Search

This study aimed to quantitatively analyze the degree and vector of commissure excursion following intraoral orthodromic temporalis transfer. Patients with unilateral facial paralysis who underwent intraoral temporalis transfer were included. Intra-oral coronoidectomy was followed by submucosa tunneling through two vertical intraoral incisions to fixate the temporalis tendon to the perioral location. Oral commissure excursion, upper lip and commissure height differences, and smile angle were measured. Postoperatively, the symmetry of commissure excursion improved in repose (affected side: 114.6 ± 7.0 mm, non-affected side: 115.2 ± 4.9 mm, p = 0.134), while asymmetry arose in smiling (affected side: 30.7 ± 3.4 mm, non-affected side: 34.5 ± 4.4 mm, p = 0.001). Furthermore, the postoperative smile angle demonstrated insufficient vertical movement on the affected side during smiling (affected side: 115.6 ± 5.8°, non-affected side: 118.4 ± 4.9°, p = 0.002) but no significant difference in repose (p = 0.134). Within the limitations of the study it seems that intraoral orthodromic temporalis transfer yields excellent resting symmetry, but smile asymmetry may occur owing to insufficient oral commissure excursion. Nevertheless, as a minimally invasive surgery, this technique can obviate visible scars and benefit patients wishing for the same and can have excellent resting symmetry. [ABSTRACT FROM AUTHOR]

A previous abdominal scar is generally considered as a challenge for breast reconstruction using abdominal flaps. Since it may interfere with the perfusion of abdominal tissue and weaken the abdominal fascia, many plastic surgeons are concerned about the theoretical risk of postoperative complications. This study aims to assess the effects of previous scar on complications in abdominal flap–based breast reconstruction. This systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline using MEDLINE, Ovid, and Cochrane databases in March 2020. All studies comparing the complication rates between patients with previous abdominal scars and control group without a scar were included. However, articles such as case series fewer than 10 patients, letters and animal studies were excluded. A total of 2109 patients underwent 2792 abdominal flap tissue transfers for breast reconstruction in the 11 studies reviewed. A previous scar increased the risk of overall flap complications (RR 1.12; 95% CI, 0.95–1.32; fixed-effect model, I2 = 13%) and donor-site complications (RR 1.35; 95% CI, 1.13–1.62; fixed-effect model, I2 = 42%, p > 0.05). In particular, the risk of donor-site wound problem was significantly higher than that in the control group (RR 1.83; 95% CI, 1.35–2.46; fixed-effect model, I2 = 19%, p > 0.05). This study result showed that the previous scar increased the risk for all types of complications compared with the control group. In patients with a vertical midline scar, it requires careful preoperative planning with CT angiography and attentive follow-up. However, with careful preoperative planning and an appropriate strategy, it is possible to overcome the detrimental effect of previous scar. I [ABSTRACT FROM AUTHOR]

Facial palsy patients require reconstructive surgery because they suffer from an expressionless and deformed appearance especially during smiling. To gain a natural smile, various dynamic procedures rather than static procedures are performed. Through cadaveric studies with clinical implications on temporalis muscle and intraoral transposition, we were able to come up with a more effective and less invasive procedure than the conventional temporalis muscle transposition or lengthening temporalis myoplasty. The aim of this study is to describe our novel surgical technique for facial reanimation and evaluate its efficacy. Two intraoral incisions were made. Through the posterior incision, the tendinous portion of the temporalis was separated from the coronoid process and anterior border of the ramus. Through the anterior incision, submucosa tunneling was performed to fixate the temporalis tendon onto the new perioral site. 14 patients with facial palsy underwent intraoral temporalis transposition and their mouth corner excursion was measured for objective assessment after surgery. At resting state, mouth and cheek drooping was improved. At smiling, the excursion of the unaffected side was 10–17 mm. For the reconstructed side, 8 cases were considered excellent (exceeding 75% of normal side), 5 cases were considered good (exceeding 50%), and 1 case fair (exceeding 25%). This temporalis transposition through the intraoral approach is a novel technique for facial reanimation reconstruction. It is s less invasive, immediately effective method with rapid recovery and minimal donor site morbidity without visible scar. IV. [ABSTRACT FROM AUTHOR]

During reconstructive surgical procedures, systemic vasopressors are frequently used to maintain normal blood pressure. However, questions have arisen regarding the pharmacologic effects of vasopressors on flap circulation. Many plastic surgeons have expressed concern about the possibility of impaired flap circulation caused by the vasoconstrictive effect of the drugs. However, the opposing argument exists that the increase in mean arterial pressure from vasoactive agents may improve flap perfusion. The purpose of this study was to evaluate the effect of commonly used vasopressors on flap circulation. The vertical rectus abdominis myocutaneous (VRAM) island flap was raised in five female pigs (38.2∼40.7 kg). Hemodynamic parameters were measured continuously by a carotid arterial catheter. A bi-directional transonic vascular doppler flow probe and Laser Doppler perfusion monitor (LDPM) unit were applied to record the continuous change in pedicle artery flow and microvascular perfusion following intravenous administration of dopamine (3, 5, 10µg/kg/minute), dobutamine (1.25, 2.5, 5µg/kg/minute), and norepinephrine (0.05, 0.1, 0.2µg/kg/minute). Both microvascular perfusion and pedicle flow were generally proportional to the mean arterial pressure, and all three vasopressors improved flap perfusion and pedicle flow without deleterious effects. Norepinephrine showed the highest microvascular perfusion and dobutamine showed the highest pedicle flow rate. The mean blood pressure was the only statistically significant factor to affect both microvascular perfusion and pedicle flow (p < 0.0001). Our results strongly suggest that the foremost three vasopressors can be used for flap surgery without deterioration, and that the maintenance of adequate systemic blood pressure is crucial for good flap circulation. [ABSTRACT FROM AUTHOR]

• Lower urinary tract symptoms (LUTS) were prevalent in male stroke survivors. • The IPSS may be useful for evaluating LUTS in male stroke patients. • Stroke may independently contribute to the development of LUTS. There is a scarcity of large population-based studies investigating lower urinary tract symptoms (LUTS) using the International Prostate Symptom Score (IPSS) in stroke survivors. We investigated the prevalence and severity of LUTS in male stroke survivors and determined the independent effect of stroke on LUTS using data from a nationwide population-based survey. Cross-sectional data obtained from the 2011 Korean Community Health Survey were analyzed. The prevalence and severity of LUTS were compared between 1936 male stroke patients and 90,506 male non-stroke participants. Multivariable logistic regression was used to identify the independent effect of stroke on LUTS. Male stroke patients more frequently reported both storage symptoms (frequency, urgency, and nocturia) and voiding symptoms (straining, weak stream, intermittency, and incomplete emptying) compared to male non-stroke population. The storage and voiding subscores of IPSS and quality of life score were higher in male stroke patients than in male non-stroke population. Multivariable logistic regression adjusted for age, socioeconomic factors, physical and mental health measures, and comorbidities, found stroke to be an independent risk factor for all 7 symptoms of LUTS. The present study confirmed a high prevalence of LUTS in male stroke survivors that cannot be attributed only to potential confounders, implying that stroke may independently contribute to the development of LUTS. Our findings warrant the need for timely detection by physicians and proper management of LUTS to promote functional outcomes and quality of life in stroke population. [ABSTRACT FROM AUTHOR]

Objectives: Adolescent asthma can be the cause of social and psychological problems. We investigated the association between asthma with other allergic diseases and suicidal risk behavior among South Korean adolescents using nationally representative data.Methods: Web-based self-report data from the Korean Youth Risk Behavior Web-Based Survey were used in this study (N = 237,022). Complex sample logistic regression was used to define the relationship between suicidal behavior and asthma (n = 7177), with other allergic diseases [asthma with allergic rhinitis (AR) or asthma with atopic dermatitis (AD) (n = 9720), asthma with AD and AR (n = 4971)].Results: Participants with asthma and other allergies showed a higher prevalence of substance use, greater sexual experience, greater perceived stress, poorer perceived health, more severe depression, more suicidal ideation, and more suicide attempts than those without allergy. Depression, suicidal ideation, and suicide attempts increased trend in the following order: no asthma, asthma only, asthma with one other allergy (asthma with AD or asthma with AR), and asthma with AD and AR. After adjusting for multiple confounders, the odds ratio for suicidal ideation with asthma and AD and AR was 1.13 [95% confidence interval (CI), 1.06-1.19] and that for suicide attempts was 1.31 (95% CI, 1.20-1.43).Conclusions: Adolescent asthma and other allergies were associated with suicidal behavior. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate whether high blood pressure and hypertension are associated with epistaxis.Methods: A retrospective study with a propensity score matching analysis was performed at the emergency departments (EDs) of a tertiary university hospital. The mean blood pressure (BP, systolic and diastolic) and proportion of subjects with elevated BP (systolic >120 and/or diastolic >80 mmHg) at presentation were compared between the epistaxis group and matched control group. The proportion of patients with newly diagnosed hypertension within six months between the two groups was also compared.Results: A total of 1353 patients with epistaxis and the same number of those with simple lacerations were matched. The mean systolic and diastolic BPs of the epistaxis group were significantly higher than those of the matched control group (157.1 ± 26.4 and 91.4 ± 17.0 mmHg versus 144.9 ± 32.4 and 84.2 ± 13.5 mmHg) (P < 0.001). The proportion of patients with elevated BP at presentation was also significantly higher in the epistaxis group (91.4%) than in the matched control group (86.2%) (P < 0.001). Of the 724 (53.5%) patients without pre-existing hypertension in the epistaxis group, 660 patients were followed, of whom 107 (16.2%) were newly diagnosed with hypertension within 6 months, which was a significantly higher percentage than among the matched controls (4.9%, P < 0.001) CONCLUSION: The patients with epistaxis had elevated BP at presentation and a higher proportion of newly diagnosed hypertension within six months compared to the matched controls. [ABSTRACT FROM AUTHOR]

Background Influenza infection is a contagious disease and annual influenza vaccination is recommended to the patients with chronic diseases. Although diabetes is an indication for influenza vaccination, the global rate of influenza vaccination is insufficient. Therefore, our study aimed to elucidate influenza vaccination statuses among patients with diabetes and the related factors in Korea. Methods A total of 32,268 subjects (4,540 with and 27,728 without diabetes) from the Korea National Health and Nutrition Examination Survey III–VI (2005–2015) were included. Socioeconomic factors and health-related factors were analyses for the relation of influenza vaccination by Student's t -test, the chi-squared test and a multivariate logistic regression analysis. Results The influenza vaccination coverage rates were 50.0% in the diabetes mellitus (DM) group and 38.2% in the non-DM group. The trends in influenza vaccination rates during KNHANES III–VI were not significant in each group (P trend  =  0.24 in the DM group, 0.30 in the non-DM group). Socioeconomic (older age, female sex, higher family income, and medical aid insurance) and health-related factors (lack of risky alcohol consumption, obesity, and recent health check-ups) were associated with influenza vaccination among patients with DM. Conclusions The rate of influenza vaccination among patients with diabetes is insufficient in Korea. More efforts are needed to increase the influenza vaccination rates among vulnerable at-risk populations. [ABSTRACT FROM AUTHOR]

Objective The present study evaluated the mental health of patients with diabetes mellitus (DM) in Korea and compared it with mental health in the general Korean population. Methods All data included in the final analyses were collected from 34,065 subjects (20 years of age or older) who participated in the 2007–2012 Korea National Health and Nutrition Examination Survey (KNHANES). The mental health of 3846 DM patients were compared with that of 30,219 controls. Results A depressed mood for 2 or more continuous weeks was reported by 13.6% of subjects with normal glucose tolerance (NGT), 14.3% of those with impaired glucose intolerance (IFG), and 17.6% of DM patients. Suicidal thoughts were reported by 15.3% of individuals with NGT, 15.6% of participants with IFG, and 17.6% of DM patients. Suicidal attempts were reported by 0.8% of people with NGT, 1.0% of those with IFG, and 1.3% of DM patients. In DM patients, the crude odds ratio (OR) for depressive mood was 1.376 (95% confidence interval [CI]: 1.258–1.504), the OR for suicidal ideation was 1.481 (95% CI: 1.361–1.611) and the OR for suicidal attempts was 1.413 (95% CI: 1.021–1.956). A multivariate analysis revealed that the ORs for depression, suicidal ideation, and suicidal attempts in DM patients were 1.178 (95% CI: 1.070–1.297), 1.152 (95% CI: 1.050–1.263), and 1.413 (95% CI: 1.021–1.956), respectively. Conclusions The present study found that DM was associated with a marked increase in suicidal behaviors. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study compares biomarker (including procalcitonin, pro-ANP, and copeptin) levels to pneumonia severity scores to predict 30-day mortality in NHAP (nursing home acquired pneumonia) patients. Methods: Seventy three patients aged≥65y, admitted to general hospitals and who fulfilled the definition of NHAP were included in the study. Data collected at admission included age, gender, nursing home admission, coexisting illness, symptoms and clinical parameters (blood pressure, pulse rate, respiratory rate and status). Additional data collected included laboratory results, radiographic findings and outcome variables. Severity of pneumonia was evaluated using a prediction rule calculated by CURB-65 criteria (confusion, urea nitrogen, respiratory rate, blood pressure, age>65y). Results: After adjustment for age, sex and CURB-65, copeptin (OR=5.60, 95% confidence interval (CI)=1.20–26.24) was associated with 30-day mortality in NHAP patients, while procalcitonin and pro-ANP were not. The areas under the receiver operating characteristic curves (AUCs) for CURB-65, in predicting mortality were 0.685 [95% CI 0.559–0.811], whereas copeptin showed slightly superior accuracy with an AUC of 0.698 (95% CI 0.568–0.827). Conclusions: Among 3 biomakers, copeptin was the strongest predictor of 30-day mortality from NHAP. The pathophysiologic and clinical implications of this finding require further investigation. [Copyright &y& Elsevier]

Abstract: Interferon gamma release assays are used for diagnosing latent tuberculosis (TB); however, their role in diagnosing tuberculous pleural effusion (TPE) is not defined. The aim of this study was to evaluate the usefulness of the QuantiFERON-TB Gold In-Tube assay (QFT-IT) and compare this assay with the tuberculin skin test (TST) for diagnosing TPE in settings where tuberculosis is endemic and bacillus Calmette–Guérin vaccination is mandatory. The TST and QFT-IT test were conducted prospectively with 101 patients presenting with clinically suspected TPE. Of the 97 evaluable subjects, 54 had TPE. The sensitivity, specificity, positive predictive value, and negative predictive value were, respectively, 76.9%, 61.1%, 74.1%, and 64.7% for QFT-IT; 72.5%, 71.7%, 77.1%, and 66.7% for TST; and 83.7%, 45.7%, 68.3%, and 66.7% for QFT-IT plus TST. Thus, the QFT-IT test may be more useful than the TST for diagnosing TPE. Although the combination of QFT-IT and TST had higher sensitivity, it had poor specificity owing to the high prevalence of latent TB in our setting. [Copyright &y& Elsevier]

Atrioesophageal fistula (AEF) is a rare but disastrous complication encountered after radiofrequency catheter ablation for atrial fibrillation or flutter. Furthermore cerebral air embolism due to AEF is considered a strong predictor of mortality. In our case a patient presented with AEF and cerebral air embolism. As a rescue effort ventricular fibrillation was induced and sustained under venoarterial extracorporeal membrane oxygenation support until emergency AEF repair was feasible. Herein we report the successful use of the above measures to prevent further air embolism in a patient with radiofrequency catheter ablation–related AEF. [ABSTRACT FROM AUTHOR]

With the emphasis on bilateral hearing nowadays, bilateral cochlear implantation has been tried out for bilateral aural rehabilitation. Bilateral sensorineural hearing loss caused by head trauma can get help from cochlear implantation. We present the case of a 44-year-old man with bilateral otic capsule violating temporal bone fractures due to head trauma. The patient demonstrated much improved audiometric and psychoacoustic performance after bilateral cochlear implantation. We believe bilateral cochlear implantation in such patient can be a very effective tool for rehabilitation. [ABSTRACT FROM AUTHOR]

Objectives: Accurate prediction of pathological N2 metastasis is crucial for choosing the best therapeutic strategy for non-small cell lung cancer (NSCLC) patients. The aim of this study is to evaluate the usefulness of metabolic heterogeneity assessed by the positron emission tomography combined with computed tomography (PET/CT) using F-18 fluorodeoxyglucose (FDG) in primary NSCLC with clinically suspected N2 metastasis in predicting pathological mediastinal lymph node metastasis.Materials and Methods: Fifty patients with newly diagnosed NSCLC and clinically suspected N2 on preoperative CT and F-18 FDG PET/CT were included. Pathological results were confirmed by surgical specimens and the coefficient of variation (COV) was used to evaluate the metabolic heterogeneity of primary tumor mass by using F-18 FDG PET/CT.Results: Among the 50 patients with clinically suspected N2, 23 patients were pathologically confirmed as positive mediastinal lymph node metastasis and 27 patients were negative. Pathologically confirmed positive mediastinal lymph node metastasis group presented higher COV than the negative metastasis group (p < 0.001). An optimal cut-off value of 41.9 was proposed for discriminating metastasis from non-metastasis group. The sensitivity and specificity were 65.2% and 88.9%, respectively (AUC: 0.84; p < 0.0001). In addition, compared with other metabolic parameters, metabolic heterogeneity defined as COV showed the superior predictability of the mediastinal metastasis. (p = 0.001) CONCLUSION: Metabolic heterogeneity which was defined as COV of primary tumor could predict pathological mediastinal lymph node metastasis in NSCLC patients with clinically suspected N2. Therefore, COV of primary tumor may play a complementary role to conventional imaging in providing nodal information before taking biopsy. [ABSTRACT FROM AUTHOR]

Branched ZnO nanowires (NWs) doped with Ni were grown by a three-step vapor phase method for the sensitive and selective detection of p -xylene. ZnO NWs were directly grown on sensor substrates with Au electrodes, which were transformed into NiO NWs by the thermal evaporation of NiCl 2 powder at 700 °C. ZnO branches doped with Ni were grown from NiO NWs by the thermal evaporation of Zn metal powder at 500 °C. The stem NiO NWs played the role of catalyst for the growth of ZnO branches through vapor–liquid–solid mechanism. The Ni-doped branched ZnO NWs showed enhanced gas response ( S = resistance ratio) to methyl benzenes, especially to 5 ppm p -xylene ( S = 42.44) at 400 °C. This value is 1.7 and 2.5 times higher than the responses to 5 ppm toluene ( S = 25.73) and C 2 H 5 OH ( S = 16.72), respectively, and significantly higher than the cross-responses to other interfering gases such as benzene, HCHO, trimethylamine, H 2 , and CO. The selective detection of xylene was attributed to the catalytic role of the Ni component. This novel method to form catalyst-doped hierarchical ZnO NWs provides a promising approach to accomplish superior gas sensing characteristics by the synergetic combination of enhanced chemiresistive variation due to the increased number of branch-to-branch Schottky barrier contacts and the catalytic function of the Ni dopant. [ABSTRACT FROM AUTHOR]