Influence of Nutritional Status on a Family-Centered Care Intervention for Older Adults with Cognitive Impairment following Hip-Fracture Surgery: Secondary Data Analysis of a Randomized Controlled Trial.

OBJECTIVES: In Taiwan, older adults with cognitive impairment who undergo hip-fracture surgery are routinely cared for by family members. This study aimed to determine if nutritional status influenced the effects of a family-centered intervention for older adults with cognitive impairment recovering from hip-fracture surgery. DESIGN: Secondary data analysis of data from a randomized controlled trial was conducted to examine the influences of nutritional status 1 month after hospital discharge on the effects of a family-centered care intervention model, which was designed for older adults with hip fracture and cognitive impairment. Outcomes were compared among participants according to nutrition status (well-nourished/poorly-nourished) and treatment approach (control/intervention). SETTING: The original study was conducted at a 3000-bed medical center from July 2015 to October 2019. PARTICIPANTS: Participants were older adults with cognitive impairment who had undergone hip-fracture surgery. Participants were assessed as poorly-nourished or well-nourished with the Mini-Nutritional Assessment (MNA) 1-month post-discharge and were then randomly assigned to either the intervention group or control group. INTERVENTION: A family-centered intervention model for family caregivers of older adults with cognitive impairment recovering from hip-fracture surgery was implemented. The intervention was delivered by geriatric nurses, which included instructions for family caregivers in overseeing exercises for strengthening the hip, understanding dietary requirements, and managing behavioral problems associated with cognitive impairment. MEASUREMENTS: Outcome measures included activities of daily living (ADLs), instrumental ADLs, hip range of motion, hip muscle strength, depression, measured with the Geriatric Depressive Scale, and physical and mental health related quality of life, measured with the Short Form Survey (SF-36), Taiwanese version. Participants were assessed at 1-, 3-, 6-, and 12-months post-discharge. RESULTS: Most of the 134 participants were assessed as poorly nourished (n = 122); 57 were the control group and 65 received the intervention. For the well-nourished participants (n = 12), four were in the intervention group and eight were controls. There were no significant differences in any outcome variables for poorly nourished participants who received the intervention compared with controls. For the sample of well-nourished participants, those who received the intervention performed significantly better in outcomes of IADLs (b = 1.74, p < .05), hip muscle strength (b = 9.64, p < .01), and physical health related quality of life (b = 10.47, p < .01). CONCLUSION: The family-centered care intervention was only effective for older adults with cognitive impairment recovering from hip-fracture surgery who were well-nourished at 1 month following hospital discharge, but not for those at risk of malnutrition. Interventions should focus on enhancing nutritional status following hip surgery which could allow the family-centered in-home intervention to be beneficial for more older adults with cognitive impairment recovering from hip-fracture surgery.

Survivin SNP-carcinogen interactions in oral cancer.

UNLABELLED: In Taiwan, oral cancer is causally associated with environmental carcinogens. Survivin is an anti-apoptotic protein and is generally considered a marker of malignancy. The current study explored the combined effect of survivin gene polymorphisms and environmental carcinogens on the risk and clinico-pathological development of oral cancer. Five single-nucleotide polymorphisms (SNPs) of survivin genes from 439 male patients with oral cancer and 424 male control participants (who did not have cancer) were analyzed. The survivin -31GG, +9194 GG, and +9809 TT homozygotes exhibited higher risk for oral cancer compared with the corresponding ancestral genotype, after adjustment for related confounders. The survivin -31, +9194, and +9809 SNPs combined with betel quid chewing and/or tobacco consumption could robustly elevate susceptibility to oral cancer. The distribution frequency of the -31 G: +9194 A: +9809 T haplotype was significantly higher in oral cancer patients than in control participants. These results suggest that survivin gene polymorphisms and their interactions with environmental carcinogens may increase susceptibility to oral cancer in Taiwanese men. ABBREVIATIONS: AOR, adjusted odds ratio; CI, confidence intervals; PCR, polymerase chain-reaction; SNP, single-nucleotide polymorphisms.

Circumnipple-incision, longitudinal-breast dissection augmentation mammaplasty.

A modification of circumnipple breast augmentation is described, which confines the minimal scar to the base of the nipple. Furthermore, a longitudinal breast parenchyma dissection is performed for breast pocket dissection that limits the injury of the lactiferous ducts and nerves to a minimum, and makes dissection and exposure of the pocket easier, even in patients whose nipples are small. This technique is especially useful in small breasts. We have performed this procedure in 57 patients, and the few complications to date are discussed in this paper.

Breast reconstruction with TRAM flap after subcutaneous mastectomy for injected material (siliconoma).

Many patients throughout the world have had breast augmentation using injectable materials. In the Far East, an adulterated impure silicone has been used by non-medical persons and unlicensed 'cosmetic surgeons' as well as by licensed physicians. The injected material usually causes a granulomatous reaction, tenderness, erythema, pain or discomfort and even skin necrosis. Eventually, the injected breast becomes very hard and develops a distorted contour. Previous treatment was by subcutaneous mastectomy with immediate or delayed reconstruction using a silicone prosthesis. The results of this were often unsatisfactory. We obtained more satisfactory results in 11 patients who had the siliconoma removed by subcutaneous mastectomy and the breast reconstructed with a de-epithelialised TRAM flap.

Breast reconstruction following excision of phylloides tumor.

There are few papers published on breast reconstruction after excision of phylloides tumor. Six patients who had reconstruction of the breast following excision of phylloides tumor are described. All underwent wide excision or subcutaneous mastectomy followed by immediate or delayed reconstruction with implants or autologous tissue. The mean follow-up was 5 years (range, 2.5-7 years). One patient died of metastases; the others survived without evidence of recurrence. The etiology, incidence, diagnosis, and treatment of these tumors are discussed. The aesthetic results in these patients is also described.

Surgical reconstruction in cryptophthalmos.

Cryptophthalmos is the congenital absence of the eyelid with skin passing continuously from the forehead onto the cheek over a malformed eye. The deformity can be classified into three types: complete, incomplete and abortive. We present the cases of two siblings, each with incomplete cryptophthalmos involving one eye. We report a three-stage reconstructive procedure in which a conchal cartilage 'sandwich' graft was first placed between the skin flap and the globe, mucous membrane subsequently grafted onto the inner surface of the cartilage graft, and lid level adjusted as the third stage.

Pilot in vitro toxicity study of 5-ALA and Photofrin in microvascular endothelial cell cultures.

Complicated hemangiomas are unique problems in which intervention with the proper laser can be an ideal solution. In this study we evaluated the toxicity of 5-Aminolevulinic acid (5-ALA) and Photofrin using in vitro models. The in vitro toxicity of 5-ALA and Photofrin was examined in a microvascular endothelial cell (MEC) culture system. The measurement of the percentage of MEC killed by various drug concentration using fluorescence viability assay. MEC incubated with 5-ALA at various concentrations for evaluation of dark toxicity showed less than a 50% cell kill. A comparison of different intervals of subcultured MEC showed that the early subculture (3 days after primary culture) is more vulnerable than later subculture (7 days after). Cells treated with Photofrin at various concentrations exhibited less than 50% cell kill (dark toxicity). The comparison of different intervals of subculture (3 days and 7 days after primary culture) showed a result similar to that of 5-ALA. All controls showed 0% cell kill. In conclusion, both 5-ALA and Photofrin are capable of destroying human microvascular endothelial cells in vitro. Drug concentrations and the power density for photodynamic therapy should be considered and will be included in our subsequent studies.

Periorbital soft-tissue and socket reconstruction.

Deformities of the periorbital soft tissue and socket after trauma or infection may involve the bony framework, orbital contents, and periorbital soft tissues, requiring careful evaluation. Soft-tissue reconstruction necessitates the appreciation of a three-dimensional defect. Structural reconstruction in conjunction with prosthetic replacement of the globe requires careful planning. Three cases illustrating problems and results after reconstructions are presented.

Use of split anterior tibial muscle flap in treating avulsion injury of leg associated with tibia exposure.

Avulsion injury of the leg may result in exposure of the anterior surface of the tibia in addition to skin loss. This exposed bone should be covered by a soft tissue flap to facilitate healing and provide durability. The split anterior tibial muscle flap is ideal in this situation because of its adjacent location, reliability, and simplicity. A cadaveric study demonstrated rich intramuscle vascular anastomoses between the segmental branches from the anterior tibial artery that provide safety in partial transfer. The technique of split anterior tibial muscle flap was applied successfully in 4 patients with leg avulsion injury associated with tibial bone exposure. The cosmetic result was good and the function of the muscle was preserved.

Traumatic eyelid invagination: case reports.

Three rare cases of upper eyelid trauma are presented. In high-speed traffic accidents, the upper eyelids were penetrated by glass, avulsed, and then, together with pieces of glass, pushed over the globe and buried deeply in the retrobulbar area. The invaginated eyelids were pulled out gently, the conjunctiva still attached to the globes. They were repaired primarily. In these patients eyelid function and cosmesis were preserved.

Jadassohn's nevus sebaceous of the head and face.

The nevus sebaceous is a congenital skin lesion that usually appears in the head and face area. The lesions often cause aesthetic problems for patients and have a high incidence of malignant degeneration. The nevus sebaceous is rarely discussed in plastic surgery literature, however. This article describes 62 cases with a review of the literature.

Complications of Oriental blepharoplasty.

The complications of Oriental blepharoplasty are described according to their clinical appearance and anatomic findings at the time of surgery. The surgical correction of these complications is presented. A total of 42 patients with complications following blepharoplasty were treated. The types of deformities were categorized from their external appearance as asymmetry, retraction and ectropion, blepharoptosis, supratarsal depression, fading of the lid fold, and hemorrhage. The causes of each type of complication are identified according to the intraoperative findings, and the correlation between preoperative and intraoperative findings is explained. Correction of these complications follows identified guidelines, and the results were good to satisfactory.

Coverage of multiple extensive pressure sores with a single filleted lower leg myocutaneous free flap.

A large free flap from an amputated lower extremity based on popliteal vessels was used for coverage of three extensive decubitus ulcers in a single operative procedure. The procedure was easy, reliable, and actually time- and cost-saving. It provided a quick solution and early rehabilitation for a difficult problem.