Tunneled island pedicle flap reconstruction for upper lateral cutaneous lip defects.

BACKGROUND: Esthetic upper lateral cutaneous lip reconstruction preserves the apical triangle, nasolabial fold symmetry, and free margin position. The tunneled island pedicle flap (IPF) is a novel single-stage reconstruction to achieve these goals. OBJECTIVES: Describe the technique and patient and surgeon-reported outcomes for the tunneled IPF reconstruction of upper lateral cutaneous lip defects. METHODS: Retrospective chart review of consecutive tunneled IPF reconstruction following Mohs micrographic surgery (MMS) at a tertiary care center between 2014 and 2020. Patients rated their scars using the validated Patient Scar Assessment Scale (PSAS), and independent surgeons rated scars using the validated Observer Scar Assessment Scale (OSAS). Descriptive statistics were generated for patient demographics and tumor defect characteristics. RESULTS: Twenty upper lateral cutaneous lip defects were repaired with the tunneled IPF. Surgeons rated scars with a composite OSAS score of 11.83 ± 4.29 (mean, SD) [scale of 5 (normal skin) to 50 (worst scar imaginable)] and an overall scar score of 2.81 ± 1.11 [scale of 1 (normal skin) to 10 (worst scar imaginable)]. Patients rated their scars with a composite PSAS score of 10 ± 5.39 [scale of 6 (best possible score) to 60 (worst)] and with an overall score of 2.2 ± 1.78 [scale of 1 (normal skin) and 10 (very different from normal skin)]. One flap was surgically revised for pincushioning, but none experienced necrosis, hematoma, or infection. CONCLUSIONS: The tunneled IPF is a single-stage reconstruction for upper lateral cutaneous lip defects with favorable scar ratings by patients and observers.

Androgens modulate neuronal vulnerability to kainate lesion.

Testosterone has been shown to have multiple beneficial effects on neuronal viability in developing and adult animals. Most often, testosterone promotes neural health indirectly via enzymatic conversion to estradiol by aromatase. Unclear is whether androgens can directly modulate vulnerability to neuronal insults in adult animals. We investigated this issue by modulating androgen status in rats prior to challenge with the excitotoxin kainate. Adult male rats were maintained in the following conditions: i) gonadectomized (GDX) to deplete endogenous androgens, ii) GDX+replacement with dihydrotestosterone (DHT) the active and non-aromatizable testosterone metabolite, iii) sham-GDX. Animals were then lesioned with kainate and surviving hippocampal neurons quantified. In the CA2/3 and hilar regions of the hippocampus, a modest lesion was observed in sham-GDX animals corresponding to approximately 25% cell loss in comparison to non-lesioned rats. The depletion of endogenous androgens by GDX significantly augmented lesion severity, consistent with the hypothesis that androgens are involved in maintaining cell viability. Importantly, DHT hormone replacement in GDX rats significantly attenuated kainate-induced neuron loss in CA2/3, suggesting direct androgen neuroprotection. These results demonstrate that androgens act as endogenous modulators of neuron viability, a function that may be compromised in aging men as a consequence of normal, age-related androgen depletion.

Technique for the harvesting of human cadaveric spines.

STUDY DESIGN: One hundred twelve fresh cadaveric spines were harvested using a newly described technique. OBJECTIVES: To develop and describe a technique for the expeditious excision of intact human cadaveric spines for biomechanical testing, to educate the dissector on the health and safety issues involved in harvesting spinal specimens, and to review the present recommendations for storage and preservation of spinal segments. SUMMARY OF THE BACKGROUND DATA: As the need for biomechanical spinal research continues to expand, the demand for fresh human cadaveric vertebral specimens increases. Previous techniques for harvesting are simplistic and sparse. This technique offers a reliable and expeditious method for procurement of spinal vertebral segments of any size. METHODS: Human cadaveric spines were harvested using an adaptation of previous posterior spinal approaches. Techniques for sectioning each vertebral region were developed. Detailed description of these techniques was meticulously documented. The procured spinal segments have been used for multiple biomechanical investigations. RESULTS: The technique has been used successfully in more than 100 spinal harvests. Approximate time required is 30 minutes. The harvested segments have been reliable biomechanical specimens in many published studies. CONCLUSIONS: A new technique for the rapid extraction of human cadaveric spines has been developed. Dissectors may benefit from the recommendations offered for sectioning of each region.

Results of the Scoliosis Research Society instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis. A multicenter study of 244 patients.

STUDY DESIGN: An outcome questionnaire was constructed to evaluate patient satisfaction and performance and to discriminate among patients with adolescent idiopathic scoliosis. OBJECTIVES: To determine reliability and validity in a new quality-of-life instrument for measuring progress among scoliosis patients. SUMMARY OF BACKGROUND DATA: Meta-analysis of the surgical treatment of adolescent idiopathic scoliosis determined that a uniform assessment of outcome did not exist. In addition, patient measures of well-being as opposed to process measures (e.g., radiographs) were not consistently reported. This established the need for a standardized questionnaire to assess patient measures in conjunction with process measures. METHODS: The instrument consists of 24 questions divided into seven equally weighted domains as determined by factor analysis: pain, general self-image, postoperative self-image, general function, overall level of activity, postoperative function, and satisfaction. The questionnaire takes approximately 5 minutes to complete and is taken at predetermined time intervals. A total of 244 of patients from three different sites responded to the questionnaire. RESULTS: The reliability based on internal consistency was confirmed with a Cronbach's alpha coefficient greater than 0.6 for each domain. In addition, acceptable correlation coefficient values greater than 0.68 were obtained for each domain by the test-retest method on normal controls. Similarly; to establish validity of the questionnaire, responses of normal high school students were compared with that of the patients. Consistent differences were noted in the domains between the two groups with P < 0.003. The largest differences were in pain (control, 29.96 +/- 0.20; patient, 13.23 +/- 5.55) and general level of activity (control, 14.96 +/- 0.20; patient, 12.16 +/- 3.23). Examination of the relationship between the domains and patient satisfaction showed that pain correlates with satisfaction to the greatest degree (Pearson's correlation co-efficient, r = -0.511; P < 0.001), followed by self-image (r = 0.412; P < 0.001). CONCLUSIONS: This questionnaire addresses patient measures for evaluation of outcome in adolescent idiopathic scoliosis surgery by examining several domains. It also allows for dynamic monitoring of scoliosis patients as they become adults. This is a validated instrument with good reliability measures.

Physical activity recognition based on rotated acceleration data using quaternion in sedentary behavior: a preliminary study.

This paper suggests a physical activity assessment method based on quaternion. To reduce user inconvenience, we measured the activity using a mobile device which is not put on fixed position. Recognized results were verified with various machine learning algorithms, such as neural network (multilayer perceptron), decision tree (J48), SVM (support vector machine) and naive bayes classifier. All algorithms have shown over 97% accuracy including decision tree (J48), which recognized the activity with 98.35% accuracy. As a result, physical activity assessment method based on rotated acceleration using quaternion can classify sedentary behavior with more accuracy without considering devices' position and orientation.

Neuregulin 3 does not confer risk for schizophrenia and smooth pursuit eye movement abnormality in a Korean population.

Located on chromosome 10q22-q23, the human neuregulin3 (NRG3) is considered to be a strong positional and functional candidate gene for schizophrenia pathogenesis. Several case-control studies examining the association of polymorphisms in NRG3 with schizophrenia and/or related traits such as delusion have been reported recently in cohorts of Han Chinese, Ashkenazi Jews, Australians and white Americans of Western European ancestry. Thus, this study aimed to comprehensively investigate the association of NRG3 genetic variations with the risk of schizophrenia and smooth pursuit eye movement (SPEM) abnormality in a Korean population. Using TaqMan assay, six single-nucleotide polymorphisms (SNPs) in the intronic region of NRG3 were genotyped and two major haplotypes were identified in 435 patients with schizophrenia as cases and 393 unrelated healthy individuals as controls. A total of 113 schizophrenia patients underwent an eye tracking task, and degree of SPEM abnormality was measured using the logarithmic values of the signal/noise (Ln S/N) ratio. Differences in frequency distributions were analyzed using logistic and regression models following various modes of genetic inheritance and controlling for age and sex as covariates. Subsequent analysis revealed that the frequency distributions of NRG3 polymorphisms and haplotypes were similar between schizophrenia patients and healthy controls of Korean ethnicity. Furthermore, no significant differences were observed between the genetic variants tested for SPEM abnormality. By elucidating a lack of association in a Korean population, findings from this study may contribute to the understanding of the genetic etiology focusing on the role of NRG3 in schizophrenia pathogenesis.

An adaptive M-wave canceler for the EMG controlled functional electrical stimulator and its FPGA implementation.

Biopotential signals have been used as command and feedback signals in systems using electrical stimulation of motor nerves to restore the lost function. In order to use the voluntary electromyography (EMG) as a control signal for the functional electrical stimulation of the same muscle, it is necessary to suppress the M-wave evoked by the electrical stimulation. We present a Gram-Schmidt (GS) prediction error filter which effectively eliminates the M-wave from voluntary EMG. The GS filter has systolic array structure, so it offers advantages for the real-time processing on the field programmable gate array (FPGA). On basis of the data obtained from model for M-wave and voluntary EMG and from CNS injury patient, the proposed GS filter showed a very promising performance.

The analysis of mental stress using time-frequency distribution of heart rate variability signal.

Conventional power spectrum methods based on fast Fourier transform (FFT), autoregressive(AR) model are not appropriate for analyzing biomedical signals whose spectral characteristics change rapidly. On the other hand, time-frequency analysis has more desirable characteristics of a time-varying spectrum. In this study, we investigated the spectral components of heart rate variability (HRV) in a time-frequency domain. Then, from the instantaneous frequency, obtained from time-frequency distribution, the method extracting frequency components of HRV was proposed. The subjects were 17 healthy young men. A coin-stacking task was used to induce mental stress. In the results, the emotional stress of subjects produced an increase in sympathetic activity. Sympathetic activation was responsible for the significant increase in the LF/HF ratio. The subjects were divided into two groups with task ability. The subject who had higher mental stress had a lack of task ability.