Factors Affecting Zero-Waste Behaviours of College Students.

This study evaluated the recognition and attitude toward microplastic and zero waste among college students and investigated the factors influencing their zero-waste behaviours. The study was conducted from 20 August 2021 to 10 September 2021, including students at a university in G metropolitan city, Republic of Korea. A total of 196 data were analysed. Statements were developed to verify how the use of disposables and the recognition, attitude, and behaviours related to zero waste were affected during the COVID-19 pandemic. Family type and usage of disposables were the factors affecting zero-waste behaviour in Model 1. In Model 2, which included the subcategory of zero-waste recognition, the health effects of microplastics and environmental preservation were significant factors. In Model 3, which included the subcategory of zero-waste attitude, the health effects of microplastics (ß = 0.149, p = 0.016), use of eco-friendly products (ß = 0.342, p < 0.001), and environmental preservation (ß = 0.317, p < 0.001) were significant factors. The use of plastic products increased dramatically during the COVID-19 pandemic. Research and education are needed to promote zero-waste behaviours with a focus on microplastics. Raising awareness of the health effects of microplastics can enhance the effectiveness of education.

Predictive Factors of Surgical Site Infection Following Cranioplasty: A Study Including 3D Printed Implants.

In patients who have undergone decompressive craniectomy (DC), subsequent cranioplasty is required to reconstruct cranial defects. Surgical site infection (SSI) following cranioplasty is a devastating complication that can lead to cranioplasty failure. The aim of the present study, therefore, was to identify predictive factors for SSI following cranioplasty by reviewing procedures performed over a 10-year period. A retrospective analysis was performed for all patients who underwent cranioplasty following DC between 2010 and 2020 at a single institution. The patients were divided into two groups, non-SSI and SSI, in order to identify clinical variables that are significantly correlated with SSI following cranioplasty. Cox proportional hazards regression analyses were then performed to identify predictive factors associated with SSI following cranioplasty. A total of 172 patients who underwent cranioplasty, including 48 who received customized three-dimensional (3D) printed implants, were enrolled in the present study. SSI occurred in 17 patients (9.9%). Statistically significant differences were detected between the non-SSI and SSI groups with respect to presence of fluid collections on CT scans before and after cranioplasty. Presence of fluid collections on computed tomography (CT) scan before (p = 0.0114) and after cranioplasty (p < 0.0000) showed significant association with event-free survival rate for SSI. In a univariate analysis, significant predictors for SSI were fluid collection before (p = 0.0172) and after (p < 0.0001) cranioplasty. In a multivariate analysis, only the presence of fluid collection after cranioplasty was significantly associated with the occurrence of SSI (p < 0.0001). The present study investigated predictive factors that may help identify patients at risk of SSI following cranioplasty and provide guidelines associated with the procedure. Based on the results of the present study, only the presence of fluid collection on CT scan after cranioplasty was significantly associated with the occurrence of SSI. Further investigation with long-term follow-up and large-scale prospective studies are needed to confirm our conclusions.

Color Doppler ultrasonography for predicting the patency of anastomosis after superficial temporal to middle cerebral artery bypass surgery.

BACKGROUND: Color Doppler ultrasonography (CDUS) is used to evaluate the surgical success and postoperative hemodynamic changes of patients who receive superficial temporal to middle cerebral artery (STA-MCA) bypass surgery. Previous studies enrolled small populations, and difficulties interpreting the results have limited their use in clinical settings. OBJECTIVE: We attempted to determine the feasibility of using CDUS to evaluate STA hemodynamics and identify the most reliable parameter as a new clinical implication for determining bypass patency. METHOD: Twenty-six patients who underwent STA-MCA bypass surgery were prospectively enrolled. Four times CDUS and two times digital subtraction angiography (DSA) were performed. The CDUS parameters were compensated using the ratio of the operated to the non-operated sides (R1) and compared before and after surgery (R2). The CDUS parameters are then compared with the patency on DSA by statistical analyses. RESULTS: Increased CDUS parameters of the mean flow rate (MFR) and cross-sectional diameter (CSD) showed significant correlations with good patency on DSA. The R2 at 1 month was identified as the most reliable parameter for predicting the patency in both MFR and CSD. Their cutoff values were 1.475 and 1.15, respectively. CONCLUSION: CDUS can be utilized for predicting the patency after STA-MCA bypass surgery; if the postoperative (compensated and compared) CDUS parameters increased by more than 47.5% in the MFR or 15% in the CSD, the patency of the anastomosis on DSA would be good.

Posterior circulation involvement and collateral flow pattern in moyamoya disease with the RNF213 polymorphism.

PURPOSE: Moyamoya disease is a chronic cerebrovascular disorder characterized by progressive stenosis of the circle of Willis with a compensatory collateral vessel network. Recent studies have identified the ring finger protein 213 gene (RNF213) as the unique susceptibility gene for moyamoya disease. The purpose of this study was to compare clinical features of moyamoya disease, especially angiographic findings, between patients with and without the RNF213 mutation. METHODS: Blood samples from 35 patients with moyamoya disease were obtained between May 2016 and May 2017. Information on age at the time of diagnosis, sex, and initial symptom were obtained via retrospective chart review. Angiographic records were evaluated. RESULTS: RNF213 variants were detected in the 28 of 35 patients (80%), including all pediatric patients (100%) and 18 of 25 adult patients (72%) in our cohort. Leptomeningeal collateral flow from posterior to anterior circulation was more frequent in the RNF213-negative group than in the RNF213-positive group (100% versus 38.9%; p = 0.020). Posterior cerebral arterial territorial involvement was more frequently observed in RNF213-positive patients than in RNF213-negative patients (50% versus 0%; p = 0.027). CONCLUSIONS: RNF213 may play a significant role in the development of collateral anastomoses.

Increased Ratio of Superficial Temporal Artery Flow Rate After Superficial Temporal Artery-to-Middle Cerebral Artery Anastomosis: Can It Reflect the Extent of Collateral Flow?

OBJECTIVE: There are several ways to identify donor artery patency and success of surgery after an anastomosis of the superficial temporal artery (STA) to the middle cerebral artery (MCA). The purpose of this study was to evaluate the ratio of bilateral STA mean flow rate (MFR) with the use of color Doppler ultrasonography (CDUS) after bypass surgery and to confirm the possibility of this value as a predictor of the extent of collateral flow. METHODS: Eleven consecutive patients who had undergone STA-MCA anastomosis were included. In every case, bilateral STA MFR, mean velocity, and cross-sectional diameter were measured preoperatively and postoperatively at 1 week, 1 month, and 2 months via CDUS. We measured the bilateral STA MFR ratio changes to compensate for systemic hemodynamic variables. RESULTS: One month after surgery, 9 of the 11 patients who underwent STA-MCA anastomosis had good patency on DSA. In patients with good patency, there was a significant increase in the baseline STA MFR ratio compared with those at 1 week, 1 month, and 2 months postoperatively (2.88, 3.07, and 4.38, respectively, P < 0.05). The mean STA cross-sectional diameter ratio also was significantly increased postoperatively in the good patency group (1.35, 1.41, and 1.49, respectively, P = 0.044). In addition, the mean STA mean velocity ratio was increased postoperatively in the good patency group (1.48, 1.40, and 1.67, respectively, P = 0.042). CONCLUSIONS: We conclude that using CDUS to measure both STA MFR ratio is a potential method to predict the extent of collateral flow through an STA-MCA anastomosis.

Demineralized Bone Matrix (DBM) as a Bone Void Filler in Lumbar Interbody Fusion: A Prospective Pilot Study of Simultaneous DBM and Autologous Bone Grafts.

OBJECTIVE: Solid bone fusion is an essential process in spinal stabilization surgery. Recently, as several minimally invasive spinal surgeries have developed, a need of artificial bone substitutes such as demineralized bone matrix (DBM), has arisen. We investigated the in vivo bone growth rate of DBM as a bone void filler compared to a local autologous bone grafts. METHODS: From April 2014 to August 2015, 20 patients with a one or two-level spinal stenosis were included. A posterior lumbar interbody fusion using two cages and pedicle screw fixation was performed for every patient, and each cage was packed with autologous local bone and DBM. Clinical outcomes were assessed using the Numeric Rating Scale (NRS) of leg pain and back pain and the Korean Oswestry Disability Index (K-ODI). Clinical outcome parameters and range of motion (ROM) of the operated level were collected preoperatively and at 3 months, 6 months, and 1 year postoperatively. Computed tomography was performed 1 year after fusion surgery and bone growth of the autologous bone grafts and DBM were analyzed by ImageJ software. RESULTS: Eighteen patients completed 1 year of follow-up, including 10 men and 8 women, and the mean age was 56.4 (32-71). The operated level ranged from L3/4 to L5/S1. Eleven patients had single level and 7 patients had two-level repairs. The mean back pain NRS improved from 4.61 to 2.78 (p=0.003) and the leg pain NRS improved from 6.89 to 2.39 (p<0.001). The mean K-ODI score also improved from 27.33 to 13.83 (p<0.001). The ROM decreased below 2.0 degrees at the 3-month assessment, and remained less than 2 degrees through the 1 year postoperative assessment. Every local autologous bone graft and DBM packed cage showed bone bridge formation. On the quantitative analysis of bone growth, the autologous bone grafts showed significantly higher bone growth compared to DBM on both coronal and sagittal images (p<0.001 and p=0.028, respectively). Osteoporotic patients showed less bone growth on sagittal images. CONCLUSION: Though DBM alone can induce favorable bone bridging in lumbar interbody fusion, it is still inferior to autologous bone grafts. Therefore, DBM is recommended as a bone graft extender rather than bone void filler, particularly in patients with osteoporosis.