Search

BackgroundFree tissue transfer to the knee region in patients with chronic post-traumatic knee osteomyelitis (CTKOM) poses a great challenge to surgeons because the remaining soft tissues adjacent to defects, including vascular structures, are usually damaged by chronic inflammation and multiple debridements. Thus, we developed an algorithm to help select the optimal recipient vessels and appropriate anterolateral thigh perforator (ALTP) flap type. In addition, we performed surgery using this algorithm and achieved successful reconstructions. This study aims to review our experiences in algorithmic reconstruction and assess its efficacy.MethodsAccording to the defect size and location, our algorithm suggested the use of various-shaped ALTP flaps with centrally located perforators (Cen-ALTP flap) or eccentrically located perforators (Ecc-ALTP flap). Besides, through the algorithm, one recipient vessel was selected among three candidates, including descending branch of the lateral circumflex femoral artery (DB-LCFA), anterior tibial artery (ATA), and posterior tibial artery (PTA). Based on this algorithmic decision, we performed individualized soft tissue reconstructions of the knee in 21 patients with CTKOM, between March 2013 and June 2021. The medical records of the patients were retrospectively reviewed.ResultsThe Cen-ALTP flap (n = 15) and ATA (n = 9) were the most commonly used for reconstruction. The Cen-ALTP flap anastomosed to the ATA was most commonly selected (n = 7) using the algorithm, followed by the Cen-ALTP flap anastomosed to the DB-LCFA (n = 5), and the Cen-ALTP flap anastomosed to the PTA (n = 3). All transferred ALTP flaps survived the follow-up period. Postoperative venous congestion in two patients and hematoma in one patient were resolved by immediate treatment. The postoperative course was uneventful.ConclusionDuring free ALTP flap transfer to CTKOM-related knee defects, we could select the optimal recipient vessel and appropriate flap type using our algorithm and obtain excellent reconstructive outcomes. Therefore, we believe that our algorithm could provide helpful guidance to reconstructive surgeons on free ALTP flap transfer to reconstruct CTKOM-related soft tissue defects.

To evaluate the implication of 18F-fluorodeoxyglucose (FDG)- and dopamine transporter (DAT)-positron emission tomography (PET) in the diagnosis and clinical symptoms of dementia with Lewy bodies (DLB), 55 DLB patients and 49 controls underwent neuropsychological evaluation and FDG-, DAT-, and 18F-Florbetaben (FBB) PET. DAT- and FDG-uptake and FDG/DAT ratio were measured in the anterior and posterior striatum. The first principal component (PC1) of FDG subject residual profiles was identified for each subject. Receiver operating characteristic curve analyses for the diagnosis of DLB were performed using FDG- and DAT-PET biomarkers as predictors, and general linear models for motor severity and cognitive scores were performed adding FBB standardized uptake value ratio as a predictor. Increased metabolism in the bilateral putamen, vermis, and somato-motor cortices, which characterized PC1, was observed in the DLB group, compared to the control group. A combination of posterior putamen FDG/DAT ratio and PC1 showed the highest diagnostic accuracy (91.8% sensitivity and 96.4% specificity), which was significantly greater than that obtained by DAT uptake alone. Striatal DAT uptake and PC1 independently contributed to motor severity and language, memory, frontal/executive, and general cognitive dysfunction in DLB patients, while only PC1 contributed to attention and visuospatial dysfunction.

Key requirements for a better performance of multimedia applications typically include lower latency, improved security, faster content retrieval, and adjustability to the traffic load. However, the current Internet often fails to meet the requirements due to the drawbacks of the host-oriented communication architecture. Those drawbacks can be overcome by a well-recognized networking paradigm, called Information-Centric Networking (ICN), that offers name-based and information-centric communication rather than host-oriented communication. This paradigm uses an in-network caching policy and may provide enhanced security along with user mobility. Therefore, the ICN architecture can outperform the current Internet in many aspects, including, but not limited to, content transfer time, traffic load control, mobility support, and efficient network management. Most of the existing research validating the ICN paradigm’s superior performance compared to the current Internet is based on simulation. In this paper, we propose a novel ICN-based testbed, where we used several modified functions for naming, routing, and caching and developed two new functions that provide mobility support and auto-playing of the retrieved content so that the performance of the ICN network is enhanced even more in terms of content delivery time or response time. The proposed testbed architecture is based on Content-Centric Networking (CCN), a prominent branch of the ICN concept. We present the testbed development procedures and the functions in detail and demonstrate that the testbed-based architecture outperforms the current Internet architecture and the basic CCN-based environment.

Users can access the Internet anywhere they go at any time due to the advancement of communications and networking technologies. The number of users and connected devices are rapidly increasing, and various forms of content are becoming increasingly available on the Internet. Consequently, several research ideas have emerged regarding the storage policy for the enormous amount of content, and procedures to remove existing content due to the lack of storage space have also been discussed. Many of the proposals related to content caching offer to identify the popularity of certain content and hold the popular content in a repository as long as possible. Although the host-based Internet has been serving its users for a long time, managing network resources efficiently during high traffic load is problematic for the host-based Internet because locating the host with their IP address is one of the primary mechanisms behind this architecture. A more strategical networking paradigm to resolve this issue is Content-Centric Networking (CCN), a branch of the networking paradigm Information-Centric Networking (ICN) that is focused on the name of the content, and therefore can deliver the requested content efficiently, securely, and faster. However, this paradigm has relatively simple content caching and content removal mechanisms, as it caches all the relevant content at all the nodes and removes the content based on the access time only when there is a lack of space. In this paper, we propose content popularity ranking (CPR) mechanism, content caching scheme, and content removal scheme. The proposed schemes are compared to existing caching schemes such as Leave Copy Everywhere (LCE) and Leave Copy Down (LCD) in terms of the Average Hop Count, content removal schemes such as Least Recently Used (LRU) and Least Frequently Used (LFU) in terms of the Cache Hit Ratio, and finally, the CCN paradigm incorporating the LCE and the LRU schemes and the host-based Internet architecture in terms of Content Delivery Time. Graphical presentations of performance results utilizing the proposed schemes show that the proposed CPR-based schemes for content caching and content removal provide better performance than the host-based Internet and the original CCN utilizing LCE and LRU schemes.

Sesame oil cakes (SOC) produced during sesame oil production can be classified as plant residues. This study aims to use SOC as a composite material for injection molding. A biocomposite containing polypropylene (PP) and SOC, namely PP/SOC, was developed and its mechanical properties were evaluated. PP/SOC is largely divided into Homo-PP/SOC (HPS) based on Homo-PP and Block-PP/SOC (BPS) based on block-PP. The specimens containing 0–50 wt% SOC were prepared through extrusion and injection molding. As a result of the evaluation, SOC acted as a reinforcement in the matrix, and HPS and BPS showed improved flexural modulus by 36.4% and 37.3% compared to the neat PP, respectively. Tensile strength, on the other hand, decreased by 58% and 55.1%, respectively. To analyze the cause of this, cross-section observation was conducted through scanning electron microscope (SEM), and phase separation and voids were confirmed to be the cause of this. Impact strength of PP/SOC tended to vary depending on the type of matrix. HPS increased by 30.9% compared to neat PP, and BPS decreased by 25%. This tendency difference appears to be the result of SOC inhibiting crystallization of PP, and it has been confirmed through x ray diffraction (XRD) and differential scanning calorimetry (DSC) analysis. Moreover, PP/SOC can be manufactured at a low cost and is environmentally friendly because it utilizes SOC, a plant residue. It can also be applied to commercial products, such as food packaging, owing to its good moldability and improved mechanical properties.

Background United States Medical Licensing Examination Step 1 will transition from numeric grading to pass/fail, sometime after January 2022. The aim of this study was to compare how program directors in orthopaedics and internal medicine perceive a pass/fail Step 1 will impact the residency application process. Methods A 27-item survey was distributed through REDCap to 161 U.S. orthopaedic residency program directors and 548 U.S. internal medicine residency program directors. Program director emails were obtained from the American Medical Association’s Fellowship and Residency Electronic Interactive Database. Results We received 58 (36.0%) orthopaedic and 125 (22.8%) internal medicine program director responses. The majority of both groups disagree with the change to pass/fail, and felt that the decision was not transparent. Both groups believe that the Step 2 Clinical Knowledge exam and clerkship grades will take on more importance. Compared to internal medicine PDs, orthopaedic PDs were significantly more likely to emphasize research, letters of recommendation from known faculty, Alpha Omega Alpha membership, leadership/extracurricular activities, audition elective rotations, and personal knowledge of the applicant. Both groups believe that allopathic students from less prestigious medical schools, osteopathic students, and international medical graduates will be disadvantaged. Orthopaedic and internal medicine program directors agree that medical schools should adopt a graded pre-clinical curriculum, and that there should be a cap on the number of residency applications a student can submit. Conclusion Orthopaedic and internal medicine program directors disagree with the change of Step 1 to pass/fail. They also believe that this transition will make the match process more difficult, and disadvantage students from less highly-regarded medical schools. Both groups will rely more heavily on the Step 2 clinical knowledge exam score, but orthopaedics will place more importance on research, letters of recommendation, Alpha Omega Alpha membership, leadership/extracurricular activities, personal knowledge of the applicant, and audition electives.

Whole-exome sequencing of cell-free DNA (cfDNA) could enable comprehensive profiling of tumors from blood but the genome-wide concordance between cfDNA and tumor biopsies is uncertain. Here we report ichorCNA, software that quantifies tumor content in cfDNA from 0.1× coverage whole-genome sequencing data without prior knowledge of tumor mutations. We apply ichorCNA to 1439 blood samples from 520 patients with metastatic prostate or breast cancers. In the earliest tested sample for each patient, 34% of patients have ≥10% tumor-derived cfDNA, sufficient for standard coverage whole-exome sequencing. Using whole-exome sequencing, we validate the concordance of clonal somatic mutations (88%), copy number alterations (80%), mutational signatures, and neoantigens between cfDNA and matched tumor biopsies from 41 patients with ≥10% cfDNA tumor content. In summary, we provide methods to identify patients eligible for comprehensive cfDNA profiling, revealing its applicability to many patients, and demonstrate high concordance of cfDNA and metastatic tumor whole-exome sequencing., Identifying the mutational landscape of tumours from cell-free DNA in the blood could help diagnostics in cancer. Here, the authors present ichorCNA, software that quantifies tumour content in cell free DNA, and they demonstrate that cell-free DNA whole-exome sequencing is concordant with metastatic tumour whole-exome sequencing.

Edge computing is a key paradigm for the various data-intensive Internet of Things (IoT) applications where caching plays a significant role at the edge of the network. This paradigm provides data-intensive services, computational activities, and application services to the proximity devices and end-users for fast content retrieval with a very low response time that fulfills the ultra-low latency goal of the 5G networks. Information-centric networking (ICN) is being acknowledged as an important technology for the fast content retrieval of multimedia content and content-based IoT applications. The main goal of ICN is to change the current location-dependent IP network architecture to location-independent and content-centric network architecture. ICN can fulfill the needs for caching to the vicinity of the edge devices without further storage deployment. In this paper, we propose an architecture for efficient caching at the edge devices for data-intensive IoT applications and a fast content access mechanism based on new clustering and caching procedures in ICN. The proposed cluster-based efficient caching mechanism provides the solution to the problem of the existing hash and on-path caching mechanisms, and the proposed content popularity mechanism increases the content availability at the proximity devices for reducing the content transfer time and packet loss ratio. We also provide the simulation results and mathematical analysis to prove that the proposed mechanism is better than other state-of-the-art caching mechanisms and the overall network efficiencies are increased.

Citizen participation in budget processes is an attractive governance strategy for creating sustainable local finance. In participatory governance, citizens are engaged in the governmental policy decision-making process for sustainable communities. Despite the importance of a participatory government, its instrumental benefits are uncertain and remain unexamined at the local level. No one has offered any extensive evidence based on large-N data to ascertain such benefits. This article fills this gap in the literature by testing the impacts of participatory budgeting on local financial outcomes. The results show that participatory governments are financially more effective and equitable without sacrificing efficiency. Advancing a more institutional perspective, this article explains the identified effects of participation mechanisms in the budget process on different local financial outcomes.

Numerous studies have demonstrated the various medicinal properties of Panax ginseng, including angiogenic, immuno-stimulating, antimicrobial, and anti-inflammatory activities, which can be helpful in chronic wound healing. However, a direct role for P. ginseng in chronic wound healing has not been demonstrated. The present study was designed to evaluate the effects of P. ginseng extract on diabetic fibroblasts in vitro. Human diabetic fibroblasts were cultured in the presence of Ginsenoside Rb1 (G-Rb1), the active component in P. ginseng (10 ng/mL), and untreated diabetic fibroblasts were used as controls. Cell proliferation, collagen synthesis, the production of various growth factors (basic fibroblast growth factor [bFGF]; vascular endothelial growth factor [VEGF]; and transforming growth factor-β1 [TGF-β1]), and the synthesis of matrix metalloproteinase 1 (MMP-1) and tissue inhibitor of metalloproteinases 1 (TIMP-1) were compared using enzyme-linked immunosorbent assay and immunofluorescence staining. Compared with the control group, G-Rb1-treated fibroblasts showed significantly (P

The mobile Internet is already playing a key role in people’s daily lives worldwide, resulting in the dramatic growth in the number of mobile devices. The size of the Internet and the amount of the traffic are being expanded rapidly, which poses various challenges. In particular, the Internet and mobile communications are entering a new era that demands faster communication services and uninterrupted content delivery. A new paradigm called content-centric networking (CCN) is considered as an appropriate way for efficient content delivery. In this paper, we propose a CCN-based efficient content delivery mechanism in the 4G network and also in the upcoming 5G network where various heterogeneous networks are converged. We also propose a novel mobility management scheme to support the content diversity and network diversity by leveraging the abundant computational resources in the mobile network. In addition, we analyze the existing approaches with respect to mobility and evaluate the performance of our seamless content delivery mechanism in terms of content transfer time, throughput, and data transmission success ratio. Simulation results are also presented to show that the content-centric wireless network with our mobility management scheme can improve the data delivery services significantly compared to the existing schemes.

Background: Central sleep apnea is characterized by loss of automatic respiration during sleep. There are only a few reports which document that medullary infarction resulted in central sleep apnea and failure in early recognition of this condition could be catastrophic. We report a case of central sleep apnea following lateral medullary infarction. Case Report: A 49-year-old woman with an unknown past history presented with sudden onset of dizziness, loss of balance, and dysarthria for 1-hour duration. Diffusion-weighted imaging confirmed right lateral medullary infarction. She had episodes of hypercapnia and respiratory arrest due to central sleep apnea, which was confirmed by polysomnography. Tracheostomy was performed and she was put on a home ventilator. After 3 months, follow-up polysomnography showed disappearance of central sleep apnea. Conclusion: Patients with lateral medullary infarction need to be monitored closely with respect to the respiratory pattern.

Salivary duct carcinoma is a rare malignant tumor that resembles high-grade breast ductal carcinoma. It was first described by Kleinsasser et al. [1] in 1968, and is characterized by aggressive behavior, early metastasis, local recurrence, and a high mortality rate. It most commonly occurs in the parotid gland. Previously reported cases of salivary duct carcinomas involved only the superficial lobe of the parotid gland or both the superficial and deep lobes [2]. This study reports an unusual case of salivary duct carcinoma confined to the deep lobe of the parotid gland. A 59-year-old man presented with a long history of a painless lump on the left preauricular area that had gradually enlarged over the previous year. He denied pain, numbness, and facial weakness. Physical examination showed a well-defined 4×3-cm mass in the left parotid region. The mass was firm, non-compressible, and non-tender on palpation. His left facial nerve function was intact (House-Brackmann grade I). Neither cervical lymphadenopathy nor abnormalities within the oral cavity were found. Fine needle aspiration, which is not diagnostic, was not performed. Computed tomography (CT) (Fig. 1) revealed a 2.5×3.2×4.1-cm, well-enhanced, huge, lobulated, and predominantly solid tumor in the superficial lobe of the left parotid gland. The preoperative laboratory data, including electrocardiography, urinalysis, and a chest radiograph, were unremarkable. A benign tumor, such as pleomorphic adenoma, was strongly suspected, and the patient was therefore taken to the operating room with the intention of performing a left superficial parotidectomy. During the operation, the branches of the facial nerve were preserved via a modified Blair incision. Subsequently, tumor involvement in the deep parotid lobe was identified (Fig. 2). Malignancy was identified in the frozen section of a sample taken from the mass located on the deep lobe. The excision of the superficial part of the parotid gland was completed, the branches of the facial nerve were subsequently elevated, and the deep lobe of the parotid gland was resected. The lesion was classified as cT2NxM0. Fig. 1 Computed tomography scan showing a solid mass in the left parotid gland. Fig. 2 Intraoperative photograph showing the mass located on the deep lobe of the parotid gland. The forceps are shown retracting the superficial lobe. The gross specimen showed a roughly ovoid, nodular, gray-white mass with an irregular border (Fig. 3). The histology report indicated that the tumor was an invasive ductal lesion with cribriform patterns and comedonecrosis (Fig. 4). The resected superfical lobe showed a normal parotid architecture and no tumor. The final diagnosis was salivary duct carcinoma of the deep lobe of the left parotid gland. One of the surgical margins was focally positive for malignancy. No perineural invasion or lymphovascular involvement was found. Control chest CT and positron emission tomography (PET)-CT were negative. Since postoperative CT and magnetic resonance imaging revealed no definitive evidence of perineural spread or metastatic lymphadenopathy, elective neck dissection was not performed. The patient received postoperative chemoradiation therapy with 60 Gy administered in 30 fractions and biweekly cisplatin monotherapy. Following temporary facial nerve paralysis (House-Brackmann grade IV), the patient recovered fully functional left facial movement (House-Brackmann grade I) five months after the operation. He has received regular follow-up for one year with no signs of recurrence or metastasis. Fig. 3 Gross specimen of the deep lobe of the parotid gland. Fig. 4 Histological features (H&E, ×200) of salivary duct carcinoma, showing a cribriform pattern. Salivary duct carcinoma represents

Background The presence of white matter hyperintensity (WMH) is related to poor long-term outcomes in stroke patients. However, the long-term outcome is unknown in patients with both large artery atherosclerosis (LAA) and WMH. Methods We investigated the impact of WMH on long-term outcome in patients with LAA. Consecutive patients in a prospective stroke registry were included. Patients were followed for a median of 7.7 years (interquartile range, 5.6–9.7). The degree of WMH was assessed by Fazekas grade on fluid-attenuated inversion recovery images. Total WMH burden was calculated by summation of Fazekas scores in periventricular and deep white matter. Severe WMH was defined as total burden score ≥ 3. Results Among 2529 patients, 639 patients (25.3%) were classified with the LAA subtype. After applying exclusion criteria, the data from 538 patients were analyzed. The mean patient age was 65.7 ± 10.3 years. Severe WMHs were found in 243 patients (45.2%). During follow-up, 200 patients (37.2%) died. Cox regression analysis showed that LAA patients with severe WMH had a 1.50-fold (95% CI, 1.12–2.00, p = 0.007) higher death rate compared to those without. In the older age group (≥65 years), Cox regression revealed that patients with severe WMH had a 1.75-fold (95% CI, 1.15–2.65, p = 0.008) higher 5-year death rate, whereas the younger age group did not have this association. Conclusion The degree of WMH might be a surrogate marker for long-term outcome in patients with LAA. Atherosclerotic burdens in both small and large arteries might impact long-term prognosis in ischemic stroke patients.

Background In 2004, we reported on 110 consecutive Asian rhinoplasty patients who were treated with the addition of a footplate incision to obtain a greater aesthetic satisfaction. We continue to perform the reported technique with several modifications, and we still think that this method contributes to Asian rhinoplasty. Methods A footplate incision was made along the caudal border of the footplate of the medial crura onto the floor of the nasal vestibule. This incision can be made alone or in combination with either endonasal or open rhinoplasty. It enables surgeons to achieve a further tip projection since the pressure of the skin flap is reduced on the tip. In this study, we emphasize a couple of recent changes that we made to our procedure after publication of the prior article. First, we excised the dog-ear that appeared at the caudal end of the extended footplate incision. After making the new tip, a dog ear can be seen at the posterior end of the footplate incision. Second, an inferior columellar dissection was also extended to achieve an additional tip projection and to improve the columello-labial angle. Results This study included 85 consecutive patients who underwent an aesthetic rhinoplasty using footplate incision techniques between August of 2010 and May of 2013. A total of 43 patients had an adequate follow-up time of over 12 months. The majority of the patients (40/43 cases) were satisfied with the results. Conclusions The authors believe that a footplate incision in aesthetic rhinoplasty is safe and can reliably achieve better results for Asian patients.

Background Negative-pressure wound therapy (NPWT) is believed to accelerate wound healing by altering wound microvascular blood flow. Although many studies using laser Doppler have found that NPWT increases perfusion, recent work using other modalities has demonstrated that perfusion is reduced. The purpose of this study was to investigate the influence of NPWT on tissue oxygenation of the foot, which is the most sensitive region of the body to ischemia. Methods Transcutaneous partial pressure of oxygen (TcpO2) was used to determine perfusion beneath NPWT dressings of 10 healthy feet. The sensor was placed on the tarso-metatarsal area of the foot and the NPWT dressing was placed above the sensor. TcpO2 was measured until it reached a steady plateau state. The readings obtained at the suction-on period were compared with the initial baseline (pre-suction) readings. Results TcpO2 decreased significantly immediately after applying NPWT, but gradually increased over time until reaching a steady plateau state. The decrease in TcpO2 from baseline to the steady state was 2.9 to 13.9 mm Hg (mean, 9.3±3.6 mm Hg; 13.5±5.8%; P Conclusions NPWT significantly decrease tissue oxygenation of the foot by 2.9 to 13.9 mm Hg. NPWT should be used with caution on feet that do not have adequate tissue oxygenation for wound healing.

A perineurioma is an uncommon neoplasm defined as a peripheral nerve sheath tumor composed exclusively of neoplastic perineurial cells, and its two main forms are intraneural and extraneural types [1]. Intraneural perineuriomas often cause motor or sensory deficits [2] and seem to be less common than extraneural ones. As intraneural perineurioma is rarely known to arise in the brachial plexus, principles of its surgical treatment have not been formulated thus far. Here, we report a rare case of surgical removal of intraneural perineurioma arising in the brachial plexus using a microsurgical interfascicular dissection technique for functional preservation. The technical feasibility and advantages of this method are discussed in this report. A 58-year-old woman was referred for the surgical management of a right axillary mass that was incidentally noted on ultrasonography. The tumor had already been diagnosed as a spindle cell tumor from an ultrasound-guided biopsy. Spindle cell tumors are soft tissue sarcomas, which require a histopathological examination because of the limited material availability in the needle aspirates [3]. To rule out malignant peripheral nerve sheath tumors, we decided on the microsurgical removal of the tumor. Under general anesthesia, the brachial plexus was approached via an infraclavicular approach. After ligation of the cephalic vein on the deltopectoral groove, the pectoralis minor muscle was divided. Below the pectoralis minor, the clavipectoral fascia was incised and the cords of the brachial plexus were inspected. The tumor originated from the sheath of the axillary nerve, which is one of the branches of the posterior cord and was found to be involved with the fascicles of the axillary nerve. It was difficult to differentiate pathologic fascicles from normal fascicles with the unaided eye (Fig. 1). Interfascicular dissection was performed with microsurgical techniques under high magnification. First, we exposed the healthy proximal portion of the axillary nerve and then differentiated each fascicle via internal neurolysis. Interfascicular dissection progressed distally toward the proximal edge of the tumor. The fascicle invaded by the tumor was very soft, brittle, and pulpy; further, it was dusky brown in color. In addition, these fascicles responded poorly to electrical stimulation by a nerve stimulator, while stimulation to the preserved fascicles caused contraction of the deltoid muscle. On the basis of these findings, we differentiated pathologic lesions from the healthy fascicles and removed the tumor with the preservation of the healthy portion of the nerve fascicles (Fig. 2). Fig. 1 Intraoperative findings. The tumor originated from the axillary nerve of the posterior cord. Fig. 2 After tumor excision, one of the fascicle groups was preserved. The mass was 0.5 cm×1.0 cm×4.5 cm in size and was well circumscribed but unencapsulated (Fig. 3). Upon histological examination, irregularly enlarged, hypercellular nerve fascicles containing spindled perineurial cells were seen arranged in pseudo-onion bulb whorls on the cross section. Upon immunohistochemical staining, endothelial membrane antigen-positive perineurial cells were seen arranged in pseudo-onion bulb whorls (Fig. 4) around S100-positive Schwann cells (Fig. 5). The tumor was eventually diagnosed as an intraneural perineurioma. Fig. 3 The resected specimen measured about 0.5 cm×1.0 cm×4.5 cm. Fig. 4 Upon immunohistochemical staining, the perineurial cells (black arrow) were positive for endothelial membrane antigen (endothelial membrane antigen, ×200). Fig. 5 Upon immunohistochemical staining, Schwann cells (black arrow) positive for S100 were surrounded by the perineurial cells (S100, ×200). Intraneural perineuriomas most commonly involve the sciatic nerve or its branches, but the tumor can occur in the brachial plexus, trigeminal nerves, and the lumbosacral plexus [4]. Intraneural perineuriomas occur relatively rarely in the brachial plexus. Although a growing intraneural perineurioma can cause destruction of nerve fascicles and progressive loss of motor function, there has been no optimal management for this tumor because of its rare occurrence and insufficient clinical research. In our case, it was very difficult to decide whether or not to remove the tumor because the patient had no subjective symptoms. However, we decided to remove the lesion and preserve the intact fascicles as much as possible in order to minimize neurologic complications. This was because the tumor could grow and give rise to functional deficits and a histologic examination was required to rule out malignancy. Nerve sheath tumors are usually removed en bloc except large tumors that necessitate excessive retraction of the surrounding fascicles to achieve an en bloc resection [5]. Intraneural perineurioma in this case could be differentiated from the intact nerve fascicles via microscopic inspection and electrical stimulation and was systematically dissected from intact fascicles along a distinct plane between the normal and the pathologic fascicles. Consequently, we could achieve en bloc removal of the tumor. There is only one report of excising schwannoma or neurofibroma of the peripheral nerve by interfascicular dissection [5], and this is the first report in which intraneural perineurioma was resected selectively by this method. Postoperatively, the patient suffered from temporary sensory and motor deficits, which were identified as axillary neuropathy by electromyography (EMG). It was expected that axillary neuropathy occurred because the intraoperative findings suggested that the tumor was involved with the fascicles of the axillary nerve. However, we assured the patient that she would recover fully, because the intact fascicles were confirmed intraoperatively. As expected, follow-up EMG at 11 months showed marked improvement. The axillary nerve divides into anterior and posterior branches. The anterior branch supplies the anterior part of the deltoid muscle and gives off a few small cutaneous branches. The posterior branch supplies the posterior part of the deltoid muscle and the teres minor muscle along with the skin over the lower two-thirds of the posterior part of this muscle, as well as that covering the long head of the triceps brachii. In our case, the initial needle EMG study showed abnormal spontaneous activity, no motor unit action potentials in the right deltoid muscle, and slightly reduced recruitment in the right teres minor muscle. The follow-up EMG at 6 months revealed complex polyphasic motor unit action potentials with discrete recruitment in the right deltoid muscle. This indicated that the axillary neuropathy was mainly limited to the anterior branch and that the degree of injury was very mild. The EMG result coincided with the operative procedure that the intact fascicles were preserved after tumor excision. Clinically, the patient gradually recovered during the 18-month follow-up period and finally regained nearly normal shoulder function. The clinical course of this patient shows that the microsurgical removal of intraneural perineurioma in the brachial plexus is possible and can produce satisfactory results. We believe that this technique can be an effective and beneficial treatment for intraneural perineurioma arising from the brachial plexus.

Background Absorbable materials offer many advantages in the reconstruction of orbital walls; however, the possibility of postoperative enophthalmos after complete absorption cannot be excluded. We evaluated the postoperative results of absorbable mesh plates used as onlay implanting on the medial orbital wall to determine whether they are suitable for medial orbital wall reconstruction. Methods The study included 20 patients with medial orbital wall fractures who were followed up for more than 2 years postoperatively. We used absorbable mesh plates in all of the patients. We measured the following: the changes in the expanded orbital volume by comparing the preoperative and postoperative computed tomography (CT) scans and the degree of clinical enophthalmos. Results There were no major complications associated with the use of absorbable materials such as infection, migration, or extrusion of mesh plates during the long-term follow-up. The orbital volumetric changes between the preoperative and postoperative CT scans were not statistically significant. However, the expanded orbital volume was not related to the degree of clinical enophthalmos. Conclusions The reconstructed orbital wall may provide supportive scar tissue to the orbital contents even after the absorbable materials have dissolved completely. Absorbable mesh plates could be another option for the reconstruction of the medial orbital wall.

Background Mammalian bite injuries create a public health problem because of their frequency, potential severity, and increasing number. Some researchers have performed fragmentary analyses of bite wounds caused by certain mammalian species. However, little practical information is available concerning serious mammalian bite wounds that require hospitalization and intensive wound management. Therefore, the purpose of this study was to perform a general review of serious mammalian bite wounds. Methods We performed a retrospective review of the medical charts of 68 patients who were referred to our plastic surgery department for the treatment of bite wounds between January 2003 and October 2012. The cases were analyzed according to the species, patient demographics, environmental factors, injury characteristics, and clinical course. Results Among the 68 cases of mammalian bite injury, 58 (85%) were caused by dogs, 8 by humans, and 2 by cats. Most of those bitten by a human and both of those bitten by cats were male. Only one-third of all the patients were children or adolescents. The most frequent site of injury was the face, with 40 cases, followed by the hand, with 16 cases. Of the 68 patients, 7 were treated with secondary intention healing. Sixty-one patients underwent delayed procedures, including delayed direct closure, skin graft, composite graft, and local flap. Conclusions Based on overall findings from our review of the 68 cases of mammalian bites, we suggest practical guidelines for the management of mammalian bite injuries, which could be useful in the treatment of serious mammalian bite wounds.

Content-centric networking is a new networking paradigm for efficient data distribution in various environments including wireless sensor networks. It is likely that everything which benefits from networking will be connected. Recently, we have seen a huge proliferation of heterogeneous wireless devices, sensors, and distributed applications. These devices may generate a vast amount of time-constrained data. Content-centric networking is greatly useful to increase the data availability and the efficiency of data delivery. Internet of Things will enable all the communication devices to be interconnected and make the data generated by or associated with devices or objects globally accessible. In this article, we propose a possible architecture, necessary components, and related mechanisms for efficient data delivery in the wireless Internet of Things environment, which is based on content-centric networking. We also present simulation results to show the feasibility of the proposed architecture.

Pilomatricoma is a benign skin neoplasm that arises from hair follicle matrix cells. It occurs on the head, neck, and upper extremities, and less frequently on the trunk and lower extremities. The etiology of pilomatricoma is subject to controversy. Trauma, insect bites, or surgery are thought to be antecedent events to the onset of the tumors. Influenza vaccination is a common annual event among individuals. Complications are usually mild and self-limiting. Prophylactic influenza vaccinations rarely cause cutaneous complications. Few cases of foreign body granuloma, infectious reaction, and other cutaneous complications have been reported. In this article, we describe a case of pilomatricoma arising at an influenza vaccination site. Although there has been a report of an association between pilomatricoma and bacille Calmette-Guerin (BCG) vaccination [1], an association with influenza vaccination has not been reported previously. The clinical manifestations and progress of the case are presented in this report. A 7-year-old girl received her routine influenza vaccination in the left upper arm. One month later, a sensation of warmth and redness developed on the vaccination site. Serous discharge was drained with a small amount of blood. Three months later, the patient was referred to the plastic surgery outpatient department, where she presented with a pinkish ulcerative nodule on her left upper arm at the site of administration of the influenza vaccine. At that time, the nodule was covered with a dressing, but it gradually became harder to the touch and larger in size. Seven months later, the nodule reached approximately 10 mm in diameter, and was fixed firmly to deep subcutaneous tissue (Fig. 1). Ultrasonographic examination revealed a heterogeneous echo texture, surrounding subcutaneous fat infiltration, and subtle vascularity (Fig. 2). Clinical differential diagnoses included foreign body granuloma, postvaccinal lymphadenitis, and pilomatricoma. Fig. 1 Nodule connected to the subcutaneous mass, at the site of administration of the influenza vaccine. Fig. 2 Heterogeneous mass-like lesion, 15 mm in diameter, embedded in subcutaneous layer. An excisional biopsy was performed. The nodule and embedded mass-like lesion were completely removed. Grossly, the specimen was surrounded by inflammation tissue (Fig. 3). Microscopic examination revealed a well-demarcated lesion stemming from the dermis that consisted of multinucleated giant cells and ghost cells with a central unstained area indicative of a lost nucleus. The characteristic basaloid cells were also identified. These cells were surrounded by a lining of squamous cells (Fig. 4). The specimen was identified as a completely excised pilomatricoma, with clear margins. There was no local recurrence at the patient's follow-up visit 7 months later. Fig. 3 Gross specimen containing projecting nodule and subcutaneous embedded mass-like lesion. Fig. 4 (A) Characteristic basaloid cells and squamous cell lining (H&E, ×12.5). (B) Cells without a detectable nucleus (ghost cells) and multinucleated giant cell at the periphery (H&E, ×100). Pilomatricoma, also known as calcifying epithelioma of Malherbe, is a benign calcifying tumor that arises from the hair matrix and presents as a slow-growing dermal or subcutaneous mass. Duflo et al. [2] reported a 20% incidence of pain and inflammation associated with pilomatricoma. Histologically, a pilomatricoma presents as a well-demarcated lesion, stemming from the dermis and extending into the subcutaneous fat. These lesions usually consist of islands of epithelial cells comprising basophilic cells with meager cytoplasm and ghost cells that have a central unstained area indicative of a lost nucleus. Although the etiopathogenesis is unknown, the virus and genetic mutation have been reported to be associated with the development of pilomatricoma [3]. Complete surgical excision remains the treatment of choice for benign pilomatricomas. In cases with tumor adherence to the dermis, the overlying skin might be excised. Although recurrence after complete excision is rare, recurrence rates of 2% to 6% were reported in the literature. Tumors found in vaccination scars could be induced by trauma, persistent inflammation/wound healing, scarring, and/or the inoculated attenuated agent itself. Pirouzmanesh et al. [3] reported that inflammation was present in 40.8% of pilomatricomas in microscopic examinations. In our case, preceding inflammation was thought to be responsible for the pilomatricoma. Several adjuvant contained in vaccine have been found to produce more inflammation. Also, a needlestick injury or similar trauma causing damaged follicular epithelium at the injection site may lead to a faulty suppression of apoptosis which in turn, may result into the formation of pilomatricoma [4]. Hematoma after the injection may be followed by a rapidly growing pilomatricoma. Although exact pathologic sequence of the disease could not be defined, such prior events were though to be possible multifactorial causes. To our knowledge, pilomatricoma has not been reported to arise in scars or following an influenza vaccination, but one study reported an occurrence of the tumor following BCG vaccination [1]. Pilomatricoma is still frequently misdiagnosed. One study showed that the rate of preoperative diagnostic accuracy is less than 49% [3]. Pilomatricoma is difficult to diagnose because of its variant morphology and sometimes unusual appearance that may be similar to more common lesions. Furthermore, because vaccination is a relatively rare cause of pilomatricoma, differential diagnosis could be more difficult in this type of case. Therefore, histopathologic examinations are required for the final diagnosis. Basaloid cells and ghost cells are known to be the two key components for the diagnosis and sufficient for a confident pathologic diagnosis of pilomatricoma. The presence of foreign body-type cells, nucleated squamous cells, and calcification, alone or in combination, was less specific, but supported a diagnosis of pilomatricoma [5]. Influenza vaccination is widely performed. Cutaneous complications have been reported following influenza vaccination. Rash, pruritus and urticaria can be occurred as an minor complication. Despite cutaneous neoplasm due to influenza vaccine are not frequently reported, few cases have been reported. The pathogenesis of pilomatricoma following vaccination injection is intriguing. However, the exact pathogenesis in our case remains unexplored. Despite the uncertainty of the diagnosis, we suggest that pilomatricoma be included in the differential diagnoses of chronic nodular lesions arising at influenza vaccination sites.

The proliferation of mobile devices has changed the trends by which people access and share contents in the communication world, leading to migration from the wired to wireless networks with high expectations of ubiquitous connectivity. These trends have motivated researchers to have interests in the future advanced mobile communications. In this paper, we concentrate on one of the most promising types of network, that is, mobile ad hoc network (MANET). Due to the highly dynamic network topology and resource shortage of MANET and the limited energy of communicating nodes, the communication route among nodes may fail frequently. To increase the applicability and sustainability of MANET in the future communication environment, we propose here a new routing protocol that constructs a stable, a reliable, and the shortest route having nodes with the minimum level of remaining energy to increase the operational lifetime of MANET. It also introduces a recovery scheme that reduces the network control overhead significantly to increase the reliability of the network. The effectiveness and robustness of our protocol and the corresponding data delivery mechanism make an ideal solution that can go a long way toward effective data dissemination in the future network.

Oncostatin M (OSM) is a multifunctional cytokine found in a variety of pathologic conditions, which leads to excessive collagen deposition. Current studies demonstrate that OSM is also a mitogen for fibroblasts and has an anti-inflammatory action. It was therefore hypothesised that OSM may play an important role in healing of chronic wounds that usually involve decreased fibroblast function and persist in the inflammatory stage for a long time. In a previous in vitro study, the authors showed that OSM increased wound healing activities of diabetic dermal fibroblasts. However, wound healing in vivo is a complex process involving multiple factors. Thus, the purpose of this study was to evaluate the effect of OSM on diabetic wound healing in vivo. Five diabetic mice were used in this study. Four full-thickness round wounds were created on the back of each mouse (total 20 wounds). OSM was applied on the two left-side wounds (n = 10) and phosphate-buffered saline was applied on the two right-side wounds (n = 10). After 10 days, unhealed wound areas of the OSM and control groups were compared using the stereoimage optical topometer system. Also, epithelialisation, wound contraction and reduction in wound volume in each group were compared. The OSM-treated group showed superior results in all of the tested parameters. In particular, the unhealed wound area and the reduction in wound volume demonstrated statistically significant differences (P < 0·05). The results of this study indicate that topical application of OSM may have the potential to accelerate healing of diabetic wounds.