Background The lateral femoral condyle (LFC) flap is a vascularized bone flap based on the superior lateral genicular artery (SLGA). Harvest technique for this flap has not yet been demonstrated. The purpose of this study was to better delineate the blood supply to the bone and skin of this flap to allow for a safe and effective harvest. Materials and methods Twenty-three lower extremities were injected with latex or a mixture of latex and barium sulfate. The SLGA was identified and dissected, documenting the course, diameter, anatomical relations, length, and branches. In the mixture group, high-resolution CT scanning was performed prior to dissection. Two additional specimens were dissected to illustrate the harvest technique. Results The SLGA originated from the popliteal artery at an average of 44.3 mm proximal to the knee joint line. The SLGA had an average diameter of 1.9 mm at origin and length of 56 mm. It coursed posterior to the femur, reaching the lateral intermuscular septum (IMS), dividing into superficial (patellar) and deep (condylar) branches, which coursed toward and gave branches to the patella and the LFC, respectively. At least one (average 1.4) septocutaneous skin perforator >5 mm emerged and ran posterior to the IMS. 3D reconstructions of the CT scans were used to confirm anatomic findings and describe a standard harvest technique. Conclusions The SLGA has consistent anatomy, adequate length, suitable diameter at origin for microvascular anastomosis, and constant perforators to bone and skin. The LFC flap provides a useful alternative to flaps from the medial knee or iliac crest.

Background The lateral femoral condyle (LFC) flap is a vascularized bone flap based on the superior lateral genicular artery (SLGA). Harvest technique for this flap has not yet been demonstrated. The purpose of this study was to better delineate the blood supply to the bone and skin of this flap to allow for a safe and effective harvest. Materials and methods Twenty-three lower extremities were injected with latex or a mixture of latex and barium sulfate. The SLGA was identified and dissected, documenting the course, diameter, anatomical relations, length, and branches. In the mixture group, high-resolution CT scanning was performed prior to dissection. Two additional specimens were dissected to illustrate the harvest technique. Results The SLGA originated from the popliteal artery at an average of 44.3 mm proximal to the knee joint line. The SLGA had an average diameter of 1.9 mm at origin and length of 56 mm. It coursed posterior to the femur, reaching the lateral intermuscular septum (IMS), dividing into superficial (patellar) and deep (condylar) branches, which coursed toward and gave branches to the patella and the LFC, respectively. At least one (average 1.4) septocutaneous skin perforator >5 mm emerged and ran posterior to the IMS. 3D reconstructions of the CT scans were used to confirm anatomic findings and describe a standard harvest technique. Conclusions The SLGA has consistent anatomy, adequate length, suitable diameter at origin for microvascular anastomosis, and constant perforators to bone and skin. The LFC flap provides a useful alternative to flaps from the medial knee or iliac crest.

Background: The medial femoral condyle free vascularized bone flap is a valuable alternative to other types of vascularized bone grafts. The donor-site morbidity and functional outcomes after flap harvest have not been fully appreciated. The authors report the postoperative outcomes and analyze the impact of increasing the size of the flap on knee donor-site morbidity. Methods: A retrospective chart review of patients who underwent medial femoral condyle flap surgery between 2001 and 2012 at their institution was performed. The size of the flap was stratified, based on the largest dimension, into three groups. Demographics, outcomes, and complications related to the flap donor site were recorded and analyzed. Subsequently, functional status was assessed by administering a validated condition-specific measure. A univariate logistic regression analysis was performed, and results were analyzed.

Nrf2 and Bach1 are important transcriptional factors that protect against reactive oxygen species (ROS). Although aberration of these molecules was associated with malignant transformation and progression, their aberration pattern in colorectal carcinoma (CRC) is not yet fully studied. In this study, Nrf2 and Bach1 were immunohistochemically examined in 93 formalin-fixed paraffin-embedded blocks of colonic tumors (65 carcinoma with their corresponding surgical margins and 28 adenomas). Nrf2 expression was gradually increased in the apparently normal mucosa (57 ± 41)-adenoma (90 ± 36)- carcinoma (198 ± 78) direction and only showed significant higher mean of expression in CRC with brisk inflammatory peritumoral response. The mean of Bach1 expression was highest in apparently normal colonic mucosa (267 ± 16), lowest in adenoma (53 ± 31) and high in carcinoma tissues (194 ± 93). Significant higher mean of expression was detected in carcinoma with: LN metastasis (p = 0.04), lymphovascular invasion (p = 0.024); perineural invasion (p = 0.03) and advanced pathological stage (p 0.001). Significant higher mean of expression of Nrf2 and Bach1 was detected in adenoma specimens with high grade dysplasia (p = 0.016 and p = 0.024) respectively. In conclusion, Nfr2 and Bach1 expression are altered in CRC but in different way. Nrf2 is gradually increasing from normal mucosa to adenoma and was highest in carcinoma but was not associated with features of tumor invasiveness. Bach1 was highest in normal mucosa; less in adenoma then increased in carcinoma and was associated with features of tumor invasiveness and metastasis. This may indicate a possible role of Nrf2 in CRC carcinogenesis and a role of Bach1 in CRC progression.

Nrf2 and Bach1 are important transcriptional factors that protect against reactive oxygen species (ROS). Although aberration of these molecules was associated with malignant transformation and progression, their aberration pattern in colorectal carcinoma (CRC) is not yet fully studied. In this study, Nrf2 and Bach1 were immunohistochemically examined in 93 formalin-fixed paraffin-embedded blocks of colonic tumors (65 carcinoma with their corresponding surgical margins and 28 adenomas). Nrf2 expression was gradually increased in the apparently normal mucosa (57 ± 41)-adenoma (90 ± 36)- carcinoma (198 ± 78) direction and only showed significant higher mean of expression in CRC with brisk inflammatory peritumoral response. The mean of Bach1 expression was highest in apparently normal colonic mucosa (267 ± 16), lowest in adenoma (53 ± 31) and high in carcinoma tissues (194 ± 93). Significant higher mean of expression was detected in carcinoma with: LN metastasis (p = 0.04), lymphovascular invasion (p = 0.024); perineural invasion (p = 0.03) and advanced pathological stage (p 0.001). Significant higher mean of expression of Nrf2 and Bach1 was detected in adenoma specimens with high grade dysplasia (p = 0.016 and p = 0.024) respectively. In conclusion, Nfr2 and Bach1 expression are altered in CRC but in different way. Nrf2 is gradually increasing from normal mucosa to adenoma and was highest in carcinoma but was not associated with features of tumor invasiveness. Bach1 was highest in normal mucosa; less in adenoma then increased in carcinoma and was associated with features of tumor invasiveness and metastasis. This may indicate a possible role of Nrf2 in CRC carcinogenesis and a role of Bach1 in CRC progression.

Nrf2 and Bach1 are important transcriptional factors that protect against reactive oxygen species (ROS). Although aberration of these molecules was associated with malignant transformation and progression, their aberration pattern in colorectal carcinoma (CRC) is not yet fully studied. In this study, Nrf2 and Bach1 were immunohistochemically examined in 93 formalin-fixed paraffin-embedded blocks of colonic tumors (65 carcinoma with their corresponding surgical margins and 28 adenomas). Nrf2 expression was gradually increased in the apparently normal mucosa (57 ± 41)-adenoma (90 ± 36)- carcinoma (198 ± 78) direction and only showed significant higher mean of expression in CRC with brisk inflammatory peritumoral response. The mean of Bach1 expression was highest in apparently normal colonic mucosa (267 ± 16), lowest in adenoma (53 ± 31) and high in carcinoma tissues (194 ± 93). Significant higher mean of expression was detected in carcinoma with: LN metastasis (p = 0.04), lymphovascular invasion (p = 0.024); perineural invasion (p = 0.03) and advanced pathological stage (p 0.001). Significant higher mean of expression of Nrf2 and Bach1 was detected in adenoma specimens with high grade dysplasia (p = 0.016 and p = 0.024) respectively. In conclusion, Nfr2 and Bach1 expression are altered in CRC but in different way. Nrf2 is gradually increasing from normal mucosa to adenoma and was highest in carcinoma but was not associated with features of tumor invasiveness. Bach1 was highest in normal mucosa; less in adenoma then increased in carcinoma and was associated with features of tumor invasiveness and metastasis. This may indicate a possible role of Nrf2 in CRC carcinogenesis and a role of Bach1 in CRC progression.

Introduction The study aims to evaluate the effect of obesity on the endometrium in women with polycystic ovarian disease (PCOD) through evaluation of endometrial and subendometrial vascularity by two-dimensional (2D) ultrasound, Doppler and three dimensional power Doppler (3DPD). Methods A prospective case-control study, conducted in a tertiary University hospital between February 2016 and December 2016. The study included 50 women with PCOD and 50 fertile regular menstruating women divided according to their body mass index (BMI) into normal weight and overweight/obese groups. Endometrial thickness and pattern combined with Doppler examination of the uterine vessels for measurement of Resistance index (RI) and pulsatility index (PI) were assessed. Evaluation of endometrial and subendometrial blood flow was performed by 3DPD using Virtual organ computer-aided analysis program. Results No significant difference in the endometrial pattern or thickness between all study groups. Endometrial volume was significantly lower in the overweight/obese PCOD women and overall in the PCOD women compared to the control group (p  0.01). Uterine artery RI was significantly higher in the PCOD women compared to the control group (p = 0.004), but no difference in uterine PI. Vascular indices of endometrial and subendometrial blood flow were significantly lower in the overweight/obese PCOD women than the normal weight PCOD women. Conclusions The endometrium is negatively affected by obesity in women with PCOD. Additionally, PCOD women had lower endometrial and subendometrial blood flow than non-PCOD women. Therefore, overweight/obese PCOD women should be encouraged to reduce their body weight in order to improve the endometrial receptivity.

Introduction The study aims to evaluate the effect of obesity on the endometrium in women with polycystic ovarian disease (PCOD) through evaluation of endometrial and subendometrial vascularity by two-dimensional (2D) ultrasound, Doppler and three dimensional power Doppler (3DPD). Methods A prospective case-control study, conducted in a tertiary University hospital between February 2016 and December 2016. The study included 50 women with PCOD and 50 fertile regular menstruating women divided according to their body mass index (BMI) into normal weight and overweight/obese groups. Endometrial thickness and pattern combined with Doppler examination of the uterine vessels for measurement of Resistance index (RI) and pulsatility index (PI) were assessed. Evaluation of endometrial and subendometrial blood flow was performed by 3DPD using Virtual organ computer-aided analysis program. Results No significant difference in the endometrial pattern or thickness between all study groups. Endometrial volume was significantly lower in the overweight/obese PCOD women and overall in the PCOD women compared to the control group (p  0.01). Uterine artery RI was significantly higher in the PCOD women compared to the control group (p = 0.004), but no difference in uterine PI. Vascular indices of endometrial and subendometrial blood flow were significantly lower in the overweight/obese PCOD women than the normal weight PCOD women. Conclusions The endometrium is negatively affected by obesity in women with PCOD. Additionally, PCOD women had lower endometrial and subendometrial blood flow than non-PCOD women. Therefore, overweight/obese PCOD women should be encouraged to reduce their body weight in order to improve the endometrial receptivity.

Introduction The study aims to evaluate the effect of obesity on the endometrium in women with polycystic ovarian disease (PCOD) through evaluation of endometrial and subendometrial vascularity by two-dimensional (2D) ultrasound, Doppler and three dimensional power Doppler (3DPD). Methods A prospective case-control study, conducted in a tertiary University hospital between February 2016 and December 2016. The study included 50 women with PCOD and 50 fertile regular menstruating women divided according to their body mass index (BMI) into normal weight and overweight/obese groups. Endometrial thickness and pattern combined with Doppler examination of the uterine vessels for measurement of Resistance index (RI) and pulsatility index (PI) were assessed. Evaluation of endometrial and subendometrial blood flow was performed by 3DPD using Virtual organ computer-aided analysis program. Results No significant difference in the endometrial pattern or thickness between all study groups. Endometrial volume was significantly lower in the overweight/obese PCOD women and overall in the PCOD women compared to the control group (p  0.01). Uterine artery RI was significantly higher in the PCOD women compared to the control group (p = 0.004), but no difference in uterine PI. Vascular indices of endometrial and subendometrial blood flow were significantly lower in the overweight/obese PCOD women than the normal weight PCOD women. Conclusions The endometrium is negatively affected by obesity in women with PCOD. Additionally, PCOD women had lower endometrial and subendometrial blood flow than non-PCOD women. Therefore, overweight/obese PCOD women should be encouraged to reduce their body weight in order to improve the endometrial receptivity.

Introduction The study aims to evaluate the effect of obesity on the endometrium in women with polycystic ovarian disease (PCOD) through evaluation of endometrial and subendometrial vascularity by two-dimensional (2D) ultrasound, Doppler and three dimensional power Doppler (3DPD). Methods A prospective case-control study, conducted in a tertiary University hospital between February 2016 and December 2016. The study included 50 women with PCOD and 50 fertile regular menstruating women divided according to their body mass index (BMI) into normal weight and overweight/obese groups. Endometrial thickness and pattern combined with Doppler examination of the uterine vessels for measurement of Resistance index (RI) and pulsatility index (PI) were assessed. Evaluation of endometrial and subendometrial blood flow was performed by 3DPD using Virtual organ computer-aided analysis program. Results No significant difference in the endometrial pattern or thickness between all study groups. Endometrial volume was significantly lower in the overweight/obese PCOD women and overall in the PCOD women compared to the control group (p  0.01). Uterine artery RI was significantly higher in the PCOD women compared to the control group (p = 0.004), but no difference in uterine PI. Vascular indices of endometrial and subendometrial blood flow were significantly lower in the overweight/obese PCOD women than the normal weight PCOD women. Conclusions The endometrium is negatively affected by obesity in women with PCOD. Additionally, PCOD women had lower endometrial and subendometrial blood flow than non-PCOD women. Therefore, overweight/obese PCOD women should be encouraged to reduce their body weight in order to improve the endometrial receptivity.