Transillumination method for intraoperative mapping subfascial plexus of free-style radial forearm flap.

BACKGROUND: Without well recognizing the vascular territories of the perforator, it might damage the pedicle and diminish the survival of the flap. This study described a transillumination method for intraoperative mapping of subfascial plexus of the perforator in radial forearm flap and also compared the perioperative outcomes and complications of the method with the standard folded, bipaddled forearm flap in head and neck reconstruction. METHODS: Between January 2011 and December 2017, we applied the transillumination method in 12 patients who underwent head and neck reconstruction with forearm flaps immediately after surgical resection of oral cancer (case group). For comparison, we identified 12 age- and gender-matched patients who received head and neck reconstruction with folded, bipaddled radial forearm flaps (control group). Demographic factors, diagnosis, flap size, perioperative data, and postoperative complications were compared between the two groups. RESULTS: There was no significant difference in harvesting time, operative time, or blood loss between the case and control groups. No patient experienced donor-site complication. There was no significant difference in recipient-site complication between the case and control groups. CONCLUSION: The transillumination method can allow plastic surgeons to easily identify the perforator vascular plexus of the radial forearm flap, which facilitates intraoperative flap design in head and neck reconstruction without increasing harvesting time and risk of postoperative complications.

The effectiveness of telemedicine on body mass index: A systematic review and meta-analysis.

OBJECT: The purpose of this study was to evaluate the clinical effectiveness of telemedicine on changes in body mass index for overweight and obese people as well as for diabetes and hypertension patients. METHODS: A systematic review of articles published before 31 August 2014, was conducted using searches of Medline, Cochrane Library, EMBASE, and CINAHL Plus. The inclusion criteria were randomised controlled trials that compared telemedicine interventions with usual care or standard treatment in adults and reported a change in body mass index. A meta-analysis was conducted for eligible studies, and the primary outcome was a change in body mass index. Subgroup analysis was performed for the type of telemedicine, main purpose of intervention, and length of intervention. RESULTS: Twenty-five randomised controlled trials comprising 6253 people were included in the qualitative and quantitative analyses. The length of intervention ranged from nine weeks to two years. The meta-analysis revealed significant differences in body mass index changes (pooled difference in means = -0.49, 95% confidence interval -0.63 to -0.34, p < 0.001) between the telemedicine and control groups. The subgroup analyses found that either Internet-based or telephone-based intervention was associated with greater changes in body mass index than in controls. Telemedicine intervention was effective in improving body mass index whether it was used for diabetes control, hypertension control, weight loss, or increasing physical activity and was also effective for people with and without diabetes or hypertension. However, only interventions with a duration ≥ 6 months significantly decreased body mass index compared to controls. CONCLUSION: Both patients with chronic disease and overweight/obese people could benefit from telemedicine interventions. We suggest that an effective telemedicine approach should be longer than six months and emphasise the importance of post-interventional follow-ups.

Intraoperative Mapping of the Subfascial Plexus Using the Transillumination Method for Head and Neck Reconstruction with Free Style Anterolateral Thigh Flaps.

Without well recognizing the vascular territories of the perforator, surgery might damage the pedicle and diminish flap survival. This study described a transillumination method for intraoperative mapping of the subfascial plexus of the perforator in the head and neck reconstruction with an anterolateral thigh (ALT) flap and also compared the perioperative outcomes and complications of the method with those of the conventional two-pedicle ALT flap. Between January 2011 and December 2017, 26 patients who underwent head and neck reconstruction with ALT flaps were evaluated as follows: 13 underwent the transillumination method (case group), and 13 (age- and sex-matched) underwent standard two-pedicle flap procedures (control group). Demographic factors, diagnosis, flap size, recipient site, perioperative data, and postoperative complications were compared between the two groups. There was no significant difference in age, sex, diagnosis, recipient sites, and flap size between the case and control groups. Regarding the perioperative outcomes, the harvesting time was significantly shorter in the case group than in the control group (60 vs. 100 minutes, p < 0.001). The operative time was shorter in the case group than in the control group, but this difference was not statistically significant (300 vs. 420 minutes, p = 0.058). The transillumination method can allow plastic surgeons to easily identify the perforator vascular plexus of the ALT flap, which facilitates intraoperative flap design in head and neck reconstruction.

Comparison of perioperative outcomes between endoscope-assisted technique and handheld acoustic Doppler for perforator identification in fasciocutaneous flaps.

The endoscopic technique has been utilized to harvest muscle flaps and detect perforators of fasciocutaneous flaps. This study aimed to compare the perioperative outcomes between the endoscope-assisted technique and handheld acoustic Doppler for perforator identification in fasciocutaneous flaps.This retrospective case-control study included patients who underwent fasciocutaneous flap reconstruction for traumatic soft tissue defects. In the case group, perforator identification was assisted by the endoscope-assisted technique. In the control group, age- and sex-matched patients received handheld acoustic Doppler to detect perforators. Perioperative outcomes, flap characteristics, and postoperative complications were compared.There were 12 patients in the case group and 12 in the control group. Compared with the control group, the case group had a significantly shorter length of donor-site wounds (9 cm vs 12 cm, P = .023) and a significantly smaller proportion of patients receiving skin grafting at the donor sites (0% vs 41.7%, P = .037). The case group had a longer operative time, but the difference was not statistically significant (180 minutes vs 150 minutes, P = .367). The amount of blood loss, the time length of postoperative drainage, and complications did not significantly differ between the 2 groups.The endoscope-assisted technique for perforator identification of fasciocutaneous flaps provided less donor-site morbidity and a significantly shorter length of donor-site wounds than the conventional handheld acoustic Doppler, which suggests that this technique could be a valuable alternative when a precise design is indicated.

Using a pedicle pectoralis major musculocutaneous flap in head and neck reconstruction after modified radical mastectomy: A case report.

RATIONALE: A pedicle pectoralis major musculocutaneous (PMMC) flap is one of the strategies for head and neck reconstruction. Seldom studies reported the case in which the skin area of previous modified radical mastectomy (MRM) had been used as a PMMC flap in head and neck reconstruction. PATIENT CONCERNS: An 84-year-old female who had suffered from left breast cancer and undergone a left modified radical mastectomy (MRM) more than 20 years earlier. DIAGNOSES: She had squamous cell carcinoma of the tongue and had undergone partial glossection and left modified radial neck dissection. Four months later, a left submandibular mass was noted with progressive enlargement and the biopsy revealed recurrent carcinoma. INTERVENTIONS: Left marginal mandibulectomy with radical neck dissection was performed and the neck area was reconstructed by a left pedicle PMMC flap harvested from the left chest wall which had the previous MRM scar. OUTCOMES: The post-operative course was uneventful with complete survival of the flap. The patient received post-operative adjuvant radiotherapy at the left neck and no delayed wound disruption or flap necrosis was noted six months after surgery. LESSONS: A pedicle PMMC flap may be harvested to achieve a functionally as well as an aesthetically pleasing outcome without compromising its viability despite the previous MRM.

Transverse rectus abdominis myocutaneous flap for postpneumonectomy bronchopleural fistula: A case report.

RATIONALE: Numerous types of flap coverage have been reported to prevent or to repair bronchopleural fistulas. Most of the flaps were harvested from chest area. However, these pedicled flaps might not be optimal for the patient who has undergone previous radiotherapy on pulmonary parenchyma because the pedicle artery of the flap might have been injured by irradiation. Therefore, an alternative flap outside of the chest area is necessary. PATIENT CONCERNS: A 61-year-old male was diagnosed of squamous cell carcinoma in right upper lobe lung (cT3N2M0, stage IIIa). After completing the neoadjuvant chemoradiotherapy, he underwent video-assisted thoracoscopic surgery with right side intrapericardial pneumonectomy. DIAGNOSIS: Persistent air leak due to postpneumonectomy bronchopleural fistula. INTERVENTIONS: Pedicled transverse rectus abdominis myocutaneous (TRAM) flap was used to repair the bronchial stump. OUTCOMES: The bronchial stump was repaired successfully, the bronchopleural fistula was obliterated, and the patient was free from air leak after following for 12 months. LESSONS: This case demonstrated that pedicled TRAM flap is a feasible alternative to repair bronchopleural fistula.

Rural older people had lower mortality after accidental falls than non-rural older people.

OBJECTIVE: This study aimed to investigate the mortality rate after falls of rural and non-rural older people and to explore the risk factors of mortality after falls among older people. PATIENTS AND METHODS: This population-based case-control study identified two groups from a nationwide claim database (National Health Insurance Research Database in Taiwan): a rural group and a non-rural group, which included 3,897 and 5,541 older people, respectively, who were hospitalized for accidental falls (The International Classification of Diseases, Ninth Revision, Clinical Modification: E880-E888) during 2006-2009. Both groups were followed up for 4 years after falls. Four-year cumulative all-cause mortality rate after falls was calculated, and the demographic factor, comorbidity, and medications were considered as the potential risk factors of mortality after falls. RESULTS: The rural group had a significantly higher frequency of fall-related hospitalizations (7.4% vs 4.3%, P<0.001), but a lower 4-year cumulative all-cause mortality rate after falls than the non-rural group (8.8% vs 23.4%, P<0.001). After adjusting for age, gender, comorbidity, and medication use, the rural group had a significantly lower risk of mortality after falls than the non-rural group (adjusted odds ratio =0.32, 95% confidence interval =0.28-0.37, P<0.001). Age, gender, place of residence, comorbidity, number of medications, and inappropriate medication use were independent risk factors of mortality after falls. CONCLUSION: The rural older people had a higher frequency of fall-related hospitalizations but lower mortality after falls than the non-rural older people. Fall prevention programs should be adjusted for difference in place of residence.

Chinese herbal medicine network and core treatments for allergic skin diseases: Implications from a nationwide database.

ETHNO-PHARMACOLOGICAL RELEVANCE: Chinese herbal medicine (CHM) is commonly used to treat skin diseases, but CHM prescription patterns are difficult to understand due to their complexity and inter-connections. This study aimed to demonstrate CHM core treatments and network for treatment of allergic skin diseases by analyzing a nationwide prescription database. MATERIALS AND METHODS: All CHM prescriptions made for atopic dermatitis (with age limitation ≤ 12 years) and urticaria for the entire year of 2011 were included. Association rule mining (ARM) combined with social network analysis (SNA) were used to analyze CHM prescriptions and explore the CHM prescription pattern and network. RESULTS: A total of 27,350 and 97,188 prescriptions for atopic dermatitis and urticaria, respectively, were analyzed. Xiao-Feng-San (XFS) was the most commonly used CHM (32% of prescriptions for atopic dermatitis and 47.4% for urticaria) and was the core treatment for both diseases. Moreover, 42 and 82 important CHM-CHM combinations were identified to establish the CHM network, and XFS with Dictamnus dasycarpus Turcz was the most prevalent (6.4% for atopic dermatitis and 9.1% for urticaria). Traditional Chinese Medicine heat syndrome was most prevalent cause. Extensive anti-inflammation, anti-allergy, anti-oxidation, and anti-bacterial effects were also found among the CHMs. CONCLUSIONS: Network analysis on CHM prescriptions provides graphic and comprehensive illustrations regarding CHM treatment for atopic dermatitis and urticaria. The CHM network analysis of prescriptions is essential to realize the CHM treatments and to select suitable candidates for clinical use or further studies.

A novel endoscopic-assisted harvesting of pedicled freestyle fasciocutaneous flaps.

The endoscopy-assisted technique has been demonstrated in harvesting muscle flaps; however, for pedicled freestyle fasciocutaneous flaps, few studies have applied this technique. We present a surgical procedure utilizing endoscopic-assisted method to identify the perforators of pedicled freestyle fasciocutaneous flaps for the reconstruction of soft tissue defects. From August to December 2012, 9 consecutive patients underwent endoscopic-assisted harvesting of fasciocutaneous flaps for the reconstruction of soft tissue defects. All of the defects were caused by trauma with tendon or bone exposure. Postoperatively, all patients were requested to return for outpatient follow-up visits for at least 3 months. The age of the 9 patients (8 men and 1 woman) ranged from 20 to 79 years (median 59 years). The defects ranged in size from 2 × 2 to 6 × 8 cm2. Two patients received anterolateral thigh transmuscular perforator flaps, 5 patients received fibular septocutaneous perforator flaps, and 2 patients received medial gastrocnemius transmuscular perforator flaps. The median incision length was 10 cm, and the median operative time was 120 minutes. None of the patients had intraoperative complications, and intraoperative bleeding was minimal (<50 mL). At the end of the 3-month follow-up period, none of the patients had any complications on either recipient or donor site, including total or partial necrosis of the flaps, flap dehiscence, hematomas, seromas, wound infections, or any conditions that indicated additional unplanned operative procedures. All of the patients had surviving flaps. Our results demonstrated that the endoscopic-assisted method could be a valuable and reliable alternative in harvesting pedicled freestyle fasciocutaneous flaps.

Identifying Chinese herbal medicine for premenstrual syndrome: implications from a nationwide database.

BACKGROUND: Premenstrual syndrome (PMS) occurs in women during their reproductive age with a quite negative impact on their daily lives. Women with PMS experience a wide range of physical or psychological symptoms and seek treatment for them. Chinese herb medicine (CHM) is commonly used for PMS and the goal of this study is to investigate the prescription patterns of CHM for PMS by using a nationwide database. METHODS: Prescriptions of CHM were obtained from two million beneficiaries randomly sampled from the National Health Insurance Research Database, a nationwide database in Taiwan. The ICD-9 code 625.4 was used to identify patients with PMS. Association rule mining and social network analysis were used to explore both the combinations and the core treatments for PMS. RESULTS: During 1998-2011, a total of 14,312 CHM prescriptions for PMS were provided. Jia-Wei-Xiao-Yao-San (JWXYS) was the CHM which had the highest prevalence (37.5% of all prescriptions) and also the core of prescription network for PMS. For combination of two CHM, JWXYS with Cyperus rotundus L. was prescribed most frequently, 7.7% of all prescriptions, followed by JWXYS with Leonurus heterophyllus Sweet, 5.9%, and Cyperus rotundus L. with Leonurus heterophyllus Sweet, 5.6%. CONCLUSIONS: JWXYS-centered CHM combinations were most commonly prescribed for PMS. To the best of our knowledge, this is the first pharmaco-epidemiological study to review CHM treatments for PMS. However, the efficacy and safety of these commonly used CHM were still lacking. The results of this study provide valuable references for further clinical trials and bench studies.

Comparative chest computed tomography findings of non-tuberculous mycobacterial lung diseases and pulmonary tuberculosis in patients with acid fast bacilli smear-positive sputum.

BACKGROUND: Early diagnosis and treatment of nontuberculous mycobacterial lung diseases (NTM-LD) and pulmonary tuberculosis (PTB) are important clinical issues. The present study aimed to compare and identify the chest CT characteristics that help to distinguish NTM lung disease from PTB in patients with acid-fast bacilli (AFB) smear-positive sputum. METHODS: From January 2009 to April 2012, we received 467 AFB smear-positive sputum specimens. A total of 95 CT scans obtained from the 159 patients were analyzed, 75 scans were from patients with PTB and 20 scans from NTM-LD. The typical chest CT findings of mycobacterial diseases were analyzed. RESULTS: In patients with PTB, the prevalence of pleural effusion (38.7% vs. 15.0%; P = 0.047), nodules < 10 mm in size (76.0% vs. 25.0%; P < 0.001), tree-in-bud pattern (81.3% vs. 55.0%; P = 0.021), and cavities (31.1% vs. 5.0%; P = 0.018) were significantly higher than patients with NTM. Of the 20 patients with NTM lung diseases, bronchiectasis and cystic changes were significantly higher than patients with PTB (20.0% vs. 4.0%; P = 0.034). In multivariate analysis, CT scan findings of nodules was independently associated with patients with diagnoses of PTB (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.02-0.30). Presence of bronchiectasis and cystic changes in CT scans was strongly associated with patients with NTM-LD (OR, 33.04; 95% CI, 3.01-362.55). CONCLUSIONS: The CT distinction between NTM-LD and PTB may help radiologists and physicians to know the most likely diagnoses in AFB-smear positive patients and avoid unnecessary adverse effects and the related costs of anti-TB drugs in endemic areas.

Functional genotype in matrix metalloproteinases-2 promoter is a risk factor for oral carcinogenesis.

BACKGROUND: Matrix metalloproteinase-2 (MMP-2) can degrade extracellular matrix and basement membrane, and play an important role in the development and progression of multiple carcinomas, including oral squamous cell carcinoma (OSCC). A -1306C-->T polymorphism in the MMP-2 promoter disrupts Sp1-binding site, and results in reduction of transcriptional activity. This study aimed to assess the association of such genotype with the risk of OSCC and oral submucous fibrosis (OSF), which is a precancerous condition that exhibits excessive collagen production and etiologically links to areca use. METHODS: Genomic DNA from the blood samples of 121 OSCC cases, 58 OSF cases and 147 controls were amplified by polymerase chain reaction (PCR) and subjected to denaturing high-performance liquid chromatography (dHPLC) analysis for genotyping. The OSCC were further classified into buccal squamous cell carcinoma (BSCC) and non-buccal squamous cell carcinoma (NBSCC), according to the site of involvement. Fisher's exact test and unconditional logistic regression models were used for statistical analysis. RESULTS: Subjects carrying CC genotype had nearly twofold increased risk for developing OSCC when comparing with CT or TT genotype. Subjects carrying CC genotype had more apparent risk (greater than fourfold) for developing NBSCC. However, no increase in risk for lymph node metastasis or advanced stage was identified in OSCC cases carrying such genotype. Preliminarily data suggest no significant association between subjects carrying CC genotype and the development of BSCC or OSF. CONCLUSION: This is the first paper demonstrating that functional genotype of MMP-2 promoter is a risk factor for oral carcinogenesis, particularly for the subsets occurring on non-buccal site.

Correlation between functional genotypes in the matrix metalloproteinases-1 promoter and risk of oral squamous cell carcinomas.

BACKGROUND: Oral squamous cell carcinoma (OSCC) and oral submucous fibrosis (OSF), which are highly associated with areca use, are prevalent in most Asian countries. Matrix metalloproteinases (MMPs) are superfamily of metal-dependent proteolytic enzymes, mediating the degradation of extracellular matrix. Insertion/deletion (-1607 2G-->1G) polymorphism has been described in the promoter region of the human matrix metalloproteinases-1 (MMP-1) genes, which cause an alteration in the transcriptional activity. This genotype is associated with risks of cancer genesis and metastasis. In this paper, we studied the relationship between such genotype and areca-associated oral diseases. METHODS: Genomic DNA from the blood of OSCC (n = 121), OSF (n = 58) cases and controls (n = 147) were amplified by polymerase chain reaction (PCR)-based genotyping. The OSCC were further grouped into buccal squamous cell carcinoma (BSCC) and non-buccal suqmaous cell carcinoma (NBSCC), in accord with the site of involvement. The significance of the differences was assessed by Fisher's exact test. RESULTS: The 2G genotype in MMP-1 promoter was observed with a higher frequency in both OSCC (0.69, P = 0.06) and NBSCC (0.76, P = 0.03) cases compared with controls (0.63), with an odds ratio of 2.17 and 4.58, respectively. This genotype was not related to the risk of OSF. No other clinicopathologic parameter was associated with the genotypes in OSCC cases. CONCLUSION: The results showed that 2G genotype in MMP-1 promoter was associated with the risk of OSCC.