Advanced Facial Rejuvenation: Synergistic Effects of Lower Blepharoplasty and Ultrasound Guided Mid-Face Lift Using Polydioxanone (PDO) Threads.

BACKGROUND: Traditional facial aging surgeries have risks and extended recovery times, leading to a demand for minimally invasive alternatives. PDO (polydioxanone) threads, which are absorbable sutures that stimulate collagen production and tissue contraction, offer improved aesthetic outcomes. This paper evaluates the combined use of PDO thread mid-cheek lift and lower blepharoplasty for facial rejuvenation. METHODS: This retrospective study compared outcomes in patients undergoing lower blepharoplasty combined with a mid-face lift using PDO threads versus those undergoing only lower blepharoplasty. Focused on individuals with baggy lower eyelids and pronounced nasolabial folds, outcome measures included the Modified Fitzpatrick wrinkle scale, Allergan® midface volume deficit scale, Width of inter zygomatic distance, Patient and Observer Scar Assessment Scale, and patient satisfaction questionnaires, assessed at baseline, 3 months, and 1 year postoperatively. RESULTS: The combined procedure demonstrated superior aesthetic outcomes and higher patient satisfaction compared to lower blepharoplasty alone. Improvements were more significant in wrinkle reduction, midface volume, and inter-zygomatic distance in the combined procedure group. Although the combined procedure had a longer mean operation time, scar assessment scores were similar between both groups, with no complications reported. CONCLUSION: The combination of lower blepharoplasty and mid-face lift using PDO threads is a comprehensive and effective approach for facial rejuvenation. It significantly enhances wrinkle reduction, mid-face lifting, and patient satisfaction. Ultrasound-guided thread lifting, a method of assessing and performing mid-face lifting, proves to be safe and efficient. This approach holds promise as a future option in cosmetic anti-aging surgery, presenting a minimally invasive alternative with natural-looking results and reduced downtime. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://link.springer.com/journal/00266 .

A Retrospective Multicenter Study of Risk Factors, Stratification, and Prognosis of Lymph Node Metastasis in T1 and T2 Colorectal Cancer.

BACKGROUND: The objective of this study was to compare the long-term prognosis of patients with T1 and T2 colorectal cancer (CRC) according to lymph node metastasis (LNM) and to identify risk factors for LNM. METHODS: We retrospectively reviewed patients who underwent curative resection for T1 or T2 CRC at five University-affiliated hospitals between January 2012 and December 2021. The patients were divided into several groups depending on the presence of LNM or the number of risk factors. RESULTS: Of the total 765 patients, 87 (11.3%) patients had LNM. These patients had poorer recurrence-free survival (RFS) than patients without LNM (72.6% vs. 88.6%). The multivariable analysis showed that high-grade tumors (p = 0.003), lymphovascular invasion (p < 0.001), and rectal location (p = 0.049) were independent predictors of LNM. When divided into groups according to the number of the three risk factors, the risk of LNM increased from 5.4% (ultralow-risk group; no risk factor) to 60.0% (high-risk group; all three risk factors) and the 5-year RFS rate decreased from 96.3% in the ultralow-risk group to 60% in the high-risk group (p < 0.001). CONCLUSION: Radical surgery should be considered for T1 and T2 CRC patients with these risk factors.

Explainable machine learning using perioperative serial laboratory results to predict postoperative mortality in patients with peritonitis-induced sepsis.

Purpose: Sepsis is one of the most common causes of death after surgery. Several conventional scoring systems have been developed to predict the outcome of sepsis; however, their predictive power is insufficient. The present study applies explainable machine-learning algorithms to improve the accuracy of predicting postoperative mortality in patients with sepsis caused by peritonitis. Methods: We performed a retrospective analysis of data from demographic, clinical, and laboratory analyses, including the delta neutrophil index (DNI), WBC and neutrophil counts, and CRP level. Laboratory data were measured before surgery, 12-36 hours after surgery, and 60-84 hours after surgery. The primary study output was the probability of mortality. The areas under the receiver operating characteristic curves (AUCs) of several machine-learning algorithms using the Sequential Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score (SAPS) 3 models were compared. 'SHapley Additive exPlanations' values were used to indicate the direction of the relationship between a variable and mortality. Results: The CatBoost model yielded the highest AUC (0.933) for mortality compared to SAPS3 and SOFA (0.860 and 0.867, respectively). Increased DNI on day 3, septic shock, use of norepinephrine therapy, and increased international normalized ratio on day 3 had the greatest impact on the model's prediction of mortality. Conclusion: Machine-learning algorithms increase the accuracy of predicting postoperative mortality in patients with sepsis caused by peritonitis.

Oncologic relevance of genetic alterations in sporadic synchronous and solitary colorectal cancer: a retrospective multicenter study.

BACKGROUND: Oncologic impact of genetic alteration across synchronous colorectal cancer (CRC) still remains unclear. This study aimed to compare the oncologic relevance according to genetic alteration between synchronous and solitary CRC with performing systematic review. METHODS: Multicenter retrospective analysis was performed for CRC patients with curative resection. Genetic profiling was consisted of microsatellite instability (MSI) testing, RAS (K-ras, and N-ras), and BRAF (v-Raf murine sarcoma viral oncogene homolog B1) V600E mutation. Multivariate analyses were conducted using logistic regression for synchronicity, and Cox proportional hazard model with stage-adjusting for overall survival (OS) and disease-free survival (DFS). RESULTS: It was identified synchronous (n = 36) and solitary (n = 579) CRC with similar base line characteristics. RAS mutation was associated to synchronous CRC with no relations of MSI and BRAF. During median follow up of 77.8 month, Kaplan-meier curves showed significant differences according to MSI-high for OS, and in RAS, and BRAF mutation for DFS, respectively. In multivariable analyses, RAS and BRAF mutation were independent factors (RAS, HR = 1.808, 95% CI = 1.18-2.77, p = 0.007; BRAF, HR = 2.417, 95% CI = 1.32-4.41, p = 0.004). Old age was independent factor for OS (HR = 3.626, 95% CI = 1.09-12.00, p = 0.035). CONCLUSION: This study showed that oncologic outcomes might differ according to mutation burden characterized by RAS, BRAF, and MSI between synchronous CRC and solitary CRC. In addition, our systematic review highlighted a lack of data and much heterogeneity in genetic characteristics and survival outcomes of synchronous CRC relative to that of solitary CRC.

Negative Pressure Wound Therapy (NPWT) after Hybrid Reconstruction of Occipital Pressure Sore Using Local Flap and Skin Graft.

Background and objectives: Pressure sores are a common medical burden among patients, particularly those who are bedridden or frail. Surgical management of occipital pressure sores poses unique challenges due to limited elasticity and the spherical shape of the scalp. This study aims to evaluate the efficacy and safety of a novel reconstruction method utilizing a local transpositional flap and split-thickness skin graft with negative pressure wound therapy (NPWT) for occipital pressure sore treatment. Material and methods: A retrospective analysis was performed on patients with occipital pressure sores who underwent hybrid reconstructions using a local flap and split-thickness skin graft in conjunction with NPWT. Surgical outcomes, including flap survival rate, graft take percentage, and complications, were assessed. A comparative analysis was performed between the NPWT group and the conventional dressing group. Results: The NPWT group (n = 24) demonstrated a significantly higher mean graft take percentage at postoperative day 14 compared with the conventional dressing group (n = 22) (98.2% vs. 81.2%, p < 0.05). No significant difference in flap survival rate was observed between the two groups. Conclusions: As the aging population continues to grow, occipital pressure sores have gained significant attention as a crucial medical condition. The innovative surgical method incorporating NPWT offers an efficient and safe treatment option for patients with occipital pressure sores, potentially establishing itself as the future gold standard for managing this condition.

A Retrospective Multicenter Study of the Clinicopathological Characteristics and Prognosis of Young Adult Patients with Colorectal Cancer: Effects of Chemotherapy on Prognosis.

BACKGROUND: The objective of this study was to evaluate clinicopathologic features of young patients with colorectal cancer (CRC) and to compare their prognosis with those of older patients Methods: We retrospectively reviewed the medical records of patients who underwent surgery for stage 0-III CRC at four university-affiliated hospitals between January 2011 and December 2020. The patients were divided into two groups, the young adult group (≤45 years) and the older group (>45 years). RESULTS: Of 1992 patients, 93 (4.6%) were young adults and 1899 (95.3%) were older patients. Young patients showed more symptoms (p = 0.014) and more poorly or undifferentiated adenocarcinoma (p = 0.047) than older patients. The young adult patients were more likely to receive adjuvant chemotherapy (p < 0.001) and multidrug agents (p = 0.029), and less likely to cease chemotherapy (p = 0.037). The five-year RFS (recurrence-free survival) rate was better in the young adults than in the older patients (p = 0.009). In the multivariable analysis, young age was a significant prognostic factor for better RFS (p = 0.015). CONCLUSIONS: Young patients with CRC had more symptoms, aggressive histological features than older patients. They received more multidrug agents and discontinued chemotherapy less often, resulting in better prognosis.

Influence of joint volume on range of motion after arthroscopic rotator cuff repair.

BACKGROUND: Capsular contracture is a well-known etiology in the primary stiff shoulder; thus capsular contracture and resultant decreased joint volume could lead to postoperative stiffness, which is a commonly reported morbidity after arthroscopic rotator cuff repair (ARCR). The purpose of this study was (1) to quantify the joint volume (total joint volume and each quadrant compartmental volume) using computed tomography arthrography (CTA) and (2) to demonstrate the relationship between joint volume and postoperative range of motion (ROM) after ARCR. MATERIALS AND METHODS: Eighty-three patients (60 ± 5.11 years, men = 26, women = 57) who had undergone ARCR between January 2015 to December 2020 due to small to medium full-thickness tear and followed by CTA 6 months postoperatively were retrospectively reviewed. An image reconstruction program (3D Slicer, version 4.11.2 software) was used to calculate the joint volume (total joint volume and quadrant compartment joint volumes; anteroinferior, anterosuperior, posterosuperior and posteroinferior). For shoulder ROM, data including scaption (Sc), external rotation on side (ERs), external rotation at 90° (ER90), and internal rotation on back (IRb) were collected 6 months postoperatively. An evaluation of the correlation between joint volume and each shoulder motion was performed. RESULTS: There were moderate correlations between the total joint volume and each motion (Sc: Pearson coefficient, 0.32, p = 0.0047; ERs: Pearson coefficient, 0.24, p = 0.0296; ER90: Pearson coefficient, 0.33, p = 0.0023; IRb: Pearson coefficient, 0.23, p = 0.0336). Among the quadrant compartments, the anteroinferior (Sc: Pearson coefficient, 0.26, p = 0.0199; ERs: Pearson coefficient, 0.23, p = 0.0336; ER90: Pearson coefficient, 0.25, p = 0.0246; IRb: Pearson coefficient, 0.26, p = 0.0168) and posterosuperior (Sc: Pearson coefficient, 0.24, p = 0.029; ER90: Pearson coefficient, 0.29, p = 0.008; IRb: Pearson coefficient, 0.22, p = 0.0491) and posteroinferior (Sc: Pearson coefficient, 0.30, p = 0.0064; ER90: Pearson coefficient, 0.29, p = 0.0072) showed moderate correlations with each shoulder motion. CONCLUSION: Total joint volume, anteroinferior compartment joint volume, posterosuperior compartment joint volume and posteroinferior compartment joint volume were related to postoperative ROM after ARCR. Perioperative methods to increase the joint volume, especially the anteroinferior, posterosuperior and posteroinferior parts of the capsule may prevent postoperative stiffness after ARCR. LEVEL OF EVIDENCE: Level III; Retrospective Case-Control Study.

Visual classification of pressure injury stages for nurses: A deep learning model applying modern convolutional neural networks.

AIMS: To develop a deep learning model for pressure injury stages classification based on real-world photographs and compare its performance with that of clinical nurses to seek the opportunity of its application in clinical settings. DESIGN: This was a retrospective observational study using a deep learning model. REVIEW METHODS: A plastic surgeon and two wound care nurses labelled a set of pressure injury images. We applied several modern Convolutional Neural Networks architectures and compared the performances with those of clinical nurses. DATA SOURCES: We retrospectively analysed the electronic medical records of hospitalized patients between January 2019 and April 2021. RESULTS: A set of 2464 pressure injury images were compiled and analysed. Using EfficientNet, in classifying pressure injury images, the macro F1-score was calculated to be 0.8941, and the average performance of two experienced nurses was reported as 0.8781. CONCLUSION: A deep learning model for classifying pressure injury images by stages was successfully developed, and the performance of the model was compared with that of experienced nurses. The classification model developed in this study is expected to help less-experienced nurses or those working in under-resourced healthcare settings determine the stages of pressure injury. IMPACT: Our deep learning model can minimize discrepancies in nurses' assessment of classifying pressure injury stages. Follow-up studies on improving the performance of deep learning models using modern techniques and clinical usability will lead to improved quality of care among patients with pressure injury. NO PATIENT OR PUBLIC CONTRIBUTION: Patients or the public were not involved in our research's design, conduct, reporting or dissemination plans because this was a retrospective study that used electronic medical records.

Self-expandable metallic stents as a bridge to surgery in obstructive right- and left-sided colorectal cancer: a multicenter cohort study.

The insertion of a self-expandable metal stent (SEMS) has been proposed as an alternative to emergent surgery (ES) for obstructive colorectal cancer (CRC). We aimed to evaluate the perioperative and oncologic outcomes of SEMS as a bridge to surgery in obstructive CRC, as compared with ES. We retrospectively reviewed the medical records of patients who underwent curative resection of obstructive CRC at four Hallym University-affiliated hospitals between January 2010 and December 2019. All patients were analyzed overall colon, then according to the side of obstruction (overall, right or left). Of 167 patients, 52 patients underwent ES and 115 underwent SEMS insertion and surgery (SEMS group). The postoperative hospital stay and time to soft diet were shorter in the SEMS group than in the ES group for overall and both sided cancer. The SEMS group had lower rates of stoma formation and severe complications for overall and for left-sided cancer. The 5-year overall survival (P = 0.682) and disease-free survival (P = 0.233) rates were similar in both groups. SEMS insertion as a bridge to surgery was associated with faster recovery, a lower rate of stoma formation with similar oncologic outcomes to those of ES.

Recombinant Oral Methioninase (o-rMETase) Combined With Oxaliplatinum Plus 5-Fluorouracil Improves Survival of Mice With Massive Colon-Cancer Peritoneal Carcinomatosis.

BACKGROUND/AIM: The present study aimed to determine if oral methioninase (o-rMETase) combined with oxaliplatinum (OXA) plus 5-fluorouracil (5-FU) increases survival of mice with peritoneal-carcinomatosis formed from HCT-116 green fluorescent protein (GFP)-expressing colon-cancer cells implanted intra-peritoneally in nude mice. MATERIALS AND METHODS: HCT-116-GFP human colon-cancer cells (2×106) were injected intraperitoneally in athymic nude mice. Forty-five HCT-116-GFP colon-cancer peritoneal-carcinomatosis nude-mouse models were divided into the following groups: untreated control; combination of 5-FU (50 mg/kg, once a week), plus OXA (6 mg/kg, once a week); combination of 5-FU + OXA + o-rMETase (100 unit/day). Tumor growth was followed weekly using non-invasive GFP imaging for 3 weeks. At necropsy, tumor tissue was obtained. Frozen sections were made for fluorescence imaging. Tumor tissues were also stained with hematoxylin and eosin. The date of death of all mice was recorded. RESULTS: o-rMETase combined with 5-FU + OXA significantly reduced peritoneal growth of the HCT-116 tumor compared to the untreated control or the combination 5-FU and OXA group. Histological analysis revealed extensive necrosis induced by the o-rMETase + 5-FU + OXA combination. The combination of 5-FU plus OXA and o-rMETase achieved significantly longer survival of the mice with peritoneal carcinomatosis compared to the control or combination of 5-FU plus OXA treatments. CONCLUSION: o-rMETase shows future clinical promise for increasing the survival of patients with peritoneal metastasis of colon cancer when combined with first-line treatment of this recalcitrant disease.

Comparison of Hybrid Abdominal Flap versus Homodigital Neurovascular Island Flap for Fingertip Amputation.

Amputation at the level of the distal phalanx is a common hand injury and is normally treated with replantation. However, if the level of injury is distal or the vessels of the stump have been crushed by injury, replantation cannot be a viable option. The aim of this study is to evaluate the functional and aesthetic outcomes of the "hybrid abdominal flap", which consists of a random-pattern abdominal skin flap and an autologous bone graft. A retrospective analysis was performed on fingertip amputation patients from March 2019 to April 2021. The patients were managed by either hybrid abdominal flaps (HAFs) or homodigital neurovascular island flaps (HNIFs). The functional and aesthetic outcomes were assessed three months after the operations. In this study, a total of 20 fingers were treated with either HAFs or HNIFs. There was a significant difference in the range of motion (ROM) and the scar quality between the two groups. All of the flaps survived without flap necrosis, and non-union of the bone was not observed. The patients were satisfied with the appearance and function of their fingers, including the ROM and sensory aspects. Our novel HAF is a functionally and aesthetically valid option for fingertip amputations with crushed stumps.

Facial reanimation using free partial latissimus dorsi muscle transfer: Single versus dual innervation method.

The aim of the present study was to analyze the consequences of partial free latissimus dorsi muscle flap with nerve splitting technique (Partial LD transfer) for facial reanimation and compare outcomes according to innervation method (singer versus dual innervation). Patients with complete unilateral facial paralysis underwent either the single (ipsilateral masseteric nerve only) or dual (ipsilateral masseteric nerve plus contralateral buccal branch of the facial nerve) nerve innervation method for facial reanimation. An assessment was carried out to compare the outcomes between the single and dual innervation. Total of 21 patients were involved in this study. In the single innervation group, 7 out of 8 patients developed a voluntary smile. However, none were able to achieve a spontaneous smile. On the other hand, 9 out of 13 patients developed a voluntary smile and 3 out of 13 patients achieved a spontaneous smile. The mean increases of smile excursion assessed by Emotrics software and Terzis grades showed no significant differences between two groups. Within the limitations of the study it seems that partial LD transfer approach utilizing the dual innervation method has a positive effect on achieving a spontaneous smile and could be a valuable option for facial reanimation.

Flap monitoring with incisional negative pressure wound therapy (NPWT) in diabetic foot patients.

Various types of flaps are considered as reconstructive options for patients with diabetic foot ulcer. However, flap reconstruction for diabetic foot ulcer treatment is particularly challenging because of the relatively limited collateral perfusion in the distal lower extremity. This study evaluated the efficacy and safety of a novel postoperative monitoring procedure implemented in conjunction with negative pressure wound therapy immediately after flap operations for treating diabetic foot. A retrospective analysis was performed on diabetic foot patients who underwent free flaps and perforator flaps from March 2019 through August 2021. The surgical outcomes of interest were the rates of survival and complications. On the third postoperative day, patients underwent computed tomography angiography to check for pedicle compression or fluid collection in the sub-flap plane. Monitoring time, as well as comparisons between NPWT and conventional methods, were analyzed. Statistical analysis was performed between the two groups. This study included 26 patients. Among patients, the negative pressure wound Therapy treated group included 14 flaps and the conventional monitoring group included 12 flaps. There was no significant intergroup difference in flap survival rate (p = 0.83). In addition, there was no significant intergroup difference in the diameters of perforators or anastomosed vessels before and after negative pressure wound therapy (p = 0.97). Compared with conventional monitoring, flap monitoring with incisional negative pressure wound therapy was associated with a significantly lower mean monitoring time per flap up to postoperative day 5. Although conventional monitoring is widely recommended, especially for diabetic foot ulcer management, the novel incisional negative pressure wound therapy investigated in this study enabled effortless serial flap monitoring without increasing complication risks. The novel flap monitoring technique is efficient and safe for diabetic foot patients and is a promising candidate for future recognition as the gold standard for flap monitoring.

Recurrence-Free Survival Outcomes Based on Novel Classification Combining Lymphovascular Invasion, Perineural Invasion, and T4 Status in Stage II-III Colon Cancer.

Background: T4 tumor, lymphovascular invasion (LVI) and perineural invasion (PNI) are regarded as one of risk factors and associated with poor outcomes in colorectal cancer. The relationship between these three combined risk factors and the prognosis for colon cancer is not yet clear. The purpose of this study was to evaluate the prognostic value of combining the risk factors T4 tumor, LVI, and PNI in stage II-III colon cancer. Methods: Between January 2011 and December 2019, we retrospectively reviewed the medical records of patients who underwent curative resection for stage II-III colon cancer at four Hallym University-affiliated hospitals. These patients are categorized into three groups based on T4, LVI and PNI: no-risk group (no risk factors), low-risk group (one risk factor), and high-risk group (two or more risk factors). Results: Of 1684 patients, the incidence of no-, low-, and high-risk group were 49.3%, 32.6%, 18.0%, respectively. The median follow-up period was 48.9 months, and the 5-year recurrence-free survival (RFS) rate decreased from 78.5% to 58.7% as the number of risk factors increased (P < 0.001). Cox's proportional hazard regression models showed that T4 (P < 0.001), LVI (P = 0.043), and PNI (P = 0.018) were independent prognostic factors for poor RFS. In subgroup analysis in stage II colon cancer, patients with one or more risk factors showed the better 5-year RFS rate when they received adjuvant chemotherapy than in those who did not (P < 0.001). Poor/mucinous differentiation, obstruction, and lymph-node positivity were independent predictors in the high risk group. Conclusion: The present study showed the histological combination of LVI, PNI, and T4 indicates a poor prognosis for RFS in patients with stage II-III colon cancer. Therefore, patients with one of these risk factors should be considered for chemotherapy and have close follow-up.

One-Dimensional Porous Li-Confinable Hosts for High-Rate and Stable Li-Metal Batteries.

Li-confinable core-shell hosts have been extensively studied because they mitigate Li dendrite growth and volume change by reducing the effective current density and storing Li inside the core space during consecutive cycling. However, despite these fascinating features, these hosts suffer from unwanted Li growth on their surface (i.e., top plating) due to the carbon shell hindering Li-ion movement especially at higher current densities and capacities, resulting in poor electrochemical performance. In this study, we propose a one-dimensional porous Li-confinable host with lithiophilic Au (Au@PHCF), which is synthesized by a scalable dual-nozzle electrospinning. Because of the well-interconnected conductive networks forming three-dimensional structure, porous shell design enabling facile Li-ion transport, and hollow core space with lithiophilic Au storing metallic Li, the Au@PHCF can suppress the Li top plating and improve the Li stripping/plating efficiency compared to their counterparts even at 5 mA cm-2, eventually achieving stable cycling performances of the LiFePO4 full cell and Au@PHCF-Li symmetric cell for over 1000 and 2000 cycles, respectively. Finite element analysis reveals that the structural merit and lithiophilicity of Au enable fast reversible Li operation at the designated core space of the Au@PHCF, implying that the structural design of the Li-confinable host is crucial for the stable operation of promising Li-metal batteries at a practical test level.

Postoperative clinical outcomes and radiological healing according to deep and superficial layer detachment in first facet involving subscapularis tendon tear.

BACKGROUND: Subscapularis tendon insertion at the first facet has separate layers (deep and superficial). The purpose of this study is to evaluate postoperative clinical outcomes and radiological healing according to each layer of detachment in the first facet involving subscapularis tendon tear. METHODS: Eighty-three patients who underwent arthroscopic repair due to First facet involving the scapularis tendon tear accompanying small to medium sized posterosuperior cuff tear were classified into three groups (group A: deep layer partial detachment, group B: deep layer complete detachment, but no superficial layer detachment, and group C: deep layer and superficial layer complete detachment). Subscapularis tendon healing was evaluated using computed tomography arthrogram and clinical result was evaluated using American Shoulder and Elbow Surgeons (ASES) shoulder score, Constant score and University of California Los Angeles (UCLA) shoulder score. RESULTS: Retear rate of the subscapularis tendon was 2.2%, 18.2%, and 33.3% in group A, group B, and group C, respectively. These rates showed statistically significant difference among the three groups, which were classified by deep and superficial layer detachment in the first facet (p=0.003). Group A showed significant difference in subscapularis tendon healing compared with group B and group C (p=0.018 and p<0.001, respectively), but there was no statistical difference between group B and group C (p=0.292). Regarding clinical outcomes, there was no significant difference among three groups in ASES and UCLA score at final follow-up (p=0.070 and p=0.106, respectively). CONCLUSIONS: Complete detachment of deep layer may be related with retear occurrence regardless with detachment of superficial layer, but clinical outcome may not be related with each layer detachment in the first facet involving subscapularis tendon tear.

Wafer-Scale Programmed Assembly of One-Atom-Thick Crystals.

Crystalline films offer various physical properties based on the modulation of their thicknesses and atomic structures. The layer-by-layer assembly of atomically thin crystals provides a powerful means to arbitrarily design films at the atomic level, which are unattainable with existing growth technologies. However, atomically clean assembly of the materials with high scalability and reproducibility remains challenging. We report programmed crystal assembly of graphene and monolayer hexagonal boron nitride, assisted by van der Waals interactions, to form wafer-scale films of pristine interfaces with near-unity yield. The atomic configurations of the films are tailored with layer-resolved compositions and in-plane crystalline orientations. We demonstrate batch-fabricated tunnel device arrays with modulation of the resistance over orders of magnitude by thickness control of the hexagonal boron nitride barrier with single-atom precision and large-scale, twisted multilayer graphene with programmable electronic band structures and crystal symmetries. Our results constitute an important development in the artificial design of large-scale films.

High Incidence of Lymph-node Metastasis in a Pancreatic-cancer Patient-derived Orthotopic Xenograft (PDOX) NOG-Mouse Model.

BACKGROUND/AIM: Our laboratory pioneered the patient-derived orthotopic xenograft (PDOX) model. An important goal of PDOX-model development is facile visualization of metastasis in live mice. In the present report we evaluated tumor growth and metastasis in pancreatic cancer PDOX NOG [Non-obese diabetes (NOD)/Scid/IL2Rγnull]-and nude-mouse models using red fluorescent protein (RFP)-expressing tumor stroma to visualize the primary tumor and metastasis. MATERIALS AND METHODS: A patient-derived pancreatic cancer was initially implanted in transgenic RFP-expressing nude mice. Then, tumor fragments, which acquired RFP expressing stroma while growing in RFP-expressing nude mice were orthotopically implanted in nude and NOG mice. The primary pancreatic tumor and metastasis were observed 8 weeks after implantation. RESULTS: Lymph-node metastases expressing red fluorescence were detected only in NOG mice. Significantly faster growth of primary pancreatic tumors and a higher incidence of lymph-node metastasis occurred in NOG mice compared to nude mice. CONCLUSION: RFP-expressing tumor stroma, which traffics together with cancer cells to lymph nodes, is useful to observe tumor behavior, such as lymph-node metastasis in a PDOX NOG-mouse model which can be used for evaluation of novel anti-metastatic agents, as well as personalized therapy to identify effective drugs.

In Situ Formed Ag-Li Intermetallic Layer for Stable Cycling of All-Solid-State Lithium Batteries.

With the timely advent of the electric vehicle era, where battery stability has emerged as a major issue, all-solid-state batteries (ASSBs) have attracted significant attention as the game changer owing to their high stability. However, despite the introduction of a densely packed solid electrolyte (SE) layer, when Li is used to increase the energy density of the cell, the short-circuit problem caused by Li protrusion is unavoidable. Furthermore, most strategies to control nonuniform Li growth are so complicated that they hinder the practical application of ASSBs. To overcome these limitations, this study proposes an Ag-Li alloy anode via mass-producible roll pressing method. Unlike previous studies reporting solid-solution-based metal alloys containing a small amount of lithiophilic Ag, the in situ formed and Ag-enriched Ag-Li intermetallic layer mitigates uneven Li deposition and maintains a stable SE/Ag-Li interface, facilitating reversible Li operation. Contrary to Li cells showing frequent initial short-circuit, the cell incorporating the Ag-Li anode exhibits a better capacity retention of 94.3% for 140 cycles, as well as stable cycling even under 12 C. Through a facile approach enabling the fabrication of a large-area anode with controllable Li growth, this study provides practical insight for developing ASSBs with stable cyclabilities.

A novel negative pressure wound therapy (NPWT) monitoring system for postoperative flap management.

ABSTRACT: Various types of flaps are widely utilized as reconstructive options for patients with soft tissue defects. However, the postoperative monitoring of the flap requires a large amount of time and effort. The aim of this study was to evaluate the efficacy and safety of this novel monitoring procedure using negative pressure wound therapy (NPWT) immediately after the flap operations.A retrospective analysis was performed on patients who underwent free flaps and perforator flaps from March 2019 to December 2020. The flaps were managed by either novel NPWT method or conventional dressing. Among NPWT group, computed tomography angiography was performed in randomly selected 5 flaps on the third postoperative day for evaluation of pedicle compression. Statistical analysis was performed between the 2 groups.A total of 54 flaps were included in this study. Twenty seven flaps were managed using novel NPWT method and 27 flaps were managed using conventional dressing. There was no statistically significant difference in flap survival rates between the 2 groups (P = .91). The patency of flap pedicles in the NPWT group was confirmed by comparing the computed tomography angiography findings. The estimated total flap monitoring time and cost for 5 days was significantly decreased by the application of the novel NPWT monitoring system.Through the application of the novel postoperative monitoring system using NPWT, there is efficient evaluation of the flap. Furthermore, safe flap monitoring is possible with the reduced risk of infection by the avoidance of multiple manual dressing performed in the conventional method.