that 96% of our patients were outpatients. Technical details will be discussed as well as complications, adjuvant and alternative procedures. The satisfaction of our patients was high (88%) and no major complications have occurred. Only three out of 200 patients had to undergo revisionary surgery.

Adult↗

The concentric medial thigh lift.

Plastic surgeons often are asked to perform horizontal medial thigh lifts because the skin of this area has poor elasticity, inducing excess skin, and also because there is upper fat deposit. This excess skin and fat lead to irritation and even functional problems. But surgeons dislike this operation because of its justified bad reputation. Obviously, this area is difficult to manage because of the many possible side effects (e.g., healing difficulty, scar migration, necrosis, effusions, pain) and unreliable results. A new way of thinking is proposed to lighten this operation and make its more frequent use possible. This horizontal technique presents several innovating points: -A new incision line located along the labia major in the perineal crease remains at the same height backward. The incision never descends into the buttock fold. -No undermining whatsoever occurs even in the resection area. Liposuction is the key to avoidance of any undermining. It is performed everywhere in the thigh, but most importantly under the resection area where all the fat must be eliminated to lighten the flap and favor its lifting. -The resection removes only the skin layers (epidermis and dermis) and not the liposucted tissue, which is very thin. Consequently, all lymphatic and other vessels are preserved, and the healing process is much easier. Moreover, there is no dead space after ascension of the flap and no risk of effusion. -The resection is realized on demand, depending on the excess of skin brought on the incision line by each anchor suture. Therefore, any tension on the skin closure is avoided. -The direction of the skin stretching is concentric toward the labia minor. Consequently, the length of the scar is shortened at both the front and the rear. -Anchor sutures pull a nonundermined skin, thus drastically decreasing the risk of necrosis. In the past 2 years, 25 patients, most of them as outpatients, have undergone surgery using this technique, with a real improvement in the quality of the result, as compared with the results from the standard technique.

Adipose Tissue↗

Open frontal lift: a conservative approach.

This study aimed to demonstrate that during an open frontal lift, transection of the galea is not necessary. The forehead is elevated, and the ptotic brow is raised after a strip of skin or scalp is removed by folding of the galea. The marcation is penciled on the skin according to the amount of skin--scalp the surgeon estimates it is necessary to remove. Local anesthesia is profusely injected, separating all layers and facilitating surgery. The skin is stripped off the galea, and then through a small incision in the middle, a large dissector separates the galea from the periosteum of the forehead and temporal regions. This dissection can be completed from the temporal area or from the blepharoplasty incisions. With a long pair of scissors, the orbital borders are reached and opened perpendicularly to the bone, releasing the fascia and muscle attachments from the orbital rim without anything being cut. During the coronal approach, once the scalp and forehead are completely mobile, the galea is folded with a continuous running 3/0 Vicryl suture, which after five or six big bites is strongly pulled to fold the galea. The wound then is sutured without tension using staples. When the incision is precapillary, the folding is fixed with Vicryl 3/0 uncolored thread, and the skin is sutured with mononylon 6/0. Complementary corrugator transections are performed from the blepharoplasty incision or by use of the endoscope. With the coronal approach, the surgery requires about 20 min, whereas the precapillary approach requires about 40 min. When only the skin is removed, bleeding is scarce and frontal postoperative edema is minimal. The author has used these techniques in 22 precapillary cases and the intracapillary procedure in 28 cases, some of which had a 4-year follow-up period. With the precapillary approach, temporary paresthesia occurred in some cases, but in all cases, sensibility was recovered within the first 2 to 6 months. With this simple and brief technique, the galea is not transected, no branches of the sensitive nerves are sectioned, and temporal and frontal arteries and veins that supply the scalp are not interrupted. Thereafter, wound healing is fast, allowing a quick recovery without areas of permanent numbness. As a result of this technique, the position of the eyebrows is the same as when frontal lifts are performed with transection of the galea and eversion of the flap, but without the side effects.

Contraindications↗

Our experience with endoscopic brow lifts.

This is a retrospective review of our experience with the endoscopic brow lift. We reviewed 128 procedures performed by two senior faculty members over the last 5 years. We evaluated the age, gender, operating time, complications, and outcome and conclude that endoscopic brow lift is a safe, efficient procedure with a low complication rate. The operating time is short, and there is a very high patient acceptance. The procedure has taken its place as an integral part of facial rejuvenation in our practice.

Alopecia↗