Background Perforator artery flaps based on the branches of intercostal arteries and lateral thoracic artery can be used for reconstruction after breast-conserving surgery (BCS). Although described more than a decade ago, these have not been adopted widely in clinical practice. We report on short-term and long-term surgical outcomes of partial breast reconstruction using chest wall perforator flaps from a prospective multicenter audit. Methods All patients operated for BCS and partial breast reconstruction using intercostal artery perforator or lateral thoracic artery perforator flaps from January 2015 to October 2018 were included in the analysis. Oncoplastic breast surgeons with appropriate level of training performed all tumor excisions and reconstructions as a single-stage procedure. Patient characteristics, treatment details and surgical outcomes were noted. Specific outcomes recorded were margin re-excision and complication rates. Results One hundred and twelve patients underwent the procedure in the given study period. The median age was 54 years. Median specimen weight was 62.5 g and median volume of excision was 121.4 mL. Fifteen patients (13.39%) underwent a margin re-excision for close or positive margins without additional morbidity. One patient required a completion mastectomy. Eight patients (7.14%) had an early complication. None of the patients required a contralateral symmetrization procedure. The results were comparable across the participating centers. Conclusions Chest wall artery perforator-based flaps are an excellent option for lateral and inferior quadrant partial breast reconstructions. The short and long-term surgical outcomes are comparable across sites and can be performed with minimal morbidity. Patient-reported outcome measures need to be studied.
Kim, Hae-Sol;Im, Ra-Joo;Kim, Hye-Eun;Lee, Chul-Gu;Seo, Jeong-Meen;Lee, Suk-Koo
Advances in pediatric surgery
/
v.13
no.2
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pp.144-154
/
2007
Liver tumors in children are rare, relatively complex, and encompass a broad spectrum of disease processes. This study reviews our experience of liver tumors during the last 10 years. Medical records of 36 cases of liver tumors in children, treated at Samsung Medical Centers, from October 1994 to December 2005, were reviewed in this study. We analyzed disease characters and survival rates as a whole and by specific disease. The median age was 3.6 years. Male and female ratio was 1:1. The most common symptom was the palpable mass in 15 cases. Others were abdominal distension in 9 cases, jaundice in 2, vomiting in 2, weight loss in 2, and pubic hair growth in 1. CT or US and liver biopsy were performed for diagnosis. There were 28 malignant tumors: malignant rhabdoid tumor (1 case), hepatocellular carcinoma (3 cases), hemangioendothelioma type II (3 cases), angiosarcoma (1 case), and hepatoblastoma (20 cases). Eight tumors were benign; hepatic adenoma (1 case), focal nodular hyperplasia (2 cases), hemangioendothelioma type I (2 cases), mesenchymal hamartoma (3 cases). In this study the clinical characteristics were not different from the other reports. Liver transplantation was performed in 3 cases-1 with hepatoblastoma and 2 with hepatocelleular carcinoma. Accurate and early diagnosis, and individualized multimodality therapeutic approaches might be important for better outcome.
Chattopadhyay Soumen;Krishnan Natraj;Maji Manas D.
International Journal of Industrial Entomology and Biomaterials
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v.12
no.1
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pp.21-28
/
2006
Peroxidase activity was measured in brown leaf spot pathogen (Myrothecium roridum) inoculated potted mulberry (Morus alba) during pre-symptomatic to various symptom development stages and compared with corresponding healthy leaf tissues. The enzyme showed a pH optimum of 7.0 and the activity was linearly increased up to 15 min of incubation. The peroxidase had a broad substrate specificity and the rates of oxidation were in the rank of pyrogallol> guaiacol> ascorbate at pH 7.0. Catechol at 10 mM inhibited 89% of guaiacol-peroxidase and 76% pyrogallol-peroxidase activities, indicated higher non-specific peroxidation in pyrogallol dependent assay system in mulberry than guaiacol. The optimum requirement for the guaiacol dependent assay was 0.2 ml (${\approx}40-60{\mu}g$ equivalent of protein) of crude enzyme source. Excepting the 8th leaf from the apex, the peroxidase activity did not vary appreciably in different leaf positions. In pre-symptomatic phases, an initial (1 to 5 min) rise of peroxidase activity was noticed in inoculated leaves, and then maintained a plateau up to 300 min. In contrary, non-infected tissue showed a slightly increased trend of enzyme level up to 420 min. In infected tissue, a sharp transient increase (3.1 fold) of peroxidase activity appeared between 300 - 420 min post infections. Afterwards, significantly different but steady maintenance of enzyme levels were observed in two treatments. On the other hand, during symptom development, a sharp increase in peroxidase activity was noticed up to 4th grade of lesion appearance (25.1 % to 50% of leaf area infection), and then declined slightly. However, in non-infected but same age healthy leaves, such huge fluctuations of enzyme level did not apparent. A high positive correlation $(R^2=0.92)$ between peroxidase activity and leaf spot development grades was also marked. The result implies that pre-symptomatic burst (between 1 - 5 and 300 - 420 min) and subsequent increased trend of guaiacol peroxidase activity may require for the symptomatic manifestation of Myrothecium leaf spot in mulberry.
Background: To determine the benefit of pelvic floor muscle exercise (PFME) with visual biofeedback on promoting patient recovery from incontinence, we investigated variables associated with the early restoration of continence for patients who underwent robot-assisted radical prostatectomy (RARP). Methods: Of the 83 patients enrolled, 41 consecutive patients completed PFME (the exercise group), and the other 42 consecutive patients just before the PFME program commenced (the control group). The primary outcome was whether PFME engagement was associated with zero pad continence restoration within 3 months of surgery. Results: Continence restoration percentages (defined as zero pads used per day) at 1, 3, and 6 months after surgery were 49.4%, 77.1%, and 94.0%, respectively. The exercise group achieved significantly higher recovery rates at 1 month (p=0.037), 3 months (p<0.001), and 6 months (p=023). Cox regression analysis demonstrated that a lower Gleason score (<8; hazard ratio [HR], 2.167), lower prostate specific antigen (<20 ng/dL; HR, 2.909), and engagement in PFME (HR, 3.731) were independent predictors of early recovery from postprostatectomy incontinence. Stratification by age showed that those younger than 65 years did not benefit significantly from exercise (log-rank test, p=0.08), but that their elderly counterparts, aged 65-70 years (p=0.007) and >70 years old (p=0.002) benefited significantly. Conclusion: This study suggests that postoperative engagement in PFME with biofeedback speeds up the recovery of continence in elderly patients (≥65 years old) that undergo RARP.
Objectives: Despite the low cost and high accessibility of manual acupuncture (MA) treatments for the carpal tunnel syndrome (CTS), this intervention has not been uniformly evaluated in systematic reviews (SR), and no SR has evaluated MA monotherapy for CTS. This review was conducted to summarize the findings and undertake a quality assessment of randomized controlled trials (RCTs) of acupuncture treatment methods for mild-to-moderate CTS to identify clinical evidence for the use of MA in CTS. Methods: We searched five databases for articles on relevant RCTs that were published until June 2021 without imposing specific restrictions, such as age or sex, on CTS patients. RCTs that evaluated MA were included without any restriction on comparator interventions. Measurement tools for evaluating pain reduction and functional improvement or for evaluating efficacy using electrophysiological indicators were included as outcome measures. Results: We included seven RCTs, of which three studies reported both post-treatment improvement effects and statistical significance using p-values for all outcomes. Five studies reported statistically significant intergroup differences (p-values for all outcomes) in posttreatment improvement. None of the studies reported severe adverse effects of MA. In all of the RCTs, the reporting rates of the 2c, 2a, and 6a items of STRICTA 2010 were 14%, 29%, and 29%, respectively. PC7 (Daereung) was used to treat CTS in all of the included studies. Conclusion: MA can be used for CTS treatment without serious adverse effects. PC7 was the most commonly used acupoint. In order to ensure objective and reliable reporting, accurate standardization of acupuncture treatment methods acupoint terms should be undertaken in future RCTs.
Kim, Jinsook;Shin, Yerim;Lee, Seungwan;Lee, Eunsung;Han, Woojae;Lee, Jihyeon
Journal of Audiology & Otology
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v.25
no.4
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pp.189-198
/
2021
Background and Objectives: This study aimed to investigate the occupational performance of Korean workers with and without hearing loss and analyze the hearing-related difficulties in the working environment. Subjects and Methods: The Amsterdam checklist for hearing and work was used for the analyses and the occupational environments of the Korean workers were investigated. Out of 129 total participants, 86 workers experienced severe to profound hearing loss and 43 had the normal hearing ability. The hearing-impaired workers were recruited from two leading vocational centers and normal-hearing workers were their colleagues. Results: The hearing-impaired workers were found to take fewer sick leaves and exhibited higher rates of permanent job statuses compared to the normal-hearing workers. Workers with hearing loss rarely detected background sound; however, they could perceive reverberation more frequently. They felt more satisfied with their careers than the normal hearing workers as they received social support and needed to put their effort into hearing for most hearing activities. Furthermore, the effort in hearing increased with the increase in job demand, job control, social support, and career satisfaction. The working hours per week increased with the increase in age, education level, job demand, job control, and social support. Different trends were observed in 9 out of 12 variables while comparing the data from the present study with that obtained from the hearing-impaired workers of the Netherlands, indicating a large difference between countries. Conclusions: Although the hearing-impaired Korean workers operate diligently with good job positions, it is necessary to enhance their acoustic environment and provide them social support. Considering the cultural background of the hearing-impaired workers, the development of suitable vocational rehabilitation programs and specific questionnaires is strongly recommended worldwide.
Kim, Jinsook;Shin, Yerim;Lee, Seungwan;Lee, Eunsung;Han, Woojae;Lee, Jihyeon
Korean Journal of Audiology
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v.25
no.4
/
pp.189-199
/
2021
Background and Objectives: This study aimed to investigate the occupational performance of Korean workers with and without hearing loss and analyze the hearing-related difficulties in the working environment. Subjects and Methods: The Amsterdam checklist for hearing and work was used for the analyses and the occupational environments of the Korean workers were investigated. Out of 129 total participants, 86 workers experienced severe to profound hearing loss and 43 had the normal hearing ability. The hearing-impaired workers were recruited from two leading vocational centers and normal-hearing workers were their colleagues. Results: The hearing-impaired workers were found to take fewer sick leaves and exhibited higher rates of permanent job statuses compared to the normal-hearing workers. Workers with hearing loss rarely detected background sound; however, they could perceive reverberation more frequently. They felt more satisfied with their careers than the normal hearing workers as they received social support and needed to put their effort into hearing for most hearing activities. Furthermore, the effort in hearing increased with the increase in job demand, job control, social support, and career satisfaction. The working hours per week increased with the increase in age, education level, job demand, job control, and social support. Different trends were observed in 9 out of 12 variables while comparing the data from the present study with that obtained from the hearing-impaired workers of the Netherlands, indicating a large difference between countries. Conclusions: Although the hearing-impaired Korean workers operate diligently with good job positions, it is necessary to enhance their acoustic environment and provide them social support. Considering the cultural background of the hearing-impaired workers, the development of suitable vocational rehabilitation programs and specific questionnaires is strongly recommended worldwide.
BACKGROUND/OBJECTIVES: Various accelerometer equations are used to predict energy expenditure (EE). On the other hand, the development of these equations and their validation studies have been conducted primarily without including older adults. This study assessed the accuracy of 8 ActiGraph accelerometer equations to predict the energy cost of walking in older adults. SUBJECTS/METHODS: Thirty-one participants with a mean age of 74.3 ± 3.3 yrs were enrolled in this study (20 men and 11 women). The participants completed 8 walking activities, including 5 treadmill and 3 self-paced walking activities. The EE was measured using a portable indirect calorimeter, with each participant simultaneously wearing the ActiGraph accelerometer. Eight ActiGraph equations were assessed for accuracy by comparing the predicted EE with indirect calorimetry results. RESULTS: All equations resulted in an overall underestimation of the EE across the activities (bias -1 to -1.8 kcal·min-1 and -0.7 to -1.8 metabolic equivalents [METs]), as well as during treadmill-based (bias -1.5 to -2.9 kcal·min-1 and -0.9 to -2.1 METs) and self-paced (bias -1.2 to -1.7 kcal·min-1 and -0.2 to -1.3 METs) walking. In addition, there were higher rates of activity intensity misclassifications, particularly among vigorous physical activities. CONCLUSIONS: The ActiGraph equations underestimated the EE for walking activities in older adults. In addition, these equations inaccurately classified the activities based on their intensities. The present study suggests a need to develop ActiGraph equations specific to older adults.
Objective: The main objective of this study was to define molecular mechanisms associated with thermal stress responses of chickens from commercial broilers (BR, Ross 308), Thai native chickens (NT) and crossbreeds between BR×NT (H75). Methods: Twenty days before reaching specific market age, chickens from each breed were divided into control and thermal-stressed groups. The stressed groups were exposed to a cyclic thermal challenge (35℃±1℃ for 6 h, followed by 26℃±1℃ for 18 h) for 20 days. Control group was raised under a constant temperature of 26℃±1℃. Pectoralis major (n = 4) from each group was collected for transcriptome analysis using HiSeq Illumina and analysis of glycogen and lactate. Gene expression patterns between control and thermal-stressed groups were compared within the same breeds. Results: Differentially expressed transcripts of 65, 59, and 246 transcripts for BR, NT, and H75, respectively, were revealed by RNA-Seq and recognized by Kyoto encyclopedia of genes and genomes database. Pathway analysis underlined altered glucose homeostasis and protein metabolisms in all breeds. The signals centered around phosphatidylinositol 3-kinase (PI3K)/Akt signaling, focal adhesion, and MAPK signaling in all breeds with slight differences in molecular signal transduction patterns among the breeds. An extensive apoptosis was underlined for BR. Roles of AMPK, MAPK signaling and regulation of actin cytoskeleton in adaptive response were suggested for H75 and NT chickens. Lower glycogen content was observed in the breast muscles of BR and NT (p<0.01) compared to their control counterparts. Only BR muscle exhibited increased lactate (p<0.01) upon exposure to the stress. Conclusion: The results provided a better comprehension regarding the associated biological pathways in response to the cyclic thermal stress in each breed and in chickens with different growth rates.
Objectives: The coronavirus disease 2019 (COVID-19) pandemic led to increased mortality rates. To assess this impact, this ecological study aimed to estimate the excess death counts in southern Iran. Methods: The study obtained weekly death counts by linking the National Death Registry and Medical Care Monitoring Center repositories. The P-score was initially estimated using a simple method that involved calculating the difference between the observed and expected death counts. The interrupted time series analysis was then used to calculate the mean relative risk (RR) of death during the first year of the pandemic. Results: Our study found that there were 5571 excess deaths from all causes (P-score=33.29%) during the first year of the COVID-19 pandemic, with 48.03% of these deaths directly related to COVID-19. The pandemic was found to increase the risk of death from all causes (RR, 1.26; 95% confidence interval [CI], 1.19 to 1.33), as well as in specific age groups such as those aged 35-49 (RR, 1.21; 95% CI, 1.12 to 1.32), 50-64 (RR, 1.38; 95% CI, 1.28 to 1.49), and ≥65 (RR, 1.29; 95% CI, 1.12 to 1.32) years old. Furthermore, there was an increased risk of death from cardiovascular diseases (RR, 1.17; 95% CI, 1.11 to 1.22). Conclusions: There was a 26% increase in the death count in southern Iran during the COVID-19 pandemic. More than half of these excess deaths were not directly related to COVID-19, but rather other causes, with cardiovascular diseases being a major contributor.
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