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Background Repair of facial laceration in the emergency department can pose a number of difficulties. Children can be uncooperative, but adults can also be if they have sustained head trauma or are intoxicated. Leukosan SkinLink consists of topical adhesive and adhesive tape that can be applied easily to long or tense wounds. In this study, the authors compared conventional suturing with Leukosan SkinLink for facial laceration patients in the emergency department. Methods The prospective study was carried out from March 2013 to September 2013 with linear facial laceration patients visiting the emergency department. Exclusion criteria were open fractures, joint injuries, skin defects, hairy skin, and mucosa. The author used Leukosan SkinLink for skin closure in the experimental group and used conventional suturing in the control group. The scar evaluation using the Patient and Observer Scar Assessment Scale (POSAS) along with satisfaction scores, procedure times, and complications were compared. Results A total of 77 patients (30 in the control group and 47 in the experimental group) participated and underwent follow-up for 6 months postoperatively. The scar assessment using the POSAS and the satisfaction score in both groups were similar. The average procedure time in the experimental group was shorter. In the control group, there were four cases of wound dehiscence, two of infection, and one of skin necrosis, whereas four cases of wound dehiscence and one allergic reaction occurred in the experimental group. Conclusions With a simple application technique, Leukosan SkinLink is a new effective method for facial laceration repair especially useful for children and uncooperative adults.

Background Maintaining stability and restoring the aesthetic appearance are the fundamental goals when managing zygomatic fractures. We aimed to evaluate the stability and anthropometric outcomes of zygomatic fracture patients who underwent two-point fixation involving the infraorbital rim and zygomaticomaxillary buttress via the transconjunctival and gingivobuccal approaches without any skin incisions. Methods We examined 15 zygomatic fracture patients who underwent two-point fixation during a 3-year period. Stability was evaluated using three-dimensional facial bone computed tomography. Superoinferior and anteroposterior displacement of the zygoma was quantified. The aesthetic appearance of the periorbital region was evaluated using indirect anthropometry with standardized clinical photographs. The ratios between the eye fissure height and width, and lower iris coverage ratio were used to evaluate aesthetical changes. The bony displacement and aesthetic ratios were analyzed using Wilcoxon or Friedman tests. The correlation between the preoperative zygoma position and anthropometric values was analyzed. Results The positions of the zygoma were similar to those on the contralateral side at the long-term follow-up. The preoperative anthropometric measurements on the fractured side differed from those on the contralateral side, although these values were close to the normal values at the long-term follow-up. Furthermore, we noted that the anteroposterior displacement strongly positively correlated with the lower iris coverage rate (Spearman's coefficient= 0.678, P=0.005). Conclusions Two-point fixation of zygomatic fractures achieved stable outcomes on long-term follow-up, and also appeared to be reliable in restoring the aesthetic appearance of the periorbital region.

Campylobacter, a common foodborne human pathogen, is considered sensitive to oxygen. Recently, aerotolerant (AT) Campylobacter jejuni with the ability to survive under aerobic stress has been reported. Here, we investigated the prevalence of hyper-aerotolerant (HAT) Campylobacter coli from duck sources (118 carcasses and meat) and its characteristics to assess potential impacts on public health. Half of 56 C. coli isolates were HAT and most harbored various virulence genes including flaA, cadF, cdtA, ceuB, and wlaN. Moreover, 98.2% of C. coli isolates showed resistance to quinolones, including ciprofloxacin (CIP), and nine (16.1%) showed high-level resistance to ciprofloxacin (Minimum Inhibitory Concentration, MIC ≥ 32 μg/mL) and most of these were HAT. Based on genetic relatedness between C. coli from duck sources and those from human sources (PubMLST and NCBI), HAT isolates sharing the same MLST sequence types were significantly more prevalent than those not sharing the same sequence types as those from human sources. Therefore, HAT C. coli is prevalent in duck sources, and is most likely transmitted to humans through the food chain given its aerotolerance. This being so, it might pose a threat to public health given its virulence and antimicrobial resistance (AMR). This study will assist in improving control strategies to reduce farm-to-table HAT C. coli transmission to humans.

Human infections with Campylobacter are primarily associated with the consumption of contaminated poultry meat. In this study, we isolated Campylobacter jejuni from retail raw chicken and duck meat in Korea and compared their aerotolerance, antibiotic resistance, and virulence gene prevalence. Whereas C. jejuni isolates from chicken dominantly belonged to multilocus sequence typing (MLST) clonal complex (CC)-21, CC-45 is the common MLST sequence type in duck meat isolates. C. jejuni strains from both chicken and duck meat were highly tolerant to aerobic stress. The prevalence of virulence genes was higher in C. jejuni strains from chicken than those from duck meat. However, antibiotic resistance was higher in duck meat isolates than chicken isolates. Based on the prevalence of virulence genes and antibiotic resistance, fluoroquinolone-resistant C. jejuni strains harboring all tested virulence genes except virB11 were predominant on retail poultry. Fluoroquinolone-resistant C. jejuni strains carrying most virulence genes were more frequently isolated in summer than in winter. The comparative profiling analysis in this study successfully demonstrated that antibiotic-resistant and pathogenic strains of C. jejuni are highly prevalent on retail poultry and that retail duck meat is an important vehicle potentially transmitting C. jejuni to humans in Korea.

BackgroundPedicled transverse rectus abdominis musculocutaneous flaps typically sacrifice the entire muscle. In our experience, the lateral strip of the rectus abdominis muscle can be spared in an attempt to maintain function and reduce morbidity. When the intercostal nerves are injured, muscle atrophy appears with time. The severed intercostal nerve was reinserted into the remnant lateral strip of the rectus abdominis muscle to reduce muscle atrophy.MethodsThe authors retrospectively reviewed 9 neurotized cases and 10 non-neurotized cases. Abdominal computed tomography was performed to determine the area of the rectus muscles. Electromyography (EMG) was performed to check contractile function of the remnant muscle. A single investigator measured the mean areas of randomly selected locations (second lumbar spine) using ImageJ software in a series of 10 cross-sectional slices. We compared the Hounsfield unit (HU) pre- and postoperatively to evaluate regeneration quality.ResultsIn the neurotization group, 7 of 9 cases maintained the mass of remnant muscle. However, in the non-neurotization group, 8 of 10 lost their mass. The number of totally atrophied muscles in each of the two groups was significantly different (P=0.027). All of the remnant muscles showed contractile function on EMG. The 9 remaining remnant rectus abdominis muscles showed declined the HU value after surgery but also within a normal range of muscle.ConclusionsNeurotization was found to be effective in maintaining the mass of remnant muscle. Neurotized remnant muscle had contractile function on EMG and no fatty degeneration by HU value.

Background For patients with neuropathy, vasculopathy, and impairment of wound healing, treatment of a diabetic foot ulcer poses many challenges. A large number of dermal analogues have been invented in an effort to overcome these challenges. Matriderm, a dermal analogue, is made from bovine collagen and elastin. This study was conducted in order to evaluate the effectiveness of Matriderm for treatment of diabetic foot ulcers, in comparison with skin grafting.Methods Sixty patients with diabetic foot ulcer were included in this prospective study. The average age of the patients, who had type II diabetes mellitus, was 58 years old. The patients were allocated to an experimental or control group with their consents. The patients were selected with their consent for inclusion in an experimental group and a control group. Patients in the experimental group received a Matriderm appliance and a split-thickness skin graft, while those in the control group received only a split-thickness skin graft.Results A shorter hospitalization period (7.52 weeks) was observed in the experimental group than in the control group (9.22 weeks), and a shorter period of time (8.61 weeks) was required for complete healing, compared with the control group (12.94 weeks), with statistical significance (P

BackgroundTo minimize the inflammatory reaction and improve healing, a new modified dermal substitute composed of an atelocollagen, chondroitin-6-sulfate, and amniotic membrane (AM) was applied to full-thickness skin defects in a pig. Atelocollagen was extracted from bovine skin, and two modified dermal substitutes were generated according to the cross-linking type.MethodsThe AM-collagen dermal substitutes were characterized and compared with currently used dermal substitutes in a pig skin defect model. There were five experimental groups: dehydrothermal (DHT) cross-linking atelocollagen with the AM on the top (AM-DHT), DHT and chemical cross-linking atelocollagen with the AM on the top (AM-DHT/chemical), Terudermis, Integra, and AlloDerm. After 3×3 cm full-thickness skin defects on the back of a pig were created, each dermal substitutes dermal substitutes was randomly grafted on the defects. Two weeks after grafting, autologous partial-thickness skin was over-grafted on the neodermis. The take rate of the dermal substitutes, skin, and histological sections were all assessed at 1, 2, and 4 weeks postoperatively.ResultsMore rapid healing and a higher take rate were evident in the AM-DHT and Terudermis groups. Histological examination revealed fewer inflammatory cells and more fibroblast hyperplasia in these two groups. Four weeks after surgery, the amount of newly formed collagen was significantly more appropriate in the AM-DHT group.ConclusionsThese observations provide supporting evidence that a newly developed amniotic-collagen dermal substitute may inhibit inflammatory reactions and promote wound healing.

BackgroundAmong the various methods for correcting nasal deformity, the composite graft is suitable for the inner and outer reconstruction of the nose in a single stage. In this article, we present our technique for reconstructing the ala and columella using the auricular chondrocutaneous composite graft.MethodsFrom 2004 to 2011, 15 cases of alar and 2 cases of columellar reconstruction employing the chondrocutaneous composite graft were studied, all followed up for 3 to 24 months (average, 13.5 months). All of the patients were reviewed retrospectively for the demographics, graft size, selection of the donor site and outcomes including morbidity and complications.ResultsThe reasons for the deformity were burn scar (n=7), traumatic scar (n=4), smallpox scar (n=4), basal cell carcinoma defect (n=1), and scar contracture (n=1) from implant induced infection. In 5 cases of nostril stricture and 6 cases of alar defect and notching, composite grafts from the helix were used (8.9×12.5 mm). In 4 cases of retracted ala, grafts from the posterior surface of the concha were matched (5×15 mm). For the reconstruction of the columella, we harvested the graft from the posterior scapha (9×13.5 mm). Except one case with partial necrosis and delayed healing due to smoking, the grafts were successful in all of the cases and there was no deformity of the donor site.ConclusionsAn alar and columellar defect can be reconstructed successfully with a relatively large composite graft without donor site morbidity. The selection of the donor site should be individualized according to the 3-dimensional configuration of the defect.

Background Axillary osmidrosis is characterized by an unpleasant odor, profuse sweating, and in some instances, staining of clothes that may socially and psychologically impair affected individuals. Various types of surgical procedures have been developed for the treatment of axillary osmidrosis. This study was undertaken to evaluate the effectiveness of subcutaneous pulsed neodymium: yttrium-aluminum-garnet (Nd-YAG) laser treatment for the treatment of axillary osmidrosis. Methods Twenty-nine patients with axillary osmidrosis were included in this study. Patients were categorized according to the results of an axillary malodor grading system, and a subcutaneous pulsed Nd-YAG laser was applied to all patients. The treatment area for the appropriate distribution of laser energy was determined using the iodine starch test (Minor's test) against a grid pattern composed of 2×2 cm squares. The endpoint of exposure was 300 to 500 J for each grid, depending on the preoperative evaluation results. The results were evaluated by measurement of axillary malodor both pre- and postoperatively using the grading system and iodine starch test. Results The average follow-up period was 12.8 months. Nineteen patients had a fair-to-good result and ten patients had poor results. The postoperative Minor's test demonstrated that there were remarkable improvements for patients with mild to moderate symptoms. Complications including superficial second degree burns (n=3) were treated in a conservative manner. A deep second degree burn (n=1) was treated by a surgical procedure. Conclusions Subcutaneous pulsed Nd-YAG laser has many advantages and is an effective noninvasive treatment for mild to moderate axillary osmidrosis.

In Cognitive Radio sensor networks, a pair of Cognitive Radio (CR) users wishing to communicate should first agree on a specific channel called control channel. Communication rendezvous is used to establish a control channel between CR users. Channel Hopping (CH) protocol is a sequence-based approach that provides an effective method for implementing rendezvous without relying on a Common Control Channel (CCC). In this approach, all CR users hop to the same rendezvous channel and hence this channel will serve as a control channel between them. In this paper, we propose two Channel Hopping Sequences (CHS) to establish a link in CR sensor networks with and without the assumption of global clock synchronization. Our schemes provide successful communication rendezvous within a bounded time interval. Theoretical analysis and simulation results showed that both schemes outperform the existing schemes used for similar purpose in terms of many performance criteria.

Two or more nodes need to establish a link on an available channel in a cognitive radio (CR) sensor network when they want to transmit data. Rendezvous is the process by which the nodes explore the available channels to establish a link when they want to communicate with each other. The method of finding a common channel is a challenging problem. A dedicated common control channel simplifies the rendezvous process, but it may create a single point of failure. In this paper, we propose a hopping sequence algorithm to provide an effective method to implement a rendezvous without relying on a dedicated control channel. Our scheme achieves a successful rendezvous within a single period in a CR sensor network. Analytical and simulation results show that our proposed scheme outperforms the existing schemes in terms of time to rendezvous, fairness, degree of overlapping, and the effect by primary user appearance.

Embedding magnetic particles into cement paste produces a smart material in which the rheological properties of the resultant paste can be actively controlled through the use of magnetorheological (MR) principles. This research investigates the rheological behavior of cement-based MR pastes with and without air entrainment to gain a better understanding of the effects of air-entrained bubbles on MR cement pastes. Such information would be critical for the use of such MR pastes in three-dimensional (3-D) concrete printing applications. It is revealed that the incorporation of entrained air increases the MR response, and this effect is related to the bubble-bridge effect. [ABSTRACT FROM AUTHOR]

Objective: While the association between depression and frailty in the elderly population has been investigated, the psychological factors that mediate such a relationship remain unknown. The identification of psychological factors in interventions for depression treatment in the elderly may assist in the treatment and care. We aimed to explore the mediating effects of anger, anxiety, and resilience on the link between frailty and depression symptoms in patients with late-life depression. Methods: A sample of 203 older adults completed questionnaires that assessed depression, anger, resilience, and anxiety. To measure frailty, participants were evaluated using a self-rated health questionnaire, weight-adjusted waist index related to sarcopenia, and weight-adjusted handgrip strength to evaluate weakness. A mediation model was tested, hypothesizing that anger, anxiety, and resilience would partially mediate the strength of the frailty-depression link in the elderly. Results: Only self-rated health showed a significant association with depressive symptoms in late-life depression. Our study demonstrated that frailty has both direct and indirect associations with depression, mediated by anger, resilience, and anxiety. Conclusion: Given that anger, resilience, and anxiety influence the link between self-rated health and depression, interventions that lead to increased resilience and decreased anger and anxiety may be promising to reduce depressive symptoms in older adults with depression. [ABSTRACT FROM AUTHOR]

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Purpose: Delirium in the intensive care unit (ICU) poses a significant safety and socioeconomic burden to patients and caregivers. However, invasive interventions for managing delirium have severe drawbacks. To reduce unnecessary interventions during ICU hospitalization, we aimed to investigate the features of delirium among ICU patients according to the occurrence of hypoactive symptoms, which are not expected to require invasive intervention. Materials and Methods: Psychiatrists assessed all patients with delirium in the ICU during hospitalization. Patients were grouped into two groups: a "non-hypoactive" group that experienced the non-hypoactive motor subtype once or more or a "hypoactive only" group that only experienced the hypoactive motor subtype. Clinical variables routinely gathered for clinical management were collected from electronic medical records. Group comparisons and logistic regression analyses were conducted. Results: The non-hypoactive group had longer and more severe delirium episodes than the hypoactive only group. Although the non-hypoactive group was prescribed more antipsychotics and required restraints longer, the hypoactive only group also received both interventions. In multivariable logistic regression analysis, BUN [odds ratio (OR): 0.993, pH OR: 0.202], sodium (OR: 1.022), RASS score (OR: 1.308) and whether restraints were applied [OR: 1.579 (95% confidence interval 1.194-2.089), p<0.001] were significant predictors of hypoactive only group classification. Conclusion: Managing and predicting delirium patients based on whether patients experienced non-hypoactive delirium may be clinically important. Variables obtained during the initial 48 hours can be used to determine which patients are likely to require invasive interventions. [ABSTRACT FROM AUTHOR]

The brain houses vital hormonal regulatory structures such as the hypothalamus and pituitary gland, which may confer unique susceptibilities to critical illness-related corticosteroid insufficiency (CIRCI) in patients with neurological disorders. In addition, the frequent use of steroids for therapeutic purposes in various neurological conditions may lead to the development of steroid insufficiency. This abstract aims to highlight the significance of understanding these relationships in the context of patient care and management for physicians. Neurological disorders may predispose patients to CIRCI due to the role of the brain in hormonal regulation. Early recognition of CIRCI in the context of neurological diseases is essential to ensure prompt and appropriate intervention. Moreover, the frequent use of steroids for treating neurological conditions can contribute to the development of steroid insufficiency, further complicating the clinical picture. Physicians must be aware of these unique interactions and be prepared to evaluate and manage patients with CIRCI and steroid insufficiency in the context of neurological disorders. This includes timely diagnosis, appropriate steroid administration, and careful monitoring for potential adverse effects. A comprehensive understanding of the interplay between neurological disease, CIRCI, and steroid insufficiency is critical for optimizing patient care and outcomes in this complex patient population. [ABSTRACT FROM AUTHOR]

Purpose: Infected malleolar bursitis sometimes requires multiple debridements, followed by soft tissue reconstruction with a flap. The purpose of this study was to evaluate the clinical outcomes of patients with infected lateral malleolar bursitis who were treated using peroneal artery perforator-based propeller flaps. Methods: We retrospectively included 10 patients who underwent reconstruction of the lateral malleolus with a peroneal artery perforator-based propeller flap due to infected lateral malleolar bursitis between 2014 and 2022. Results: The average follow-up time was 77.2 weeks. Six patients experienced complete healing; three developed partial flap necrosis, and one had a long-lasting seroma. All patients with complications had long-term diabetes. Conclusion: Partial flap necrosis in patients with diabetes may occur because of impaired microcirculation. A peroneal artery perforator-based propeller flap could be useful for soft tissue reconstruction in select patients without diabetes or in patients with diabetes who have infected lateral malleolar bursitis. [ABSTRACT FROM AUTHOR]