Flap Monitoring Using Interstitial Fluid Glucose Measurements.

Background: Various flap monitoring techniques have been used in the early detection of anastomotic thrombus; however, the use of automatic and continuous monitoring methods is presently uncommon. The purpose of this study was to investigate trends in interstitial fluid glucose concentration (IFG) in flap monitoring by measuring IFG automatically and continuously. Methods: Nine patients underwent unilateral breast reconstruction using a transverse rectus abdominis myocutaneous flap with vascular anastomosis. Two IFG measuring devices were attached to each patient. One device was attached to the flap (flap IFG) and the other to the healthy breast (control IFG). In each case, flap IFG, control IFG, and IFG ratio (flap IFG/control IFG) were recorded in the initial 72 h post-surgery (first half) and also in the subsequent 72 h (second half). In all of the cases, the mean values recorded in the first half and those in the second half were compared. Results: All flaps survived. The flap IFG didn't fall below 40 mg/dL in the first half. The minimum flap IFG and IFG ratio were 42 mg/dL and 0.55 in the first half. The flap IFG was significantly higher in the first half than in the second half in all cases, and the IFG ratio was similar in 8 cases. Furthermore, mean flap IFG and mean IFG ratio in all cases in the first half were significantly higher than in the second half. Conclusions: IFG measurements may complement conventional flap monitoring, particularly in the early postoperative period.

Historique: Diverses techniques de surveillance du lambeau sont utilisées pour favoriser le dépistage précoce du thrombus anastomotique, mais peu de méthodes de surveillance automatique et continue sont utilisées en ce moment. La présente étude visait à examiner les tendances du glucose interstitiel (GI) lors de la surveillance du lambeau par une mesure automatique et continue. Méthodologie: Neuf patientes ont subi une reconstruction mammaire unilatérale au moyen d'un lambeau myocutané du grand droit transverse avec anastomose vasculaire. Chaque patiente était dotée de deux dispositifs de mesure du GI. L'un d'eux était fixé au lambeau (GI du lambeau) et l'autre au sein en bonne santé (GI témoin). Dans chaque cas, les chercheurs ont enregistré le GI du lambeau, le GI témoin et le ratio du GI (GI du lambeau/GI témoin) pendant les 72 premières heures suivant l'opération (première moitié), puis pendant les 72 heures suivantes (deuxième moitié). Dans tous les cas, les chercheurs ont comparé les valeurs moyennes enregistrées pendant la première moitié à celles enregistrées pendant la deuxième moitié. Résultats: Tous les lambeaux ont survécu. Le GI du lambeau n'a pas chuté sous 40 mg/dl pendant la première moitié. Le ratio minimal du GI était de 42 mg/dl et 0,55 pendant la première moitié. Dans tous les cas, le GI du lambeau était beaucoup plus élevé pendant la première moitié que pendant la deuxième moitié, et le ratio du GI était semblable dans huit cas. De plus, dans tous les cas, le GI moyen du lambeau et le ratio moyen du GI était beaucoup plus élevé pendant la première moitié que la deuxième. Conclusions: Les mesures de GI peuvent compléter la surveillance habituelle du lambeau, notamment au début de la période postopératoire.

Inter- and intra-rater reproducibility of quantitative T1 measurement using semiautomatic region of interest placement in myometrium.

PURPOSE: This study aimed to investigate the inter- and intraobserver reproducibility of quantitative T1 (qT1) measurements using manual and semiautomatic region of interest (ROI) placements. We hypothesized the usefulness of the semiautomatic method, which utilizes a three-dimensional (3D) anatomical relationship between the myometrium and other tissues, for minimizing ROI placement variation, thereby improving qT1 reproducibility compared to the manual approach. The semiautomatic approach, which considered anatomical relationships, was expected to enhance reproducibility by reducing ROI placement variabilities. MATERIALS AND METHODS: This study recruited 23 healthy female volunteers. Data with variable flip angle (VFA) and inversion recovery were acquired using 3D-spoiled gradient echo and spin echo sequences, respectively. T1 maps were generated with VFA. Manual and semiautomatic ROI placements were independently conducted. Mean qT1 values were calculated from the T1 maps using the corresponding pixel values of the myometrial ROI. Inter- and intraobserver reproducibility of qT1 values was investigated. The inter- and intraobserver reproducibility of qT1 values was evaluated by calculating the coefficient of variation (CoV). Further, reproducibility was evaluated with inter- and intraobserver errors and intraclass correlation coefficients (ICCs). Bland-Altman analysis was utilized to compare the results, estimate bias, and determine the limits of agreement. RESULTS: The mean inter- and intraobserver CoV of the qT1 values for semiautomatic ROI placement was significantly lower than those for manual ROI placement (p < 0.05 and p < 0.01, respectively). ICCs for semiautomatic ROI placement were greater than those for manual ROI placement. Further, the mean inter- and intraobserver errors for semiautomatic ROI placement were significantly lower than those for manual ROI placement (p < 0.05 and p < 0.01, respectively). CONCLUSION: Semiautomatic ROI placement demonstrated high reproducibility of qT1 measurements compared with manual methods. Semiautomatic ROI placement may be useful for evaluating uterine qT1 with high reproducibility.

Synthesis and Photocatalytic Activity of Novel Polycyclopentadithiophene.

A novel π-conjugated polymer based on cyclopentadithiophene (CPDT) and poly(4,4']-(((4Hcyclopenta[2,1-b:3,4-b']dithiophene-4,4-diyl)bis(ethane-2,1-diyl))bis(oxy))bis(4-oxobutanoic acid)) (PCPDT-CO2H) was prepared as a sparingly soluble material. The generation of hydroxyl radicals from PCPDT-CO2H in water was confirmed by using coumarin as a hydroxyl radical indicator. Furthermore, PCPDT-CO2H was found to catalyze the oxidative hydroxylation of arylboronic acid and the oxidation of benzaldehyde, indicating that PCPDT-CO2H can be a promising candidate for metal-free and 100% organic heterogeneous photocatalysts.

Elucidation of Substituent-Responsive Reactivities via Hierarchical and Asymmetric Assemblies in Crystalline p-Quinodimethane Derivatives.

We propose a mechanism for substituent-responsive reactivities of p-quinodimethane derivatives with four ester groups through their hierarchical and asymmetric assembly modes. Four asymmetric 7,8,8-tris(methoxycarbonyl)-p-quinodimethanes with a 7-positioned ethoxycarbonyl (2 a(H)), 2'-fluoroethoxycarbonyl (2 b(F)), 2'-chloroethoxycarbonyl (2 c(Cl)), or 2'-bromoethoxycarbonyl (2 d(Br)) were synthesized and crystallized. 2 a(H), 2 b(F) and 2 d(Br) afforded only one shape crystal, while 2 c(Cl) did two polymorphic 2 c(Cl)-α and 2 c(Cl)-ß. UV-irradiation induced topochemical polymerization for 2 a(H), no reactions for 2 b(F) and 2 c(Cl)-α, and [6+6] photocycloaddition dimerization for 2 c(Cl)-ß and 2 d(Br). Such substituent-responsive reactivities and crystal structures were compared with those of the known symmetric 7,7,8,8-tetrakis(alkoxycarbonyl)-p-quinodimethanes such as 7,7,8,8-tetrakis(methoxycarbonyl)- (1 a(Me)-α and 1 a(Me)-ß), 7,7,8,8-tetrakis(ethoxycarbonyl)- (1 b(Et)), and 7,7,8,8-tetrakis(bromoethoxycarbonyl)- (1 c(BrEt)). The comparative study clarified that the reactivities and crystal structures are classified into four types that link to each other. This linkage is understandable when we analyze the crystal structures through the following hierarchical and asymmetric assemblies; conformers, dimers, one dimensional (1D)-columns, two dimensional (2D)-sheets, and three dimensional (3D)-stacked sheets (3D-crystals). This supramolecular viewpoint is supported by intermolecular interaction energies among neighbored molecules with the density functional theory (DFT) calculation. Such research enables us to elucidate the substituent-responsive reactivities of the crystals, and reminds us of the selection of the right path in a so-called "maze game".

Comparison of Two Types of Tapes for Taping After Breast Reconstruction Using Silicone Materials.

BACKGROUND: Several kinds of tapes are used for postoperative wounds, which occasionally cause contact dermatitis and result in noticeable pigmentation. A comparison of the postoperative course between different tapes has not been reported. This study aimed at investigating the differences between two postoperative tapes used after breast reconstruction with silicone materials for simple mastectomy. MATERIALS AND METHODS: Eighty-eight nonconsecutive patients undergoing tissue expander operation and 75 nonconsecutive patients undergoing tissue expander and silicone breast implant operations were included in this prospective study. Two postoperative tapes were used: a nonwoven surgical tape (Yu-ki ban®) or a hypoallergenic polyester-woven fabric tape (Atofine TM), which have different base materials, a removed keratinocyte area, and moisture permeability. We determined the differences in the incidence of skin complications, scar width, and aesthetic results with respect to scarring between the patients using Yu-ki ban and those using Atofine. RESULTS: Statistically similar results were achieved for the patients who underwent reconstruction using either the tissue expander or silicone breast implant. Scar width was similar between the groups; however, the incidence of skin complications was significantly lower in patients using Atofine than in those using Yu-ki ban. Aesthetic results with respect to scarring were better in patients using Atofine than in those using Yu-ki ban, with a significant difference in the incidence of pigmentation between the groups. CONCLUSION: The tape with higher moisture permeability and a lower removed keratinocyte area should be used to reduce the incidence of contact dermatitis and achieve better aesthetic results with respect to scarring.

Making the upper edge of a silicone breast implant invisible by fat onlay-grafting harvested from the affected inframammary fold.

BACKGROUND: In silicone breast implant (SBI)-based breast reconstructions, aesthetic outcomes are often low due to the visible upper edge of the SBI. To ameliorate this, grafting fat harvested from the SBI operative field has not been reported to date. Therefore, we aimed to develop a novel technique for fat onlay-grafting, harvested from the inframammary fold (IMF) of the reconstructed breast, and investigate its usefulness. METHODS: A total of 90 patients who underwent SBI-based breast reconstruction after a simple mastectomy were included in this study. The harvested fat was recorded by weight and grafted evenly to the medial and median upper edge of the SBI on the pectoralis major muscle. We applied this technique to 30 patients (fat onlay-grafting group) and compared them with the 60 patients (no-grafting group) who did not undergo our technique using the postoperative 1-year aesthetic outcome scores of the medial and median upper edge of the SBI. Furthermore, we investigated the correlation between the weight of harvested fat and body mass index. RESULTS: No postoperative wound complications occurred, and infection, hardened fat, and fat lysis were not found in the fat onlay-grafting group. The medial and total aesthetic outcome scores in the fat onlay-grafting group were significantly higher than those in the no-grafting group (P<0.05). The average weight of harvested fat was 11.9 [5-32] g. The correlation between the weight of the harvested fat and body mass index was significantly positive (R2=0.7119, P<0.05). CONCLUSIONS: Our technique made the upper edge of the SBI invisible. Further, it was simple and less invasive with safe augmentation. Therefore, we believe that this technique can contribute to better aesthetic outcomes in SBI-based breast reconstruction.

Breast reconstruction using delayed pedicled transverse rectus abdominis muscle flap with supercharging: reports of three cases.

Breast reconstruction using a pedicled transverse rectus abdominis muscle (TRAM) flap is a well-established surgical procedure. Although studies suggest that transplanting this flap using a delayed method reduces the risk of partial flap necrosis, challenges persist. Hence, we present three cases of breast reconstruction using a pedicled TRAM flap with both delaying and supercharging. Patient age, excised tissue volume for mastectomy, and follow-up period were as follows: Case 1, 58 years, 429 cm3, 5 months; Case 2, 35 years, 910 cm3, 6 months; and Case 3, 56 years, 489 cm3, 4 months. One patient (Case 2) required a large flap tissue volume to achieve breast symmetry, whereas the other two (Cases 1 and 3) had long, longitudinal scars from previous cesareans sections. In a delayed surgery, the flap was partially elevated with partial dissection and no ligation of the deep inferior epigastric artery and vein (DIEAV). An artificial dermis with a silicone membrane (Teldermis®) was used to prevent adhesion of the rectus abdominal muscles and DIEAV to the surrounding tissue. Supercharging was performed by anastomosis between the ipsilateral DIEAV and internal thoracic AV. Flaps in zones I-III and in half of zone IV for Case 2, and zones I-III for Cases 1 and 3, were transferred; all survived without infection. This method allowed the transferring of a larger tissue volume compared with the conventional pedicled TRAM flap-transfer method. Thus, it may be useful for patients who require larger tissue volume or high-risk patients.

A Novel Technique to Achieve Rapid Wound Healing of Donor Site Wounds in Split-Thickness Skin Grafts of a Patient Undergoing Anticoagulation Therapy.

Split-thickness skin grafts constitute an established and widely used procedure for treating skin ulcers. However, in patients on anticoagulation therapy, wound healing abnormalities can prevent smooth epithelialization of their donor site. We aimed to investigate the usefulness of a technique to facilitate smooth wound healing through partial dimension reduction, and spared skin grafts back of donor sites with split-thickness skin grafts for patients undergoing anticoagulation therapy and investigate its usefulness. Partial dimension reduction and spared skin grafting back was performed on the donor site in 4 cases (group A), and the conventional method (moist dressing) was performed in 3 cases (group B). We compared the time to achieve complete epithelialization, the degree of pain, the frequency of dressing changes during the perioperative period, and the cosmetic results 6 months after surgery in both groups. The spared skin graft achieved good circulation. The time to achieve complete epithelialization was 3.1 weeks (2.5-4 weeks) in group A and 5.7 weeks (3-8 weeks) in group B; group A tended to experience less pain and fewer dressing changes during the perioperative period than group B. In addition, group A yielded superior cosmetic results to group B. Our technique can contribute to increasing the defense against physical stimulation in the donor site. Therefore, rapid wound healing and easy wound management can be achieved. We believe that it may be useful in split-thickness skin grafts for patients undergoing anticoagulation therapy.

Effective Salvage Surgery of a Severely Congested Propeller Perforator Flap Using a Postoperative Delay Technique and Negative-Pressure Wound Therapy.

Wound edge-based propeller perforator flaps have often been applied to soft tissue reconstruction of sacral pressure sores. Although this flap often causes necrosis due to overtension and twisting of the perforators, salvage surgery using a postoperative delay technique has not been reported thus far. In this article, we present a case in which we successfully reconstructed a sacral pressure sore using a wound edge-based propeller perforator flap. The flap caused severe congestion, which had a concern due to the potential wide-ranging flap loss; it was subsequently salvaged by an emergent delay procedure and negative-pressure wound therapy on day 2 postoperatively.

Optimal intraoperative selection of the projection of silicone breast implant using simplified cotton sizers.

BACKGROUND: It is occasionally difficult to accurately measure the projection of the unaffected breast in unilateral breast reconstruction and decide the optimal projection of a silicone breast implant (SBI). SBI ready-made sizers are useful for selecting the optimal SBI; however, the cost of procuring multiple types of this ready-made sizers is high. Therefore, we aimed to develop a novel technique for selecting SBIs using simplified cotton sizers, intraoperatively. METHODS: We applied the novel technique on 15 patients who underwent SBI-based breast reconstruction after simple mastectomy, among whom two or three SBI candidates had similar height and width but different projection. The breast reconstructed using a cotton SBI sizer was compared with the unaffected breast in the sitting position. We then selected the optimal SBI with a little higher projection than that of the unaffected breast. At the postoperative 1 year, we confirmed whether we could select better SBI among the prepared SBIs. RESULTS: Creating and applying the cotton SBI sizer required approximately 10 min in all cases. Optimal SBI selection among the prepared SBIs was seen in 14 cases; capsule contracture occurred in 1 case. CONCLUSIONS: A simplified cotton SBI sizer is recommended because it is easy and inexpensive to develop and provides reliable assistance in identifying the optimal SBI projection.

Inter- and intra-observer reproducibility of quantitative analysis for FP-CIT SPECT in patients with DLB.

BACKGROUND: Dopamine transporter single photon emission CT (DAT-SPECT) is useful in the evaluation of dementia with Lewy bodies (DLB). The specific binding ratio (SBR) is an index to measure DAT density. However, poorly reproducible cases are occasionally experienced in clinical practice. We hypothesized that distance-weighted histogram (DWH) may be useful to improve the reproducibility of SBR. The purpose of this study was to investigate inter- and intra-observer reproducibility of SBR with conventional and DWH methods, and to visually evaluate the precision in reference voxel of interest (VOI) definition using these methods. METHODS: This study included 50 adult patients with probable DLB. They underwent brain MRI, DAT-SPECT, and cerebral blood flow SPECT with N-isopropyl-p-[123I]iodoamphetamine (I-123 IMP). SBR of the striatum was calculated using conventional and DWH method. For inter-observer reproducibility validation, conventional and DWH SBR were independently evaluated by experienced nuclear medicine physicians; these measurements were repeated by the nuclear medicine physician to investigate intra-observer reproducibility. RESULTS: Proper reference VOI definition was achieved in 60.0% using conventional SBR and in 98.0% with DWH SBR. Both conventional and DWH SBR demonstrated good inter- and intra-observer reproducibility, however, there were statistically significant inter- and intra-observer variations with conventional SBR measurements. Average inter- and intra-observer errors of conventional SBR were 7.9 and 6.1%, respectively. Conversely, DWH SBR errors were not observed in all patients. Moreover, average inter- and intra-observer errors were significantly higher in conventional SBR with improper reference VOI definition than in that with proper reference VOI definition. CONCLUSIONS: Although the reproducibility of conventional and DWH SBR was good, inter- and intra-observer bias could not be ignored in conventional SBR, particularly with improper reference VOI definition. Thus, DWH may be useful to improve inter- and intra-observer reproducibility of SBR.

A Quantitative Evaluation of Hepatic Uptake on I-131 Whole-Body Scintigraphy for Postablative Therapy of Thyroid Carcinoma.

This study aimed to determine clinical association between quantitative hepatic uptake on postablative whole-body scan (WBS) with differentiated thyroid cancer (DTC) prognosis. We analyzed 541 scans of 216 DTC patients who were divided into 3 groups based on radioactive iodine (I-131) WBS uptake and clinical follow-up: group 1 (completion of ablation), group 2 (abnormal uptake in the cervical region), and group 3 (abnormal uptake with distant metastases). For each group, we calculated the ratio of I-131 WBS hepatic uptake (H) to cranial uptake as background (B); this ratio was defined as H/B. Furthermore, we made a distinction between group 1, as having completed radioactive iodine therapy (RIT) (CR), and group 2 and 3, as requiring subsequent RIT (RR). The average H/B scores were 1.34 (median, 1.36; range 1.00-2.1) for group 1; 1.89 (median, 1.75; range 1.41-4.20) for group 2; and 2.09 (median, 1.90; range 1.50-4.32) for group 3. Bonferroni multiple comparisons revealed significant differences in H/B among these groups. The H/B of group 1 was significantly smaller than that of other 2 groups (P < 0.0001). The precise cutoff value of H/B for therapeutic effect was ≤1.5. Moreover, 159 of 160 scans in the CR and 375 of 381 patients in the RR were correctly diagnosed using this cutoff value in the final outcome of RIT, yielding a sensitivity, specificity, positive predictive value, and negative predictive value of 99.4%, 98.4%, 99.7%, and 96.3%, respectively. Increased hepatic uptake of I-131 on WBS may predict disease-related progression.

The vitamin E derivative, EPC-K1, suppresses inflammation during hepatic ischemia-reperfusion injury and exerts hepatoprotective effects in rats.

BACKGROUND: An important component of postoperative management includes alleviation of hepatic ischemia-reperfusion (I/R) injury, which commonly results from liver surgery. EPC-K1 is a hydroxyl radical scavenger reported to have mitigating effects on I/R injury in many organs. This study evaluates the effects of EPC-K1 on hepatic I/R injury. MATERIALS AND METHODS: Rats were injected subcutaneously with either EPC-K1 (100 mg/kg) or saline. The hepatic artery and left branch of the portal vein were clamped for 45 min under general anesthesia. Indicators of liver function, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH), and of liver tissue damage were evaluated after 6h and 24h of reperfusion. Serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and high-mobility group box 1 (HMGB1) protein were measured, and apoptosis was quantified via caspase 3/7 activity and TUNEL assay. RESULTS: AST, ALT, and LDH levels increased significantly as a result of hepatic I/R injury, but were attenuated by EPC-K1 administration. Histologic findings revealed that normal structure of the hepatic parenchyma was maintained in rats pretreated with EPC-K1. TNF-α, IL-6, and HMGB1 levels rose significantly after reperfusion, together with activation of the inflammatory response. However, EPC-K1 administration suppressed levels of inflammatory markers and attenuated the inflammatory response. Moreover, EPC-K1 administration prevented apoptosis as determined by inhibition of caspase 3/7 activity and a decrease in apoptotic cells. CONCLUSIONS: Results demonstrate that EPC-K1 inhibits the inflammatory response and suppresses apoptosis during hepatic I/R injury. This suggests that EPC-K1 has hepatoprotective effects, and may be a valuable and novel therapeutic agent in the clinical setting.

[Control of postoperative nausea and vomiting by preventive administration of dexamethasone].

BACKGROUND: Postoperative nausea and vomiting (PONV) are the most frequent side effects after anesthesia. Patients with persistent PONV continue to be impaired in performing their normal daily activities. We studied the controlling effect of dexamethasone (4 mg) before the induction of general anesthesia in the prevention of PONV. METHODS: Ninety-one patients were divided into respiratory surgery group (dexamethasone N=22, none N=23) and gynecology group (dexamethasone N=22, none N=24), respectively. Dexamethasone group received dexamethasone 4 mg before the induction of general anesthesia. PONV and antiemetic requirements were recorded. RESULTS: In the dexamethasone group (respiratory surgery, gynecology), the incidences of PONV during the initial 24 hour postoperative period were 36.4% (N=8), and 18.2% (N=4), respectively. In the none group, the incidences were 43.5% (N=10), and 41.7% (N=10), respectively Antiemetic requirements were 22.7% (N=5), 9.1% (N=2), 39.1% (N=9), and 20.1% (N=5), respectively (NS). In gynecology group, in almost all the patients droperidol was used in epidural anesthesia. Combination of dexamethasone and droperidol may have greater antiemetic action than a single drug. CONCLUSIONS: Combination therapy with dexamethasone and droperidol may reduce PONV in patients undergoing surgery.

[Optimization of dark-blood T2-weighted sequence in myocardium magnetic resonance imaging].

The evaluation of myocardium characterization is an important role in cardiac MRI. The dark-blood (DB) sequence is used for non-enhanced T2-weighted myocardial images. The purpose of this study was to evaluate and optimize the DB T2WI sequence in myocardium images. We changed the parameters TE, echo train length (ETL), inversion time (TI), and fat suppression method, respectively. Data acquisition with end-diastolic phase was effective for avoiding the blur that was caused by cardiac motion. Consequently, the optimal setting of ETL and TI was important for myocardial images. STIR was suitable for fat suppression in unstable susceptibility. Setting the parameters synchronized with the cardiac cycle provided optimal myocardial images in DB T2WI.