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Few studies have assessed the efficacy and safety of reconstruction of sternal infection using a pectoralis muscle flap combined with a rectus abdominis muscle (RAM) sheath fasciocutaneous flap. We report here our experience with this procedure to reconstruct the sternal defect in patients (n = 46) with a deep sternal wound infection (DSWI) after cardiac surgery. After wound reconstruction, the proportion of prolonged mechanical ventilation use and intensive care unit (ICU) stay were 17.4% (n = 8) and 21.7% (n = 10), respectively. The 30-day all-cause mortality was 15.2%; recurrence rate was 17.4%; postoperative complications were 15.2%; and median hospital stay was 31 (0-157) days. Multivariate logistic regression analysis revealed that hypertension (β = 21.32, 95%CI 4.955-37.68, P = .014), drainage-tube use (β = 0.944, 95%CI 0.273-1.614, P = .008), and prolonged intensive care unit stay (β = 53.65, 95%CI 31.353-75.938, P .001) were significantly correlated with hospital stay. In conclusion, a procedure including surgical debridement, sternal reconstruction with bilateral PM and RAM sheath flap, long-term antibiotics, and adequate drainage is a beneficial technique in the reconstruction of deep sternal wound infection after cardiac surgery. Duration of drainage tube use may be as an index for a hospital stay or wound healing.

Due to the non-linear and complex characteristics of oil futures prices, they are easily affected by external factors. Therefore, predicting the price of oil futures is a very challenging topic in deep learning time series, but the existing literature lacks research on introducing relevant features. Therefore, the purpose of this paper is to use a two-way attention mechanism to predict oil futures prices and import gold prices as features. The data source is taken from Yahoo Finance, providing 5146 items from 2000/02/28 to 2020/06/29. The paper uses CNNBiLSTM, CNNBiGRU models and Attention CNNBiLSTM, Attention CNNBiGRU, Dual Attention CNNBiGRU, Dual Attention CNNBiLSTM and TPA-LSTM, Prophet, ARIMA that increase the attention mechanism to conduct experiments to find the best model. Moreover, explore the sliding window review days to deal with two-dimensional time series data and the influence of the delay of the typical days to predict the experiment's impact. The experimental results show that increasing the number of review days will decrease the prediction accuracy. The new model is imported using the two-dimensional time series method, and the attention mechanism is integrated. Importing CNNBiGRU with a dual attention mechanism from 80% of the training items and 20% of the test items in the experimental data set can improve the overall prediction accuracy. For example, the model BiGRU has improved the RMSE from 2.79 to 1.85 by adding a dual attention mechanism. In addition, it is found that if the regression model has large fluctuations in the prediction data, it will increase the RMSE and MAE, especially in the experimental items of 96% training and 4% testing data sets.

In this paper, system identification by the deep learning model (DLM) is proposed to compare with the self-learning particle swarm optimization (SLPSO) for a mechatronic motor-table system. Firstly, the complete dynamic formulation containing both mechanical equation with nonlinear frictional force and electrical equation is successfully formulated. Secondly, the governing equations are employed in the DLM and SLPSO to identify the unknown parameters for the mechatronic system. It is shown that the system identification can be successfully performed by using the DLM and SLPSO in this paper. In numerical simulations and experimental results, we discuss their advantage and disadvantage, and it is found that the DLM can identify the unknown parameters better converging toward the real ones when comparing with the SLPSO.

Background Reuse of cardiac implantable electronic devices (CIEDs) can reduce the cost of using these expensive devices. However, whether resterilized CIEDs will increase the risk of reinfection in patients with previous device infection remains unknown. The aim of the present study is to compare the reinfection rates in patients who had initial CIED infection and underwent reimplantation of resterilized CIEDs or new devices. Methods Data from patients with initial CIED infection who received debridement of the infected pocket and underwent reimplantation of new or resterilized CIEDs at MacKay Memorial Hospital, Taipei, Taiwan, between January 2014 and June 2019 were retrospectively analyzed. Patient characteristics, relapse rates of infection, and potential contributing factors to the infection risk were examined. Results Twenty-seven patients with initial CIED infection and reimplanted new CIEDs (n = 11) or resterilized CIEDs (n = 16) were included. During the 2-year follow-up, there were 1 (9.1%) and 2 (12.5%) infection relapses in the new and resterilized CIED groups, respectively. No relapse occurred for either group if the lead was completely removed or cut short. The median duration between debridement and device reimplantation in patients with infection relapse vs patients without relapse was 97 vs 4.5 days for all included patients, and 97 vs 2 days and 50.5 vs 5.5 days for the new and resterilized CIED groups, respectively. Conclusions Subpectoral reimplanting of resterilized CIEDs in patients with previous device infection is safe and efficacious. With delicate debridement and complete extraction of the leads, the CIED pocket infection relapse risk can be greatly decreased.

Objective: To explore the significance of pelvic organ prolapse (POP) on pelvic floor muscle (PFM) function among women with lower urinary tract symptoms (LUTS). Materials and methods: Four-dimensional ultrasound data of 577 women with LUTS were retrospectively analyzed. The bladder neck and genital hiatus were assessed during resting, coughing, and squeezing. The bladder neck location, genitohiatal size, and genitohiatal location were evaluated with bladder neck distance (BNd) and bladder neck angle (BNa), genitohiatal dimension (GHd) and genitohiatal area (GHAR), and genitohiatal angle (GHa), respectively. Results: Compared with women without POP (n = 306), women with POP (n = 271) exhibited higher rates of levator complete avulsion (6.5% vs. 40.2%, P

This parallel-two-group randomized experimental study including a supervised group and an unsupervised group examined the longitudinal effects of pelvic floor muscle training (PFMT) combined with yoga on genitourinary symptoms and the health-related quality of life (HRQOL), and compared practice adherence rates of the two groups. A sample of women experiencing ≥1 genitourinary symptom(s) were recruited and assigned to a supervised group or an unsupervised group. The supervised group attended supervised group practice sessions and performed at-home practice of PFMT and yoga. The unsupervised group performed at-home practice of PFMT and yoga. Information was collected at five time points (n = 91). Generalized estimating equation procedures were used to examine the intervention effects. An independent t-test was conducted to compare the practice adherence rates. Both groups' genitourinary symptoms and HRQOL significantly improved over time. The supervised group displayed greater improvements in genitourinary symptoms and HRQOL and better adherence than did the unsupervised group.

The exhaust emissions from Internal Combustion Engines (ICE) are currently one of the main sources of air pollution. This research presented a method for improving the exhaust gases and the performance of a Spark-Ignition (SI) engine using a water vapor injection system and a Non-Thermal Plasma (NTP) system. These two systems were installed on the intake manifold to investigate their effects on the engine’s performance and the characteristics of exhaust emission using different air/fuel (A/F) ratios and engine speeds. The temperatures of the injected water were adjusted to 5 and 25 °C, using a thermoelectric cooler (TEC) temperature control device. The total hydrocarbons (HC), nitrogen oxide (NOx), and engine torque were measured at different A/F ratios and engine speeds. The results indicated that the adaptation of the water vapor injection system and NTP system increased the content of the combustibles and combustion-supporting substances while achieving better emissions and torque. According to the test results, while the engine torque under 25 °C water+NTP was raised to 7.29%, the HC under 25 °C water+NTP and the NOx under 25 °C water were reduced to 16.31% and 11.88%, respectively. In conclusion, the water vapor injection and the NTP systems installed on the intake manifold could significantly reduce air pollution and improve engine performance for a more sustainable environment.

Additive manufacturing (AM) has the advantages of providing materials with lightweight microporous structures and customized features, and being environmentally safe. It is widely used in medical sciences, the aerospace industry, biological research, engineering applications, and other fields. Among the many additive manufacturing methods, fused deposition modeling (FDM) is relatively low-cost, wastes less raw material and has a lower technical threshold. This paper presents a study on 3D printing based on FDM by changing two printing parameters, namely the printing temperature and filling percentage. The produced polylactic acid (PLA) material was analyzed through tensile and Shore D hardness tests and the differences in mechanical properties before and after the UV curing process were analyzed. The results show that increasing the filling percentage or increasing the printing temperature can effectively improve the tensile Young’s modulus, ultimate tensile strength, elongation, and Shore hardness of the material. The UV curing process could enhance the rigidity and hardness of the material significantly but reduced the strength and toughness of the material. These findings could benefit researchers studying FDM with the goal of achieving sustainable manufactured materials.

In order to optimize the efficiency of the Fused deposition modeling (FDM) process, this study used polylactic acid (PLA) material under different parameters (the printing angle and the raster angle) to fabricate specimens and to explore its tensile properties. The effect of the ultraviolet (UV) curing process on PLA materials was also investigated. The results showed that the printing and raster angles have a high impact on the tensile properties of PLA materials. The UV curing process enhanced the brittleness and reduced the elongation of PLA material. Different effects were observed on tensile strength and modulus of specimens printed with different parameters after UV curing. The above results will be a great help for researchers who are working to achieve sustainability of PLA materials and FDM technology.

Background An iatrogenic tracheoesophageal (TE) fistula is one possible complication after total laryngectomy with flap reconstruction. We used sternocleidomastoid (SCM) rotation flap to close a TE fistula. Methods and results A 69-year-old man with laryngeal cancer underwent total laryngectomy with radial forearm free flap reconstruction. A tracheostoma stenosis was noticed 7 months after the tracheostomy tube was removed. The patient underwent tracheostoma dilatation; the iatrogenic TE fistula was noticed 1 month later. We used SCM rotation flap to close the TE fistula. The postoperative course was uneventful. A barium esophagogram showed no leakage in the esophagus. Conclusions Tracheoesophageal fistula can be reconstructed with an SCM rotation flap. If the TE fistula is of a suitable size, this reconstructive strategy is effective and simple to close persistent TE fistula and avoid further airway complications.

The antlion optimization algorithm (ALO) is one of the most effective algorithms to solve combinatorial optimization problems, but it has some disadvantages, such as a long runtime. As a result, this problem impedes decision makers. In addition, due to the nature of the problem, the speed of convergence is a critical factor. As the size of the problem dimension grows, the convergence speed of the optimizer becomes increasingly significant. Many modified versions of the ALO have been developed in the past. Nevertheless, there are only a few research articles that discuss better boundary strategies that can increase the diversity of ants walking around an antlion to accelerate convergence. A novel exponential-weighted antlion optimization algorithm (EALO) is proposed in this paper to address slow convergence rates. The algorithm uses exponential functions and a random number in the interval 0, 1 to increase the diversity of the ant’s random walks. It has been demonstrated that by optimizing twelve classical objective functions of benchmark functions, the novel method has a higher convergence rate than the ALO. This is because it has the most powerful search capability and speed. In addition, the proposed method has also been compared to other existing methods, and it has obtained superior experimental results relative to compared methods. Therefore, the proposed EALO method deserves consideration as a possible optimization tool for solving combinatorial optimization problems, due to its highly competitive results.

Background The presence of reactive and strong pelvic floor muscle (PFM) activities is supposed to be associated with better urinary and sexual functions in female stress urinary incontinence (SUI). Aim This study was to explore the association of baseline PFM activities, both volitional and reflex, with urinary and sexual functions in women with SUI but who had no experience of PFM training programs before. Methods Secondary analysis of a prospectively maintained database identified 125 sexually active women with SUI who had met the eligibility criteria. All patients had undergone intravaginal digital examination and pelvic ultrasound to detect volitional and reflex PFM activities, respectively, and responded to questionnaire surveys, including short forms of the urogenital distress inventory, incontinence impact questionnaire-7, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. On pelvic ultrasound, an inward clitoral motion and an anorectal lift preceding or during coughing were regarded as the presence of reflex activities of the PFM. Outcomes The relationship of volitional and reflex PFM activities with pelvic floor dysfunction relating questionnaires and urethral function on urodynamic studies was analyzed. Result Of the 125 women studied, 30 (24.0%) had volitional PFM contraction strength less than grade 2, 74 (59.2%) grade 2 to 3, and 21 (16.8%) greater than grade 3 based on the modified Oxford grading scale. During or preceding coughing, an inward clitoral motion was not observed on ultrasound in 9 (7.2%) women and an anorectal lift was not observed in 8 (6.4%) women. The strength of volitional PFM contraction and the presence or absence of anorectal lift reflex was not associated with urethral and sexual function. In contrast, the absence of reflex inward clitoral motion was significantly associated with lower maximum urethral closure pressure (P = .042) and higher scores of urogenital distress inventory-6 (P = .006) and incontinence impact questionnaire-7 (P = .029). Clinical implications Higher volitional PFM contraction strength was not associated with better sexual and urinary functions; however, loss of one reflex PFM activity was associated with poorer urinary function. Strengths & Limitation To our knowledge, this is the first study that evaluates the association of baseline PFM activities with sexual and urinary functions in female SUI. Nevertheless, the cross-sectional design of this study cannot well support the cause-effect relationship CONCLUSION Besides PFM physiotherapy for enhancing sexual and urinary functions in female SUI, additional treatment strategies such as neuromodulation should take into consideration for those who had absent reflex PFM activities.

Fused Deposition Modeling (FDM) can be used to manufacture any complex geometry and internal structures, and it has been widely applied in many industries, such as the biomedical, manufacturing, aerospace, automobile, industrial, and building industries. The purpose of this research is to characterize the polylactic acid (PLA) and polyethylene terephthalate glycol (PETG) materials of FDM under four loading conditions (tension, compression, bending, and thermal deformation), in order to obtain data regarding different printing temperatures and speeds. The results indicated that PLA and PETG materials exhibit an obvious tensile and compression asymmetry. It was observed that the mechanical properties (tension, compression, and bending) of PLA and PETG are increased at higher printing temperatures, and that the effect of speed on PLA and PETG shows different results. In addition, the mechanical properties of PLA are greater than those of PETG, but the thermal deformation is the opposite. The above results will be a great help for researchers who are working with polymers and FDM technology to achieve sustainability.

The Morel-Lavallee lesion (MLL) is a posttraumatic close degloving injury, which is often underdiagnosed at first. Patients with MLLs usually present with tender and enlarging soft tissue swelling with fluctuation, decreased skin sensation, ecchymosis, or even skin necrosis hours to days after the inciting injury. The lesion can lead to intractable morbidity if it remains untreated. There is no consensus regarding the treatment for MLL at present. Here, we report an MLL in the pretibial region of a 43-year-old woman who experienced a low-energy contusion in a motorbike accident. The pretibial lesion was diagnosed using sonography and fine-needle aspiration. We successfully treated the patient by performing percutaneous debridement via a small incision and injections of fibrin after conservative treatment failed. The method we herein propose achieved the goal of open surgical debridement, providing faster recovery and a high degree of patient comfort. We reviewed the available pertinent literature and propose our own treatment protocol with the aim to establish common therapies ofMLL.

Research on the use of ultrasound to explore the pelvic floor in women is rarely done with introital ultrasound. This study aimed to investigate the performance of four-dimensional (4D) introital ultrasound in the perioperative assessment of pelvic floor muscle (PFM) function in women with cystocele. The reliability and agreement of ultrasound measurements were determined by intraclass correlation coefficients (ICC) with 95 % confidence interval and Bland-Altman analysis in 20 women. The validity of ultrasound parameters was assessed by correlating squeezing ultrasound measurements with the modified Oxford scale (MOS) in 317 women. 4D introital ultrasound data of 241 women with (n = 29) and without (n = 212) postoperative cystocele at the 12-month postoperative assessment were retrospectively analyzed. Levator avulsion was diagnosed using tomographic ultrasound imaging. Involuntary and voluntary PFM functions were explored by dynamic changes in the bladder neck and genital hiatus, respectively, upon coughing and squeezing on 4D introital ultrasound. The ICC for the reliability of all tested ultrasound parameters was good to very good. The changes and change ratios of most ultrasound measurements from resting to squeezing were fairly correlated with MOS. Women with postoperative cystocele demonstrated more rates of complete levator avulsion [41.3 % vs. 4.7 %, P 0.001, odds ratio (OR) 14.26, 95 % confidence interval (CI) 4.88-42.42] and fewer rates of capable voluntary PFM contraction (65.5 % vs. 92.5 %, P 0.001, OR 0.16, 95 % CI 0.06-0.43) than those without postoperative cystocele postoperatively. 4D introital ultrasound is feasible to assess perioperative PFM function in women with cystocele.ZIEL: Die Forschung über den Einsatz von Ultraschall zur Untersuchung des Beckenbodens bei Frauen wird selten mit Introitus-Sonografie durchgeführt. Ziel dieser Studie war es, die Leistungsfähigkeit der 4-dimensionalen (4D) Introitus-Sonografie bei der perioperativen Beurteilung der Funktion der Beckenbodenmuskulatur (PFM) bei Frauen mit Zystozele zu untersuchen. Die Reliabilität und Übereinstimmung der Ultraschallmessungen wurden bei 20 Frauen mittels Intraklassen-Korrelationskoeffizienten (ICC) mit 95 %-Konfidenzintervall und Bland-Altman-Analyse bestimmt. Die Validität der Ultraschallparameter wurde bei 317 Frauen durch Korrelation der Ultraschallmessungen beim Pressen mit der modifizierten Oxford-Skala (MOS) beurteilt. Daten der 4D-Introitus-Sonografie von 241 Frauen mit (n = 29) und ohne (n = 212) postoperative Zystozele in der 12-monatigen postoperativen Erfassung wurden retrospektiv analysiert. Eine Levator-Avulsion wurde mittels tomografischen Ultraschalls diagnostiziert. Die nichtwillentlichen und willentlichen PFM-Funktionen wurden durch dynamische Veränderungen im Blasenhals bzw. im genitalen Hiatus beim Husten und Pressen im 4D-Introital-Ultraschall untersucht. Die ICC für die Reliabilität aller untersuchten Ultraschallparameter war gut bis sehr gut. Bei den meisten Ultraschallmessungen waren die Änderungen und die Änderungsverhältnisse zwischen Ruhezustand und Pressen ordentlich mit der MOS korreliert. Frauen mit postoperativer Zystozele zeigten im Vergleich zu Frauen ohne eine höhere Rate an vollständiger Levator-Avulsion (41,3 % vs. 4,7 %; p 0,001; Odds-Ratio (OR) 14,26; 95 %-Konfidenzintervall (CI) 4,88–42,42) und eine geringere Fähigkeit zur willentlichen PFM-Kontraktion (65,5 % vs. 92,5 %; p 0,001; OR 0,16; 95 %-CI 0,06–0,43). Die 4D-Introitus-Sonografie ist zur Beurteilung der perioperativen PFM-Funktion bei Frauen mit Zystozele durchführbar.

Objectives To report 5-year clinical and imaging outcomes of primary transoburator midurethral sling (TOT) procedures for uncomplicated urodynamic stress incontinence (USI). Materials and Methods We retrospectively investigated the data of 136 women who underwent primary TOT procedures for uncomplicated USI. All women received preoperative as well as 1-year and 5-year postoperative assessments comprising clinical interview, pelvic examination, and introital four-dimensional (4D) ultrasound. The primary outcome was stress urinary incontinence (SUI), defined as the report of SUI in patient interview, a positive response to item 3 of the short form of the Urogenital Distress Inventory (UDI-6), or a positive cough stress test and negative dysuria or urinalysis. Secondary outcomes included SUI severity, SUI bother, scores on the short forms of the UDI-6 and Incontinence Impact Questionnaire (IIQ-7), rates of de novo overactive bladder (OAB) symptoms, de novo voiding dysfunction, groin/thigh pain, and sling exposure, as well as ultrasound manifestations of bladder neck, midurethra, and sling. Results At 1 and 5 years, rates for SUI (7.4% vs 8.8%, P = 0.824), de novo OAB symptoms (4.4% vs 5.1%, P = 1.000), de novo voiding dysfunction (11.2% vs 10.3%, P = 1.000), groin/thigh pain (3.7% vs 0.7%, P = 0.216), and sling exposure (2.2% vs 0.0%, P = 0.246) were similar. Scores on the UDI-6 and IIQ-7 were significantly decreased postoperatively. Sling location and a more cranioventral midurethral location were sustained during follow-up. Conclusions For uncomplicated USI, TOT has good and sustained clinical and imaging outcomes, though a notable rate of de novo voiding dysfunction.

Vascular occlusion is a rare but severe complication of dermal filler injections. Early treatment of this complication produces better outcomes. Current diagnostic methods for vascular occlusion in the skin are subjective and imprecise; these include capillary refill time, skin color, and reports of pain. This study aimed to assess the use of laser Doppler imaging (LDI) in the evaluation and treatment of vascular complications caused by dermal filler injections. This retrospective study used laser Doppler imaging (LDI) in 13 patients who developed vascular occlusion after facial dermal filler injections, with subsequent follow-up. The precise areas of perfusion observed on LDI were compared with the findings of clinical and photographic evaluation. The results showed that LDI accurately identified areas of vascular occlusion and improved treatment precision among these thirteen patients. The procedure was more precise than visual inspection or photographic evidence. Satisfactory outcomes were achieved for all patients, and no procedure-related complications were reported. Collectively, LDI provides fast, noninvasive, and accurate delineation of areas of vascular occlusion caused by complications of dermal filler injections and avoids several subjective shortcomings of visual and photographic evaluations. Thus, LDI effectively tracks treatment outcomes. However, large-scale studies are required to confirm the present findings.

OBJECTIVES The purpose of this study was to explore the association between mesh location and de novo stress urinary incontinence (SUI) after transvaginal mesh procedures. METHODS We retrospectively analyzed a database of women who had received transvaginal mesh procedures for stage III or greater cystocele according to the Pelvic Organ Prolapse Quantification system. Only data for women who neither reported SUI preoperatively nor had received concomitant anti-incontinence surgery were included for analyses. The mesh location was investigated by sonography via the percentage of the urethra covered by mesh, defined as the number calculated by dividing the portion of the urethral length covered by mesh (the distance from the bladder neck to the point of the urethra, which was indicated by an imaginary line at the level of the lower [caudal] mesh end and perpendicular to the urethra) by the total urethral length (the distance from the bladder neck to the external urethral meatus) in the sagittal plane. The resting, straining, coughing, and squeezing mesh locations of women who did (n = 29) and did not (n = 54) report SUI at the 12-month follow-up were compared. RESULTS At the 12-month follow-up, women who reported SUI had a significantly smaller straining percentage of the urethra covered by mesh (mean ± SD, 28.5% ± 9.6%) compared with continent women (35.2% ± 15.8%), indicating a more proximal straining mesh location. CONCLUSIONS Sonography is useful in investigating the location of the transvaginal mesh. De novo SUI after transvaginal mesh procedures is associated with a more proximal straining mesh location.

AIMS To compare the surgical outcomes of conventional surgeries with or without concomitant transobturator vaginal mesh (TVM) for ≥Stage 3 pelvic organ prolapse (POP). METHODS We retrospectively investigated 166 women who received conventional surgery including vaginal total hysterectomy, modified McCall culdoplasty, and AP-repair (conventional group) and 98 women with concomitant TVM (mesh group). Follow-up at 3, 12, and 24 months comprised symptom interview, pelvic examination, and ultrasound assessments. The primary outcome was anatomical success defined as ≤Stage 1 POP. Secondary outcomes were subjective symptoms, ultrasound manifestations, and complications. RESULTS Both groups showed improvements in functional and anatomical outcomes after operations. Compared with the conventional group, the mesh group had higher rates of de novo stress urinary incontinence (SUI) at 3-month (3.6% vs 19.4%; P

The transformation abilities of CD44s and CD44v6 in normal intestinal epithelial cells have not yet been reported. Herein, we established both CD44s and CD44v6 overexpressing stable clones from rat IEC-6 cells and demonstrated that the CD44v6 clones had higher saturation density and anchorage independence. Additionally, CD44v6 clones were more resistant to oxaliplatin and irinotecan which might be attributed to a significantly increased B-cell lymphoma 2 level and a reduced DNA damage response in these cells. Moreover, c-Met and vascular endothelial growth factor receptor 2 signalings were involved in modulating the saturation density in CD44v6 clones. Interestingly, higher activation of both AKT and extracellular-signal-regulated kinase (ERK) were detected in CD44v6 clones which might account in part for the cell density-independent nuclear localization of Yes-associated protein (YAP). To no surprise, increases of both saturation density and anchorage independence in CD44v6 clones were markedly diminished by PI3K, AKT, MEK, and ERK inhibitors as well as YAP knockdown. By contrast, overexpression of a constitutively active YAP robustly increased the aforementioned phenotypes in IEC-6 cells. Collectively, our results suggest that upregulation of CD44v6, but not CD44s, induces the transformation of normal intestinal epithelial cells possibly via activating the c-Met/AKT/YAP pathway which might also explain the important role of CD44v6 in the initiation of various carcinomas.

Full-thickness abdominal wall defects may result from trauma, tumor resection, or infection. Management of these defects poses a significant challenge. Few studies have been conducted on using the pedicle anterolateral thigh (ALT) flap to reconstruct a defect of over half the anterior abdominal wall. We report a large abdominal wall reconstruction with island pedicle ALT flap with tensor fascia lata plus vastus lateralis muscle. An 80-year-old man with a large recurrent abdominal wall tumor had undergone two tumor resections after 2010. The pathology report demonstrated fibromatosis in 2010. Recently, computed tomography revealed a large, lobulated mass measuring approximately 11.8 cm × 5.3 cm × 8.8 cm, with heterogeneous enhancement, located at the left abdominal wall with cutaneous and subcutaneous involvement and adjacent omentum thickening. Wide excision and subsequent reconstruction of the abdominal wall defect with a pedicle ALT flap was conducted. The permanent histology report confirmed fibrosarcoma. Partial skin necrosis was noted after reconstruction surgery, and a second operation was performed to debride the necrotic skin. Wound healing was optimal, without any recurrence. Large primary abdominal fibrosarcoma is rare; thus, reconstruction of the postoperative defect is particularly challenging for plastic surgeons. In this case, we successfully used the pedicle ALT flap with tensor fascia lata plus vastus lateralis muscle to reconstruct the abdominal wall defect in the patient. This is an effective yet simple single-stage reconstructive procedure for defect repair.

Aims To explore functional changes of pelvic floor muscle (PFM) after successful Perigee procedures. Methods We retrospectively analyzed information from 145 women having achieved anatomic success, defined as

OBJECTIVES To explore the clinical importance and surgical outcomes of Green type III cystocele in women with anterior vaginal prolapse. METHODS A database of 336 women with a Ba point higher than -3 cm on the Pelvic Organ Prolapse Quantification system was retrospectively reviewed. Investigated data comprised those obtained from a clinical interview, the Pelvic Organ Prolapse Quantification system, and sonography. Initially, the baseline data between women with (n = 126) and without (n = 210) Green type III cystocele on sonography were compared. Subsequently, 6-month postoperative data between women who had Green type III cystocele on sonography and underwent either anterior colporrhaphy (n = 25) or a Perigee procedure (n = 76) were compared. RESULTS Women with Green type III cystocele had symptoms of voiding dysfunction more frequently, stress urinary incontinence less frequently, and more bulging (mean ± SD, 2.7 ± 1.2 versus 1.9 ± 1.5 for women with versus without Green type III cystocele; P = .001), a greater likelihood of stage II or higher cystocele (86.5% versus 60.0% for women with versus without Green type III cystocele; P < .001), as well as more caudodorsal bladder neck and genitohiatal positions and a wider genital hiatus on sonography. Women with Green type III cystocele had a greater likelihood of stage 0 cystocele (64.0% versus 89.5% for anterior colporrhaphy versus Perigee; P< .001) and more ventral bladder neck positions after Perigee procedures. CONCLUSIONS The presence of Green type III cystocele in women with anterior vaginal prolapse is associated with more functional impairments and anatomic defects. Despite comparable functional outcomes, Perigee procedures provide better anatomic outcomes for the anterior vagina in women with Green type III cystocele than anterior colporrhaphy does in the short term.

In the conventional classroom, many obstacles hinder interaction between an instructor and students, such as limited class hours, fixed seating, and inadequate time for meetings after class. This work develops a novel multimedia mobile classroom feedback system (MMCFS) that instantly displays students' responses, such as class-related questions or answers to questions on a quiz, on the instructor's computer. This system reinforces interaction between instructors and students and improves learning efficiency. Its features are as follows: 1) automatic attendance checking; 2) in-class real-time evaluation; 3) improved willingness of students to raise questions; 4) immediate grade enquiring; 5) cross-platform functionality; 6) a virtual mobile classroom; 7) data integrity; 8) low construction cost; 9) group learning; and 10) learning process recording. This system uses a client-server and three-tiered architecture models as its framework. When a class is in progress, the instructor only requires a notebook computer with a web browser, while students need a mobile phone or equivalent mobile devices with built-in Java Platform, Micro Edition (J2ME) and wireless support. A web server and the rear-end database can be located outside the classroom when network connections are available. Attendance checking, conducting quizzes, instant question inquiring, and grade inquiring are the four primary functions of the system. A questionnaire is applied to evaluate system's interactivity, mobility, and functionality. The 105 subjects comprised two classes of undergraduate students. The questionnaire addresses interactivity, mobility, and functionality. Its purpose was to compare the proposed system and the interactive response system (IRS). Experimental results show that the proposed system has superior interactivity, mobility, and functionality.