text:
It’s been a rough trot for Martin Nguyen since he was awarded ONE Championship’s Martial Artist of the Year in 2017. “The Situ-Asian” rose to fame after crushing the previously unbeaten Marat Gafurov to win the featherweight title in August 2017. He then backed it up with a legitimately terrifying knockout of lightweight champion Eduard Folayang in November 2017.
Nguyen was a two-division champion and sought more. In his next fight, he challenged Bibiano Fernandes for the bantamweight title but lost a tight split decision. Until that day, Nguyen had never made it to the scorecards. He’d finished all of his opponents and only ever been defeated by Gafurov when he only had four fights under his belt.
Since then, however, the 30-year-old has been tied to decision outcomes in his next two fights. He successfully defended his title against current lightweight challenger Christian Lee before then attempting to earn another shot at Fernandes. Nguyen was matched against tough Team Lakay fighter Kevin Belingon in an interim featherweight title fight in July last year but would go on to lose a unanimous decision after never really kicking into gear.
Now training at Hard Knocks 365 in the United States, Nguyen told The Body Lock that he is ‘hungry again’ and is seeking a stoppage victory this Friday.

lowercased:
it’s been a rough trot for martin nguyen since he was awarded one championship’s martial artist of the year in 2017. “the situ-asian” rose to fame after crushing the previously unbeaten marat gafurov to win the featherweight title in august 2017. he then backed it up with a legitimately terrifying knockout of lightweight champion eduard folayang in november 2017.
nguyen was a two-division champion and sought more. in his next fight, he challenged bibiano fernandes for the bantamweight title but lost a tight split decision. until that day, nguyen had never made it to the scorecards. he’d finished all of his opponents and only ever been defeated by gafurov when he only had four fights under his belt.
since then, however, the 30-year-old has been tied to decision outcomes in his next two fights. he successfully defended his title against current lightweight challenger christian lee before then attempting to earn another shot at fernandes. nguyen was matched against tough team lakay fighter kevin belingon in an interim featherweight title fight in july last year but would go on to lose a unanimous decision after never really kicking into gear.
now training at hard knocks 365 in the united states, nguyen told the body lock that he is ‘hungry again’ and is seeking a stoppage victory this friday.


text: We work with clients in establishing and administering all types of employee benefit plans, including health, disability, retirement, and cafeteria plans. This includes advice concerning the Affordable Care Act, COBRA, HIPAA, withdrawal liability, and qualified retirement plans, such as 401(k) plans, 403(b) plans, 457(b) plans, defined contribution/defined benefit pension plans, employee stock ownership plans, and executive compensation programs. We assist on tax withholding issues and related independent contractor/employee determinations and we defend our clients in all types of benefit controversies with employees.

lowercased: we work with clients in establishing and administering all types of employee benefit plans, including health, disability, retirement, and cafeteria plans. this includes advice concerning the affordable care act, cobra, hipaa, withdrawal liability, and qualified retirement plans, such as 401(k) plans, 403(b) plans, 457(b) plans, defined contribution/defined benefit pension plans, employee stock ownership plans, and executive compensation programs. we assist on tax withholding issues and related independent contractor/employee determinations and we defend our clients in all types of benefit controversies with employees.


text:
After surgery and radiation therapy, the use of hormone therapy is another common choice for the main treatment of prostate cancer. Generally, it is used to modify the production of testosterone, a hormone that can feed the cancerous cells in the prostate to grow. There are several factors that affect the decision of your doctor in using this kind of cancer treatment.
As many other things in cancer treatment, the use of hormone therapy for cancer of prostate could carry the risk of some side effects, too.
But in general, the benefits of using the treatment should outweigh the risk of potential side effects. You and your doctor can discuss about this issue before you take hormone treatment.
Since there are some types of medicines for hormone therapy, the side effects also can vary from medicine to medicine. But they are categorized into two main groups, short term and long term side effects.
ED (impotence), it is a common side effect after taking some medicines for hormone therapy, especially for those that can completely stop the production of testosterone. The problem improves once you stop taking the medicine, but this prognosis can vary (typically depending on the kind of medicine you take and how long you take it).
Weakness and tired, another common side effect. To cope with it, there are some helpful approaches. These include doing gentle exercise most days of the week, getting adequate rest each day, and sticking with a well-balanced diet.
Hot flashes, this symptom is similar to one that goes during menopause. It should improve as you get used to the medicine. Some lifestyle approaches can help. These include not drinking coffee & tea, avoid nicotine, and keep far away from anything that can make you overheated.
Prostate cancer can cause pain, but it can get worse when you start taking hormone therapy and this is often called as tumor flare pain. Fortunately, there are some medicines that can help cope with it.
Tenderness of breast. It is usually a consequence from high dose of medicine for hormone treatment. Like in tumor flare pain, some medicines are available to help ease this tenderness.
Some patients find that they experience problems of difficulty remembering, difficulty concentrating, or other memory problems. If you do find that memory changes are causing a significant impact on your daily routine, talk to your specialist or doctor!
In long term, taking hormone treatment might increase the risk of having earlier heart attack. Some studies show that elderly men (older than 65) with hormone therapy for six months or longer may have increased risk of heart problems. Therefore, make sure to tell your doctor if you have any issues related to your heart before taking the treatment!
The risk of osteoporosis! The use of hormone treatment in long term can pose the risk of bone fracture. Before and after taking the treatment, your specialist may ask you to take certain test (such as DEXA test) to measure the strength of your bone and mineral density. If you are at risk of osteoporosis, vitamin D and calcium supplements can be prescribed. Other lifestyle approaches such as avoid smoking, restrict alcohol, and do regular exercise (weight-bearing exercise) can help, too.
The treatment may affect your mood, causing mood swings or even depression. The best way to cope with the problem is by talking to your partner. If this is not helpful enough, you can consider taking counseling with a counselor.
When you need to use hormone therapy for prostate cancer?
Hormone is naturally found in our body. It is essential for some body’s functions, such as for controlling the activity & growth of our healthy cells.
As mentioned before, it’s thought that cancerous cells in the prostate depend on testosterone, a male hormone. These abnormal cells use testosterone for their nutrient supply to grow.
For this reason, doctors think that reducing the amount of this hormone can inhibit the growth of the cancer or reduce the risk of the cancer from returning after the treatment. Even if necessary, sometimes doctors may need to completely stop the testosterone production.
Hormone treatment is commonly considered powerful enough to get rid of some prostate cancer symptoms and control the progression of the cancer. But after a few years, sometime there is a time of when the cancerous cells become resistant to the treatment. If this occurs, the use of hormone treatment may be no longer effective.
In general, the stage and other factors that affect the way of ‘how fast your prostate cancer spreads and becomes aggressive’ can play a key role in whether or not you need to take hormone therapy!
Can Prostate Cancer Spread to the Brain?

lowercased:
after surgery and radiation therapy, the use of hormone therapy is another common choice for the main treatment of prostate cancer. generally, it is used to modify the production of testosterone, a hormone that can feed the cancerous cells in the prostate to grow. there are several factors that affect the decision of your doctor in using this kind of cancer treatment.
as many other things in cancer treatment, the use of hormone therapy for cancer of prostate could carry the risk of some side effects, too.
but in general, the benefits of using the treatment should outweigh the risk of potential side effects. you and your doctor can discuss about this issue before you take hormone treatment.
since there are some types of medicines for hormone therapy, the side effects also can vary from medicine to medicine. but they are categorized into two main groups, short term and long term side effects.
ed (impotence), it is a common side effect after taking some medicines for hormone therapy, especially for those that can completely stop the production of testosterone. the problem improves once you stop taking the medicine, but this prognosis can vary (typically depending on the kind of medicine you take and how long you take it).
weakness and tired, another common side effect. to cope with it, there are some helpful approaches. these include doing gentle exercise most days of the week, getting adequate rest each day, and sticking with a well-balanced diet.
hot flashes, this symptom is similar to one that goes during menopause. it should improve as you get used to the medicine. some lifestyle approaches can help. these include not drinking coffee & tea, avoid nicotine, and keep far away from anything that can make you overheated.
prostate cancer can cause pain, but it can get worse when you start taking hormone therapy and this is often called as tumor flare pain. fortunately, there are some medicines that can help cope with it.
tenderness of breast. it is usually a consequence from high dose of medicine for hormone treatment. like in tumor flare pain, some medicines are available to help ease this tenderness.
some patients find that they experience problems of difficulty remembering, difficulty concentrating, or other memory problems. if you do find that memory changes are causing a significant impact on your daily routine, talk to your specialist or doctor!
in long term, taking hormone treatment might increase the risk of having earlier heart attack. some studies show that elderly men (older than 65) with hormone therapy for six months or longer may have increased risk of heart problems. therefore, make sure to tell your doctor if you have any issues related to your heart before taking the treatment!
the risk of osteoporosis! the use of hormone treatment in long term can pose the risk of bone fracture. before and after taking the treatment, your specialist may ask you to take certain test (such as dexa test) to measure the strength of your bone and mineral density. if you are at risk of osteoporosis, vitamin d and calcium supplements can be prescribed. other lifestyle approaches such as avoid smoking, restrict alcohol, and do regular exercise (weight-bearing exercise) can help, too.
the treatment may affect your mood, causing mood swings or even depression. the best way to cope with the problem is by talking to your partner. if this is not helpful enough, you can consider taking counseling with a counselor.
when you need to use hormone therapy for prostate cancer?
hormone is naturally found in our body. it is essential for some body’s functions, such as for controlling the activity & growth of our healthy cells.
as mentioned before, it’s thought that cancerous cells in the prostate depend on testosterone, a male hormone. these abnormal cells use testosterone for their nutrient supply to grow.
for this reason, doctors think that reducing the amount of this hormone can inhibit the growth of the cancer or reduce the risk of the cancer from returning after the treatment. even if necessary, sometimes doctors may need to completely stop the testosterone production.
hormone treatment is commonly considered powerful enough to get rid of some prostate cancer symptoms and control the progression of the cancer. but after a few years, sometime there is a time of when the cancerous cells become resistant to the treatment. if this occurs, the use of hormone treatment may be no longer effective.
in general, the stage and other factors that affect the way of ‘how fast your prostate cancer spreads and becomes aggressive’ can play a key role in whether or not you need to take hormone therapy!
can prostate cancer spread to the brain?


text:
Lori Schutz, the daughter of Peter Schutz, was the guest speaker at our 2018 Annual Banquet. Peter Schutz was the CEO of Porsche AG from 1981 to 1987 and he was instrumental in turning around Porsche AG. At our annual banquet on October 27, Lori Schutz (the daughter of Peter Schutz) gave an inspiring speech about how her late father blocked the plan to end production of the signature 911 model, which remains the quintessential Porsche. She also told us how Peter made the decision to enter the Porsche 936 in the 1981 24 Hours of Le Mans and won the race.
Peter Schutz was born in Berlin, Germany in 1930. According to industry sources, Ferry Porsche personally invited Peter Schutz to apply for the CEO position at Porsche AG. In 1980, when Porsche was in the midst of its first money-losing year, Peter was selected among 12 candidates to be the CEO of Porsche AG. Porsche AG had the following three issues at the time: the exchange rate increased the prices of German parts, the quality control problem, and the lacklustre interest in the new designs of the Porsche 924 and 928 models.
At the same time, the announcement to cancel the production of the Porsche 911 models led to low morale in the engineering department. While Peter was in the office of Helmuth Bott (Chief of Engineering at Porsche AG 1978-1988), he saw a chart that showed the projected production and sales numbers of the 924 and 928 models for the next 20 years, but the line for 911 ended in 1981. Peter used a large black marker to extend the 911’s line to the end of the chart, onto the wall, around the hallway and told Bott to “make it happen”! Peter also discovered that the quality control was merely due to a simple problem related to the camshaft, and that issue was quickly fixed.
During 1981, the Porsche racing team was planning to enter three modified 924s in 24 Hours of Le Mans but Peter knew these models had no chance of winning. The 24 Hours of Le Mans is the world’s oldest sports car endurance race and one of the most influential in motorsports history. About 61 days prior to the race on June 13/14, Peter asked the engineer to pull a Porsche 936 from the museum display and install an experimental engine that Porsche had developed for Indy Car Racing. They had a whole team of engineers and staff that worked around the clock to build the race car in time for the race. The car was built at Weissach, which was approximately five kilometers away from the main plant.
Just a few days after Peter decided to enter the Porsche 936 into 1981 24 Hours of Le Mans, he received phone calls from the best race car drivers in the world – Jack Ickx, Derek Bell, Jochen Mass, Al Holbert, Hurley Haywood, Vern Schuppan, and Hans Stuck who all told him they would like to drive a Porsche at Le Mans. Later, Peter found out the reason he got these phone calls… Heinz Metzger (one of the Porsche engine designers), had the connection with the race car drivers.
At the 1981 24 Hours of Le Mans, Porsche tested the 2.6L engine which was derived from a never-raced Indianapolis 500 engine and fitted it in a pair of 936 chassis. Jack Ickx shared one of the updated 936s with Derek Bell; Jochen Mass, Vern Schuppan and Hurley Haywood drove the other. The engine test was successful. After the first hour of the race, Ickx and Bell built a large advance and remained in the lead for the rest of the race ( total of 354 laps) and they won by an even greater margin than in 1976 – 14 laps! Porsche also set a record in the history of Le Mans because the winning car ran the whole 24 hours without any issues other than adding engine oil and fuel and changing the brakes and tires. And it was the first time in 20 years that Professor Porsche went to watch the race.
During Peter’s tenure at Porsche AG, Porsche worldwide sales almost doubled from 28,000 units in 1980/81 to 53,000 units in 1986. The ultimate 911, (the 959), was also developed in 1986. Given Peter’s background as an engineer and his wealth of experience in marketing and management, Peter became a world-class speaker and presenter in many seminars and conferences after he retired. Peter passed away in November 2017 at the age of 87.
Peter wrote a book called, “The Driving Force, Getting Extraordinary Results with Ordinary People” and the book is about his life journey and lessons learned during his professional career. Lori Schutz will be the guest speaker at our Tuesday, March 12, 2019 Social, which will be hosted by Porsche Centre North Toronto. Advance registration is required and you can order the book when you register at www.clubregistration.net The cost of the book is C$32.50 or US$25.00. Please bring cash or cheque when you pick up the book from Lori at the Tuesday, March 12th Social, so you can save the shipping cost.
Lori Schutz wore her father’s tie to the banquet.

lowercased:
lori schutz, the daughter of peter schutz, was the guest speaker at our 2018 annual banquet. peter schutz was the ceo of porsche ag from 1981 to 1987 and he was instrumental in turning around porsche ag. at our annual banquet on october 27, lori schutz (the daughter of peter schutz) gave an inspiring speech about how her late father blocked the plan to end production of the signature 911 model, which remains the quintessential porsche. she also told us how peter made the decision to enter the porsche 936 in the 1981 24 hours of le mans and won the race.
peter schutz was born in berlin, germany in 1930. according to industry sources, ferry porsche personally invited peter schutz to apply for the ceo position at porsche ag. in 1980, when porsche was in the midst of its first money-losing year, peter was selected among 12 candidates to be the ceo of porsche ag. porsche ag had the following three issues at the time: the exchange rate increased the prices of german parts, the quality control problem, and the lacklustre interest in the new designs of the porsche 924 and 928 models.
at the same time, the announcement to cancel the production of the porsche 911 models led to low morale in the engineering department. while peter was in the office of helmuth bott (chief of engineering at porsche ag 1978-1988), he saw a chart that showed the projected production and sales numbers of the 924 and 928 models for the next 20 years, but the line for 911 ended in 1981. peter used a large black marker to extend the 911’s line to the end of the chart, onto the wall, around the hallway and told bott to “make it happen”! peter also discovered that the quality control was merely due to a simple problem related to the camshaft, and that issue was quickly fixed.
during 1981, the porsche racing team was planning to enter three modified 924s in 24 hours of le mans but peter knew these models had no chance of winning. the 24 hours of le mans is the world’s oldest sports car endurance race and one of the most influential in motorsports history. about 61 days prior to the race on june 13/14, peter asked the engineer to pull a porsche 936 from the museum display and install an experimental engine that porsche had developed for indy car racing. they had a whole team of engineers and staff that worked around the clock to build the race car in time for the race. the car was built at weissach, which was approximately five kilometers away from the main plant.
just a few days after peter decided to enter the porsche 936 into 1981 24 hours of le mans, he received phone calls from the best race car drivers in the world – jack ickx, derek bell, jochen mass, al holbert, hurley haywood, vern schuppan, and hans stuck who all told him they would like to drive a porsche at le mans. later, peter found out the reason he got these phone calls… heinz metzger (one of the porsche engine designers), had the connection with the race car drivers.
at the 1981 24 hours of le mans, porsche tested the 2.6l engine which was derived from a never-raced indianapolis 500 engine and fitted it in a pair of 936 chassis. jack ickx shared one of the updated 936s with derek bell; jochen mass, vern schuppan and hurley haywood drove the other. the engine test was successful. after the first hour of the race, ickx and bell built a large advance and remained in the lead for the rest of the race ( total of 354 laps) and they won by an even greater margin than in 1976 – 14 laps! porsche also set a record in the history of le mans because the winning car ran the whole 24 hours without any issues other than adding engine oil and fuel and changing the brakes and tires. and it was the first time in 20 years that professor porsche went to watch the race.
during peter’s tenure at porsche ag, porsche worldwide sales almost doubled from 28,000 units in 1980/81 to 53,000 units in 1986. the ultimate 911, (the 959), was also developed in 1986. given peter’s background as an engineer and his wealth of experience in marketing and management, peter became a world-class speaker and presenter in many seminars and conferences after he retired. peter passed away in november 2017 at the age of 87.
peter wrote a book called, “the driving force, getting extraordinary results with ordinary people” and the book is about his life journey and lessons learned during his professional career. lori schutz will be the guest speaker at our tuesday, march 12, 2019 social, which will be hosted by porsche centre north toronto. advance registration is required and you can order the book when you register at www.clubregistration.net the cost of the book is c$32.50 or us$25.00. please bring cash or cheque when you pick up the book from lori at the tuesday, march 12th social, so you can save the shipping cost.
lori schutz wore her father’s tie to the banquet.


text:
The flowers are very beautiful when we walk around the garden, and a lot of people use different flowers wallpapers for designs and for use on different works on the computer. Now we share with you a compilation of flowers wallpapers for designs and for share that you can download in the gallery below. Enjoy the compilation.
This entry was posted in Wallpapers and tagged art, design, flower, flowers, garden, nature, wallpapers, walls by Emiliano Morla (Google+). Bookmark the permalink.

lowercased:
the flowers are very beautiful when we walk around the garden, and a lot of people use different flowers wallpapers for designs and for use on different works on the computer. now we share with you a compilation of flowers wallpapers for designs and for share that you can download in the gallery below. enjoy the compilation.
this entry was posted in wallpapers and tagged art, design, flower, flowers, garden, nature, wallpapers, walls by emiliano morla (google+). bookmark the permalink.


text:
There is a need to identify an inexpensive, effective method to prevent postoperative adhesion formation. The objective of this study was to create a novel model for studying omentum as a pelvic adhesion barrier.
Randomized, prospective, controlled surgical intervention with serial follow-up in 16 female rabbits at a University-based Center for Comparative Medicine. Interventions included bilateral hysterotomy incision and repair. The left hysterotomy was randomized into coverage with an omental flap or graft; the right hysterotomy remained uncovered. Adhesions were scored via laparoscopy on postoperative days 2, 4, 8, and 12; postmortem evaluation and scoring took place on postoperative day 16. Statistical tests consisted of Kappa tests of agreement between adhesion scorers and Kruskal-Wallis nonparametric tests for the comparison of adhesion scores by intervention arm and by uterine horn.
All omental flaps and grafts survived. The only significant difference in mean adhesion scores was seen in non-hysterotomy-associated adhesions, where grafts had a lower score than flaps (p = 0.03).
Survival of all omental flaps and grafts demonstrates that this is a practical model for studying omentum as a pelvic adhesion barrier. Determining the efficacy of omentum as a pelvic adhesion barrier will require further investigation.
Every experienced surgeon has encountered adhesions in the operating room. Adhesions vary histologically and may be filmy, dense, vascular or avascular. The presence of adhesions intraoperatively often mandates extensive adhesiolysis for completion of many obstetric and gynecologic procedures. Furthermore, adhesions are a significant cause of morbidity including infertility, chronic pain, and bowel obstruction. Significant data have been published with regard to the use of various methods of adhesion prevention, including peritoneal infusions and synthetic adhesion barriers. These data have demonstrated variable success in reducing adhesion formation, and many of these methodologies are associated with significant financial costs. Therefore, there is still a need to identify an inexpensive, effective method to prevent adhesion formation.
Omentum is an intra-abdominal fold of visceral peritoneum that is easily accessible during pelvic surgery and has the potential to be an excellent barrier to prevent adhesions . Omental tissue has already been successfully used in thoracic , oncologic [3–7], vascular [2, 8], general [9, 10], and reconstructive surgery . Its unique characteristics include high concentrations of thromboplastin for hemostasis [2, 11] and a trophic effect on surrounding tissues, allowing a free graft to survive in the peritoneal cavity. The omentum also possesses extensive vascularity and is capable of rapid angiogenesis and capillary ingrowth [12, 13]. Moreover, affixing omentum to denuded surfaces of canine bowel and bladder has been shown to prevent scarring and adhesion formation .
Free omental grafts have been useful also as vascular patches in animals . When utilized for this purpose, they do not retain their native vascular supply after transposition but have been observed to establish vascular communications with pericardium and various peritoneal structures by quickly invading pleural and serosal surfaces . Graft size is important, though; studies have shown marked necrosis of larger grafts and minimal necrosis of thin grafts in canines after four days . Pedicled omental flaps do maintain their blood supply, thus decreasing the potential for ischemic necrosis. In humans, flaps have even been used to cover and strengthen intestinal and colonic anastomoses [14, 16], in breast reconstruction [9, 10], and to reduce complications after pelvic lymphadenectomy . Yet the use of omentum in gynecologic, specifically uterine, surgery has not been well-investigated. Therefore, the primary purpose of this pilot study was to develop an animal model that can be used to study the utility of the omentum in pelvic surgery. Secondarily, we wanted to investigate the effectiveness of two different omentum-derived adhesion barriers, an autologous free omental graft and a pedicled omental flap, in the prevention of postoperative adhesions.
This was a randomized, prospective, controlled surgical intervention with serial follow-up conducted at a University-based Center for Comparative Medicine. Based on an established animal model , we obtained sixteen sexually mature New Zealand white rabbits weighing 4-5 kg from a commercial source (Burleson Enterprises, Inc., Unionville, Virginia). The rabbits were observed for six days to allow for acclimation and assessment of health. The animals were maintained on a Teklad Global 2031 high-fiber rabbit diet (Harlan, Madison, Wisconsin) and water ad libitum. Approval for the study was obtained from the Animal Care and Use Committee and the Institutional Review Board at the University of Virginia Health System (Protocol #3781).
Each rabbit underwent adhesion induction surgery, the day of which was denoted as postoperative day 0. A 5 cm vertical midline infraumbilical incision was made through epidermis, subcutaneous and mammary tissue, fascia, rectus muscle and peritoneum until the peritoneal cavity was entered. The uterus was then identified and exteriorized. Electrocautery was used to make a 3 cm incision in both uterine horns, and each hysterotomy was repaired with 2–0 Vicryl suture (Ethicon Inc., Cornelia, Georgia) in a baseball stitch (Figure 1A). The right uterine horn served as the control in every rabbit. Thus, there was no omental covering over the right hysterotomy site, and it was returned to the abdomen immediately after repair of the hysterotomy. The left uterine horn in each rabbit was randomized into one of two intervention groups: coverage with an autologous free omental graft or with a pedicled omental flap. The omentum was gently pulled down from the upper abdomen and exteriorized. Then, using electrocautery, an approximately 2 cm incision was made from the right omental edge toward the midline only crossing one major artery to include adequate vasculature in the flap (Figure 1B). After the initial incision was made, the flap was rotated and sutured over the hysterotomy with seven interrupted stitches of 4–0 Monocryl (Ethicon) in a fashion that adequately covered the hysterotomy without creating tension on the omentum (Figure 1C). For the free omental graft, electrocautery was used across the inferior edge of the omentum to create an approximately 2 cm x 0.5 cm unattached piece of omentum; then this graft was placed over the hysterotomy and secured with seven interrupted stitches using 4–0 Monocryl (Figure 1D). The intervention horn was then returned to the pelvis. The hysterotomy and its repair as well as the creation and attachment to the uterus of both flaps and grafts was performed by the same surgeon (APB). We ensured that there was no tension on horns with flaps prior to closure. The fascia and rectus muscle were reapproximated in a running full-thickness stitch using 2–0 Vicryl suture. The skin was closed with 4–0 Vicryl suture with a running subcuticular stitch, and the knot was buried.
Adhesion induction surgery. A. Hysterotomy repair. B. Creation of the omental flap. C. Omental flap attached to uterine horn. D. Omental graft attached to uterine horn.
Every rabbit was randomly assigned a unique numerical identifier, which was used to distinguish each animal throughout the study. For the adhesion induction and scoring surgeries, the investigators were blinded to each rabbit’s identity and intervention group.
The rabbits were randomly divided into two groups, A and B, both of which underwent identical adhesion induction surgeries; half of each group had flaps, and half had grafts. Group A underwent look-back laparoscopy on postoperative days 2 and 8, while Group B underwent look-back procedures on postoperative days 4 and 12. This system was created to minimize the number of surgeries for each rabbit. Laparoscopies were performed using a 10 mm scope (Storz, Tuttlingen, Germany) via a single 12 mm supraumbilical (on the first laparoscopy) or left upper quadrant port (on the second laparoscopy) placed using an open technique. Laparoscopy was selected for look-back procedures to reduce the risk for additional adhesion formation from the look-back procedure itself . Separate sites were used for the first and second laparoscopies in each animal to avoid damage to internal structures that might be adherent to the first laparoscopic site, a technique used in humans. A pneumoperitoneum was created using CO2 gas at 2 L/min flow until an intraabdominal pressure of 5-6 mmHg was obtained. Trendelenburg positioning allowed for easy viewing of each uterine horn and hysterotomy site. Adhesions were scored using a modified version of the system designed by Fiedler et al.  (Table 1) without including the tenacity scale in order to avoid adhesiolysis during the look-back surgeries. Scoring was done independently by two or three present surgeons (APB, AKS, DWS), and images were captured for scoring by the third surgeon when not present so that all animals had three adhesion scores averaged to determine the mean visual adhesion score.
All surgeries were performed under sterile conditions after shaving and prepping the animals. Anesthesia consisted of ketamine 50 mg/kg (100 mg/mL; Fort Dodge Animal Health, Fort Dodge, Iowa) and xylazine 5 mg/kg (20 mg/mL; Butler Schein Animal Health, Dublin, Ohio) administered intramuscularly. Rabbits were masked with 100% oxygen during the procedure and monitored for hyperventilation and hypoxia. Anesthesia was maintained with isoflurane to effect. Each rabbit received antibiotic prophylaxis consisting of 22.7 mg of enrofloxacin (Bayer, Shawnee Mission, Kansas) prior to and two days after each surgery for infection prophylaxis. Rabbits were also given 0.05 mg/kg buprenorphine subcutaneously before surgery, two hours post-surgery, and twice daily for two days post-surgery to provide adequate analgesia. During look-back procedures, rabbits were given the same dosage of buprenorphine before and after the procedure along with morning and evening doses on postoperative day one. At the conclusion of each surgery, all incision sites were infiltrated with 1 mL of 0.25% bupivacaine for sustained analgesia.
On postoperative day 16, rabbits were anesthetized with 2 mL ketamine (100 mg/mL) and 1 mL xylazine (20 mg/mL) intramuscularly, and then euthanized using 1 mL of 390 mg/mL pentobarbital sodium (Virbac AH Inc., Fort Worth, Texas) by intravenous or intracardiac injection. Postmortem laparotomy and thorough inspection of the abdominal and pelvic organs for adhesion formation was performed. Again, adhesions were scored using the system designed by Fiedler et al.  (Table 1), this time additionally utilizing the tenacity scale (Table 2). As before, scoring was done independently by the two or three present surgeons, and images were captured for scoring by the third surgeon when not present. All scores were averaged together to create a mean visual adhesion score and mean tenacity score.
Statistical tests consisted of Kappa tests of agreement between adhesion scorers and Kruskal-Wallis nonparametric tests for the comparison of adhesion scores by intervention arm and by uterine horn. The statistical analysis used an alpha level of 0.05, and all analyses were conducted with SAS 9.1.3 (SAS Institute, Cary, North Carolina).
At the time of each laparoscopic look-back and at the postmortem evaluation, all flaps and grafts were noted to survive based on appearance. All flaps and grafts appeared well vascularized without discoloration or concern for tissue ischemia or necrosis. All sixteen rabbits survived every surgery, and there were very few complications. Postoperatively, one rabbit was given a single dose of 10 mg ketoprofen subcutaneously to treat additional postoperative pain, the experience of which was determined by direct observation of the rabbit. Interestingly, this rabbit had a right uterine horn that was found at the initial hysterotomy procedure to be filled with a milky fluid, but the subject remained afebrile throughout the acclimation and experimental periods. Also postoperatively, another rabbit had a ventral hernia with an associated seroma requiring a repair and look-back via laparotomy instead of laparoscopy. The data from this rabbit were discarded secondary to our concern that the adhesion formation process was compromised by the hernia and repair.
For the rabbits with omental flaps, the mean adhesion score for the right (control) uterine horn was 0.38 (sd 1.0, range 0–2.67) versus 0 (sd 0, range 0–0) in the left (intervention) horn, which was not statistically different (p = 0.32). For the rabbits with free omental grafts, the mean adhesion score for the control uterine horn was 1.33 (sd 2.0, range 0–5) versus 0.6 (sd 1.2, range 0–3) for the intervention uterine horn, which also was not statistically different (p = 1.00). There was no statistical difference between the adhesion scores of the flap and graft control horns (p = 0.26, Kruskal-Wallis test). There was no statistical difference between the adhesion scores of the flap and graft intervention horns (p = 0.17) (Figure 2). The absolute difference between the horns (average control uterine horn adhesion score minus average intervention uterine horn adhesion score) did not differ when comparing the flap group to the graft group on any postoperative day: 2, 4, 8, 12, or 16.
Visual adhesion scores. Visual adhesion scores by location and intervention at postmortem evaluation.
Relative to non-horn-associated adhesions in the abdomen, the rabbits with free omental grafts had no adhesions, while the rabbits with omental flaps had a mean abdominal adhesion score of 1.38 (sd 2.36, range 0–5). This difference was statistically significant (p = 0.03, Kruskal-Wallis) (Figure 2).
There were eight adhesions in six of the rabbits. The tenacity scores are graphed in Figure 3 by adhesion location (intervention horn, control horn, or non-horn-associated adhesion) and intervention group (flap or graft) for each adhesion. The mean tenacity score of the adhesions with omental flaps was 3.0 (sd 0, range 3–3) versus 2.2 with free omental grafts (sd 0.8, range 1–3); this was not statistically different (p = 0.12).
Tenacity scores. Tenacity scores of each adhesion by location and intervention at postmortem evaluation.
The agreement between the three adhesion scorers was at least “substantial” and “almost perfect” between two of the observers . The kappa score ranged from 0.70 (95% CI 0.41–0.99) to 1.0 (95% CI 1.0–1.0) for the right uterine horn and was 1.0 (95% CI 1.0–1.0) for the left uterine horn.
The primary purpose of this pilot study was to test an animal model for the study of the omentum in pelvic adhesion prevention. We anticipated that the omental interventions might undergo necrosis and form severe adhesions, grafts more so than flaps due to absence of native blood supply. On the contrary, all omental grafts and flaps survived; therefore, this is a practical model for the study of omentum in pelvic adhesion prevention.
The secondary objective of this investigation was to compare autologous free omental grafts to pedicled omental flaps. There was no significant difference in adhesion scores between intervention and control horns or between flap and graft subjects at the hysterotomy site. There was also no significant difference in average tenacity scores of all adhesions in subjects with flaps versus those with grafts. As this was a pilot study, it was not powered to detect small differences between groups. Yet, we did see significantly fewer non-horn-associated adhesions in rabbits with free omental grafts versus those with omental flaps. If this decrease in general abdominal adhesions were to hold true in women, it would be equally as important since both fertility and operative abdominal entry can be affected by adhesions not directly attached to the uterus.
We did see a large variation in adhesion formation in the control group. This could likely be corrected if the adhesion induction surgery was performed via laparoscopy to decrease adhesions that form due to the laparotomy instead of solely from the hysterotomy.
With few rabbits forming adhesions, we are not able to say that the intervention was beneficial; but this pilot study provides a novel model with which to study the role of the omentum in pelvic adhesion prevention. The strengths of this study include its prospective nature and randomization of rabbits into intervention group. Also, the method used for hysterotomy creation mimics the procedure utilized for cesarean section hysterotomy and abdominal myomectomy, common gynecologic procedures that are known to induce adhesions. Furthermore, we had blinded adhesion scorers, used a previously validated scoring system, and our interrater agreement was substantial. The use of laparoscopy for adhesion monitoring instead of laparotomy decreased the potential for adhesion formation after the initial adhesion induction surgery; and finally, we were able to perform a thorough evaluation of the pelvis at the time of autopsy.
The primary weakness of the study is the low number of adhesions available to be scored. Future studies could incorporate more hysterotomy sites or additional thermal damage by electrocautery to induce further adhesion formation. Most adhesion formation should occur within 14 days postoperatively, so the length of the study should not be considered a weakness. Our data fit this since we did not see a significant increase in the number or severity of adhesions throughout the sixteen days.
Adhesions are a known source of both short-term and long-term morbidity, and the current barrier methods for their prevention are costly and not optimally effective. In addition, some barriers are known to increase the formation of adhesions if hemostasis is not maintained. Omentum is readily available, easy to apply, noninflammatory, and inexpensive with the added ability to contain foreign matter and microbes, yet it has not been fully investigated for its potential to prevent pelvic adhesions. The survival of all flaps and grafts demonstrates that this rabbit model is an effective method for studying the omentum as a pelvic adhesion barrier. The significantly lower number of non-uterine adhesions seen with the omental grafts as compared to the flaps suggests that grafts may be a superior methodology. Future studies with a larger number of rabbits and more adhesiogenic methods should be undertaken to fully elucidate the ability of omentum to prevent pelvic adhesions.
The data sets supporting the results of this article are included within the article where they are cited and then listed in the references section.
Each author has 1) made substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data; 2) been involved in drafting the manuscript and revising it critically for important intellectual content; 3) given final approval of the version to be published; and 4) agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors read and approved the final manuscript.
The authors wish to thank James Patrie for his data analysis assistance and Jeremy Gatesman and Gina Wimer for their excellent animal care.

lowercased:
there is a need to identify an inexpensive, effective method to prevent postoperative adhesion formation. the objective of this study was to create a novel model for studying omentum as a pelvic adhesion barrier.
randomized, prospective, controlled surgical intervention with serial follow-up in 16 female rabbits at a university-based center for comparative medicine. interventions included bilateral hysterotomy incision and repair. the left hysterotomy was randomized into coverage with an omental flap or graft; the right hysterotomy remained uncovered. adhesions were scored via laparoscopy on postoperative days 2, 4, 8, and 12; postmortem evaluation and scoring took place on postoperative day 16. statistical tests consisted of kappa tests of agreement between adhesion scorers and kruskal-wallis nonparametric tests for the comparison of adhesion scores by intervention arm and by uterine horn.
all omental flaps and grafts survived. the only significant difference in mean adhesion scores was seen in non-hysterotomy-associated adhesions, where grafts had a lower score than flaps (p = 0.03).
survival of all omental flaps and grafts demonstrates that this is a practical model for studying omentum as a pelvic adhesion barrier. determining the efficacy of omentum as a pelvic adhesion barrier will require further investigation.
every experienced surgeon has encountered adhesions in the operating room. adhesions vary histologically and may be filmy, dense, vascular or avascular. the presence of adhesions intraoperatively often mandates extensive adhesiolysis for completion of many obstetric and gynecologic procedures. furthermore, adhesions are a significant cause of morbidity including infertility, chronic pain, and bowel obstruction. significant data have been published with regard to the use of various methods of adhesion prevention, including peritoneal infusions and synthetic adhesion barriers. these data have demonstrated variable success in reducing adhesion formation, and many of these methodologies are associated with significant financial costs. therefore, there is still a need to identify an inexpensive, effective method to prevent adhesion formation.
omentum is an intra-abdominal fold of visceral peritoneum that is easily accessible during pelvic surgery and has the potential to be an excellent barrier to prevent adhesions . omental tissue has already been successfully used in thoracic , oncologic [3–7], vascular [2, 8], general [9, 10], and reconstructive surgery . its unique characteristics include high concentrations of thromboplastin for hemostasis [2, 11] and a trophic effect on surrounding tissues, allowing a free graft to survive in the peritoneal cavity. the omentum also possesses extensive vascularity and is capable of rapid angiogenesis and capillary ingrowth [12, 13]. moreover, affixing omentum to denuded surfaces of canine bowel and bladder has been shown to prevent scarring and adhesion formation .
free omental grafts have been useful also as vascular patches in animals . when utilized for this purpose, they do not retain their native vascular supply after transposition but have been observed to establish vascular communications with pericardium and various peritoneal structures by quickly invading pleural and serosal surfaces . graft size is important, though; studies have shown marked necrosis of larger grafts and minimal necrosis of thin grafts in canines after four days . pedicled omental flaps do maintain their blood supply, thus decreasing the potential for ischemic necrosis. in humans, flaps have even been used to cover and strengthen intestinal and colonic anastomoses [14, 16], in breast reconstruction [9, 10], and to reduce complications after pelvic lymphadenectomy . yet the use of omentum in gynecologic, specifically uterine, surgery has not been well-investigated. therefore, the primary purpose of this pilot study was to develop an animal model that can be used to study the utility of the omentum in pelvic surgery. secondarily, we wanted to investigate the effectiveness of two different omentum-derived adhesion barriers, an autologous free omental graft and a pedicled omental flap, in the prevention of postoperative adhesions.
this was a randomized, prospective, controlled surgical intervention with serial follow-up conducted at a university-based center for comparative medicine. based on an established animal model , we obtained sixteen sexually mature new zealand white rabbits weighing 4-5 kg from a commercial source (burleson enterprises, inc., unionville, virginia). the rabbits were observed for six days to allow for acclimation and assessment of health. the animals were maintained on a teklad global 2031 high-fiber rabbit diet (harlan, madison, wisconsin) and water ad libitum. approval for the study was obtained from the animal care and use committee and the institutional review board at the university of virginia health system (protocol #3781).
each rabbit underwent adhesion induction surgery, the day of which was denoted as postoperative day 0. a 5 cm vertical midline infraumbilical incision was made through epidermis, subcutaneous and mammary tissue, fascia, rectus muscle and peritoneum until the peritoneal cavity was entered. the uterus was then identified and exteriorized. electrocautery was used to make a 3 cm incision in both uterine horns, and each hysterotomy was repaired with 2–0 vicryl suture (ethicon inc., cornelia, georgia) in a baseball stitch (figure 1a). the right uterine horn served as the control in every rabbit. thus, there was no omental covering over the right hysterotomy site, and it was returned to the abdomen immediately after repair of the hysterotomy. the left uterine horn in each rabbit was randomized into one of two intervention groups: coverage with an autologous free omental graft or with a pedicled omental flap. the omentum was gently pulled down from the upper abdomen and exteriorized. then, using electrocautery, an approximately 2 cm incision was made from the right omental edge toward the midline only crossing one major artery to include adequate vasculature in the flap (figure 1b). after the initial incision was made, the flap was rotated and sutured over the hysterotomy with seven interrupted stitches of 4–0 monocryl (ethicon) in a fashion that adequately covered the hysterotomy without creating tension on the omentum (figure 1c). for the free omental graft, electrocautery was used across the inferior edge of the omentum to create an approximately 2 cm x 0.5 cm unattached piece of omentum; then this graft was placed over the hysterotomy and secured with seven interrupted stitches using 4–0 monocryl (figure 1d). the intervention horn was then returned to the pelvis. the hysterotomy and its repair as well as the creation and attachment to the uterus of both flaps and grafts was performed by the same surgeon (apb). we ensured that there was no tension on horns with flaps prior to closure. the fascia and rectus muscle were reapproximated in a running full-thickness stitch using 2–0 vicryl suture. the skin was closed with 4–0 vicryl suture with a running subcuticular stitch, and the knot was buried.
adhesion induction surgery. a. hysterotomy repair. b. creation of the omental flap. c. omental flap attached to uterine horn. d. omental graft attached to uterine horn.
every rabbit was randomly assigned a unique numerical identifier, which was used to distinguish each animal throughout the study. for the adhesion induction and scoring surgeries, the investigators were blinded to each rabbit’s identity and intervention group.
the rabbits were randomly divided into two groups, a and b, both of which underwent identical adhesion induction surgeries; half of each group had flaps, and half had grafts. group a underwent look-back laparoscopy on postoperative days 2 and 8, while group b underwent look-back procedures on postoperative days 4 and 12. this system was created to minimize the number of surgeries for each rabbit. laparoscopies were performed using a 10 mm scope (storz, tuttlingen, germany) via a single 12 mm supraumbilical (on the first laparoscopy) or left upper quadrant port (on the second laparoscopy) placed using an open technique. laparoscopy was selected for look-back procedures to reduce the risk for additional adhesion formation from the look-back procedure itself . separate sites were used for the first and second laparoscopies in each animal to avoid damage to internal structures that might be adherent to the first laparoscopic site, a technique used in humans. a pneumoperitoneum was created using co2 gas at 2 l/min flow until an intraabdominal pressure of 5-6 mmhg was obtained. trendelenburg positioning allowed for easy viewing of each uterine horn and hysterotomy site. adhesions were scored using a modified version of the system designed by fiedler et al.  (table 1) without including the tenacity scale in order to avoid adhesiolysis during the look-back surgeries. scoring was done independently by two or three present surgeons (apb, aks, dws), and images were captured for scoring by the third surgeon when not present so that all animals had three adhesion scores averaged to determine the mean visual adhesion score.
all surgeries were performed under sterile conditions after shaving and prepping the animals. anesthesia consisted of ketamine 50 mg/kg (100 mg/ml; fort dodge animal health, fort dodge, iowa) and xylazine 5 mg/kg (20 mg/ml; butler schein animal health, dublin, ohio) administered intramuscularly. rabbits were masked with 100% oxygen during the procedure and monitored for hyperventilation and hypoxia. anesthesia was maintained with isoflurane to effect. each rabbit received antibiotic prophylaxis consisting of 22.7 mg of enrofloxacin (bayer, shawnee mission, kansas) prior to and two days after each surgery for infection prophylaxis. rabbits were also given 0.05 mg/kg buprenorphine subcutaneously before surgery, two hours post-surgery, and twice daily for two days post-surgery to provide adequate analgesia. during look-back procedures, rabbits were given the same dosage of buprenorphine before and after the procedure along with morning and evening doses on postoperative day one. at the conclusion of each surgery, all incision sites were infiltrated with 1 ml of 0.25% bupivacaine for sustained analgesia.
on postoperative day 16, rabbits were anesthetized with 2 ml ketamine (100 mg/ml) and 1 ml xylazine (20 mg/ml) intramuscularly, and then euthanized using 1 ml of 390 mg/ml pentobarbital sodium (virbac ah inc., fort worth, texas) by intravenous or intracardiac injection. postmortem laparotomy and thorough inspection of the abdominal and pelvic organs for adhesion formation was performed. again, adhesions were scored using the system designed by fiedler et al.  (table 1), this time additionally utilizing the tenacity scale (table 2). as before, scoring was done independently by the two or three present surgeons, and images were captured for scoring by the third surgeon when not present. all scores were averaged together to create a mean visual adhesion score and mean tenacity score.
statistical tests consisted of kappa tests of agreement between adhesion scorers and kruskal-wallis nonparametric tests for the comparison of adhesion scores by intervention arm and by uterine horn. the statistical analysis used an alpha level of 0.05, and all analyses were conducted with sas 9.1.3 (sas institute, cary, north carolina).
at the time of each laparoscopic look-back and at the postmortem evaluation, all flaps and grafts were noted to survive based on appearance. all flaps and grafts appeared well vascularized without discoloration or concern for tissue ischemia or necrosis. all sixteen rabbits survived every surgery, and there were very few complications. postoperatively, one rabbit was given a single dose of 10 mg ketoprofen subcutaneously to treat additional postoperative pain, the experience of which was determined by direct observation of the rabbit. interestingly, this rabbit had a right uterine horn that was found at the initial hysterotomy procedure to be filled with a milky fluid, but the subject remained afebrile throughout the acclimation and experimental periods. also postoperatively, another rabbit had a ventral hernia with an associated seroma requiring a repair and look-back via laparotomy instead of laparoscopy. the data from this rabbit were discarded secondary to our concern that the adhesion formation process was compromised by the hernia and repair.
for the rabbits with omental flaps, the mean adhesion score for the right (control) uterine horn was 0.38 (sd 1.0, range 0–2.67) versus 0 (sd 0, range 0–0) in the left (intervention) horn, which was not statistically different (p = 0.32). for the rabbits with free omental grafts, the mean adhesion score for the control uterine horn was 1.33 (sd 2.0, range 0–5) versus 0.6 (sd 1.2, range 0–3) for the intervention uterine horn, which also was not statistically different (p = 1.00). there was no statistical difference between the adhesion scores of the flap and graft control horns (p = 0.26, kruskal-wallis test). there was no statistical difference between the adhesion scores of the flap and graft intervention horns (p = 0.17) (figure 2). the absolute difference between the horns (average control uterine horn adhesion score minus average intervention uterine horn adhesion score) did not differ when comparing the flap group to the graft group on any postoperative day: 2, 4, 8, 12, or 16.
visual adhesion scores. visual adhesion scores by location and intervention at postmortem evaluation.
relative to non-horn-associated adhesions in the abdomen, the rabbits with free omental grafts had no adhesions, while the rabbits with omental flaps had a mean abdominal adhesion score of 1.38 (sd 2.36, range 0–5). this difference was statistically significant (p = 0.03, kruskal-wallis) (figure 2).
there were eight adhesions in six of the rabbits. the tenacity scores are graphed in figure 3 by adhesion location (intervention horn, control horn, or non-horn-associated adhesion) and intervention group (flap or graft) for each adhesion. the mean tenacity score of the adhesions with omental flaps was 3.0 (sd 0, range 3–3) versus 2.2 with free omental grafts (sd 0.8, range 1–3); this was not statistically different (p = 0.12).
tenacity scores. tenacity scores of each adhesion by location and intervention at postmortem evaluation.
the agreement between the three adhesion scorers was at least “substantial” and “almost perfect” between two of the observers . the kappa score ranged from 0.70 (95% ci 0.41–0.99) to 1.0 (95% ci 1.0–1.0) for the right uterine horn and was 1.0 (95% ci 1.0–1.0) for the left uterine horn.
the primary purpose of this pilot study was to test an animal model for the study of the omentum in pelvic adhesion prevention. we anticipated that the omental interventions might undergo necrosis and form severe adhesions, grafts more so than flaps due to absence of native blood supply. on the contrary, all omental grafts and flaps survived; therefore, this is a practical model for the study of omentum in pelvic adhesion prevention.
the secondary objective of this investigation was to compare autologous free omental grafts to pedicled omental flaps. there was no significant difference in adhesion scores between intervention and control horns or between flap and graft subjects at the hysterotomy site. there was also no significant difference in average tenacity scores of all adhesions in subjects with flaps versus those with grafts. as this was a pilot study, it was not powered to detect small differences between groups. yet, we did see significantly fewer non-horn-associated adhesions in rabbits with free omental grafts versus those with omental flaps. if this decrease in general abdominal adhesions were to hold true in women, it would be equally as important since both fertility and operative abdominal entry can be affected by adhesions not directly attached to the uterus.
we did see a large variation in adhesion formation in the control group. this could likely be corrected if the adhesion induction surgery was performed via laparoscopy to decrease adhesions that form due to the laparotomy instead of solely from the hysterotomy.
with few rabbits forming adhesions, we are not able to say that the intervention was beneficial; but this pilot study provides a novel model with which to study the role of the omentum in pelvic adhesion prevention. the strengths of this study include its prospective nature and randomization of rabbits into intervention group. also, the method used for hysterotomy creation mimics the procedure utilized for cesarean section hysterotomy and abdominal myomectomy, common gynecologic procedures that are known to induce adhesions. furthermore, we had blinded adhesion scorers, used a previously validated scoring system, and our interrater agreement was substantial. the use of laparoscopy for adhesion monitoring instead of laparotomy decreased the potential for adhesion formation after the initial adhesion induction surgery; and finally, we were able to perform a thorough evaluation of the pelvis at the time of autopsy.
the primary weakness of the study is the low number of adhesions available to be scored. future studies could incorporate more hysterotomy sites or additional thermal damage by electrocautery to induce further adhesion formation. most adhesion formation should occur within 14 days postoperatively, so the length of the study should not be considered a weakness. our data fit this since we did not see a significant increase in the number or severity of adhesions throughout the sixteen days.
adhesions are a known source of both short-term and long-term morbidity, and the current barrier methods for their prevention are costly and not optimally effective. in addition, some barriers are known to increase the formation of adhesions if hemostasis is not maintained. omentum is readily available, easy to apply, noninflammatory, and inexpensive with the added ability to contain foreign matter and microbes, yet it has not been fully investigated for its potential to prevent pelvic adhesions. the survival of all flaps and grafts demonstrates that this rabbit model is an effective method for studying the omentum as a pelvic adhesion barrier. the significantly lower number of non-uterine adhesions seen with the omental grafts as compared to the flaps suggests that grafts may be a superior methodology. future studies with a larger number of rabbits and more adhesiogenic methods should be undertaken to fully elucidate the ability of omentum to prevent pelvic adhesions.
the data sets supporting the results of this article are included within the article where they are cited and then listed in the references section.
each author has 1) made substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data; 2) been involved in drafting the manuscript and revising it critically for important intellectual content; 3) given final approval of the version to be published; and 4) agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. all authors read and approved the final manuscript.
the authors wish to thank james patrie for his data analysis assistance and jeremy gatesman and gina wimer for their excellent animal care.


text: This entry was posted on Sunday, February 4th, 2018 at 9:48 pm and is filed under Meetings.	You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

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text:
Discussion in 'Professional Catering' started by foodie5951, Dec 3, 2009.
I am catering an Office Christmas Party for 30 and they want Beef Brisket. I need ideas for a starch side dish. Last year i served roasted potatoes with onions and rosemary for the hot starch side (with roast beef). It will need to be cooked in advance and travel about 20 minutes to be put into chafing dishes at the site.
Hopefully something not requiring alot of prep; as in mashed potatoes.
Roasted baby red or yukon potatoes, cippolini onion, rosemary, salt & pepper, olive oil.
Thanks for your reply Kristen, but as stated, last year I served roasted potatoes with onions and rosemary for the hot starch side (with roast beef).
is there a reason that won't work this year?
What about mashed potatoes? Ok, I am sure you already thought of it but have ruled it out. So how about a butternut squash puree, or even mashed sweet potatoes? Add some cayenne pepper to take away the sweet and get it further on the savory side; that way it won't seem like baked yams or sweet potato casserole. Or there is always some sort of root vegetable puree. I find that roasted potatoes don't end up traveling as well in a hot box. And I don't know where you are located, but what about polenta or cheese grits?
I'd go with potato latkes, it's authentic to the brisket.
Shred and rinse some potatoes, bind with egg white, sour cream, and herbs. Pan fry to brown, finish in the oven, shingle in the hotel pan, and bring to the chafer.
They won't hold hot as well as mashed, but it's easier to figure portioning when you prepare 40-50 individual pancakes, rather than trying to guess at mashed potatoes.
How about cutting out potatoes altogether and doing lots and lots of yorkshire puds. I think you do similar in US n call them popovers. They can be made the day before n warmed. Then u can do some starchy veg. Glazed parsnips will hold well.
If You want a potato thing, mashed potatoes and swede (rutabaga?) with lots of butter and pepper would work.In Scotland we call it Clapshot.
They don't want the same items as last year.
Thanks to all who replied, but I was just told that they would like a rice dish for their starch this year. Happy Cooking to one and all!!
I'm late to this party since you've already decided on a rice dish, but I wanted to add a comment. I've been asked for twice baked potatoes for 3 different parties this season. I thought that was a little strange since I've never offered them before. Comfort food in a bad economy, maybe?
Thanks lentil, but i am relieved they asked for a rice dish, because the other menu items are numerous and time consuming enough.
I agree! I'd take a rice dish over twiced baked, too!
The party was a huge success, I served what I named "Emerald Rice" for the starch and they loved it, it was basmati rice (made with chicken stock) with chopped scallions, Italian Parsley and Pistachios (?). I am so glad I decided not to do a potato dish for a starch again, this was soooo simple.
Happy New Years to all the foodies!!
I know I'm late to reply, but just wanted to say that your recipe caught my attention and I would love to try it once. Thanks for sharing it!
I am also late replying to your post - I hope you like it as much as they did!!

lowercased:
discussion in 'professional catering' started by foodie5951, dec 3, 2009.
i am catering an office christmas party for 30 and they want beef brisket. i need ideas for a starch side dish. last year i served roasted potatoes with onions and rosemary for the hot starch side (with roast beef). it will need to be cooked in advance and travel about 20 minutes to be put into chafing dishes at the site.
hopefully something not requiring alot of prep; as in mashed potatoes.
roasted baby red or yukon potatoes, cippolini onion, rosemary, salt & pepper, olive oil.
thanks for your reply kristen, but as stated, last year i served roasted potatoes with onions and rosemary for the hot starch side (with roast beef).
is there a reason that won't work this year?
what about mashed potatoes? ok, i am sure you already thought of it but have ruled it out. so how about a butternut squash puree, or even mashed sweet potatoes? add some cayenne pepper to take away the sweet and get it further on the savory side; that way it won't seem like baked yams or sweet potato casserole. or there is always some sort of root vegetable puree. i find that roasted potatoes don't end up traveling as well in a hot box. and i don't know where you are located, but what about polenta or cheese grits?
i'd go with potato latkes, it's authentic to the brisket.
shred and rinse some potatoes, bind with egg white, sour cream, and herbs. pan fry to brown, finish in the oven, shingle in the hotel pan, and bring to the chafer.
they won't hold hot as well as mashed, but it's easier to figure portioning when you prepare 40-50 individual pancakes, rather than trying to guess at mashed potatoes.
how about cutting out potatoes altogether and doing lots and lots of yorkshire puds. i think you do similar in us n call them popovers. they can be made the day before n warmed. then u can do some starchy veg. glazed parsnips will hold well.
if you want a potato thing, mashed potatoes and swede (rutabaga?) with lots of butter and pepper would work.in scotland we call it clapshot.
they don't want the same items as last year.
thanks to all who replied, but i was just told that they would like a rice dish for their starch this year. happy cooking to one and all!!
i'm late to this party since you've already decided on a rice dish, but i wanted to add a comment. i've been asked for twice baked potatoes for 3 different parties this season. i thought that was a little strange since i've never offered them before. comfort food in a bad economy, maybe?
thanks lentil, but i am relieved they asked for a rice dish, because the other menu items are numerous and time consuming enough.
i agree! i'd take a rice dish over twiced baked, too!
the party was a huge success, i served what i named "emerald rice" for the starch and they loved it, it was basmati rice (made with chicken stock) with chopped scallions, italian parsley and pistachios (?). i am so glad i decided not to do a potato dish for a starch again, this was soooo simple.
happy new years to all the foodies!!
i know i'm late to reply, but just wanted to say that your recipe caught my attention and i would love to try it once. thanks for sharing it!
i am also late replying to your post - i hope you like it as much as they did!!


text:
This ShowerBench is practical and attractive which will give you the time to enjoyall the benefits of a shower, Sit, relax and let the shower water soothe awaythe pressures of your day.
Chic and modern design provides you with convenientand neat typing feel. With solid bamboo construction, this chair is able towithstand repeated shower use and provides extra stability while in use.Lightweight and compact designs make it easy move and restorage. This stool isas comfortable as it is beautiful.

lowercased:
this showerbench is practical and attractive which will give you the time to enjoyall the benefits of a shower, sit, relax and let the shower water soothe awaythe pressures of your day.
chic and modern design provides you with convenientand neat typing feel. with solid bamboo construction, this chair is able towithstand repeated shower use and provides extra stability while in use.lightweight and compact designs make it easy move and restorage. this stool isas comfortable as it is beautiful.


text:
Attend a cricket match or AFL game at the SCG – Best atmosphere!
Have a burger at Mary’s – The best burgers in town!
Dinner at Cafe Sydney – best view of Circular Quay & the Opera House. Must try the salted caramel chocolate peanut tart. AMAZING!

lowercased:
attend a cricket match or afl game at the scg – best atmosphere!
have a burger at mary’s – the best burgers in town!
dinner at cafe sydney – best view of circular quay & the opera house. must try the salted caramel chocolate peanut tart. amazing!


text:
A: Intense price competition from developing countries has had a negative effect on the whole market. I don't know if our company can survive next year.
B: ___________________________________, then the very first thing we need to do is create unique products, making them stand out from the others.
A: Intense price competition from developing countries has had a negative effect on the whole market.
I don't know if our company can survive.
B: If we want to defeat our competitors and increase profit margins, then the very first thing we need to do is create unique products, making them stand out from the others.

lowercased:
a: intense price competition from developing countries has had a negative effect on the whole market. i don't know if our company can survive next year.
b: ___________________________________, then the very first thing we need to do is create unique products, making them stand out from the others.
a: intense price competition from developing countries has had a negative effect on the whole market.
i don't know if our company can survive.
b: if we want to defeat our competitors and increase profit margins, then the very first thing we need to do is create unique products, making them stand out from the others.


text:
New Jersey Bass Fishing Information and Fishing Reports. Great place for discussion on tips, techniques, places to fish, fishing reports, presentations, fishing gear, fishing news, lakes, rivers, ponds.
Include a Photo with your Fishing Report!
Post Clubs, Locations, Dates, and Results here!

lowercased:
new jersey bass fishing information and fishing reports. great place for discussion on tips, techniques, places to fish, fishing reports, presentations, fishing gear, fishing news, lakes, rivers, ponds.
include a photo with your fishing report!
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text:
An ever-growing focus on the contents of your stomach has given rise to a number of diets—but we’re not talking about food. Rather, this focus is on your microbiome, or the collection of bacteria that’s in your gut and plays a significant role in everything from digestion to metabolism to the immune system.
The latest newcomer to this trend is the Hadza Diet, but it’s not as faddish as you might suspect. It’s the way hunter-gatherers, known as the Hadza, in Tanzania have eaten for their long history (15,000-plus years!), and recently-published research on their diet can give us clues on how Americans can eat for better health. Diseases such as Crohn’s, inflammatory bowel, ulcerative colitis, and colon cancer just aren’t as prevalent in this population—could their microbiome be the reason why?
It turns out that the Hadza people have species of bacteria inside of them that Americans simply don’t have, such as one that helps metabolize carbs and another that interacts with your immune system. We’re probably not going to get all of that bacteria back, but there is something that’s easily accessible but missing in the standard American diet compared to the Hadza’s: fiber. Americans average 15 grams of fiber a day; Hadza average 100 to 150 grams. The bacteria in your system likes to feast on these prebiotics, flourishing with every gram of fiber you consume.
If you want to reduce your risk of the aforementioned diseases and simply feel better on a day-to-day basis, add foods such as jicama, dandelion greens, onions, asparagus, bananas, and oats. Each of these is rich in a certain type of fiber known as fructans, and that’s what’s going to get your gut looking a little more like the Hadza’s—without any supplements, hunting, or foraging required.

lowercased:
an ever-growing focus on the contents of your stomach has given rise to a number of diets—but we’re not talking about food. rather, this focus is on your microbiome, or the collection of bacteria that’s in your gut and plays a significant role in everything from digestion to metabolism to the immune system.
the latest newcomer to this trend is the hadza diet, but it’s not as faddish as you might suspect. it’s the way hunter-gatherers, known as the hadza, in tanzania have eaten for their long history (15,000-plus years!), and recently-published research on their diet can give us clues on how americans can eat for better health. diseases such as crohn’s, inflammatory bowel, ulcerative colitis, and colon cancer just aren’t as prevalent in this population—could their microbiome be the reason why?
it turns out that the hadza people have species of bacteria inside of them that americans simply don’t have, such as one that helps metabolize carbs and another that interacts with your immune system. we’re probably not going to get all of that bacteria back, but there is something that’s easily accessible but missing in the standard american diet compared to the hadza’s: fiber. americans average 15 grams of fiber a day; hadza average 100 to 150 grams. the bacteria in your system likes to feast on these prebiotics, flourishing with every gram of fiber you consume.
if you want to reduce your risk of the aforementioned diseases and simply feel better on a day-to-day basis, add foods such as jicama, dandelion greens, onions, asparagus, bananas, and oats. each of these is rich in a certain type of fiber known as fructans, and that’s what’s going to get your gut looking a little more like the hadza’s—without any supplements, hunting, or foraging required.