Differential inducibility of transmembrane peptidoglycan recognition proteins (PGRPs) by bacterial challenges in the earthworm, Eisenia andrei.

Peptidoglycan recognition proteins (PGRPs) and Toll-like receptors (TLRs) are highly conserved pattern recognition receptors (PRRs). Earthworms possess genes encoding TLRs that specifically respond to Gram-positive bacteria. In addition, several PGRPs have been recently identified, which are predicted to exhibit amidase activity but lack receptor function. In lophotrochozoans, a membrane-bound PRR responsible for detecting Gram-negative bacteria remains unidentified. This study reveals several novel transmembrane peptidoglycan recognition proteins (Ean-PGRPLs) in earthworms, whose mRNA expression increases in response to Gram-negative but not Gram-positive bacteria. This indicates that Ean-PGRPLs may serve as a PRR associated with intracellular signaling for Gram-negative bacteria.

Novel soy protein isolate/sodium alginate-based functional aerogel for efficient uptake of organic dye from effluents.

In response to the increasing global concern regarding water pollution, there is a growing demand for the development of novel adsorbents capable of effectively eliminating hazardous organic pollutants from effluents. In this study, we present a functional soy protein isolate (SPI)/sodium alginate (ALG)/polyethyleneimine (PEI) aerogel prepared via a facile chemical crosslinking process as a novel adsorbent with excellent capabilities for removing toxic methyl blue (MB) dye from effluents. Thanks to the synergistic dense oxygen and nitrogen-containing functional groups in the networks, the ALG/SPI/PEI (ASP) aerogel displayed high adsorption capacity for MB (106.3 mg/g) complying the adsorption kinetics and isotherm with the pseudo-second-order and Langmuir models, respectively. Remarkably, the MB adsorption capability of the ASP aerogel surpasses that of its pristine counterpart and outperforms recently reported adsorbents. Moreover, the aerogel maintained >80% of initial adsorption capability in the fourth regenerative cycle, indicating excellent reusability. The superior MB adsorbability coupled with high-efficiency regenerability in this study reveal the significant potential of ASP aerogel in efficiently eliminating organic dye from wastewater.

A nationwide study of regional preference and graft survival of kidney transplantation in South Korea: patterns of centralization in the capital area

Purpose@#This study aims to investigate regional patterns and graft survival rates in kidney transplantation (KT) within South Korea using the National Health Insurance Service database. @*Methods@#By analyzing KT data from 2002 to 2017, including patient residency, KT location, and post-KT dialysis information, graft survival was assessed through post-KT dialysis and validated against Ulsan University Hospital and the Korean Organ Transplantation Registry’s 2017 report. @*Results@#Among the 20,978 KTs, 60.5% occurred in the Korean capital, Seoul, whereas 39.5% occurred outside. The overall graft survival rate was 81.5% with a median survival duration of 57 months. Patient survival was 83.8%, with a median survival duration of 61 months. For KTs from 2002 to 2007, the 10-year graft and patient survival rates were 89.1% and 90.3%, respectively. The KT recipients living outside Seoul who underwent the KT within their residential regions had a graft survival rate of 88.3%, and those receiving KTs outside their original region had a graft survival rate of 88.0%. Among Seoul residents who underwent KTs in the city, the graft survival rate was 90.5%. Importantly, hospital location did not significantly affect graft survival rates (P = 0.136). @*Conclusion@#This study revealed a regional preference for KT in South Korea, particularly in the capital city, likely because of nonresidents. Nevertheless, the graft and patient survival rates showed no significant regional disparities. These findings emphasize the necessity for equitable KT service access across regions in order to optimize patient outcomes.

Prevention and treatment of microstomia

The mouth, located in the lower third of the face, is a uniquely visible structure. It serves as a vital organ both aesthetically and functionally, playing a key role in speech, expression, and fundamental oral functions. Consequently, any alterations or defects in its shape, due to various causes, can lead to aesthetic and functional deficiencies. These issues may also result in challenges with social interactions and a decrease in confidence. In cases of microstomia, various surgical approaches are proposed based on the location, extent, shape, and cause of the defect, leading to numerous case reports. Plastic surgeons are proficient in oral reconstruction; however, cases of microstomia are relatively rare, which reduces their familiarity and interest in these cases. Additionally, preferences for oral size and shape vary according to factors such as geographical region and ethnicity, further complicating the functional definition of microstomia. Therefore, both subjective patient and physician judgments play crucial roles in the diagnosis and treatment of microstomia, as these may vary depending on individual and societal aspects. This review aims to classify the various causes and definitions of microstomia, as well as its non-surgical and surgical treatment options, with the goal of the treatment of this condition.

A Multicenter Survey of Percutaneous Endoscopic Gastrostomy in 2019 at Korean Medical Institutions

Background/Aims@#This study aimed to review the indications, methods, cooperation, complications, and outcomes of percutaneous endoscopic gastrostomy (PEG). @*Methods@#Questionnaires were sent to 200 hospitals, of which 62 returned their questionnaires, with a response rate of approximately 30%. Descriptive statistics were calculated to analyze the responses to the questionnaires. @*Results@#In 2019, a total of 1,052 PEGs were performed in 1,017 patients at 62 hospitals. The main group who underwent PEG was older adult patients with brain disease, particularly stroke.Nutritional supply was an important purpose of the PEG procedure. “The pull method” was the most commonly used for initial PEG insertion. The complications related to PEG were mostly mild, with leakage being the most common. Patients who underwent PEG procedures were primarily educated regarding the post-procedure management and complications related to PEG.Preoperative meetings were skipped at >50% of the institutions. Regarding the cooperation between the nutrition support team (NST) and the physician performing PEG, few endoscopists answered that they cooperated with NST before and after PEG. Moreover, the rate of NST certification obtained by physicians performing PEG and the frequency of attendance at NST-related conferences were relatively low. @*Conclusions@#This study shows a similar trend to that found in the previous PEG guidelines.However, it covers new aspects, including team-based work for PEG procedure, nutrition support, and education for patients and guardians. Therefore, each medical institution needs to select an appropriate method considering the medical environment and doctor’s abilities.

Hepatic Steatosis but Not Fibrosis Is Independently Associated with Poor Outcomes in Patients with Inflammatory Bowel Disease

Background/Aims@#Increased prevalence of nonalcoholic fatty liver disease (NAFLD) and inflammatory bowel disease (IBD) has been reported. However, the effects of NAFLD on the outcome of IBD remains unclear. We investigated whether the presence of NAFLD could influence the outcomes of patients with IBD. @*Methods@#We recruited 3,356 eligible patients with IBD into our study between November 2005and November 2020. Hepatic steatosis and fibrosis were diagnosed using hepatic steatosisindex of ≥30 and fibrosis-4 of ≥1.45, respectively. The primary outcome was clinical relapse, defined based on the following: IBD-related admission, surgery, or first use of corticosteroids, immunomodulators, or biologic agents for IBD. @*Results@#The prevalence of NAFLD in patients with IBD was 16.7%. Patients with hepatic ste-atosis and advanced fibrosis were older, had a higher body mass index, and were more likely to have diabetes (all p<0.05). @*Conclusions@#Hepatic steatosis was independently associated with increased risks of clinical relapse in patients with ulcerative colitis and Crohn’s disease, whereas fibrotic burden in the liver was not. Future studies should investigate whether assessment and therapeutic intervention for NAFLD will improve the clinical outcomes of patients with IBD.

Effects of COVID-19 vaccines on patient-reported outcomes in patients with inflammatory bowel disease: a multicenter survey study in Korea

Background/Aims@#The impact of vaccination on inflammatory bowel disease (IBD) patients is still unknown, and no studies have assessed the changes in patient-reported outcomes (PROs) after vaccination in patients with IBD. Therefore, in this study, we investigated the impact of vaccines on the PROs of patients with IBD. @*Methods@#We conducted a questionnaire survey of patients with IBD who visited outpatient clinics at 4 specialized IBD clinics of referral university hospitals from April 2022 to June 2022. A total of 309 IBD patients were included in the study. Patient information was collected from a questionnaire and their medical records, including laboratory findings, were reviewed retrospectively. Risk factors associated with an increase in PROs after COVID-19 vaccination were analyzed using logistic regression analyses. In addition, we assessed whether there were differences in variables by vaccine order using the linear mixed model. @*Results@#In multivariate analysis, young age ( < 40 years) and ulcerative colitis (UC) were found to be independent risk factors for aggravation of PROs in patients with IBD. In all patients, platelet count significantly increased with continued vaccination in multiple pairwise comparisons. In UC patients, PROs such as the short health scale, UC-abdominal signs and symptoms, and UC-bowel signs and symptoms were aggravated significantly with continued vaccination. There was no significant increase in the variables of patients with Crohn’s disease. @*Conclusions@#Therefore, there may be a need to counsel patients with IBD younger than 40 years of age, and patients with UC before they receive COVID-19 vaccinations.

Relationship networks among nurses in acute nursing care units / 한국간호교육학회지

Purpose@#The purpose of this study was to explore the characteristics of social networks among registered nurses in acute nursing care units. @*Methods@#This study used a survey design. Four nursing units from two acute hospitals were selected using a convenience method, and 83 nurses from those nursing units participated in the study in July 2022. The positive influences among nurses included friendship, collaboration, advice, and referent networks, and the negative influences included avoidance and bullying networks. Using the NetMiner program, the k-means clustering technique was applied to create groups of nodes with similar characteristics. The general characteristics of the participants were analyzed by mean, standard deviation, frequency, and ANOVA or chi-squared test. @*Results@#As a result of dividing the 83 nurse participants into four clusters, positive influencers, silent peers, unwelcome peers, and active bullies were identified. Positive influence group nurses were frequently mentioned in the friendship, collaboration, advice, and referent networks. On the other hand, nurses in the unwelcome group and the active bullying group were frequently mentioned in the avoidance and bullying networks. @*Conclusion@#Social networks that have a positive or negative impact on nursing performance are created through different relationships between nurses. Nurse managers can use the findings to create a more supportive and collaborative environment. Further research is needed to develop intervention programs to improve interactions and relationships between fellow nurses.

Trends and Barriers in Diabetic Retinopathy Screening: Korea National Health and Nutritional Examination Survey 2016–2021

Background@#The prevalence of diabetes is increasing globally, highlighting the importance of preventive healthcare. This study aimed to identify the diabetic retinopathy (DR) screening rates and risk factors linked to DR screening nonadherence in the Korean population through a nationally representative sample survey. @*Methods@#Among the Korea National Health and Nutrition Examination Survey database from 2016 to 2021, participants aged ≥ 40 years with diabetes were included. The weighted estimate for nonadherence to DR screening within a year was calculated. Risk factor analyses were conducted using univariate and multivariate logistic regression. @*Results@#Among the 3,717 participants, 1,109 (29.5%) underwent DR screening within the past year, and this national estimate exhibited no statistically significant difference from 2016 to 2021 (P = 0.809). Nonadherence to annual DR screening was associated with residing in rural areas, age ≥ 80 years, low educational level, self-reported good health, absence of ocular disease, current smoking, lack of exercise and dietary diabetes treatment, and no activity limitation (all P < 0.05). @*Conclusion@#The recent DR screening rate in Korea was relatively low. Factors associated with apathy and complacency towards personal health were associated with the nonadherence to DR screening. Educational interventions have the potential to enhance the annual screening rate for diabetic patients.

Impact of COVID-19 Infection and Its Association With Previous Vaccination in Patients With Myasthenia Gravis in Korea: A Multicenter Retrospective Study

Background@#During the coronavirus disease 2019 (COVID-19) pandemic, patients with myasthenia gravis (MG) were more susceptible to poor outcomes owing to respiratory muscle weakness and immunotherapy. Several studies conducted in the early stages of the COVID-19 pandemic reported higher mortality in patients with MG compared to the general population. This study aimed to investigate the clinical course and prognosis of COVID-19 in patients with MG and to compare these parameters between vaccinated and unvaccinated patients in South Korea. @*Methods@#This multicenter, retrospective study, which was conducted at 14 tertiary hospitals in South Korea, reviewed the medical records and identified MG patients who contracted COVID-19 between February 2022 and April 2022. The demographic and clinical characteristics associated with MG and vaccination status were collected. The clinical outcomes of COVID-19 infection and MG were investigated and compared between the vaccinated and unvaccinated patients. @*Results@#Ninety-two patients with MG contracted COVID-19 during the study. Nine (9.8%) patients required hospitalization, 4 (4.3%) of whom were admitted to the intensive care unit. Seventy-five of 92 patients were vaccinated before contracting COVID-19 infection, and 17 were not. During the COVID-19 infection, 6 of 17 (35.3%) unvaccinated patients were hospitalized, whereas 3 of 75 (4.0%) vaccinated patients were hospitalized (P < 0.001). The frequencies of ICU admission and mechanical ventilation were significantly lower in the vaccinated patients than in the unvaccinated patients (P = 0.019 and P = 0.032, respectively). The rate of MG deterioration was significantly lower in the vaccinated patients than in the unvaccinated patients (P = 0.041). Logistic regression after weighting revealed that the risk of hospitalization and MG deterioration after COVID-19 infection was significantly lower in the vaccinated patients than in the unvaccinated patients. @*Conclusion@#This study suggests that the clinical course and prognosis of patients with MG who contracted COVID-19 during the dominance of the omicron variant of COVID-19 may be milder than those at the early phase of the COVID-19 pandemic when vaccination was unavailable. Vaccination may reduce the morbidity of COVID-19 in patients with MG and effectively prevent MG deterioration induced by COVID-19 infection.

Clinical Features of Iridocorneal Endothelial Syndrome in Korean Patients

Purpose@#To document the distribution and clinical features of iridocorneal endothelial (ICE) syndrome in its various subtypes observed in patients who visited a single institution in Korea. @*Methods@#A retrospective analysis was conducted on the medical records of patients diagnosed with ICE syndrome at the Department of Ophthalmology, Yeungnam University Hospital, from 1993 to 2023. The cases were classified into Chandler syndrome, progressive iris atrophy, and iris nevus syndrome based on the severity of corneal and iris abnormalities. We also examined the presence of glaucoma, corneal edema, and iris abnormalities at diagnosis. @*Results@#In all, 22 eyes from 21 patients with ICE syndrome were included. The mean age at diagnosis was 56.6 ± 16.1 years with a female predominance (20 patients, 95.5%). The syndrome was primarily unilateral (20 patients, 95.5%). Subtypes included 9 eyes with Chandler syndrome (40.9%), 7 eyes with progressive iris atrophy (31.8%), and 6 eyes with iris nevus syndrome (27.3%). Glaucoma was present in 15 eyes (68.2%), with 8 eyes (36.4%) undergoing glaucoma surgery. Of the 7 eyes that had trabeculectomy as initial glaucoma surgery, six experienced poor intraocular pressure control leading to Ahmed valve implantation in 4 cases. Corneal edema was noted in 10 eyes (45.5%) at diagnosis progressing to corneal decompensation in 6 eyes (27.3%). @*Conclusions@#ICE syndrome in Korea predominantly affects middle-aged women and occurs unilaterally with Chandler syndrome being the most common subtype. Given the high risk for glaucoma development, suboptimal outcomes of trabeculectomy, and significant risk for corneal decompensation, ongoing management efforts are essential for glaucoma and corneal function preservation.

The value of presepsin, procalcitonin, and C-reactive protein in sepsis associated organ failure in the emergency department: a retrospective analysis according to the Sepsis-3 definition

Objective@#Early diagnosis of sepsis is essential for bundle treatment. The purpose of this study was to determine the clinical significance of presepsin in sepsis related organ failure in the emergency department compared to other inflammatory markers. @*Methods@#This was a retrospective review. Enrolled patients were divided into three groups, namely non-infectious organ failure, sepsis, and septic shock groups. The efficacy of presepsin, procalcitonin, and C-reactive protein (CRP) in discriminating sepsis were compared among the three patient groups. The presepsin, procalcitonin, and CRP levels were compared between 28-day survivors and non-survivors among those with sepsis. @*Results@#A total of 277 patients with organ failure were included. The areas under the receiver operating characteristic curve (AUROCs) of presepsin, procalcitonin, and CRP for differentiating sepsis from non-infectious organ failure were 0.622, 0.777, and 0.809, respectively. The areas under the curve (AUCs) of presepsin, procalcitonin, and CRP for differentiating sepsis from septic shock were 0.717, 0.667, and 0.609, respectively. The AUCs of presepsin, procalcitonin, and CRP for predicting sepsis related mortality were 0.743, 0.635, and 0.632, respectively. Sepsis patients with high presepsin levels had a higher mortality than those with lower presepsin levels. @*Conclusion@#Presepsin is a good marker to differentiate septic shock from sepsis and predict mortality. CRP can aid the differential diagnosis of non-infectious causes in patients with organ failure.

Subfoveal Nodule Affecting Visual Prognosis in Coats Disease

Purpose@#To investigate the characteristics of subfoveal nodules in Korean patients with Coats disease and their association with visual outcomes @*Methods@#A retrospective analysis was conducted within the medical records of patients with stage 2B or 3A1 Coats disease, including clinical features, imaging, presence of either a subfoveal nodule or macular fibrosis, and visual outcome. @*Results@#Twelve patients were present with stage 2B or 3A1 Coats disease, and nine patients (75%) presented with subfoveal nodule. Between the group without subfoveal nodule and the group with subfoveal nodule, there were no significant differences in age (mean, 14.0 ± 1.7 years vs. 27.7 ± 21.8 years; p = 0.482), sex (all men), stage of the disease (stage 2B: three patients vs. eight patients, p > 0.999; stage 3A1: none vs. one patient, p > 0.999), extension of retinal exudation (mean, 7.7 hours vs. 4.1 hours; p = 0.209) and peripheral telangiectasia (mean, 3.7 hours vs. 4.2 hours; p = 0.727), and follow-up duration (mean, 65.0 months vs. 46.1 months; p = 0.600). There were significantly more patients with severe visual loss (≤20 / 200) among the patients with subfoveal nodule (none vs. seven patients, p = 0.045), and the cause for severe visual loss was macular fibrosis in all cases. Macular fibrosis developed significantly more frequently in the patients with subfoveal nodule (none vs. seven = patients, p = 0.045). @*Conclusions@#This study is the first study covering the analysis of subfoveal nodules in Korean patients with Coats disease. The existence of a subfoveal nodule at the initial diagnosis serves as an indicator predicting the development of macular fibrosis and a less favorable visual outcome in the patients with Coats disease. A multicenter study with a larger patient pool and further studies toward the therapeutic approach for the subfoveal nodule and macular fibrosis are needed.

Risks of Cancer Associated with Therapeutic Drugs for Inflammatory Bowel Disease / 대한소화기학회지

Crohn's disease and ulcerative colitis are lifelong chronic inflammatory conditions, with many patients requiring ongoing immunomodulatory drug therapy for maintenance treatment. Recent therapeutic goals in inflammatory bowel disease (IBD) are not only aimed at symptomatic remission but also at achieving mucosal healing to improve the natural course of the disease. In this context, therapeutic approaches are being applied in clinical settings that involve early and appropriate use of drugs, such as immunomodulators or biologics, that have the potential to induce healing of the inflamed intestine before irreversible intestinal damage occurs. All drugs that continuously control intestinal inflammation in IBD can heal the mucosa and potentially reduce the incidence of colitis-associated bowel cancer; however, the continuous use of immunosuppressants can potentially increase the risk of malignancies. The safety issues of the drugs used in clinical practice are partly confirmed during their development processes or shortly after initial marketing, but in other cases, they are estimated through post-marketing case reports or epidemiological studies, sometimes decades after drug approval. This review explores the risks associated with malignancies related to the treatment of IBD, focusing on drugs currently approved in Republic of Korea.

Aerobic Capacity and Obesity Ratio of Korea Firefighters by Job Duties:Implications for Fitness Management / 대한스포츠의학회지

Purpose@#Firefighting duties range from field roles such as suppression, rescue, and emergency medical services (EMS) to various administrative tasks. Despite these differences, they face uniform fitness standards in Korea. This study seeks to define distinct fitness needs for each duty and provide data for customized standards. @*Methods@#One hundred seventy-six Korean male firefighters participated, categorized into suppression (n=76), rescue (n=22), administrative (n=27), and EMS (n=51) roles. All underwent maximal oxygen consumption (VO2 max) tests for aerobic capacity, with body composition measured using bioelectrical impedance and height recorded with a stadiometer. @*Results@#The VO2 max (mL/kg/min) among Korean male firefighters varied across different job duties: suppression (39.96±5.84), rescue (44.84±4.85), administration (40.27±7.01), and EMS (40.51±6.75). Rescue had the highest VO2 max, which was significantly higher (p=0.013). The body mass index (BMI, kg/m2 ) values were as follows: suppression (25.07±2.55), rescue (24.95±1.71), EMS (24.33±3.21), and administration (25.10±2.48). There was no statistically significant difference in BMI values (p=0.464). @*Conclusion@#This study evaluated the VO2 max and BMI of South Korean male firefighters according to their job duties. It found that 54.5% did not meet the recommended VO2 max standard of 42 mL/kg/min for their activities, and 77.5% had a BMI indicating overweight or higher. However, it is important to note that not every firefighting duty requires high fitness levels. The key is ensuring firefighters possess the fitness necessary for their specific roles to maintain safety and efficiency. The study aims to provide data for creating fitness management guidelines tailored to the diverse duties of firefighters.

Are There Hopeful Therapeutic Strategies to Regenerate the Infarcted Hearts?

Ischemic heart disease remains the primary cause of morbidity and mortality worldwide.Despite significant advancements in pharmacological and revascularization techniques in the late 20th century, heart failure prevalence after myocardial infarction has gradually increased over the last 2 decades. After ischemic injury, pathological remodeling results in cardiomyocytes (CMs) loss and fibrosis, which leads to impaired heart function.Unfortunately, there are no clinical therapies to regenerate CMs to date, and the adult heart’s limited turnover rate of CMs hinders its ability to self-regenerate. In this review, we present novel therapeutic strategies to regenerate injured myocardium, including (1) reconstruction of cardiac niche microenvironment, (2) recruitment of functional CMs by promoting their proliferation or differentiation, and (3) organizing 3-dimensional tissue construct beyond the CMs. Additionally, we highlight recent mechanistic insights that govern these strategies and identify current challenges in translating these approaches to human patients.

Novel anatomical guidelines for botulinum neurotoxin injection in the mentalis muscle:a review / 대한해부학회지

The mentalis muscle is a paired muscle originating from the alveolar bone of the mandible. This muscle is the main target muscle for botulinum neurotoxin (BoNT) injection therapy, which aims to treat cobblestone chin caused by mentalis hyperactivity. However, a lack of knowledge on the anatomy of the mentalis muscle and the properties of BoNT can lead to side effects, such as mouth closure insufficiency and smile asymmetry due to ptosis of the lower lip after BoNT injection procedures. Therefore, we have reviewed the anatomical properties associated with BoNT injection into the mentalis muscle.An up-to-date understanding of the localization of the BoNT injection point according to mandibular anatomy leads to better injection localization into the mentalis muscle. Optimal injection sites have been provided for the mentalis muscle and a proper injection technique has been described. We have suggested optimal injection sites based on the external anatomical landmarks of the mandible. The aim of these guidelines is to maximize the effects of BoNT therapy by minimizing the deleterious effects, which can be very useful in clinical settings.

Scar revision in areas subjected to excessive tension using intraoperative and postoperative long-term tension reduction techniques

Background@#Surgical scars subjected to excessive tension tend to widen and become hypertrophic due to strong mechanical stretching forces. In this study, we evaluated the clinical outcomes of combined intraoperative and postoperative long-term tension reduction techniques for the revision of scars subjected to excessive tension. @*Methods@#In total, 64 cases (62 patients) underwent scar revision and were followed for 6 months or more. The long-term tension reduction technique included intraoperative subcutaneous fascial and deep dermal closure using nonabsorbable nylon sutures and postoperative long-term skin taping for 3 to 8 months. The final scars were objectively evaluated using our Linear Scar Evaluation Scale (LiSES, 0-10 scale), which consisted of five categories: width, height, color, texture, and overall appearance. @*Results@#All 64 cases healed successfully, without early postoperative complications such as infection or dehiscence. The follow-up period ranged from 6 months to 6 years. The LiSES scores ranged from 5 to 10 (mean: 8.2). Fifty-one cases (79.6%) received a score of 8 to 10, which was assessed as “very good” by the evaluator. Two cases with a score of 5 (3%) showed partial hypertrophic scars at the last follow-up visit. All patients were highly satisfied with their final outcomes, including the two patients who experienced partial hypertrophic scars. @*Conclusions@#A combination of intraoperative and postoperative long-term tension reduction techniques can achieve the goal of long-term dermal support and satisfactory aesthetic outcomes for scar revision in areas subjected to excessive tension.

Surgical outcomes of suprafascial and subfascial radial forearm free flaps in head and neck reconstruction

Background@#Conventional radial forearm free flaps (RFFFs) are known to be safe, but can result in donor site complications. Based on our experiences with suprafascial and subfascial RFFFs, we evaluated the safety of flap survival and surgical outcomes. @*Methods@#This was a retrospective study of head and neck reconstructions using RFFFs from 2006 to 2021. Thirty-two patients underwent procedures using either subfascial (group A) or suprafascial (group B) dissection for flap elevation. Data were collected on patient characteristics, flap size, and donor and recipient complications, and the two groups were compared. @*Results@#Thirteen of the 32 patients were in group A and 19 were in group B. Group A included 10 men and three women, with a mean age of 56.15 years, and group B included 16 men and three women, with a mean age of 59.11 years. The mean defect areas were 42.83 cm² and 33.32 cm², and the mean flap sizes were 50.96 cm² and 44.54 cm² in groups A and B, respectively. There were 13 donor site complications: eight (61.5%) in group A and five (26.3%) in group B. Flexor tendon exposure occurred in three patients in group A and in none in group B. All flaps survived completely. A recipient site complication occurred in two patients (15.4%) in group A and three patients (15.8%) in group B. @*Conclusions@#Complications and flap survival were similar between the two groups. However, tendon exposure at the donor site was less prevalent in the suprafascial group, and the treatment period was shorter. Based on our data, suprafascial RFFF is a reliable and safe procedure for reconstruction of the head and neck.

Radiographic Factors of Proximal Junctional Failure According to Age Groups in Adult Spinal Deformity

Background@#Patient age has been associated with the development of proximal junctional failure (PJF). The characteristics of adult spinal deformity (ASD) are considered different between younger and older age groups. We hypothesized that the radiographic risk factors of PJF would be different according to age groups. This study aimed to evaluate different radiographic risk factors of PJF between two age groups undergoing thoracolumbar fusion for ASD. @*Methods@#ASD patients aged ≥ 60 years who underwent thoracolumbar fusion from the low thoracic level (T9–T12) to the sacrum were included. The minimum follow-up duration was 2 years. PJF was defined as proximal junctional angle (PJA) ≥ 20°, fixation failure, fracture, myelopathy, or necessity of revision surgery. Using various radiographic risk factors including age-adjusted ideal pelvic incidence (PI)-lumbar lordosis (LL), univariate and multivariate analyses were performed separately in two age groups: < 70 years and ≥ 70 years. @*Results@#A total of 186 patients (90.3% women) with a mean age of 69 years were enrolled. The mean follow-up duration was 67.4 months. PJF developed in 97 patients (52.2%). There were fractures in 53 patients, PJA ≥ 20° in 26, fixation failure in 12, and myelopathy in 6. PJF developed more frequently in patients 70 years or older than in those younger than 70 years. In patients aged less than 70 years, preoperative LL, PI-LL, and a change in LL were significant risk factors in univariate analysis. Multivariate analysis showed only a change in LL was significant for PJF development (odds ratio [OR], 1.025; p = 0.021). On the other hand, in patients 70 years or older, postoperative LL, postoperative PI-LL, and overcorrection relative to the conventional PI-LL target (within ± 10°) and age-adjusted ideal PI-LL target were significant risk factors. On multivariate analysis, only overcorrection of PI-LL relative to the age-adjusted ideal target was a single significant risk factor of PJF (OR, 5.250; p = 0.024). @*Conclusions@#In patients younger than 70 years, a greater change in LL was associated with PJF development regardless of PIrelated values. However, in older patients, overcorrection of PI-LL relative to the age-adjusted PI-LL target was a significant risk factor of PJF.