Developing a Practical Tool for Predicting Wound Healing Outcomes of Patients with Diabetic Forefoot Ulcers: Focus on Vasculopathy and Infection.

OBJECTIVE: To develop a preliminary risk scoring system to predict the prognosis of patients with diabetic forefoot ulcers based on the severity of vasculopathy and infection, which are the major risk factors for amputation. METHODS: Forefoot was defined as the distal part of the foot composed of the metatarsal bones and phalanges and associated soft tissue structures. The degree of vasculopathy was graded as V0, V1, or V2 according to transcutaneous partial oxygen tension values and toe pressure. The degree of infection was graded as I0, I1, or I2 according to tissue and bone biopsy culture results. The risk scores were calculated by adding the scores for the degree of vasculopathy and infection and ranged from 0 to 4. Wound healing outcomes were graded as healed without amputation, minor amputation, or major amputation. The authors evaluated wound healing outcomes according to risk scores. RESULTS: As the risk score increased, the proportion of patients who underwent both major and minor amputations increased (P < .001). In the multivariate logistic analysis, the odds ratios of amputation also increased as the risk score increased. Patients with a risk score of 4 were 75- and 19-fold more likely to undergo major and minor amputations, respectively, than patients with a risk score of 0 (P = .006 and P < .001). CONCLUSIONS: The risk score can be used as an indicator to predict the probability of amputation in patients with diabetic forefoot ulcers.

Justifying the Gompertz curve of mortality via the generalized Polya process of shocks.

A new probabilistic model of aging that can be applied to organisms is suggested and analyzed. Organisms are subject to shocks that follow the generalized Polya process (GPP), which has been recently introduced and characterized in the literature. Distinct from the nonhomogeneous Poisson process that has been widely used in applications, the important feature of this process is the dependence of its future behavior on the number of previous events (shocks). The corresponding survival and the mortality rate functions are derived and analyzed. The general approach is used for justification of the Gompertz law of human mortality.

On some mortality rate processes and mortality deceleration with age.

A specific mortality rate process governed by the non-homogeneous Poisson process of point events is considered and its properties are studied. This process can describe the damage accumulation in organisms experiencing external shocks and define its survival characteristics. It is shown that, although the sample paths of the unconditional mortality rate process are monotonically increasing, the population mortality rate can decrease with age and, under certain assumptions, even tend to zero. The corresponding analysis is the main objective of this paper and it is performed using the derived conditional distributions of relevant random parameters. Several meaningful examples are presented and discussed.

VGG19 demonstrates the highest accuracy rate in a nine-class wound classification task among various deep learning networks: a pilot study.

BACKGROUND: Current literature suggests relatively low accuracy of multi-class wound classification tasks using deep learning networks. Solutions are needed to address the increasing diagnostic burden of wounds on wound care professionals and to aid non-wound care professionals in wound management. OBJECTIVE: To develop a reliable, accurate 9-class classification system to aid wound care professionals and perhaps eventually, patients and non-wound care professionals, in managing wounds. METHODS: A total of 8173 training data images and 904 test data images were classified into 9 categories: operation wound, laceration, abrasion, skin defect, infected wound, necrosis, diabetic foot ulcer, chronic ulcer, and wound dehiscence. Six deep learning networks, based on VGG16, VGG19, EfficientNet-B0, EfficientNet-B5, RepVGG-A0, and RepVGG-B0, were established, trained, and tested on the same images. For each network the accuracy rate, defined as the sum of true positive and true negative values divided by the total number, was analyzed. RESULTS: The overall accuracy varied from 74.0% to 82.4%. Of all the networks, VGG19 achieved the highest accuracy, at 82.4%. This result is comparable to those reported in previous studies. CONCLUSION: These findings indicate the potential for VGG19 to be the basis for a more comprehensive and detailed AI-based wound diagnostic system. Eventually, such systems also may aid patients and non-wound care professionals in diagnosing and treating wounds.

Rejuvenation of the Lower Eyelid and Midface with Deep Nasolabial Fat Lift in East Asians.

BACKGROUND: Correcting infraorbital hollowness is an important procedure for midface rejuvenation. Sub-orbicularis oculi fat lift is a commonly used method. However, adipose tissue, which has been thought of as sub-orbicularis oculi fat, has recently been controversial. The objective of this study was to introduce a method of midface rejuvenation using deep nasolabial fat lift (MRDN) by means of lower blepharoplasty and to compare surgical outcomes between MRDN and lower blepharoplasty with fat transposition (LBF). METHODS: The medical records of patients who had undergone midface rejuvenation with lower blepharoplasty between 2013 and 2020 were retrospectively reviewed. Questionnaires, digital photographs, and charts were used to evaluate the surgical outcomes and complications. The degree of aging was graded as mild, moderate, or severe. LBF and MRDN were used for mild and severe grades, respectively. For the moderate grade, the preferred surgical method of the two methods was selected and surgical outcomes were compared. The MRDN technique included LBF. RESULTS: Postoperative satisfaction was significantly higher ( P < 0.001), recurrence rate for tear trough ( P = 0.046) and fat bulging ( P = 0.005) was significantly lower, duration of swelling ( P < 0.001) was significantly longer, and incidence of chemosis ( P = 0.024) was significantly higher in the MRDN group than in the LBF group. Regarding lid malposition, transient retraction was higher in the LBF group, whereas cicatricial ectropion was higher in the MRDN group; however, these differences were not significant. CONCLUSION: MRDN is associated with higher patient satisfaction and surgical longevity without serious complications than LBF. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Variables acceptance reliability sampling plan for items subject to inverse Gaussian degradation process.

Until now, in the literature, a variety of acceptance reliability sampling plans have been developed based on different life test plans. In most of the reliability sampling plans, the decision procedures to accept or reject the corresponding lot are developed based on the lifetimes of the items observed on tests, or the number of failures observed during a pre-specified testing time. However, frequently, the items are subject to degradation phenomena and, in these cases, the observed degradation level of the item can be used as a decision statistic. In this paper, we develop a variables acceptance sampling plan based on the information on the degradation process of the items, assuming that the degradation process follows the inverse Gaussian process. It is shown that the developed sampling plan improves the reliability performance of the items conditional on the acceptance in the test and that the lifetimes of items after the reliability sampling test are stochastically larger than those before the test. A study comparing the proposed degradation-based sampling plan with the conventional sampling plan which is based on a life test is also performed.