Oncologic outcomes after immediate breast reconstruction following mastectomy: comparison of implant and flap using propensity score matching.

BACKGROUND: Although immediate breast reconstruction has been reported to be oncologically safe, no affirmative study comparing the two reconstruction methods exists. We investigated breast cancer recurrence rates in two breast reconstruction types; implant reconstruction and autologous flap reconstruction. METHODS: A retrospective cohort study was performed on propensity score-matched (for age, stage, estrogen receptor status) patients who underwent IBR after mastectomy at Seoul National University Hospital between 2010 and 2014. The main outcomes determined were locoregional recurrence-free interval (LRRFI) and disease-free interval (DFI). RESULTS: We analyzed 496 patients among 731 patients following propensity score matching (Median age 43, 247 implant reconstruction and 249 flap reconstruction). During median follow-up of 58.2 months, DFI was not different between the two groups at each tumor stage. However, flap reconstruction showed inferior DFI compared to implant reconstruction in patients with high histologic grade (p = 0.012), and with high Ki-67 (p = 0.028). Flap reconstruction was related to short DFI in multivariate analysis in aggressive tumor subsets. Short DFI after flap reconstruction in aggressive tumor cell phenotype was most evident in hormone positive/Her-2 negative cancer (p = 0.008). LRRFI, on the other hand, did not show difference according to reconstruction method regardless of tumor cell aggressiveness. CONCLUSION: Although there is no difference in cancer recurrence according to reconstruction method in general, flap-based reconstruction showed higher systemic recurrence associated with histologically aggressive tumors.

The Reconstruction of the Central Tubercle in Bilateral Cleft Lips: Bilateral Lateral Mucosal Advancement Flap With Reinforcement of the Orbicularis Oris Muscle.

BACKGROUND: There are various methods to correct the whistle deformity in bilateral cleft lip. In case of the central deficiency with concomitant lateral excess, local tissue rearrangement can be used to reposition the lateral tissue. We designed bilateral lateral advancement flap with reinforcement of the orbicularis oris muscle. METHOD: Thirteen bilateral cleft lip patients with whistling lip deformity from July 2009 to February 2017 underwent our method of tubercle formation. Vertical upper lip measurements of upper lip were recorded. Augmentation percentage was documented using follow-up measurements compared with preoperative measurements. The average follow-up period was 16.2 months (range, 9-26 months). The axis of the flap and central incision were placed on the red line (wet-dry vermilion border). Dissection was performed through the submucosal plane. After entire dissection, inter-orbicularis oris muscle suture on both medial edge of the flap was performed. In case it was necessary, back-cutting incision on both curvature of the central orbicularis oris could facilitate central augmentation. Elevated superior and inferior trap-door flaps were trimmed to make natural central lip line along with the lateral mucosal flaps. Both lateral parts of vermilions were closed in V-Y advancement fashion. RESULT: The vertical height of central tubercle (T) had a mean increase of 136.9%, which was significantly different from preoperative measurement (P < 0.05). There were no surgical complications. CONCLUSIONS: Our surgical method is safe, useful, and effective to correct the whistle deformity of the central deficiency with concomitant lateral excess.

Correlation Between Speech Outcomes and the Amount of Maxillary Advancement After Orthognathic Surgery (Le Fort I Conventional Osteotomy and Distraction Osteogenesis) in Patients With Cleft Lip and Palate.

BACKGROUND: The purpose of this study is to evaluate the factors affecting the speech outcome following Le fort I conventional osteotomy(CO) or Le Fort I distraction osteogenesis(DO) in patients with cleft lip and palate at a single institution. METHOD: Records of cleft lip and palate patients who underwent orthognathic surgery between 2010 and 2015 were reviewed. Data included age at orthognathic surgery, sex, cleft lip and palate type, type of orthognathic surgery, the amount of maxillary advancement, and speech assessment. Speech outcomes were classified into 2 categories. Compared with the pre and post-operative Pittsburgh Weighted speech scale scores, in case that the post-operative total score is increased the authors define it as "Speech deterioration" and if not, the authors define it as "Speech preservation." RESULT: The 44 patients were identified, 33 patients underwent CO and 11 patients underwent DO. The mean age was 19.4 ±â€Š1.4. The mean period time of speech evaluation after orthognathic surgery was 1.0 ±â€Š0.46 year. The mean amount of maxillary advancement was 7.2 ±â€Š3.2 mm and show significant correlation with speech outcomes. (P = 0.012) . In CO group, the patients who had the maxilla 1∼5 mm advancement maintained their speech completely and 44% of patients with 6∼8 mm deteriorated their speech. In DO group, patients with 9∼10 mm maintained their speech completely, 50% of patients with 11∼12 mm deteriorated their speech and 100% of patients with 13∼16 mm deteriorated their speech. According to the relationship between the amount of maxillary advancement and speech outcomes, there was a statistically significant correlation in both CO and DO groups. (P = 0.04, 0.029). CONCLUSION: It was found that speech of the patients with more amount of maxillary advancement tended to get worse. Also, it was observed that there exist some stable ranges of maxillary advancement for speech safety which does not effect on speech. (1∼5 mm in CO group and 9∼10 mm in DO group).

Flap reconstruction of soft tissue defect after resecting a huge hemangioma of the nose.

Hemangioma is a benign vascular tumor that grows by endothelial cell hyperplasia. It occurs most frequently in the head and neck region. Nose reconstruction is tricky because of its unique threedimensional structure and different tissue components. We report a case of successful reconstruction of near-total nose defect using the paramedian forehead flap combined with a nasolabial flap, immediately after excision of nasal hemangioma. A 49-year-old male patient was presented with a huge mass at the nose. Preoperative magnetic resonance imaging showed prominent vascular channels extending to the forehead and cheek. Complete resection of the mass was performed, which resulted in an eccentric defect. The right paramedian forehead flap and the left nasolabial flap were designed and transferred to the defect. Flap division was performed 1 month later. The patient is satisfied with the overall appearance and did not develop any functional deficit.

Immediate Lower Extremity Reconstruction Using an Anterolateral Thigh Free Flap With Simultaneous Interposition Graft of Descending Branches of Lateral Circumflex Femoral Vessels.

In a severely injured leg with acute limb ischemia, both immediate revascularization of an endangered part and coverage of soft tissue defect are crucial to limb salvage. In this article, we report a case of an anterolateral thigh free flap with interposition graft of descending branches of the lateral circumflex femoral vessels. A 18-cm-long graft was harvested and used to replace the injured anterior tibial vessels. One month later, a duplex sonogram revealed intact circulation to both the interposition graft and the flap. Despite anatomic inconstancy, the anterolateral thigh free flap is commonly utilized in reconstructive surgeries. When descending branches of the lateral femoral circumflex vessels were included sufficiently, its pedicle can be used to bridge a vascular defect in the extremity while covering soft tissue defect.

Finding the evidence for protein-protein interactions from PubMed abstracts.

MOTIVATION: Protein-protein interactions play critical roles in biological processes, and many biologists try to find or to predict crucial information concerning these interactions. Before verifying interactions in biological laboratory work, validating them from previous research is necessary. Although many efforts have been made to create databases that store verified information in a structured form, much interaction information still remains as unstructured text. As the amount of new publications has increased rapidly, a large amount of research has sought to extract interactions from the text automatically. However, there remain various difficulties associated with the process of applying automatically generated results into manually annotated databases. For interactions that are not found in manually stored databases, researchers attempt to search for abstracts or full papers. RESULTS: As a result of a search for two proteins, PubMed frequently returns hundreds of abstracts. In this paper, a method is introduced that validates protein-protein interactions from PubMed abstracts. A query is generated from two given proteins automatically and abstracts are then collected from PubMed. Following this, target proteins and their synonyms are recognized and their interaction information is extracted from the collection. It was found that 67.37% of the interactions from DIP-PPI corpus were found from the PubMed abstracts and 87.37% of interactions were found from the given full texts. AVAILABILITY: Contact authors.

ISO/IEEE 11073 PHD message generation toolkit to standardize healthcare device.

As senior population increases, various healthcare devices and services are developed such as fall detection device, home hypertension management service, and etc. However, to vitalize healthcare devices and services market, standardization for interoperability between device and service must precede. To achieve the standardization goal, the IEEE 11073 Personal Health Device (PHD) group has been standardized many healthcare devices, but until now there are few devices compatible with the PHD standard. One of main reasons is that it isn't easy for device manufactures to implement standard communication module by analyzing standard documents of over 600 pages. In this paper, we propose a standard message generation toolkit to easily standardize existing non-standard healthcare devices. The proposed toolkit generates standard PHD messages using inputted device information, and the generated messages are adapted to the device with the standard state machine file. For the experiments, we develop a reference H/W, and test the proposed toolkit with three healthcare devices: blood pressure, weighting scale, and glucose meter. The proposed toolkit has an advantage that even if the user doesn't know the standard in detail, the user can easily standardize the non-standard healthcare devices.

Home healthcare settop-box for senior chronic care using ISO/IEEE 11073 PHD standard.

As the number of seniors with chronic disease increases, the need of home healthcare settop-box is increased to manage their chronic disease in their home environment. Using the home healthcare settop-box, the patients can regularly check their health data, and finally, it can lead the decrease of medical expenses. For the home healthcare settop-box, the most important factor is the standard compatibility, which can interoperate with standard devices of any other companies. In this paper, we propose a home healthcare settop-box using ISO/IEEE 11073 PHD standard. It collects health data according to the PHD standard, and provides a chronic-care service based on the collected data. The proposed settop-box is connected with 3 devices of weigh scale, blood pressure monitor, and glucose meter, and tested at 10 homes for a month. Lastly, the proposed settop-box can be used for various healthcare services such as Google Health and Telemedicine Services using a healthcare platform server.

Daily activity recognition system for the elderly using pressure sensors.

As transformed to aging society rapidly, the number of old persons who live alone is drastically increased. Because these old people may have disorder of bodily function, and be suffering from geriatric disease, needs of a health assistance system to make them healthier are strongly increased. In this paper, we propose a daily activity recognition system for an old person using pressure sensors. The target daily activities are MEAL, SLEEP, EXCRETION, GO-OUT, and REST. The proposed system installs pressure sensors to furniture and floors in home, and recognizes daily activities based on the object usage information. By using the proposed system, we can provide a warning sign for unhealthy cases such as skipping meals. And, the families who live in remote place can check that their parent takes a healthy daily living.

Normalization of gene/protein names in biological literatures using Vector-Space Model.

As the number of biological literatures grows exponentially, needs for text mining system are increased. In text mining area, normalization is mapping gene/protein names to a database. It is necessary to combine extracted information from various literatures and to create a database or an ontology using literatures. Previous normalization researches used direct comparison methods between a database and literatures, but it is weak to extremely variational gene/protein names in literatures. Therefore, in this paper, we propose a normalization method using Vector-Space Model. For each gene/protein name, we rank identifiers using Vector-Space Model, and find the most similar identifier with the name. Experimental result shows the proposed method has 70.7% f-measure.

BioProber: software system for biomedical relation discovery from PubMed.

The numbers of articles and journals that are published are increasing at a considerable rate, and the published information is growing continuously and fast. Because of this, researches to acquire knowledge automatically have been carried out in the areas of information retrieval, information extraction and text mining. Information retrieval approaches are good for specific topics that the number of related articles is small. But, if the number is bigger, searching skill and knowledge acquisition ability are useless. Though many efforts have been made to extract information from literature, many approaches have concentrated on specific entities, such as proteins, genes and their interactions, and much information is still remained in unstructured text. So, we have developed a system that discovers relations between various categories of biomedical entities. Our system collects abstracts from PubMed by queries representing a topic and visualizes relationship from the collection by automatic information extraction.